Differential cytokine levels and immunoreactivities against Mycobacterium tuberculosis antigens between tuberculous and malignant effusions.
Much effort has been devoted to the identification of immunologically important factors in tuberculous pleurisy (TBP) and malignant pleurisy (MP) to improve the differential diagnosis of the two major causes of lymphocyte-dominant pleurisy. This study evaluated the immunoreactivity and potential diagnostic utility of both host (cytokines and chemokines) and pathogen (mycobacterial proteins) factors in pleural effusions. Effusion samples were collected from 41 patients with MP caused by lung cancer and from 81 patients with TBP. The concentrations of nine cytokines and chemokines (interleukin (IL)-12 p40, interferon (IFN)-gamma, tumor necrosis factor (TNF)-alpha, IL-6, IL-10, CXCL8/IL-8, CXCL10/IP-10, CCL3/MIP-1alpha, and CCL4/MIP-1beta) and antibody responses (IgG, IgM, and IgA) against five Mycobacterium tuberculosis antigens (early secreted antigenic target (ESAT)-6, 30-kDa, MTB12, 38-kDa, and a heparin-binding hemagglutinin (HBHA)) were determined in pleural fluids using enzyme-linked immunosorbent assays (ELISA). In the logistic regression, IFN-gamma (odds ratio, 7.178; 95% confidence interval (CI), 2.258-22.817; p=0.001), IL-12 p40 (odds ratio, 11.037; 95% CI, 3.38-36.037; p<0.001), and IL-6 (odds ratio, 3.295; 95% CI, 1.147-9.463; p=0.027) were found to be statistically significant cytokines predicting tuberculous from malignant effusions. Although IgG responses to all of the M. tuberculosis antigens tested were significantly higher in effusions from TBP (p<0.001) compared with those from MP, the logistic regression showed IgG levels for ESAT-6 and MTB12 to be statistically significant for differentiation of TBP from MP. HBHA showed the highest sensitivity of IgM antibody responses in TBP in comparison with other antigens. These data indicate that selected mycobacterial antigens (ESAT-6 and MTB12) and cytokine markers (IFN-gamma, IL-12p40, and IL-6) provide useful information for differentiating tuberculous and malignant effusions in clinical practice.
Yang
Chul-Su
CS
Department of Microbiology, College of Medicine, Chungnam National University, Daejeon 301-747, South Korea.
Lee
Ji-Sook
JS
Lee
Hye-Mi
HM
Shim
Tae Sun
TS
Son
Ji Woong
JW
Jung
Sung-Soo
SS
Kim
Jun-Sang
JS
Song
Chang-Hwa
CH
Kim
Hwa-Jung
HJ
Jo
Eun-Kyeong
EK
D000907:Antibodies, Bacterial / Q000378:metabolism*; D000942:Antigens, Bacterial / Q000276:immunology; D015415:Biomarkers / Q000378:metabolism; D016207:Cytokines / Q000378:metabolism*; D003937:Diagnosis, Differential; D006801:Humans; D016015:Logistic Models; D016066:Pleural Effusion, Malignant / Q000276:immunology*; D014396:Tuberculosis, Pleural / Q000276:immunology*
D000907:Antibodies, Bacterial; D000942:Antigens, Bacterial; D015415:Biomarkers; D016207:Cytokines; C072681:Mycobacterium tuberculosis antigens