title: TLR2-induced cytokine responses may characterize HIV-infected patients experiencing mycobacterial immune restoration disease.
abstract: OBJECTIVE
  Most HIV patients who experience Mycobacterium tuberculosis-associated immune restoration disease (TB IRD) display elevated interferon-gamma (IFNγ) responses against mycobacterial antigens, but these can occur without an IRD. Recognition of mycobacteria-associated molecular patterns through toll-like receptors (TLRs) on dendritic cells and monocytes induces cytokine production. Here, we investigate TLR-induced responses in IRD.
  
  
  METHODS
  Peripheral blood mononuclear cells (PBMCs) were collected at approximately weeks 0, 6, 12, 24 and 48 after antiretroviral therapy from five patients experiencing TB IRD, nine matched non-IRD patients and 15 healthy controls.
  
  
  METHODS
  IFNγ production by PBMC stimulated with protein purified derivative (PPD) was assessed by ELISpot. TLR2 expression on myeloid dendritic cells (mDCs) and monocytes was assessed by flow cytometry. TNFα, IL-12p40 and IL-10 were measured by ELISA in 24-h cultures of PBMC with lipomannan (mycobacteria-derived TLR2 agonist).
  
  
  RESULTS
  TLR2 expression on mDC and monocytes was higher in patients than controls at baseline (P < 0.005). TLR2 expression decreased to normal levels on mDC by week 12, but remained higher on monocytes at week 24 (P = 0.02). At week 24, IRD patients showed higher IFNγ responses to PPD (P = 0.02), TLR2 expression on monocytes (P = 0.006) and lipomannan-induced TNFα production (P = 0.016) than non-IRD patients. Lipomannan-induced TNFα and IL-12p40 responses paralleled TB IRD in the patients with high TLR2 expression. IL-10 levels did not associate with IRD.
  
  
  CONCLUSIONS
  TLR2-induced pro-inflammatory cytokines by dendritic cells or monocytes may contribute to the pathogenesis of mycobacterial IRD.
authors: School of Pathology and Laboratory Medicine, University of Western Australia, Perth, Australia. dtan@meddent.uwa.edu.au
authors: Dino B A
authors: DB
authors: Tan
authors: Andrew
authors: A
authors: Lim
authors: Yean K
authors: YK
authors: Yong
authors: Sasheela
authors: S
authors: Ponnampalavanar
authors: Sharifah
authors: S
authors: Omar
authors: Adeeba
authors: A
authors: Kamarulzaman
authors: Martyn A
authors: MA
authors: French
authors: Patricia
authors: P
authors: Price