Browsing by Author "Ahmed Bolad, Amal Elhaj"

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    Dynamics of Th2 IL-4 and IL-10 Cytokines During the Treatment of Pulmonary Tuberculosis
    (جامعة النيلين-مركز النيلين الطبي, 2013) Ahmed Bolad, Amal Elhaj; Atif Elagib
    Tuberculosis is (TB), an infection caused by mycobacterium tuberculosis, responsible for high morbidity and mortality worldwide. It is one of the major causes of morbidity and mortality in Sudan. Cytokine profile determines clinical outcome of the disease and responses to treatment as well. A T helper 2 (Th2) responses lead to release of IL-4, and IL-10, promoting B lymphocyte activation leading to an antibody response and promoting an anti-inflammatory macrophage response. Interleukin-4 (IL-4), an anti-inflammatory cytokine has been implicated to downregulate IFN-γ, and thus has a harmful effect on TB patients. IL10 cytokine has the capacity to inhibit Th1 activation and thus terminates cell mediated immune responses. The aim of the present study was to determine Th2 cytokine profile in patients with tuberculosis to identify immunological marker for follow up of the disease activity and to study the outcome of antituberculosis treatment as well. To examine this, blood samples were collected from newly diagnosed HIV negative pulmonary tuberculosis patients and from apparently healthy individuals as controls following an informed consent. Blood samples were also collected at several intervals during the treatment with anti-tuberculosis drugs. Levels of Th2 cytokines IL-4 and IL-10 were measured pre and during treatment using commercial available enzyme-linked immune-sorbent assay (ELISA). Data were analyzed using SPSS 20. The results showed that, the median serum level of IL-4 was 20 and 35 pg/ml higher in new cases (untreated patients) and in patients under treatment with oral anti-tuberculosis, respectively, compared with that of Controls (p=0.001). Median levels of IL10 were similar in both controls and new cases groups (35pg/ml), but lower in patients under treatment group (20pg/ml). Despite that, the difference in levels of IL-10 was not statistically different between patients and controls (p=0.243). Increase in levels of IL-4 during treatment showed that Th2 immune responses still present and may indicate active disease and thus IL4 cytokine may be a possible marker for the disease activity. Result showed that, IL-4 has the potential to be used as marker for TB severity (specificity=91%) having the area under the curve AUC of 0.659.
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    Levels of tumor necrosis factor-alpha (TNF-α) and Interferon gamma (IFN-γ) s During Tuberculosis treatment
    (Al Neelain Medical Research Centre, 2013) Ahmed Bolad, Amal Elhaj; Atif Elagib
    Cytokines play a major role in protection against Mycobacterium tuberculosis infection and regulate the immune responses at a cellular level. A T helper 1 (Th1) cytokine interferon gamma (IFN-γ) is one of the most important cytokines which activate the macrophages to produce tumor necrosis factor-alpha (TNF-α). At physiological levels, TNF-α has anti-microbial activities through the apoptotic effect. Excessive production of TNF-α have been implicated in immunopathogenesis of tuberculosis. The aim of the present study was to determine Th1 cytokine profile in patients with tuberculosis to identify immunological marker for follow up of the disease activity, and on the other hand, to study the outcome of anti-tuberculosis treatment. To examine this, blood samples were collected at several intervals before and during the treatment with anti-tuberculosis drugs. Levels of IFN-γ, TNF-α pre and during treatment using commercial available enzyme-linked immune-sorbent assay (ELISA). Data were analyzed using SPSS 20. Receiver Operating Characteristic (ROC) Curve analysis has been carried out to assess their discriminative power and to determine cut-off values. Analysis has been carried out further by calculating other measures of diagnostic test accuracy.The results showed that the levels of TNF- were significantly increased in patients before and after the treatment than those in control (p=0.001). Levels for IFN-γ were not statistically different between patients and controls (p=0.351). A decrease in TNF-α levels dose not conflict with the finding that IFN-γ had highest level in patients under treatment as the difference between those and newly diagnosed patients was not statistically different. TNF-α can be used as a marker for TB severity, having that the area under the curve (AUC) for TNF-α is .824 (95% CI: .737 - .912). For the chosen cut-off level of 5pg/ml, it has a sensitivity of 85% and a lower specificity of 70%. TNF-α test is most beneficial where prevalence is very low or very high.