Cytokine Dysregulation in pulmonary Tuberculosis: The role of TNF-α/IL-10 and TNF-α/TGF-β ratios as severity indicators

Background In human tuberculosis, Mycobacterium tuberculosis elicits immunopathology characterized by abnormal expression of plasma cytokines. This immunopathology may influence the severity of illness and the efficacy of prolonged anti-mycobacterial treatment. Methods The study analysed TNF-α, IL-10, and TGF-β levels in 90 pulmonary tuberculosis patients and compared them with 90 healthy individuals. The tuberculosis patients were categorized as mild, moderate, or advanced based on chest x-ray results, and the ratio of pro-inflammatory to anti-inflammatory cytokines was compared. Results All three cytokines were present in most tuberculosis patients, and their concentrations were noticeably higher than in healthy individuals. The ratio of TNF-α/IL-0 and TNF-α/TGF-β demonstrated the most powerful discriminatory ability in determining the severity of tuberculosis. The levels of TNF-α/IL-0 and TNF-α/TGF-β in individuals with moderate and advanced tuberculosis were markedly elevated compared to those with mild cases. The area under the curve (AUC) for TNF-α/TGF-β and TNF-α/IL-0 was determined to be 0.823 and 0.814, respectively. Conclusions The elevated ratio of TNF-α/IL-0 and TNF-α/TGF-β in the sera of TB patients may contribute to an excessive pro-inflammatory response, whereas a lower ratio may regulate excessive inflammation. Both the TNF-α/IL-0 and TNF-α/TGF-β ratios may effectively categorize the tuberculosis severity and have the potential to serve as biomarkers for evaluating the early response to treatment.