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Corticosteroid-modulated immune activation in the tuberculosis immune reconstitution inflammatory syndrome.

Meintjes, Graeme, Skolimowska, Keira H., Wilkinson, Katalin A., Matthews, Kerryn, Tadokera, Rebecca ORCID: https://orcid.org/0000-0001-5195-2376, Conesa-Botella, Anali, Seldon, Ronnett, Rangaka, Molebogeng X., Rebe, Kevin, Pepper, Dominique J. and Morroni, Chelsea (2012) Corticosteroid-modulated immune activation in the tuberculosis immune reconstitution inflammatory syndrome. American journal of respiratory and critical care medicine, 186 (4).

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Rationale: HIV–tuberculosis-associated immune reconstitution inflammatory syndrome (TB-IRIS) is an immunopathological reaction to mycobacterial antigens induced by antiretroviral therapy. Prednisone reduces morbidity in TB-IRIS, but the mechanisms are unclear.

Objectives: To determine the effect of prednisone on the inflammatory response in TB-IRIS (antigen-specific effector T cells, cytokines, and chemokines).

Methods: Blood was taken from participants in a randomized placebo-controlled trial of prednisone for TB-IRIS, at 0, 2, and 4 weeks. Participants received prednisone at a dosage of 1.5 mg/kg/day for 2 weeks followed by 0.75 mg/kg/day for 2 weeks, or placebo at identical dosages.

Measurements and Main Results: Analyses included IFN-γ enzyme-linked immunospot (ELISPOT), reverse transcription-polymerase chain reaction on peripheral blood mononuclear cells after restimulation with heat-killed Mycobacterium tuberculosis, Luminex multiplex cytokine analysis of corresponding tissue culture supernatants, and Luminex multiplex cytokine analysis of serum. Fifty-eight participants with TB-IRIS (31 receiving prednisone, 27 receiving placebo) were included. In serum, significant decreases in IL-6, IL-10, IL-12 p40, tumor necrosis factor-α, IFN-γ, and IFN-γ–induced protein-10 concentrations during prednisone, but not placebo, treatment were observed. No differences in ELISPOT responses comparing prednisone and placebo groups were shown in response to ESAT-6 (early secreted antigen target-6), Acr1, Acr2, 38-kD antigen, or heat-killed H37Rv M. tuberculosis. Purified protein derivative ELISPOT responses increased over 4 weeks in the prednisone group and decreased in the placebo group (P = 0.007).

Conclusions: The beneficial effects of prednisone in TB-IRIS appear to be mediated via suppression of predominantly proinflammatory cytokine responses of innate immune origin, not via a reduction of the numbers of antigen-specific T cells in peripheral blood.

Item Type: Article
Status: Published
DOI: https://doi.org/10.1164/rccm.201201-0094oc
School/Department: School of Science, Technology and Health
URI: https://ray.yorksj.ac.uk/id/eprint/9379

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