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Thorax. 2017 Oct;72(10):946-949. doi: 10.1136/thoraxjnl-2016-209397. Epub 2017 Feb 3.

Corticosteroids and infliximab impair the performance of interferon-γ release assays used for diagnosis of latent tuberculosis.

Edwards A1, Gao Y2,3, Allan RN1,4, Ball D4, de Graaf H1,4,5, Coelho T1,6, Clifford V7, Curtis N7, Williams A2,3,8,9, Faust SN1,4,10,11, Mansour S1, Marshall B1,10,12, Elkington P1,10,12, Tebruegge M1,7,10,11.

Author information

1
Academic Unit of Clinical & Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.
2
Academic Unit of Cancer Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.
3
CRUK NIHR Southampton Experimental Cancer Medicine Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
4
NIHR Wellcome Trust Clinical Research Facility, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
5
Department of Paediatric Rheumatology, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
6
Department of Paediatric Gastroenterology, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
7
Department of Paediatrics, The University of Melbourne & Murdoch Children's Research Institute, Parkville, Australia.
8
Department of Immunology, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
9
Wessex Investigational Sciences Hub, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
10
NIHR Respiratory Biomedical Research Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
11
Department of Paediatric Infectious Diseases & Immunology, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
12
Department of Respiratory Medicine, University Hospital NHS Foundation Trust, Southampton, UK.

Abstract

The impact of immunosuppression on interferon-γ release assays and novel cytokine biomarkers of TB infection, mycobacteria-specific IL-2, IP-10 and TNF-α responses was investigated in an ex vivo model. Cytokine responses in standard QuantiFERON-TB Gold in-Tube (QFT-GIT) assays were compared with duplicate assays containing dexamethasone or infliximab. Dexamethasone converted QFT-GIT results from positive to negative in 30% of participants. Antigen-stimulated interferon-γ, IL-2 and TNF-α responses were markedly reduced, but IP-10 responses were preserved. Infliximab caused QFT-GIT result conversion in up to 30% of participants and substantial reductions in all cytokine responses. Therefore, corticosteroids and anti-TNF-α agents significantly impair interferon-γ release assay performance. IP-10 may be a more robust TB biomarker than interferon-γ in patients receiving corticosteroids.

KEYWORDS:

Tuberculosis

PMID:
28159773
DOI:
10.1136/thoraxjnl-2016-209397
[Indexed for MEDLINE]

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