Differences in cytokine and chemokine profiles in cerebrospinal fluid caused by the etiology of cryptococcal meningitis and tuberculous meningitis in HIV patients.

Xu, Lijun; Xu, Yufan; Zheng, Yanghao; Peng, Xiuming; Yang, Zongxing; Cao, Qing; Xiang, Dairong; Zhao, Handan

The roles of cytokines and chemokines in HIV-associated cryptococcal meningitis (HCM) and HIV-associated tuberculous meningitis (HTBM) are debatable. In sum, 34 HIV-infected patients without meningitis, 44 HCM patients and 27 HTBM patients were enrolled for study. The concentrations of 22 cytokines/chemokines in cerebrospinal fluid (CSF) were assayed in at admission. Principal component analysis (PCA), Pearson and logistic regression analyses were used to assess the role of cytokines/chemokines in HCM and HTBM. We found the levels of Th17, Th1 (IL-12p40, IFN-γ, TNFα and TNF-β) and Th2 (IL-2/4/5/6/10) cytokines were elevated in patients with meningitis compared with those in HIV-infected patients without CNS infection. Furthermore, the IL-1Ra, IL-12p40, IL-17α and MCP-1 levels were higher in HCM patients, while the IFN-γ, RANTES and IP-10 levels were higher in HTBM patients. Elevated CSF concentrations of IL-17a, TNF-β, IL-5, IL-12p40 and IL-1Rα were closely related to meningitis, but elevated IP-10, MCP-1, RANTES, and IFN-γ levels and CSF WBCs were protective factors against HCM. Our study suggested HIV-infected patients with low CSF WBCs have a high risk of HCM. Th1, Th2 and Th17 cytokines/chemokines mediate differences in the pathogenesis of HCM and TBM. Overexpressed proinflammatory MCP-1, RANTES, IFN-γ and IP-10 in CSF are protective factors against HCM but not HTBM.