Diagnostic value of interleukin-12 p40 in tuberculous pleural effusions

Valdés, Luís; José, Esther San; Dobaño, José Manuel Álvarez; Golpe, Antonio; Valle, José M. González del; Penela, Pedro; Barcala, Francisco Javier González

doi:10.1183/09031936.00085008

Cited by 26 publications

(18 citation statements)

References 37 publications

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“…6 Several meta-analyses and subsequent studies [29][30][31][32] have indicated that IFN␥ has a high yield in the diagnosis of TBPE (sensitivity 89%, specificity 97%). However, in the present study, as in others by our group, 4,8 its yield has been lower, although within the range obtained in the meta-analyses (sensitivity 64 -100%, specificity 86 -100%). This could be due to disparities between the studies included in the meta-analyses, as regards the subjects (range 21-595), the observed prevalence of tuberculosis (13.8 -74.2%), or the methods of determination.…”

Section: Discussionsupporting

confidence: 79%

“…The yield of the rest of the biomarkers was similar to previous studies. 8,[26][27][28] In the present study the overall misclassification rate of ADA-2 was significantly lower than that of ADA, although this could be explained by the increased number of empyema pleural effusions in our series.…”

Section: Discussioncontrasting

confidence: 73%

“…1 Unfortunately, the conventional methods for diagnosing pleural inflammations have limitations, such as lack of yield by culture and staining, and wait-time to culture Mycobacterium tuberculosis. 2,3 The analysis of pleural fluid interferon-gamma (IFN␥), adenosine deaminase (ADA), and its iso-enzymes, lysozyme, interleukin (IL), and lymphocyte subpopulations, [4][5][6][7][8][9] has, in some cases, improved the diagnostic yield of tuberculous pleural effusion (TBPE). This way, with the determination of ADA (a reference when evaluating the usefulness of new biomarkers in the diagnosis of TBPE), it has been questioned whether, in view of the elevated ADA in young people who live in areas with a high tuberculosis incidence, a pleural biopsy needs to be performed to establish the diagnosis.…”

Section: Introductionmentioning

confidence: 99%

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Interleukin 27 Could Be Useful in the Diagnosis of Tuberculous Pleural Effusions

Valdés

José

Ferreiro³

et al. 2013

Respir Care

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BACKGROUND: The diagnosis of tuberculous pleural effusion (TBPE) has some limitations. We studied the efficacy of interleukin-27 (IL-27) in the diagnosis of TBPE. METHODS: We measured IL-27, adenosine deaminase (ADA), ADA-2, interferon-gamma (IFN␥), and the ADA⅐IL-27 and ADA-2⅐IL-27 products in all the pleural effusion fluids. The diagnostic yield of IL-27 was evaluated with receiver operating characteristic curves. RESULTS: Of 431 pleural effusions, 70 were tuberculous, 146 were neoplastic, 58 were parapneumonic, 28 were empyemas, 88 were transudates, and 41 were other types. With a cutoff point of 0.55 ng/mL, IL-27 had a sensitivity of 91.4% and a specificity of 85.1%, which were significantly less than ADA, ADA-2, IFN␥, ADA⅐IL-27, or ADA-2⅐IL-27. The area under the receiver operating characteristic curve for IL-27 (0.963) was also significantly lower than that for the other markers, except for IFN␥. However, IL-27 improved the sensitivity of ADA and ADA-2 through ADA⅐IL-27 and ADA-2⅐IL-27 products (100% for both). CONCLUSIONS: IL-27 is less efficient than ADA and ADA-2 in the diagnosis of TBPE. However, ADA⅐IL-27 and ADA-2⅐IL-27 improve the diagnostic sensitivity of ADA and ADA-2, and thus could be useful in situations of high clinical suspicion and low ADA level. A value above the cutoff point of the latter is practically diagnostic of TBPE.

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Section: Discussionsupporting

confidence: 79%

Section: Discussioncontrasting

confidence: 73%

Section: Introductionmentioning

confidence: 99%

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Interleukin 27 Could Be Useful in the Diagnosis of Tuberculous Pleural Effusions

Valdés

José

Ferreiro³

et al. 2013

Respir Care

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“…IL-12 is a cytokine that plays an important role in the immune response to intracellular pathogens such as M. tuberculosis (Valdés et al 2009). IL-12 molecule includes two polypeptide subunits, p40 and p35, linked covalently.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Performance of Different Pleural Fluid Biomarkers in Tuberculous Pleurisy

Klimiuk

Krenke

Safianowska

et al. 2014

Advances in Experimental Medicine and Biology

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Due to the paucibacillary nature of tuberculous pleural effusion the diagnosis of pleural tuberculosis is challenging. This prospective study was undertaken to evaluate the diagnostic performance of ten different pleural fluid biomarkers in the differentiation between tuberculous and non-tuberculous pleural effusions. Two hundred and three patients with pleural effusion (117 men and 86 women, median age 65 years) were enrolled. Routine diagnostic work-up, including thoracentesis and pleural fluid analysis, was performed to determine the cause of pleural effusion. The following biomarkers were measured in pleural fluid: adenosine deaminase (ADA), interferon gamma (IFN-γ), interleukin 2 soluble receptor (IL-2sRα), sub-unit p40 of interleukin 12b (IL-12p40), interleukin 18 (IL-18), interleukin 23 (IL-23), IFN-γ induced protein 10 kDa (IP-10), Fas-ligand, human macrophage-derived chemokine (MDC) and tumor necrosis factor alfa (TNF-α). There were 44 (21.7%) patients with tuberculous pleural effusion, 88 (43.3%) patients with malignant pleural effusion, 35 (17.2%) with parapneumonic effusion/pleural empyema, 30 (14.8%) with pleural transudates, and 6 (3%) with miscellaneous underlying diseases. Pleural fluid IFN-γ was found the most accurate marker differentiating tuberculous from non-tuberculous pleural effusion, with sensitivity, specificity, PPV, NPV, and AUC 97%, 98%, 95.5%, 99.4%, and 0.99, respectively. Two other biomarkers (IP-10 and Fas ligand) also showed very high diagnostic accuracy with AUC≥0.95. AUC for ADA was 0.92. We conclude that IFN-γ, IP-10, and Fas-ligand in pleural fluid are highly accurate biomarkers differentiating tuberculous from non-tuberculous pleural effusion.

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“…Together or in isolation, both activation signals can result in NK cell responses (Vivier et al 2011). Because tuberculous pleural microenvironment is plenty of soluble mediators and cells with stimulatory potential (Shimokata et al, 1991;Valdés et al, 2009;Vankayalapati et al, 2000), we hypothesized that NK cells arriving to this site may turn activated. Indeed, we found an elevated percentage of NK cells expressing the early activation markers CD69 and HLA-DR together with enhanced expression of the lymphocyte function-associated antigen 1a integrin (LFA-1/ CD11a) and its ligand, intercellular adhesion molecule-1 (ICAM-1, CD54) (Schierloh et al, 2005a(Schierloh et al, , 2005b).…”

Section: Pleural Nk Cells Exhibit Activated Phenotypementioning

confidence: 99%

Role of NK Cells in Tuberculous Pleurisy as Innate Promoters of Local Type 1 Immunity with Potential Application on Differential Diagnosis

Schierloh¹,

Barrera²,

Sasiain³

2012

Understanding Tuberculosis - Analyzing the Origin of Mycobacterium Tuberculosis Pathogenicity

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Diagnostic value of interleukin-12 p40 in tuberculous pleural effusions

Cited by 26 publications

References 37 publications

Interleukin 27 Could Be Useful in the Diagnosis of Tuberculous Pleural Effusions

Interleukin 27 Could Be Useful in the Diagnosis of Tuberculous Pleural Effusions

Diagnostic Performance of Different Pleural Fluid Biomarkers in Tuberculous Pleurisy

Role of NK Cells in Tuberculous Pleurisy as Innate Promoters of Local Type 1 Immunity with Potential Application on Differential Diagnosis

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