Interferon Gamma And Vitamin D3

EFFECT OF 1,25 DIHYDROXYVITAMIN D3 ON SERUM GAMMA INTERFERON LEVEL IN PULMONARY TUBERCULOSIS PATIENT Zen Ahmad1, Erwin Azmar1, Pohan M.Y.H1, Theodorus2 1 Division Of Pulmonology Department of Internal Medicine, Medical Faculty Sriwijaya University 2 Department of Clinical Pharmacology, Medical Faculty Sriwijaya University Palembang South Sumatera

Abstract Introduction. Tuberculosis (TB) remains a global health problem especially in South-east Asian region. Effective treatment strategies is need to eradicate the disease. Improving of preventive and curative methods is need by exploring the underlying factors of protective immunity and disease development in infected individuals.1,25 Dihydroxyvitamin D3 (1,25(OH)2D3) has gained significant importance in tuberculosis due to its immunoregulatory activities. Our aim was to evaluate the effect of 1,25(OH)2D3 on gamma interferon (IFN-γ) level in pulmonary tuberculosis(PTB) patient. Methods. Randomized Controlled Study, double blind, has been done in Pulmonology Clinic Muhammad Husin General Hospital Palembang, July 2007 until December 2007. Serum IFN-γ level from 20 pulmonary tuberculosis patients which were given oral anti tuberculosis in FixedDose Combination (FDC) and 0,25 μg 1,25(OH)2D3 once daily orally and 18 patients from control group were given FDC and placebo were evaluated before and after intensive-phase. Results. In Vitamin D3 group the level of serum IFN-γ was decreased significantly than placebo group at the end of intensive-phase. Improvement of radiological finding, clinical sign and symptom in vitamin D3 group is better than placebo group. Table 1. Comparison of Gamma-Interferon Level in both groups Variable

VITD Before

IFN- γ

10,88 ± 8,40

Placebo After 3,91±3,99

p* 0,046

Before 9,75±6,30

After

p*

p**

4,77 ± 4,45

0,002

0,011

p*

p**

level (pg/dl) *T-test , **Non-paired T-test, p < 0,05 Tabel 2. Improvement of Chest X-Ray lesion in both groups C-XR lesion VITD (n=20) Placebo (n=18) before

after

p*

before

after

moderate

9

5

0,021

7

4

minimal

-

2

-

3

normal

-

2

-

0

severe

11

5

11

6

moderate

-

5

-

4

minimal

-

0

-

1

normal

-

1

-

0

*T-test **Non-paired T-test, p > 0,05

0,000 0,155

Table 3. Sputum Acid Fast Bacilli (AFB) conversion in both groups Groups ______________Conversion____________ Total YES NO VIT D

20

0

20

Placebo

15

3

18

Total * Fischer exact-test, p > 0,05

35

3

38

p* 0,097

Table 4. Efficacy of Treatment on Hemoglobin, BSR, Lymphocyte, Albumin and BMI level Variables VITD Placebo before Hemoglobin 11,03 + 1,61

after

p*

before

p*

p**

11,91 + 1,53 0,000 17,06 + 2,32 17,69 + 2,25 0,000

0,998

19,83 + 18,85 0,001

0,049

Lymphocyte 20,40 + 7,32 22,15 + 4,65 0,000 15,50 + 6,54 22,33 + 8,98 0,000

0,410

BSR

42,70 + 31,71 20,95 + 21,5 0,001 55,72 + 33,90

after

0,000

0,555

16,62 + 2,72 18,03 + 2,34 0,000 17,06 + 2,32 17,69 + 2,25 0,000 BMI *T-test, **Non-paired T-test, p <0,05

0,734

Albumin

2,92 + 0,72

3,55 + 0,61

0,000 2,69 + 0,50

3,30 + 0,54

Conclusions. Addition of Vitamin D on FDC treatment during the intensive-phase decreased the gamma interferon level in Pulmonary TB patient. There were no significant difference statistically of improvement of radiological lesion, AFB sputum conversion, hemoglobin, lymphocyte, albumin, and BMI level between two groups Keywords: Interferon gamma; Pulmonary tuberculosis; 1,25 Dihydroxyvitamin D3 For correspondence: email address : [email protected], or [email protected] Abstract was published in Respirology (2008) 13, (Suppl. 5) A124

Journal compilation @ 2008 Asia Pacific Society of Respirology