Immunoregulation in the pulmonary tuberculosis human: study of extension of the pulmonary lesions. / Imunoregulação na tuberculose pulmonar humana: estudo de extensão da lesão pulmonar.

AUTOR(ES)
DATA DE PUBLICAÇÃO

2008

RESUMO

Tuberculosis (TB) is one of the infectious diseases that cause approximately 3 million deaths and 8 million of new cases, in the worldwide, annually. This infectious disease caused by Mycobacterium tuberculosis, has attracted the attention of many studies due to the high mortality and multiresistance of the bacillus. Many factors are involved in this disease, as: previous exposition, nutrition, smoker, etilist, presence of other disease and immune response. The immune cellular response against the TB disease can be defined as Th1 response, since the production of IFN-γ and TNF-α by CD4+ and CD8+ lymphocytes, are present and are important for the control of the disease. The immune response, in general, controls the infection without tecidual damage or evolve for the forms most serious of the disease. Therefore, the knowledge of this immune response is critical for the development of strategies of control and treatment. The objective of this work was to study the production of the cytokines of the Th1 and Th2 (IFN-γ, TNF-α, IL-12 and IL-10) type, in individuals with latent tuberculosis (comunicantes) and in patients with pulmonary tuberculosis disease in activity, analyzing in this last group the association between the production of the cytokines and the extension of the pulmonary lesion. Fourty five patients with active pulmonary tuberculosis and twenty three non infected subjects of both sex, with age between 18 and 50 years, smoker or non-smoker were selected. Patients with co-morbidities such cancer, HIV and diabetes were excluded. TTI were used in all subjects. The pulmonary lesion was measured by Computer Tomographia scan, using Casarini criterions (1999). All the results were statistically analysed, using a significant level, p <0.05. The blood was drawn, with heparin without PBMC separation and incubated in RPMI 1640 medium with penicillin (100 U/ml)/streptomycin (100ug/ml) for 48h at 370C in a 5% CO2. The whole blood was stimulated with SAC, LPS, rIL-12, rIL-10+PPD, antiIL-10+PPD, PMA-IONO, PPD and without stimulation (medium alone). The supernatants were collected and stored frozen at -700C for cytokines measured by ELISA capture. The results showed that the levels of IL-10 after stimulation with LPS, SAC and PPD compared with the medium alone presented significant difference statistics (p <0.05) between the groups. The correlation between the cytokines and the extension of the pulmonary lesion, showed that TNF-α (r = 0.2370) presented more closed from the better correlation (p = 0.064). The associations from each cytokine with the pulmonary lesion, <15 and >15, values were carried by ROC curve. A statistical significant association was found, by ROC curve only to TNF-α (p = 0.0166), with a sensitivity of 61% and specificity of 78.1%. In conclusion, the patients who had strong reaction to the TTI showed little possibilities to develop more extensive pulmonary lesion. The smoker patients presented three times more chance to develop extensive pulmonary lesions (≥ 15) than non-smoker patients. The presence of IFN-γ and IL-12 levels, in the beginning of TB disease (<60 days), suggest a protect immune response from this cytokines.

ASSUNTO(S)

tuberculose meia-idade doenças transmissíveis emergentes imunologia celular humanos adulto tuberculosis feminino tuberculose pulmonar citocinas masculino pulmonary tuberculosis cytokines emerging communicable diseases

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