Assessment of oxidative stress in serum of pulmonary tuberculosis patients

Vishal Wagh, Shreewardhan Rajopadhye, Sandeepan Mukherjee, Anant Urhekar, Deepak Modi


Background: Tuberculosis (TB) remains a human health issue and often deadly infectious disease in low-middle income nations. In TB, oxidative stress is a result of tissue inflammation, poor dietary intake of micronutrients due to illness, free radical burst from activated macrophages. This study was conducted prospectively to evaluate the oxidative stress in TB.

Methods: The study included 30 newly diagnosed TB positive patients and 30 healthy individuals. Pro-oxidant markers like the thiobarbituric acid reactive species (TBARS) and nitric oxide were studied from serum. Antioxidant parameter like serum total-SH was also assessed.

Results: Levels of pro-oxidants were significantly increased whereas antioxidant defense markers were significantly impaired in the TB group. Nitric oxide and TBARS were increased (p<0.0001) where glutathione was decreased (p<0.0001) in TB population compared to healthy controls.

Conclusions: Marked oxidative stress were seen in the TB population as compared to the healthy cohort. The role of antioxidant therapy may therefore be evaluated in the management of TB.  



Tuberculosis, Oxidative stress, TBARS, Nitric oxide, GSH

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Bulatovic VM, Wengenack NL, Uhl JR, Hall L, Roberts GD, Iii FRC, et al. Oxidative Stress Increases Susceptibility of Mycobacterium tuberculosis to Isoniazid. Antimicrob Agents Chemother. 2002;46(9):2765-71.

Cooper AM, Segal BH, Frank AA, Holland SM, Orme IM, Orme IANM. Transient Loss of Resistance to Pulmonary Tuberculosis in p47 phox − / − Mice Transient Loss of Resistance to Pulmonary Tuberculosis. Infect Immun. 2000;68(3):1231-4.

Wiid I, Seaman T, Hoal EG, Benade AJ, Van Helden PD. Total Antioxidant Levels are Low During Active TB and Rise with Anti-tuberculosis Therapy. IUBMB Life. 2004;56(2):101-6.

Palanisamy GS, Kirk NM, Ackart DF, Shanley CA, Orme IM, Randall J. Evidence for Oxidative Stress and Defective Antioxidant Response in Guinea Pigs with Tuberculosis. Plos one. 2011;6(10).

Birben E, Sahiner UM, Sackesen C, Erzurum S, Kalayci O. Oxidative stress and antioxidant defense. World Allergy Organ J. 2012;5(1):9-19.

Ghezzi P. Role of glutathione in immunity and inflammation in the lung. Int J Gen Med. 2011;4:105-13.

Vijayamalini MMS. Lipid peroxidation, vitamins C, E and reduced glutathione levels in patients with pulmonary tuberculosis. Cell Biochem Funct. 2004;22(1):19-22.

Venketaraman V, Rodgers T, Linares R, Reilly N, Swaminathan S, Hom D, et al. Glutathione and growth inhibition of Mycobacterium tuberculosis in healthy and HIV infected subjects. AIDS Res Ther. 2006;3:5.

Adebimpe WO, Faremi AO, Nassar SA. Effects of treatment on free radicals in patients with pulmonary tuberculosis in South Western Nigeria. Afr Health Sci. 2015;15(4):1256-61.

Pavanelli WR, Jerley J, Silva N. The Role of Nitric Oxide in Immune Response Against Trypanosoma Cruzi Infection. The Open Nitric Oxide Journal 2010;2:1-6.

Bulatovic VM, Wengenack NL, Uhl JR, Hall L, Roberts GD, Rusnak F. Oxidative Stress Increases Susceptibility of Mycobacterium tuberculosis to Isoniazid. Antimicrob Agents Chemother. 2002;46(9):2765-71.

Green LC, Wagner DA, Glogowski J, Skipper PL WJ et al. Analysis of nitrate, nitrite, and nitrate in biological fluids. Anal Biochem. 1982;126(1):131-8.

Brown RK KF. Free Radicals: A Practical Approach. Oxford University Press. 1996. 119-131 p.

Sedlak JLR. Estimation of total, protein-bound, and nonprotein sulfhydryl groups in tissue with Ellman’s reagent. Anal Biochem. 1968;25(1):192-205.

Ellman GL. Tissue sulfhydryl groups. Arch Biochem Biophys. 1959;82(1):70-7.

Venketaraman V, Millman AMS, Swaminathan S, Goetzb M, Lardizabalc AF, Homb DNDC. Glutathione levels and immune responses in tuberculosis patients. Microbial Pathogenesis. 2008. p. 255–61.

Allen M, Bailey C, Cahatol I, Dodge L, Yim J, Kassissa C, et al. Mechanisms of control of Mycobacterium tuberculosis by NK cells : role of glutathione. Front Immunol. 2015;6(October):1-9.

Venketaraman V, Dayaram YK, Talaue MT, Connell ND. Glutathione and nitrosoglutathione in macrophage defense against Mycobacterium tuberculosis. Infect Immun. 2005;73(3):1886-9.

Morris D, Nguyen T, Kim J, Kassissa C, Khurasany M, Luong J, et al. An elucidation of neutrophil functions against Mycobacterium tuberculosis infection. Clin Dev Immunol. 2013;2013:959650.

Kulkarni R, Deshpande A, Saxena R, Saxena K. A study of serum malondialdehyde and cytokine in tuberculosis patients. J Clin Diagnostic Res. 2013;7(10):2140-2.

Madebo T, Lindtjorn B, Aukrust P, Berge RK. Circulating antioxidants and lipid untreated tuberculosis patients in peroxidation products in Ethiopia. Am J Clin Nutr. 2003;78(1):117-22.

Kandukuri E, Sarma DVHS, Sushma P, Moulali D. Serum MDA (Malondialdehyde),hs-CRP and Adenosine Deaminase Levels in Pulmonary Tuberculosis Patient’s. International Journal of Scientific and Research Publications. 2015;5(2):1-3.

Pearl JE, Torrado E, Tighe M, Fountain JJ, Solache A, Strutt T, et al. Nitric oxide inhibits the accumulation of CD4+CD44hiTbet+CD69lo T cells in mycobacterial infection. Eur J Immunol. 2012;42(12):3267-79.

Idh J, Mekonnen M, Abate E, Wedajo W, Werngren J, Ängeby K, et al. Resistance to first-line anti-TB drugs is associated with reduced nitric oxide susceptibility in Mycobacterium tuberculosis. PLoS One. 2012;7(6):3-8.