The effect of prescribing a complex of essential amino acids on the level of human-beta-defensin-1 in patients with drug-susceptible and drug-resistant pulmonary tuberculosis

Abstract

With the expansion of M. tuberculosis resistance, more and more attention is being paid to alternative pathogenetic therapies that can stimulate the host's immune response. The purpose of the study was to determine the effect of prescribing a complex of essential amino acids on the level of Human-beta-defensin-1 in patients with drug-susceptible and drug-resistant pulmonary tuberculosis. Materials and methods. 50 patients with drug-susceptible tuberculosis (TB) and 50 patients with drugresistant TB (multidrug-resistant and extensively drug resistant TB) were included to the study. The patients with were divided into 3 groups: patients in Group 1 did not receive additional treatment, patients in Group 2 received essential amino acids in tablets for 30 days, patients in Group 3 received injectable essential amino acids for 10 days and after that they received essential amino acids in tablets for 20 days. HBD-1 level was measured in blood serum by ELISA at the treatment onset, after 30 and after 60 days in all the patients. Results. Comparison of the HBD-1 level in patients with susceptible TB after 30 days of treatment showed its highest level in Group 3 (21.59±5.33 μmol/L, median – 17.14 μmol/L), lower level in Group 2 (19.41±3.66 μmol/L, median – 20.17 μmol/L) and the lowest level in Group 1 (9.25±1.95 μmol/L, median – 4.42 μmol/L), p<0.05. After 60 days of treatment, patients with drug susceptible TB showed the opposite results with the highest level of HBD-1 in Group 1 (26.18±2.82 μmol/L, median – 29.17 μmol/L), lower level in Group 2 (16.57±3.95 μmol/L, median – 11.11 μmol/L) and the lowest level in Group 3 (6.32±1.44 μmol/L, median – 3.99 μmol/L). Comparison of the HBD-1 level in patients with drug resistant TB after 30 days of treatment also showed its highest levels in Group 2 (21.65±3.27 μmol/L, median – 20.19 μmol / L) and Group 3 (20.98±7.91 μmol/L, median – 11.01 μmol/L), and significantly lower level in Group 1 (10.79±2.91 μmol/L, median – 4.09 μmol/L), p<0.05. After 60 days of drug resistant TB treatment, the highest HBD-1 level was observed in Group 1 (63.24±9.73 μmol/L, median – 58.15 μmol / L), its lower level was in Group 2 (18.99±2.09 μmol/L, median – 20.26 μmol/L) and the lowest level was in Group 3 (13.86±3.63 μmol/L, median – 13.97 μmol/L), p<0, 05. Conclusions. The appointment of the complex of essential amino acids in the pathogenetic therapy of tuberculosis allows to increase the production of Human-beta-defensin-1 in both patients with drug susceptible and drug resistant tuberculosis, which leads to a more balanced immune response and an increase in the effectiveness of anti-tuberculosis therapy. Key words: tuberculosis, amino acids, MDR-TB, treatment