Key result
The frequency of Treg cells and CD4+IL-9+ cells was significantly lower in the pleural fluid of patients with tuberculous pleural effusion compared to those with non-tuberculous pleural effusions.
Why the study?
Does the frequency of T helper cell subsets in pleural fluid differentiate tuberculous pleural effusions from non-tuberculous pleural effusions?
Observational (n=88)
No
Does the frequency of T helper cell subsets in pleural fluid differentiate tuberculous pleural effusions from non-tuberculous pleural effusions?
Pleural fluid Treg cells and CD4+IL-9+ cells are significantly lower in tuberculous pleural effusions compared to non-tuberculous effusions, offering potential diagnostic utility alongside ADA.
Answers are grounded in this paper and cite their sources.
Th subtype profiling in pleural fluid may differentiate TPE from MPE; leaves open diagnostic utility pending larger validation studies.
Background: Tuberculous pleural effusion (TPE) is one of the most common forms of extrapulmonary tuberculosis (Tb). Patients with TPE or malignant pleural effusions (MPE) frequently have a similar lymphocytic pleural fluid profile. Since the etiology of PE in various diseases is different, identifying the cellular components may provide diagnostic clues for understanding the pathogenesis. Objective: We determined the frequency of T helper (Th) subtypes in the PEs for differentiation of Tb and non-Tb patients. Methods: Thirty patients with TPE, 30 patients with MPE, 14 patients with empyema (EMP), and 14 patients with parapneumonic effusion (PPE) were enrolled between December 2018 and December 2019. Five-milliliter fresh PE in tubes containing heparin as an anticoagulant was obtained from patients. The frequencies of CD4+IL-9+, CD4+IL-22+, CD+IL-17+, and regulatory T-cells CD4+CD25+ FOXP3+ (Treg) were determined by flow cytometry. Results: Treg cells have a lower frequency in TPE patients [4.2 (0.362-17.24)] compared with non-TPE patients [26.3 (3.349-76.93, p < 0.0001)]. The frequency of CD4+IL-9+ cells was significantly lower in TPE patients [3.67 (0.87-47.83)] compared with non-TPE groups [13.05 (1.67-61.45), p < 0.0001]. On the contrary, there was no significant difference in the frequency of CD4+IL-17+ and CD4+IL-22+ cells between TPE and non-TPE patients (p = 0.906 and p = 0.2188). Receiver-operator curve (ROC) analysis demonstrated that CD4+CD25+FOXP3+ T cells [optimal cutoff value = 13.6 (%), sensitivity 90%, specificity 75.86%] could be considered as predictor for TPE. However, adenosine deaminase [cutoff value 27.5 (IU/l), sensitivity 90%, specificity 96.5%] levels had an even greater predictive capacity. Conclusion: ADA, Treg cells, and CD4+IL-9+ cells may differentiate TPE from non-TPE patients. However, these results need validation in an independent large cohort.
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Roofchayee et al. (2021) conducted an observational in Pleural effusion (n=88). Tuberculous pleural effusion vs. Non-tuberculous pleural effusion was evaluated on Frequency of Treg cells (CD4+CD25+FOXP3+) in pleural fluid (p=<0.0001). The frequency of Treg cells and CD4+IL-9+ cells was significantly lower in the pleural fluid of patients with tuberculous pleural effusion compared to those with non-tuberculous pleural effusions.
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