Urinary LAM is a marker of disseminated TB and higher mycobacterial burden, which is associated with a worse prognosis
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• Urinary LAM is due to haematogenously disseminated renal TB
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Cox et al. 2015 [26]
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• HIV-TB patients with mycobacteraemia have a higher mortality
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Cummings et al. 2015 [56]
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• Higher concentrations of urinary LAM are associated with higher mycobacterial burden
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Kerkhoff et al. 2014 [19]
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Urinary LAM is a proxy for a low CD4 cell count
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• HIV-TB patients with positive urinary LAM tests have lower CD4 cell counts
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Minion et al. 2011 [11]
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• Mortality is higher in patients with lower CD4 cell counts
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Gupta et al. 2015 [34]
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LAM itself contributes to immunosuppression, impairing host defences against MTB and other opportunistic infections
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• LAM is a virulence factor for MTB
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Strohmeier et al. 1999 [35]
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• LAM inhibits immune responses, with direct inhibitory effects on macrophage activation and function
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Mishra et al. 2011 [38]
Neyrolles et al. 2011 [41]
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• LAM inhibits pro-inflammatory cytokines, e.g. IL-12 and TNF-α
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• LAM enhances the secretion of anti-inflammatory cytokines, e.g. IL-10
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