Generalized AA-amyloidosis in a 58-year-old Caucasian woman with an 18-month history of gastrointestinal tuberculosis

 We report on a 58-year-old Caucasian woman who went to a general practitioner about recurrent abdominal pain, night sweats and weight loss of a few weeks’ duration. Once gynaecological disease had been ruled out, the patient was admitted to hospital with severe abdominal pain and intestinal obstruction and a right-sided hemicolectomy was performed. Following the investigation of osteolytic lumbar vertebrae, 18 months after visiting the general practitioner the patient was finally found to be suffering from generalized AA-amyloidosis secondary to gastrointestinal tuberculosis. This had been misinterpreted as Crohn’s disease. Re-examination of the specimens from the right-sided hemicolectomy demonstrated that scanty deposits of AA-amyloid were present 9 months after the first presentation. AA-amyloid can thus be present in serious inflammatory disease even during the first 9 months after the initial clinical presentation. Received: 23 June 1998 / Accepted: 19 August 1998     

Differential regulation of Th1 and Th2 cells by p91–110 and p21–40 peptides of the 16-kD α-crystallin antigen of Mycobacterium tuberculosis

Permissively recognized peptides which can activate lymphocytes from subjects with a variety of class II HLA types are interesting diagnostic and vaccine candidates. In this study we generated T helper clones reactive to the permissively recognized p21–40 and p91–110 peptides of the 16-kD heat shock protein of Mycobacterium tuberculosis. All the clones specific for p91–110 secreted interferon-gamma (IFN-γ) and were of the Th1 phenotype. By contrast, the p21–40 peptide favoured the generation of IL-4-producing clones. Antibody blockade established that the peptide-specific Th clones could either be DR-, DP- or DQ-restricted. Thus, two permissively recognized sequences p21–40 and p91–110 from the same mycobacterial antigen can drive the differentiation of functionally distinct T helper subsets. Attempts to immunize against tuberculosis should bear in mind epitope specificity if a favourable Th subtype response is to be generated.     

Influence of Mycobacterium tuberculosis on differential activation of helper T-cells

Host defence against tuberculosis infection involves T-lymphocyte mediated cellular immune responses. In this study we assessed T-cell activation by studying the early signal transduction events and production of cytokines by human CD4+ T-cells. The study constituted of five groups of subjects: (a) untreated acid fast bacilli (AFB)+ve TB patients who have not started anti-tuberculosis therapy (ATT) [New]; (b) patients who have taken ATT for two months [2T]; (c) patients who have taken ATT for six months [6T]; (d) mantoux positive healthy controls [T+ve]; (e) mantoux negative healthy controls [T-ve]. We found that mantoux positive healthy controls produced significantly higher levels of IP3, intracellular Ca2+ and presented increased PKC activity when CD4+ T-cells were stimulated with M. tuberculosis H37Rv cell lysate as compared to mantoux negative controls. Furthermore, decreased expression of CD54 (ICAM-1) and reduced [Ca2+]i were seen in TB patients as compared to T+ve healthy controls. TB patients showed significantly lower levels of IL-2 and IFNgamma and higher levels of IL-4 as compared to normal healthy controls, suggesting a diminished Th1 response. Thus, the reciprocal changes in cytokines, reduced [Ca2+]i levels, and CD54 expression in patients imply phenotype shifting of Th precursors to Th2 type in TB patients.     

Pulmonary tuberculosis due to bacille Calmette-Guérin

Summary Immunotherapy using bacille Calmette-Guérin (BCG) has gained increasing acceptance in the management of superficial bladder cancer. Systemic reactions after intravesical instillation of BCG are rare. However, when the therapy is complicated, the lung often becomes involved. Since the pathogenesis of lung infiltrates after immunotherapy is unknown, we report on a patient who developed a lung infiltrate after receiving BCG immunotherapy for bladder cancer. The infectious etiology was established by culture confirmation of a BCG strain in the broncheoalveolar lavage fluid.Abbreviation BCG bacille Calmette-Guérin     

结核分枝杆菌Ag85B与IL-12基因真核共表达质粒的构建及表达

目的 :构建结核分枝杆菌Ag85B和鼠IL 12基因的共表达载体pBud85B IL12。方法 :将结核分枝杆菌Ag85B基因和鼠IL 12基因同时克隆入含多启动子的共表达载体pBudCE4 .1中 ,构建真核共表达质粒pBud85B IL12。以pBud85B IL12转染COS 7细胞 ,通过RT PCR及ELISA方法检测目的基因的表达。结果 :在COS 7细胞中同时可检测到Ag85B和IL12的表达。结论 :pBud85B IL12共表达质粒的成功构建 ,为对其免疫原性、免疫反应性及免疫保护作用的进一步研究奠定了基础     

蛋白激酶Cθ信号途径在结核分枝杆菌抗原激活人γδT细胞增殖和分化中的作用

目的 研究蛋白激酶Cθ(protein kinase Cθ,PKCθ)信号途径在结核分枝杆菌抗原(Mycobacterium tuberculosis antigen,Mtb-Ag)激活人γδT细胞增殖和分化中的作用.方法 健康人外周血单个核细胞(PBMC)用Mtb-Ag和IL-2优势刺激和扩增γδT细胞,或预先用5.0μmol/L Rottlerin(楸毒素)预处理,培养不同时间后,用流式细胞术(FCM)检测γδT细胞表面活化分子和细胞因子表达;同时采用活体染料羧基荧光素乙酰乙酸(CFSE)标记细胞,流式细胞术分析Mtb-Ag刺激γδT细胞后的增殖和各子代细胞百分率.结果 PBMC经Mtb-Ag刺激后3d,γδT细胞CD69和CD25表达分别为46.2%和45.6%,而Rotderin预处理显著地抑制了CD69和CD25表达(P＜0.01);PBMC经Mtb-Ag激活培养5、10和15d,培养扩增细胞中的γδT细胞比例分别为9.6%、54.6%和82.4%,其中第5天已有少部分γδT细胞发生增殖,第10天和第15天时几乎全部γδT细胞分裂都在6代以上,用Rottlerin预处理,显著抑制了γδT细胞增殖反应,但在培养第10天后仍有少部分γδT细胞发生增殖反应;同时在培养第7天、14天和21天,用PMA(佛波酯)+Ionomycin(离子霉素)再刺激后,产生IFN-γ的γδT细胞均在80%左右;培养21d时,有2.6%的γδT细胞表达IL-4.在Rottlerin预处理组产生TH1型细胞因子IFN-γ的γδT细胞均显著减少(P＜0.05),而γδT细胞表达TH2型细胞因子IL-4则几乎完全抑制(P＜0.01).结论 PKCθ信号途径在Mtb-Ag刺激γδT细胞的增殖和分化中均起重要作用.     

结核分枝杆菌Rv2450蛋白诱导小鼠免疫应答的实验研究

目的:以原核表达的结核分枝杆菌Rv2450蛋白在小鼠体内诱导体液和细胞免疫应答。方法:采用皮下包埋的方法,以预先转移到硝酸纤维素膜上的原核表达的Rv2450蛋白免疫小鼠(10只)3次,每次间隔2周。用间接ELISA法检测免疫小鼠血清特异性抗体的滴度。末次免疫完成后4周,处死3只免疫小鼠并分离脾淋巴细胞,体外经PPD(2μg/孔)刺激后,用MTT比色法检测免疫小鼠脾淋巴细胞的增殖指数。用ELISA法检测脾淋巴细胞悬液中IFN-γ、IL-10及IL-12的水平。结果:Rv2450蛋白免疫小鼠血清特异性抗体的滴度为1∶3200,淋巴细胞增殖指数为3.76±0.19。免疫小鼠脾淋巴细胞培养液中IFN-γ、IL-10及IL-12的含量,分别为(1740±19)ng/L、(678±15)ng/L、(469±13)ng/L,均高于各组的生理盐水对照组(P<0.05)。结论:Rv2450有可能作为新型结核疫苗的候选组分。     

分枝杆菌噬菌体D29气溶胶特性的研究

目的 为了研究噬菌体D29气溶胶吸入治疗结核分枝杆菌的可行性,测试了噬菌体D29耐雾化能力、喷雾量、气溶胶粒径等气溶胶特性参数.方法 负压实验室气雾柜内发生噬菌体D29气溶胶,TSI3321气溶胶粒径分析仪测试了气溶胶空气动力学直径.Anderson六级空气微生物采样器测试了生物粒子气溶胶中值直径.据雾化前后噬菌体D29的浓度变化及体积变化得到噬菌体D29的雾化时间存活率和雾化量.结果 噬菌体D29气溶胶空气动力学直径为0.872 μm,生物粒子气溶胶中值直径为2.21 μm.噬菌体D29在雾化5、15、30、45、60 min后的存活率分别为89.78%、77.19%、48.86%、33.99%、30.12%.气溶胶的雾化量为232 μl/min.结论 噬菌体D29气溶胶粒径、耐雾化能力及喷雾量等气溶胶参数可以进一步进行动物气溶胶吸入治疗结核分枝杆菌感染方面的研究.     

Long-term follow-up of patients with tuberculosis as a complication of tumour necrosis factor (TNF)-α antagonist therapy: safe re-initiation of TNF-α blockers after appropriate anti-tuberculous treatment

This study investigated the long-term outcome of patients with tuberculosis (TB) as a complication of tumour necrosis factor (TNF)-α blocker therapy. All TB cases ( n  =   21) complicating TNF-α blocker therapy from French university hospitals were collated between January 2000 and September 2002. Outcome was assessed via a postal questionnaire during September 2005. The mortality rate after 4 years was 4.8%, and one patient had relapsed and six (29%) patients had recommenced TNF-α antagonist treatment, after appropriate anti-TB therapy, without reactivation. These data support the concept that TNF-α antagonists can be restarted in TB patients provided that adequate anti-TB treatment has been completed.     

Lower expression of Th1-related cytokines and inducible nitric oxide synthase in mice with streptozotocin-induced diabetes mellitus infected with Mycobacterium tuberculosis

Diabetes mellitus is an important predisposing factor for tuberculosis. The aim of this study was to investigate the mechanism underlying this association using a murine model. Mice with streptozotocin-induced diabetes mellitus were prone to Mycobacterium tuberculosis infection, as indicated by increased numbers of live bacteria in lung, liver and spleen. In diabetic mice, the levels of IL-12 and IFN-gamma in the lung, liver and spleen were lower than those in control animals on day 14 postinfection, while the opposite was true for IL-4 levels in the lung and liver. The expression pattern of inducible nitric oxide synthase (iNOS), in the two mice types was as for IL-12 and IFN-gamma. In addition, peritoneal exudate cells obtained from diabetic mice produced lower amounts of IL-12 and NO than those from control mice, when stimulated in vitro with M. bovis BCG. Spleen cells from diabetic mice infected with M. tuberculosis produced a significantly lower amount of IFN-gamma upon restimulation with purified protein derivatives (PPD) than those from infected nondiabetic mice. Interestingly, addition of high glucose levels (33 mM) to the cultures of PPD-restimulated spleen cells reduced the synthesis of IFN-gamma only in diabetic mice, and not in nondiabetic mice. Finally, control of blood glucose levels by insulin therapy resulted in improvement of the impaired host protection and Th1-related cytokine synthesis. Our results suggest that the reduced production of Th1-related cytokines and NO account for the hampered host defense against M. tuberculosis infection under diabetic conditions.