Possible role of transforming growth factor β in tuberculous meningitis

Transforming growth factor β (TGF-β) is an anti-inflammatory cytokine and its role in hydrocephalus and stoke has been suggested. Tuberculous meningitis (TBM) is associated with exudates, stroke, hydrocephalus and tuberculoma, but the role of TGF-β has not been evaluated in relation to these changes.

To evaluate the cerebrospinal fluid (CSF) TGF-β level in the patients with TBM, and correlate these with clinical findings, MRI changes, paradoxical response and outcome at 6months.

TBM patients diagnosed on the basis of clinical, CSF and MRI criteria were prospectively included. The clinical details including duration of illness, seizures, focal motor deficit, Glasgow Coma Scale (GCS) score and stage of TBM were noted. Presence of exudate, hydrocephalus, tuberculoma and infarction in MRI was also noted. MRI was repeated at 3months and presence of paradoxical response was noted. Cerebrospinal fluid TGF-β was measured using ELISA on admission and repeated at 3months and these were compared with 20 controls.

TGF-β level was significantly higher in TBM compared to the controls (385.76±249.98Vs 177.85±29.03pg/ml, P<0.0001). TGF-β correlated with motor deficit, infarction and tuberculoma on admission but did not correlate with CSF abnormalities, drug induced hepatitis, paradoxical response and outcome. TGF-β level at 3months was significantly lower than the baseline but remained higher than the controls.

CSF TGF-β levels are elevated in TBM and correlate with infarction and tuberculoma.