Fig 1.
Relationship between malnutrition, infection and immunity.
Malnutrition is considered the most relevant risk factor for illness and death. This direct relationship between malnutrition and death is mainly due to the resulting immunodeficiency and, consequently, greater susceptibility to infectious agents. Many factors affect the degree and distribution of malnutrition and micronutrient deficiency around the world, with poverty being the primary reason. Other factors which are also deeply involved in malnutrition include: socioeconomic instability; impaired educational development; unsanitary conditions; poor food practices and the shortage or ineffectiveness of nutrition programs.
Fig 2.
The figure represents the inclusion/exclusion criteria adopted for recruitment of the study population. The population was categorized into four groups namely: Malnourished group with Active TB (n = 32), Malnourished group with Latent TB (n = 90), Malnourished group (n = 130) and Healthy control group (n = 23) (Grey boxes indicate the groups included in the final analysis). TB-Tuberculosis, TST-Tuberculin Skin Test, Cut-off point is atleast 10 mm, QFT- QuantiFERON-TB Gold, Cut-off is atleast 0.35 IU/μl. TLC-Total leukocyte count, Hb-Hemoglobin count (g/ml)
Table 1.
Demographic characteristics of the population under study.
Table 2.
Hematological parameters of the population under study.
Table 3.
Baseline characteristics of population under study.
Fig 3.
Mean BMI, Leptin, QFT and TST values in different categories.
Bar graphs represent the mean values in different study groups. Graphs were plotted using GraphPad Prism (version 5.03). Error bars represent mean ± standard deviation. BMI- Body mass index, TST-Tuberculin Skin Test, Cut-off point is atleast 10 mm, QFT- QuantiFERON-TB Gold, Cut-off is atleast 0.35 IU/μl, Leptin values are indicated as absorbance at 450 nm. Leptin levels were evaluated in serum SPIbio Human EIA kit.
Fig 4.
Representative 1-DE gel images of identified proteins in different categories.
Boxes indicate the differentially expressed protein bands in different study groups. Gel imaging and analysis was done using Image Lab software (version 4.0, BioRad). The protein bands in the test groups were compared against healthy control group.
Fig 5.
Expression of proteins by densitometric analysis.
Pie charts represent the intensities of protein bands assessed by densitometric analysis in different study groups. Gel analysis was done using Image Lab software (BioRad) (Version 4.0)
Table 4.
Mascot Search Results.
Fig 6.
Evaluation of TB biomarkers in original and follow-up samples of the population under study.
Chart shows a comparison between the levels of TB biomarkers (30 kDa antigen, ADA; Adenosine deaminase, Mycobacterial Dormancy Regulon Protein Rv2623, Multiplex antigens; Ag85B; M.tb Ag85B secretory protein, Hsp-16; 16 kDa heat-shock protein, 45kDa antigen, GroES; M.tb 10kDa chaperonin, ESAT-6; 6 kDa early secretory antigenic target and CFP-10; 10 kDa culture filtrate protein, QFT; QunatiFERON-TB Gold test and TST; Tuberculin Skin Test) in original and follow-up cases of Melghat categorized into three groups; Latent to Active TB group (n = 1), Latent to Latent TB Group (n = 5) and Active to Active TB group (n = 3).
Table 5.
Protein functions in tuberculosis and malnutrition.
Fig 7.
Mechanisms involved in the acute phase protein response in malnutrition and TB.
Malnutrition and the anorectic effects of pro-inflammatory cytokines in the brain result in a negatively changed hepatic synthesis. In diseased condition, the pro-inflammatory cytokines TNF-α, IL-1 and IL-6 play a key role in the hepatic APR. They activate hepatocytic receptors, and synthesis of varying APPs starts. During latent form of infection, release of IL-10 by the Kupffer cells results in suppression of the local IL-6 production by gene suppression pathways coactivated on receptor binding. This results in rapid hepatic removal of circulating cytokines followed by down-regulation of hepatocytic APR.