ENZYMES OF PURINE METABOLISM AND LYMPHOCYTE SUBPOPULATIONS IN PATIENTS WITH DRUG-SENSITIVE AND DRUG-RESISTANT INFILTRATIVE PULMONARY TUBERCULOSIS

AbstractThe purpose of study was to evaluate the state of the enzymes of the purinergic system and the subpopulation composition of lymphocytes in patients with newly diagnosed infiltrative pulmonary tuberculosis, depending on the drug resistance of Mtb to anti-tuberculosis drugs. In 109 patients with drug-resistant and drug-sensitive Mtb who achieved significant or less pronounced improvement after the intensive phase of chemotherapy, the activity of adenosine deaminase (eADA-1, 2), the concentration of ecto-5'-nucleotidase (eNT5E), CD26 (DPPIV), and the subpopulation composition of lymphocytes were evaluated before treatment. In patients isolating drug-sensitive Mtb strains who achieved a "less pronounced improvement", the concentration and activity of ectoenzymes responsible for the formation of extracellular adenosine (eNT5E) and its transformation (eADA-1 and eADA-2), the proportion of cytotoxic T cells was higher compared with patients who achieved significant improvement. Patients isolating drug-resistant Mtb strains who achieved a "less pronounced improvement" had lower absolute counts of T-lymphocytes and helper T cells with an increase in the proportion of cytotoxic T cells and increased eADA-2 activity, compared with individuals who achieved significant improvement. Thus, prior to the initiation of tuberculosis chemotherapy, the activity of purine metabolism enzymes and the subpopulation composition of lymphocytes were not associated with the characteristics of Mtb drug resistance. The relationship between the parameters of purinergic regulation enzymes and the number/ proportion of lymphocytes was revealed in patients who achieved significant improvement, with less pronounced improvement, regardless of the drug resistance of Mtb, no such relationships were found. This indicates an imbalance of inflammatory factors and the immune response to Mtb in individuals who showed the worst results from the intensive phase of chemotherapy. Taking into account the contribution of each component of protective reactions is necessary for the appointment of adequate chemotherapy, pathogenetic therapy and immunocorrection aimed at stopping the progression of the disease.

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