Utility of B Cell Activating Factor (BAFF)
and a Proliferation induced Ligand (APRIL)
Cytokines as Markers of Response to
Dr. Anuj Singhal,
Department of Internal Medicine, Armed Forces Medical College, Pune-411040, Maharashtra, India.
Introduction: Serum estimation of cytokines, that play an important role in the pathogenesis of tuberculosis, may be useful to predict early response to Anti-Tubercular Therapy (ATT). This study will help in identifying the role of cytokines in predicting the early response to Tuberculosis (TB).
Aim: To find out the utility of B Cell Activating Factor (BAFF) and a proliferation induced ligand (APRIL) cytokines as markers of response to ATT in patients with active TB.
Materials and Methods: This was a prospective pilot study carried out at two Tuberculosis Nodal Centers in Pune city, Maharashtra, India. All new Pulmonary Tuberculosis (PTB) cases either sputum positive or sputum negative were considered for enrollment. Exclusion criteria included those subjects whose clinical history was suspected of MDR-TB. Based on their sputum positivity, the PTB patients were divided into two groups: subjects with active PTB patients whose sputum smear was negative for AFB or whose Cartridge-Based Nucleic Acid Amplification Test (CBNAAT) did not detect MTB and group 2 consisted of active PTB patients with sputum smear positive for AFB or MTB detected on CBNAAT. Then, serum was drawn for estimation of BAFF, APRIL, CRP and serum ferritin. The same estimation was repeated after first and second months of standard Intensive Phase (IP) of ATT. All statistical tests were performed using Stata Statistical Software: Release 13. College Station, TX: Stata Corp LP.
Results: In this study, 124 patients were analysed; on clinical examination, the most common clinical finding was of consolidation followed by pleural effusion and the most common radiographic finding was consolidation. There was no significant difference in change in acute phase reactants before and after IP in two groups. Receiver Operating Characteristic (ROC) plot for baseline values of BAFF and APRIL for group 2 subjects showed no significant area under the curve. Hierarchical modeling did not show any statistically significant correlation between sputum conversion, and change in levels of BAFF, APRIL, ferritin and CRP and weight gain.
Conclusion: This study looked at utility of two specific cytokines BAFF and APRIL as biomarkers of treatment response in TB. There was no significant difference in the levels of these cytokines (BAFF and APRIL) before and after IP of ATT.