Antimycobacterial immune responses in patients with pulmonary sarcoidosis

Introduction: Sarcoidosis is a multisystem granulomatous disease of unknown origin. Pathogenetic involvement of Mycobacterium tuberculosis has frequently been discussed in the aetiology of sarcoidosis; however, studies still remain contradictory. Objective: We addressed the question of mycobacterial involvement in the pathogenesis of sarcoidosis by analysing cellular immune responses to mycobacterial antigens. Methods: We examined the interferon (IFN)‐γ production by enzyme‐linked immunospot in response to purified protein derivate (PPD) mycobacterial‐specific antigen early secretory antigenic target (ESAT)‐6 and culture filtrate protein (CFP)‐10 by peripheral blood mononuclear cells (PBMCs) and bronchoalveolar‐lavage mononuclear cells (BALMCs) of patients with pulmonary sarcoidosis, smear‐negative tuberculosis and controls. Results: Release of IFN‐γ in response to ex vivo contact with PPD, ESAT‐6 or CFP‐10 by BALMC and PBMC were comparable among patients with sarcoidosis and controls (PBMC P = 0.2326; BALMC P = 0.1767) and were less frequently observed in both groups compared to patients with tuberculosis (BALMC P < 0.05; PBMC P < 0.0001). Within PBMC, the immunophenotype of sarcoidosis patients differed from that of patients with tuberculosis, as well as from that of controls, while within BALMC it resembled that of patients with tuberculosis. Conclusion: In contrast to patients with tuberculosis, the frequency of mycobacteria‐specific local and systemic immune responses is not elevated in patients with sarcoidosis when compared to controls. The immunophenotype represents the local resemblance of the granulomatous reaction underlying tuberculosis and sarcoidosis while showing systemical difference. These observations do not support a role of an infection with M. tuberculosis in the pathogenesis of sarcoidosis. Please cite this paper as: Hörster R, Kirsten D, Gaede KI, Jafari C, Strassburg A, Greinert U, Kalsdorf B, Ernst M and Lange C. Antimycobacterial immune responses in patients with pulmonary sarcoidosis. The Clinical Respiratory Journal 2009; 3: 229–238.