title: Role of surfactant protein A in the pathogenesis of tuberculosis in subjects with human immunodeficiency virus infection.
abstract: Human immunodeficiency virus (HIV)-infected subjects are at increased risk for tuberculosis even before there is a significant loss of CD4 lymphocytes. A factor was found to be present in the bronchoalveolar lavage (BAL) of HIV-infected subjects that promoted the attachment of M. tuberculosis (MTB) organisms to alveolar macrophages (AMs). Using 51Cr-labeled MTB organisms, BAL from control subjects resulted in MTB attachment to AMs at 11.6% +/- 1.0%; in contrast, BAL from HIV-infected subjects increased attachment to 33.1% +/- 3.8% (P < 0.001). Surfactant protein A (SP-A) levels in BAL of normal controls was 1.9 +/- 0.3 micrograms/ml and was 5.5 +/- 0.4 micrograms/ml in the BAL of HIV-infected subjects (P < 0.01). When SP-A was removed by immunoprecipitation from the BAL of HIV-infected subjects, MTB attachment decreased from 33.1% +/- 3.8% to 11.3% +/- 0.4% (P < 0.001), a value identical to control levels. Exogenous human SP-A (5 micrograms/ml) was added back to the immunoprecipitated BAL and the enhanced attachment of MTB was restored. These data suggest that BAL from HIV-infected subjects contain a factor that facilitates MTB attachment to AMs, the first critical step in the establishment of infection. This factor appears to be SP-A.
authors.affiliation: Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, USA.
authors.forename: W J
authors.initials: WJ
authors.lastname: Martin
authors.forename: J F
authors.initials: JF
authors.lastname: Downing
authors.forename: M D
authors.initials: MD
authors.lastname: Williams
authors.forename: R
authors.initials: R
authors.lastname: Pasula
authors.forename: H L
authors.initials: HL
authors.lastname: Twigg
authors.forename: J R
authors.initials: JR
authors.lastname: Wright
mesh_terms: D000818:Animals; D001422:Bacterial Adhesion / Q000187:drug effects*; D001992:Bronchoalveolar Lavage Fluid / Q000737:chemistry / Q000166:cytology; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D016676:Macrophages, Alveolar / Q000382:microbiology; D008297:Male; D051379:Mice; D008807:Mice, Inbred BALB C; D009169:Mycobacterium tuberculosis / Q000472:pathogenicity; D011510:Proteolipids / Q000494:pharmacology*; D037662:Pulmonary Surfactant-Associated Protein A; D037661:Pulmonary Surfactant-Associated Proteins; D011663:Pulmonary Surfactants / Q000494:pharmacology*; D014397:Tuberculosis, Pulmonary / Q000209:etiology*
chemical_list: D011510:Proteolipids; D037662:Pulmonary Surfactant-Associated Protein A; D037661:Pulmonary Surfactant-Associated Proteins; D011663:Pulmonary Surfactants