Correlation between Resistin, Tuberculosis and Khat Addiction: A Study from South Western Province of Saudi Arabia

Abstract

Tuberculosis(TB) is a disease of global significance, which accounts for a death in every 15 seconds. Recent studies shows TB is rising in certain parts of the world, and Saudi Arabia is one of them. Several factor contribute in predisposing the subjects for infection including but not limited to addiction to various compounds which have immune modulation properties, such as amphetamines and Heroin etc. Khat a plant whose leaves are chewed for its euphoric effect in east Africa and Arabian Peninsula including Saudi Arabia, is considered as mildly addictive, and its principle compound, Cathinone shares structural and functional similarity with amphetamine a known immunomodulator. Tuberculosis being a disease of immune modulation has a varied spectrum of complex interplay of proinflammatory molecules, resistin is one of them. In the present study, we try to explore the trinity of khat addiction, serum resistin level and tuberculosis by correlating the serum resistin level in non khat addicted healthy subjects, khat addicted healthy subjects, and in patients, both khat addicted and non khat addicted, with active tuberculosis. We observed significantly higher resistin level among the apparently healthy khat addicted subjects as compared to non addicted healthy controls. Thereafter, when we compare the resistin levels between khat addicted and non khat addicted TB patients we did not found significant difference between the two groups. However bacillary load was observe to be significantly higher among the khat addicted TB patient as compare to non addicted one. Validation of above results in animal model revealed dose dependant increase in bacillary growth in the Wistar rats treated with khat. Taken together these results suggest the role of khat in immune modulation albeit in the limited frame of resistin level.

Magnitude and predictors of khat use among patients with tuberculosis in Southwest Ethiopia: A longitudinal study

“…However, health professionals should create awareness regarding the effect of khat on mental and physical health so that patients may consider reducing their khat use. In this study, almost all khat users (96.2%) believe that khat use reduces TB symptoms, however, this is in clear contrast to the study indicating that patients with khat use had a higher bacterial load [30].…”

“…Because, both khat and alcohol were found to have a potential impact on the immunity of the user and associated with mental distress so that patients may develop severe medical and mental health complications or die earlier than non-users [ 26 , 52 , 53 ]. Furthermore, these two substances have an association with treatment-resistant tuberculosis [ 30 , 32 , 54 , 55 ].…”

“…Besides, TB seems to be more frequently underdiagnosed in khat users [ 27 – 29 ]. Khat users with TB were found to have higher bacillary load and were more likely to develop drug resistance [ 30 ]. Also, they were more likely to be stigmatized [ 31 ], had longer treatment regimens [ 32 ], poor adherence [ 7 , 19 ], poor appetite [ 33 ], and increased levels of anxiety [ 10 ].…”

Tuberculosis among Jimma University Undergraduate Students: First Insight about the Burden of Tuberculosis in Ethiopia Universities—Cross-Sectional Study

“…As a consequence, most of them lose their appetite which in turn leads to loss of weight and immune suppression. Some of the chemical contents of khat were also described before to cause loss of appetite [ 19 ]. This may create an opportunity for TB bacilli to initiate infection or reactivation.…”

“…For example, it is described that dietary deficiency of micronutrients like zinc, vitamin D, vitamin A, vitamin C, and iron can cause profound impairment of immunity that are critical to “fight” tuberculosis [ 22 ]. Moreover, one of the ingredients of khat cathinone is shown to have immunomodulatory effect which might further increase the vulnerability of khat chewers for TB [ 19 ]. Previous studies done in Ethiopia also described the significant relation between TB with smoking and khat chewing [ 18 , 23 ].…”