title: Human in vitro immune responses to Mycobacterium tuberculosis.
abstract: METHODS
  T helper cells can be divided into 2 subsets on the basis of their cytokine generation. T helper 1 cells secreting gamma interferon and interleukin 2 appear to be more prominent in patients with limited tuberculous disease.
  
  
  OBJECTIVE
  The purpose of this study was to evaluate human T helper cell immune responses to mycobacterial antigens in vitro and correlate these with the clinical features of patients with tuberculous infection or disease.
  
  
  METHODS
  We studied 51 subjects and 11 controls who were grouped according to disease involvement as follows: 1) Mantoux negative, BCG negative, no disease; 2) Mantoux positive, no disease; 3) localized extrapulmonary; 4) healed pulmonary; 5) active pulmonary; and 6) miliary/disseminated. Peripheral blood mononuclear cells were cultured with PHA, PPD or Tetanus Toxoid, proliferation assessed and the supernatant analysed using an ELISA for IFN gamma. ELISA was also used to measure M. tuberculosis specific antibodies in the serum.
  
  
  RESULTS
  Mantoux size correlated with PPD proliferation r = 0.5, P = 0.005 and gamma IFN production r = 0.36, P < 0.01. All groups produced abundant gamma IFN although there was a trend toward higher production in groups 3 and 4. M. tuberculosis specific IgA (P = 0.003) and IgG1 (P = 0.002) was higher in groups 5 and 6. Those patients with limited disease (groups 2-4) had significantly lower levels of IgG4 than patients with severe disease (groups 5 & 6) (P < 0.02).
  
  
  CONCLUSIONS
  In conclusion patients with healed or extrapulmonary disease have immune responses in vitro suggestive of a TH1 (cell mediated immune) response, whereas patients with miliary/disseminated disease have antibody production suggestive of a TH2 response, together with high gamma IFN production. Both TH1 and TH2 responses may be necessary for host protection if there is a high bacillary load.
authors.affiliation: Department of Respiratory Medicine, Green Lane Hospital, Auckland, New Zealand. mwilsher@ahsl.co.nz
authors.forename: M L
authors.initials: ML
authors.lastname: Wilsher
authors.forename: C
authors.initials: C
authors.lastname: Hagan
authors.forename: R
authors.initials: R
authors.lastname: Prestidge
authors.forename: A U
authors.initials: AU
authors.lastname: Wells
authors.forename: G
authors.initials: G
authors.lastname: Murison
mesh_terms: D000208:Acute Disease; D000328:Adult; D000907:Antibodies, Bacterial / Q000097:blood; D002478:Cells, Cultured; D006801:Humans; D007070:Immunoglobulin A / Q000097:blood; D007074:Immunoglobulin G / Q000097:blood; D007371:Interferon-gamma / Q000378:metabolism; D015848:Interleukin-5 / Q000378:metabolism; D015850:Interleukin-6 / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000472:pathogenicity*; D018709:Statistics, Nonparametric; D006377:T-Lymphocytes, Helper-Inducer / Q000276:immunology*; D018417:Th1 Cells / Q000276:immunology; D018418:Th2 Cells / Q000276:immunology; D014374:Tuberculin Test; D014376:Tuberculosis / Q000276:immunology* / Q000382:microbiology
chemical_list: D000907:Antibodies, Bacterial; D007070:Immunoglobulin A; D007074:Immunoglobulin G; D015848:Interleukin-5; D015850:Interleukin-6; D007371:Interferon-gamma