Abstract
There have been few reports on the kinetics of hemodialyzed (HD) patients’ immune responses in latent tuberculosis infection (LTBI). Therefore, in the present study, messenger ribonucleic acid (mRNA) expression levels of nine immune markers were analyzed to discriminate between HD patients with LTBI and healthy individuals. Nine cytokines and chemokines were screened through relative mRNA expression levels in whole blood samples after stimulation with Mycobacterium tuberculosis (MTB)-specific antigens from HD patients with LTBI (HD/LTBI), HD patients without LTBI, and healthy individuals, and results were compared with the QuantiFERON-TB Gold In-Tube (QFT-GIT) test. We confirmed that the C-C motif chemokine 11 (CCL11) mRNA expression level of the HD/LTBI group was significantly higher than the other two groups. Especially, the CCL11 mRNA expression level of the >0.7 IU/mL group in the QFT-GIT test was significantly higher than the <0.2 IU/mL group in the QFT-GIT test and the 0.2–0.7 IU/mL group in the QFT-GIT test (p = 0.0043). The present study reveals that the relative mRNA expression of CCL11 was statistically different in LTBI based on the current cut-off value (i.e., ≥0.35 IU/mL) and in the >0.7 IU/mL group. These results suggest that CCL11 mRNA expression might be an alternative biomarker for LTBI diagnosis in HD patients.
Highlights
Introduction iationsThere have been few reports on the accurate prevalence of tuberculosis (TB) in highrisk groups, such as the elderly, patients with diabetes or chronic kidney disease, etc.According to the Korean Society of Nephrology end-stage renal disease (ESRD) registry data in 2018, TB incidence was 0.5% in hemodialyzed (HD) patients [1]
HD groups were older than the healthy controls (HCs) group; there was no difference between HD/latent tuberculosis infection (LTBI) and HD/normal groups
The IFN-γ of the messenger ribonucleic acid (mRNA) expression level of the Mycobacterium tuberculosis (MTB)-specific antigen-stimulated whole blood sample was not significantly different among the three groups according to LTBI diagnosis and QuantiFERON-TB Gold In-Tube (QFT-GIT) test response, the mRNA expression levels of HC groups were higher than HD groups
Summary
There have been few reports on the accurate prevalence of tuberculosis (TB) in highrisk groups, such as the elderly, patients with diabetes or chronic kidney disease, etc. According to the Korean Society of Nephrology end-stage renal disease (ESRD) registry data in 2018, TB incidence was 0.5% in hemodialyzed (HD) patients [1]. ESRD receiving dialysis is a risk factor of active TB, which is 25.3 times more prevalent in this group than in individuals with normal renal function [2]. This relationship is likely associated with alterations in the immune system, such as conversion from latent TB infection (LTBI) to active TB due to various factors including uremia. Interferon gamma (IFN-γ) release assays (IGRAs) are currently used to identify LTBI cases and are useful even in immunocompromised hosts; they should be interpreted carefully because of low sensitivity and specificity in a high-burden setting [3].
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