L-arginine and vitamin D: novel adjunctive immunotherapies in tuberculosis.
Worsening drug resistance and the need for prolonged treatment in tuberculosis (TB) require innovative solutions including investigation of inexpensive, safe adjunctive immunotherapies. L-arginine, the precursor of nitric oxide, and vitamin D recently have elucidated mycobactericidal and immunomodulatory actions against TB and are deficient in people with TB. We review the potential of these agents as adjunctive TB immunotherapies and explore how comparative clinical trials might help clarify their relative importance in the human TB immune response. By enhancing mycobacterial killing in macrophages, L-arginine and vitamin D might have the potential to enable shorter duration of treatment, reduced infectivity and improved response in drug-resistant TB.
Ralph
Anna P
AP
International Health Division, Menzies School of Health Research, Building 58, Royal Darwin Hospital Campus, Casuarina, Northern Territory, 0810, Australia. annaralph@bigpond.com
Kelly
Paul M
PM
Anstey
Nicholas M
NM
D000276:Adjuvants, Immunologic / Q000008:administration & dosage / Q000627:therapeutic use*; D001120:Arginine / Q000008:administration & dosage / Q000627:therapeutic use*; D002460:Cell Line; D006801:Humans; D007167:Immunotherapy / Q000379:methods*; D008262:Macrophage Activation; D008264:Macrophages / Q000276:immunology / Q000382:microbiology; D009169:Mycobacterium tuberculosis / Q000187:drug effects*; D014376:Tuberculosis; D014397:Tuberculosis, Pulmonary / Q000276:immunology / Q000628:therapy*; D014807:Vitamin D / Q000008:administration & dosage / Q000627:therapeutic use*
D000276:Adjuvants, Immunologic; D014807:Vitamin D; D001120:Arginine