Neutrophils in tuberculosis--first line of defence or booster of disease and targets for host-directed therapy?

Necrotizing granulomas, exacerbating pathogenesis and neutrophil influx at the site of infection are hallmarks of active pulmonary tuberculosis (TB) in humans. The role of polymorphonuclear neutrophils (PMN) in host defence and TB pathogenesis has recently attracted broader interest. Association of infiltrating PMN, enhanced mycobacterial load and disease exacerbation in both, mice susceptible to experimental TB as well as in TB patients, link PMN to exacerbated pathology. Targeting PMN resulted in smaller lung lesions and reduced mycobacterial burden. Therefore, PMN-associated molecules represent interesting biomarkers to determine TB severity and treatment success. More importantly, PMN are putative targets for host-directed therapies (HDT) in TB. Due to the rise of multi- and extensively drug-resistant Mycobacterium tuberculosis isolates, HDT represent adjunct measures to support antibiotic treatment by ameliorating pathology and local host defences.