IFNγ and chemokines CXCL9 and CCL2 have been shown to be markers of disease severity in TB [15–17]. CXCL10 is thought to be a non-specific marker of inflammation in pulmonary diseases [18, 19]. Chemokines CXCL10 and CCL2 have been identified as adjunct biomarkers of TB together with IFNγ,  and CXCL9 has been shown to differentiate disease severity between patients with TB. The responses of whole blood cells of patients with TB differ from those of healthy controls . An effective tool must be a strong modulator of immune responses even
in infected individuals with depressed immunity. Here we have compared MTBs, ESAT6 and CFP10-stimulated whole blood cell responses by measuring IFNγ, IL10 and chemokines CCL2, CXCL9 and CXCL10. We found MTBs-induced IFNγ and CXCL10 differentiate severity in both pulmonary and extrapulmonary TB tested in a TB endemic regions PD0332991 mouse in an HIV-negative population. Subject selection and diagnosis. Patients were recruited from the Aga Khan University (AKUH), Indus Hospital, Karachi, and OJHA Institute for Chest Diseases, DOW University of Health Sciences, Karachi. The study was approved by the Ethical Review Committees of the AKUH and DUHS. All samples were taken with written informed consent. All patients were HIV-negative. Patients were either untreated or treated with <1 week of anti-tuberculous
therapy. Exclusion criteria included diabetes mellitus, chronic renal failure, chronic liver disease and also patients on corticosteroid therapy to assure relatively unmodulated immunological parameters. Isolation of M. tuberculosis selleckchem was performed using both Lowenstein Jensen medium and MGIT (Becton Dickinson, Franklin Lakes, NJ, USA) systems in the AKUH Clinical Laboratory, Karachi. Patients were classified as having pulmonary tuberculosis (PTB) or extrapulmonary tuberculosis (ETB) as per WHO guidelines for treatment of TB . Severity of PTB
was classified as minimal, moderately advanced or far advanced pulmonary TB using a modified classification of the National Tuberculosis Association of the USA based on extent of lung tissue involvement . Severity of ETB was assessed by the same guidelines that provide a case definition of an extrapulmonary case with several sites affected on the site representing Teicoplanin the most severe form of the disease . According to these guidelines, severe disseminated ETB (D-ETB) includes meningitis, miliary, bilateral pleural effusion, spinal, intestinal and genito-urinary TB. Cases with tuberculous lymphadenopathy and unilateral pleural effusion are classified as less-severe ETB (L-ETB). Pulmonary tuberculosis was diagnosed by clinical examination, chest X-ray, sputum acid-fast bacillus (AFB) microscopy and/or AFB culture . Patients with minimal (n = 2), moderate (n = 21) and far advanced (Adv-PTB, n = 13) disease were included in the study.