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Neutrophil activation and enhanced release of granule products in HIV-TB immune reconstitution inflammatory syndrome

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Title: Neutrophil activation and enhanced release of granule products in HIV-TB immune reconstitution inflammatory syndrome
Authors: Nakiwala, J
Walker, NF
Diedrich, CR
Worodria, W
Meintjes, G
Wilkinson, RJ
Mayanja-Kizza, H
Colebunders, R
Kestens, L
Wilkinson, KA
Lowe, DM
Item Type: Journal Article
Abstract: Background: Tuberculosis immune reconstitution inflammatory syndrome (TB-IRIS) remains incompletely understood. Neutrophils are implicated in tuberculosis pathology but detailed investigations in TB-IRIS are lacking. We sought to further explore the biology of TB-IRIS and, in particular, the role of neutrophils. Setting: Two observational, prospective cohort studies in HIV/TB coinfected patients starting antiretroviral therapy (ART), 1 to analyze gene expression and subsequently 1 to explore neutrophil biology. Methods: nCounter gene expression analysis was performed in patients with TB-IRIS (n = 17) versus antiretroviral-treated HIV/TB coinfected controls without IRIS (n = 17) in Kampala, Uganda. Flow cytometry was performed in patients with TB-IRIS (n = 18) and controls (n = 11) in Cape Town, South Africa to determine expression of neutrophil surface activation markers, intracellular cytokines, and human neutrophil peptides (HNPs). Plasma neutrophil elastase and HNP1-3 were quantified using enzyme-linked immunosorbent assay. Lymph node immunohistochemistry was performed on 3 further patients with TB-IRIS. Results: There was a significant increase in gene expression of S100A9 (P = 0.002), NLRP12 (P = 0.018), COX-1 (P = 0.025), and IL-10 (P = 0.045) 2 weeks after ART initiation in Ugandan patients with TB-IRIS versus controls, implicating neutrophil recruitment. Patients with IRIS in both cohorts demonstrated increases in blood neutrophil count, plasma HNP and elastase concentrations from ART initiation to week 2. CD62L (L-selectin) expression on neutrophils increased over 4 weeks in South African controls whereas patients with IRIS demonstrated the opposite. Intense staining for the neutrophil marker CD15 and IL-10 was seen in necrotic areas of the lymph nodes of the patients with TB-IRIS. Conclusions: Neutrophils in TB-IRIS are activated, recruited to sites of disease, and release granule contents, contributing to pathology.
Issue Date: 2-Jan-2018
Date of Acceptance: 16-Oct-2017
URI: http://hdl.handle.net/10044/1/52486
DOI: https://dx.doi.org/10.1097/QAI.0000000000001582
ISSN: 1525-4135
Publisher: Lippincott, Williams & Wilkins
Start Page: 221
End Page: 229
Journal / Book Title: JAIDS-Journal of Acquired Immune Deficiency Syndromes
Volume: 77
Issue: 2
Copyright Statement: Copyright © 2017 The Author(s). Published by Wolters Kluwer Health, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial License 4.0 (CCBY-NC), where it is permissible to download, share, remix, transform, and buildup the work provided it is properly cited. The work cannot be used commercially without permission from the journal.
Sponsor/Funder: Wellcome Trust
Wellcome Trust
Wellcome Trust
Funder's Grant Number: 087754/Z/08/Z
104803/Z/14/ZR
094000/Z/10/Z
Keywords: 1103 Clinical Sciences
Virology
Publication Status: Published
Appears in Collections:Department of Medicine
Faculty of Medicine



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