Tumor Necrosis Factor Blockers Influence Macrophage Responses toMycobacterium tuberculosis

Tumor necrosis factor (TNF)-alpha is a proinflammatory cytokine that mediates inflammation in response to various pathogens, including Mycobacterium tuberculosis, but is also a key factor in the pathogenesis of rheumatoid arthritis and other autoimmune diseases. Three TNF-alpha-suppressing drugs have been approved to treat selected autoimmune diseases; 2 are monoclonal antibodies against TNF-alpha (adalimumab and infliximab), and the other is a soluble TNF receptor/Fc fusion protein (etanercept). TNF blockers have been shown to increase the risk of reactivation of latent tuberculosis, and this risk is higher in patients treated with the monoclonal antibodies. We studied the effects of TNF-alpha blockers on the maturation of mycobacteria-containing phagosomes in human macrophages. All 3 drugs had an inhibitory effect on IFN-gamma-induced phagosome maturation in phorbolmyristate acetate-differentiated human THP-1 cells. Adalimumab and infliximab, but not etanercept, suppressed phagosome maturation in primary human peripheral blood monocyte-derived macrophages in the presence or absence of IFN-gamma. Treatment of macrophages with TNF-alpha led to increased maturation of phagosomes containing Mycobacterium bovis bacillus Calmette-Guérin or M. tuberculosis H37Rv. These results suggest a role for TNF-alpha in activating phagosome maturation and highlight a mechanism through which TNF-alpha blockade can affect the host response to mycobacteria.