Mycobacteria Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar.
Epidemiology Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar.
Front Immunol. 2021 Dec 22;12:805157. doi: 10.3389/fimmu.2021.805157. eCollection 2021.
Pregnancy triggers an alteration of the immune functions and increases the risk of developing the active tuberculosis (TB) symptoms in exposed women. The effect of pregnancy on the specific immune responses used for most of the TB immunodiagnostic assays is not well documented. Here we investigated the changes in the -specific IFN-γ production in age-matched pregnant and non-pregnant women according to their TB exposition status.
We conducted a prospective cohort study on HIV-seronegative pregnant and non-pregnant women with compatible pulmonary TB symptoms addressed to TB healthcare facilities in Antananarivo, Madagascar. Active pulmonary TB was bacteriologically assessed with culture from sputum samples. Clinical data and blood samples were collected at inclusion and after 6 months of follow-up for each individual included. Whole blood samples were stimulated with QuantiFERON TB-Gold Plus (QFT-P) assay antigens. Plasma IFN-γ concentrations were then assessed by ELISA.
A total of 284 women were investigated for the study including 209 pregnant women without confirmed TB (pNTB), 24 pregnant women with bacteriologically confirmed active TB (pATB), 16 non-pregnant women with active TB (ATB), and 35 non-pregnant healthy donors (HC). At inclusion, IFN-γ responses are lower in the pregnant women compared to their age-matched non-pregnant counterparts and independently of their TB status. Among the pregnant women, higher concentrations of -specific IFN-γ were observed in those exposed to TB, but with a lower magnitude in the active TB compared to the latently infected pregnant women (p < 0.05 with TB1 and p < 0.01 with TB2). After 6 months of follow-up, the -specific IFN-γ responses return to their baseline concentrations except for the pregnant women treated for TB for which none of the QFT-P positive reversed to negative (0%, 0/10) at the end of their TB treatment.
These results support the concept of specific immune priorities characterized by a concomitant reduction in inflammatory immunity during pregnancy and corroborate the important role of activating the specific immune responses to control the infection when the pregnant women are exposed to the pathogen.
妊娠会引发免疫功能改变，并增加已暴露于结核分枝杆菌（Mycobacterium tuberculosis，MTB）的女性发生活动性结核病（tuberculosis，TB）症状的风险。妊娠对大多数 TB 免疫诊断检测中使用的特定免疫反应的影响尚未得到很好的记录。在此，我们根据 TB 暴露状况，研究了年龄匹配的妊娠和非妊娠女性中 - 特异性 IFN-γ 产生的变化。
我们对马达加斯加塔那那利佛的 TB 保健机构收治的 HIV 血清阴性的妊娠和非妊娠、具有相符的肺 TB 症状的女性进行了一项前瞻性队列研究。通过从痰样本中进行培养来对活动性肺 TB 进行细菌学评估。在纳入时以及每位纳入个体的 6 个月随访时收集临床数据和血样。用 QuantiFERON TB-Gold Plus（QFT-P）检测试剂盒的抗原刺激全血样本。然后通过 ELISA 评估血浆 IFN-γ 浓度。
共有 284 名女性接受了研究，包括 209 名未确诊 TB 的妊娠女性（pNTB）、24 名经细菌学证实的妊娠活动性 TB 女性（pATB）、16 名非妊娠活动性 TB 女性（ATB）和 35 名非妊娠健康对照者（HC）。在纳入时，与年龄匹配的非妊娠对照组相比，妊娠女性的 IFN-γ 反应较低，且与 TB 状态无关。在妊娠女性中，与潜伏感染的妊娠女性相比，暴露于 TB 的女性观察到更高浓度的 - 特异性 IFN-γ，但活动性 TB 中的幅度较低（与 TB1 相比 p < 0.05，与 TB2 相比 p < 0.01）。6 个月随访后，除了接受 TB 治疗的孕妇外，所有 QFT-P 阳性者均未转为阴性（0%，10/10），- 特异性 IFN-γ 反应恢复到基线浓度。
这些结果支持特定免疫优先级的概念，其特征是在妊娠期间炎症免疫同时减少，并证实了当孕妇接触病原体时，激活特定免疫反应以控制感染的重要作用。
