Kinetics of T-cell-based assays on cerebrospinal fluid and peripheral blood mononuclear cells in patients with tuberculous meningitis
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Background/Aims: The goal of this study was to monitor tuberculosis (TB)-specificT-cell responses in cerebrospinal f luid-mononuclear cells (CSF-MCs) andperipheral blood mononuclear cells (PBMCs) in patients with tuberculous meningitis(TBM) over the course of anti-TB therapy. Methods: Adult patients (≥ 16 years) with TBM admitted to Asan Medical Center,Seoul, South Korea, were prospectively enrolled between April 2008 and April2011. Serial blood or CSF samples were collected over the course of the anti-TBtherapy, and analyzed using an enzyme-linked immunosorbent spot (ELISPOT)assay. Results: Serial ELISPOT assays were performed on PBMCs from 17 patients (sevendefinite, four probable, and six possible TBM) and CSF-MC from nine patients(all definite TBM). The median number of interferon-gamma (IFN-γ)-producingT-cells steadily increased during the first 6 months after commencement ofanti-TB therapy in PBMCs. Serial CSF-MC ELISPOT assays revealed significantvariability in immune responses during the first 6 weeks of anti-TB therapy,though early increases in CSF-MC ELISPOT results were associated with treatmentfailure or paradoxical response. Conclusions: Serial analysis of PBMCs by ELISPOT during the course of treatmentwas ineffective for predicting clinical response. However, increases inTB-specific IFN-γ-producing T-cells in CSF-MC during the early phase of anti-TB therapy may be predictive of clinical failure.
Abstract
Background/Aims: The goal of this study was to monitor tuberculosis (TB)-specificT-cell responses in cerebrospinal f luid-mononuclear cells (CSF-MCs) andperipheral blood mononuclear cells (PBMCs) in patients with tuberculous meningitis(TBM) over the course of anti-TB therapy. Methods: Adult patients (≥ 16 years) with TBM admitted to Asan Medical Center,Seoul, South Korea, were prospectively enrolled between April 2008 and April2011. Serial blood or CSF samples were collected over the course of the anti-TBtherapy, and analyzed using an enzyme-linked immunosorbent spot (ELISPOT)assay. Results: Serial ELISPOT assays were performed on PBMCs from 17 patients (sevendefinite, four probable, and six possible TBM) and CSF-MC from nine patients(all definite TBM). The median number of interferon-gamma (IFN-γ)-producingT-cells steadily increased during the first 6 months after commencement ofanti-TB therapy in PBMCs. Serial CSF-MC ELISPOT assays revealed significantvariability in immune responses during the first 6 weeks of anti-TB therapy,though early increases in CSF-MC ELISPOT results were associated with treatmentfailure or paradoxical response. Conclusions: Serial analysis of PBMCs by ELISPOT during the course of treatmentwas ineffective for predicting clinical response. However, increases inTB-specific IFN-γ-producing T-cells in CSF-MC during the early phase of anti-TB therapy may be predictive of clinical failure.
참고문헌 (24)
- Kim SH, "Rapid diagnosis of tuberculous meningitis by T cell-based assays on peripheral blood and cerebrospinal fluid mononuclear cells", Clin Infect Dis, 50, pp.1349~1358 (2010)
- Patel VB, "Cerebrospinal T-cell responses aid in the diagnosis of tuberculous meningitis in a human immunodeficiency virus- and tuberculosis-endemic population", Am J Respir Crit Care Med, 182, pp.569~577 (2010)
- Kim SH, "Diagnosis of central nervous system tuberculosis by T-cell-based assays on peripheral blood and cerebrospinal fluid mononuclear cells", Clin Vaccine Immunol, 15, pp.1356~1362 (2008)
- Thomas MM, "Rapid diagnosis of Mycobacterium tuberculosis meningitis by enumeration of cerebrospinal fluid antigen-specific T-cells", Int J Tuberc Lung Dis, 12, pp.651~657 (2008)
- Carrara S, "Use of a T cell-based assay for monitoring efficacy of antituberculosis therapy", Clin Infect Dis, 38, pp.754~756 (2004)
- Aiken AM, "Reversion of the ELISPOT test after treatment in Gambian tuberculosis cases", BMC Infect Dis, 6, pp.66~ (2006)
- Kobashi Y, "Transitional changes in T-cell responses to Mycobacterium tuberculosis-specific antigens during treatment", J Infect, 58, pp.197~204 (2009)
- Katiyar SK, "Use of the QuantiFERON-TB Gold In-Tube test to monitor treatment efficacy in active pulmonary tuberculosis", Int J Tuberc Lung Dis, 12, pp.1146~1152 (2008)
- Dheda K, "Interpretation of Mycobacterium tuberculosis antigen-specific IFN-gamma release assays (T-SPOT.TB) and factors that may modulate test results", J Infect, 55, pp.169~173 (2007)
- Marais S, "Tuberculous meningitis: a uniform case definition for use in clinical research", Lancet Infect Dis, 10, pp.803~812 (2010)
- Blumberg HM, "American Thoracic Society", Centers for Disease Control and Prevention, Am J Respir Crit Care Med, pp.2003, 167[DOI]
- Kim SH, "Diagnostic usefulness of a T-cell based assay for extrapulmonary tuberculosis", Arch Intern Med, 167, pp.2255~2259 (2007)
- 박기호, "폐외결핵 환자에서의 치료에 따른 연속적인 T-SPOT.TB 검사", Infection and Chemotherapy, 43(3), pp.245~250 (2011), 대한감염학회
- Vekemans J, "Tuberculosis contacts but not patients have higher gamma interferon responses to ESAT-6 than do community controls in The Gambia", Infect Immun, 69, pp.6554~6557 (2001)
- Ulrichs T, "Numbers of IFN-gamma-producing cells against ESAT-6 increase in tuberculosis patients during chemotherapy", Int J Tuberc Lung Dis, 4, pp.1181~1183 (2000)
- Ferrand RA, "Interferon-gamma responses to ESAT-6 in tuberculosis patients early into and after anti-tuberculosis treatment", Int J Tuberc Lung Dis, 9, pp.1034~1039 (2005)
- Al-Attiyah R, "Restoration of mycobacterial antigen-induced proliferation and interferon-gamma responses in peripheral blood mononuclear cells of tuberculosis patients upon effective chemotherapy", FEMS Immunol Med Microbiol, 38, pp.249~256 (2003)
- Pathan AA, "Direct ex vivo analysis of antigen-specific IFN-gamma-secreting CD4 T cells in Mycobacterium tuberculosis-infected individuals: associations with clinical disease state and effect of treatment", J Immunol, 167, pp.5217~5225 (2001)
- Lee SW, "Serial interferon-gamma release assays during treatment of active tuberculosis in young adults", BMC Infect Dis, 10, pp.300~ (2010)
- Chee CB, "Tuberculosis treatment effect on T-cell interferon-gamma responses to Mycobacterium tuberculosis-specific antigens", Eur Respir J, 36, pp.355~361 (2010)
- Cheng VC, "Risk factors for development of paradoxical response during antituberculosis therapy in HIV-negative patients", Eur J Clin Microbiol Infect Dis, 22, pp.597~602 (2003)
- Kim SH, "Immunologic paradox in the diagnosis of tuberculous meningitis", Clin Vaccine Immunol, 16, pp.1847~1849 (2009)
- Thwaites GE, "Diagnosis of adult tuberculous meningitis by use of clinical and laboratory features", Lancet, 360, pp.1287~1292 (2002)
- Thwaites GE, "Dexamethasone for the treatment of tuberculous meningitis in adolescents and adults", N Engl J Med, 351, pp.1741~1751 (2004)