International Journal of Health Sciences and Research
Volume 14; Issue: 3; March 2024
Website: www.ijhsr.org
Original Research Article ISSN: 2249-9571
Markers of Oxidative Stress Evaluation in People
Living with Pulmonary Tuberculosis
Dr Anil Batta
Professor & Head, Dept. of Biochemistry, Muzaffarnagar Medical College, Muzaffarnagar
DOI: https://doi.org/10.52403/ijhsr.20240314
ABSTRACT
Pulmonary tuberculosis (TB) is one of the most common infectious diseases globally. This study was
done to assess the levels of vitamins C and E, glutathione peroxidase, catalase, superoxide dismutase,
and lipid peroxidation product (malondialdehyde) in pulmonary tuberculosis patients in
Muzaffarnagar Medical College & Hospital, Muzaffarnagar (MMC). A total of 90 individuals (males
and females), comprising 30 newly diagnosed pulmonary tuberculosis patients yet to commence
therapy. Thirty old cases on therapy and a control group consisting of 30 healthy individuals of the
same age range (35-55 years). The levels of Vitamin C, Vitamin E, glutathione peroxidase, catalase,
and superoxide dismutase in pulmonary tuberculosis were determined using the standard method. The
results showed that the levels of Vitamin C (1.64±0.41 mg/dl), Vitamin E (1.46±0.38 mg/dl),
glutathione peroxidize (0.89±0.07 iu/L), catalase (70.49±2.02 iu/L) and superoxide dismutase
(65.45±3.48 iu/L) in pulmonary tuberculosis were significantly decreased when compared with
controls (1.91±0.42 mg/dl, 0.84±0.31 mg/ldl, 72.60±2.58 iu/L, 0.94±0.06 iu/L, 68.65±2.83 iu/L)
respectively (p<0.05). While the level of malondialdehyde (8.7±1.81 mol/ml) was significantly
increased (p<0.05) in pulmonary tuberculosis when compared with control (4.91±1.90 mol/ml).
However, the levels of antioxidants were increased in pulmonary tuberculosis on antituberculosis
drugs when compared with those not on therapy. These probably indicate that antioxidant status is
significantly reduced in pulmonary tuberculosis patients which may be associated with high levels of
free radicals and oxidative stress. Hence, supplementation of pulmonary tuberculosis patients with
diet or drugs containing antioxidants can improve their condition.
Keywords: Pulmonary tuberculosis, antioxidant, oxidative stress
INTRODUCTION is infected with Mycobacterium tuberculosis
Mycobacterium tuberculosis is considered and the majority of these individuals live in
as an etiologic agent of tuberculosis (TB) less developed countries [6]. It is commonly
with the identifying feature of the organism a disease of the lung where it forms a
being an acidfast property[1] Pulmonary localized infection after inhalation.
Tuberculosis (PTB) occurs when M. Worldwide, TB is responsible for more than
tuberculosis primarily attacks the lungs[2]. 1.5 million deaths every year [7] with an
However, it can spread from there to other estimated rate of 13.7 million prevalent
organs. Pulmonary TB is curable with an cases of TB in 2007 (206 per 100.000
early diagnosis and antibiotic treatment [3]. populations) [8]. Therefore, despite recent
Tuberculosis is a leading health problem progress, TB remains an important global
worldwide and remains one of the leading public health problem [9].
causes of death from infectious diseases [4]. Pulmonary tuberculosis is the commonest
It is a highly infectious disease that is form of tuberculosis characterized by
widely distributed throughout the globe [5]. general symptoms such as unexplained
Almost one-third of the world’s population cough, dehydration, vomiting, unexplained
International Journal of Health Sciences and Research (www.ijhsr.org) 81
Volume 14; Issue: 3; March 2024
Dr Anil Batta. Markers of oxidative stress evaluation in people living with pulmonary tuberculosis
tiredness, weight loss, high remittent or around 14.6 million people had active TB
intermittent pyrexia, and loss of appetite at disease with 9 million
the prodromal period, and specific new cases [14]. The annual incidence rate
respiratory symptoms like hemoptysis, varies from 356 per 100,000 in Africa to 41
pleural pain, and others depending on the per 100,000 in the Americas [10]. The rise
site involved [5]. It can affect in human immune virus (HIV) infection and
extrapulmonary regions like lymph nodes, the neglect of TB control programs have
bones and joints, skin, meninges, eyes, enabled a resurgence of TB. The emergence
kidneys, and also the gastrointestinal tracts, of drug-resistant strains has also contributed
where it to the TB epidemic, with 20% of TB cases
causes an insidious disease that sometimes from 2000 to 2004 being resistant to
develops without any striking clinical standard TB treatments, and 2% resistant to
evidence. It is a disease of the lungs where it second-line TB drugs. Although
forms a localized infection after inhalation Mycobacterium tuberculosis is more
[10] common, Mycobacterium bovis which
The pathogenesis of TB is multifactorial and affects cattle can also be found in man [14]
includes the effects of oxidative stress [4]. Recent studies suggest that in pulmonary
Reactive oxygen species (ROS) and reactive tuberculosis, there is an increase in several
nitrogen intermediates (RNI) are induced by circulating markers of free radical activity,
mycobacteria through the activation of indicating ongoing oxidative stress and a
phagocytes by respiratory burst mechanism, decrease in antioxidant activity which may
which is crucial to host defense but may contribute to the development of lung
promote tissue injury, and inflammation [1] function abnormalities [15]. Although these
and may further contribute to are important parts of the host defense
immunosuppression. Pulmonary fibrosis and against the organism, enhanced reactive
dysfunction in TB are thought to be a oxygen species (ROS) generation may
consequence of chronic inflammatory promote tissue injury and inflammation.
events involving pro-inflammatory This further contributes to immune
cytokines, activated macrophages, and ROS suppression. Moreover, the malnutrition that
that stimulate fibroblast proliferation and is commonly associated with patients with
mononuclear cell DNA damage [11] TB may further contribute to the impaired
Tuberculosis is an infectious disease caused antioxidant capacity in these patients which
by the bacterium Mycobacterium may result in severe oxidative stress that has
tuberculosis (MTB) [12]. It is a highly been reported in TB patients due to
infectious disease that is widely distributed malnutrition and poor immunity [16]. To
throughout the world. The disease is maintain normal lung function, there must
influenced by economic and nutritional be a protective antioxidants balance
factors; although educational background, between toxic ROS and antioxidants which
immunity, and hormonal status have been protects the body from the damaging effects
associated with the prevalence. The of ROS. Antioxidants are physiologic
economic and nutritional factors account for substances that are derived both from
the highest prevalence in developing endogenous and exogenous sources and act
countries. The World Health Organization to quench ROS. An antioxidant is a
(WHO) reports showed that there were an molecule that inhibits the oxidation of other
estimated 9.3 million cases of TB in 2007 molecules. Oxidation is a chemical reaction
[8]. The WHO declared TB a global health that can produce free radicals, leading to
emergency in 1993, and the “Stop TB” chain reactions that may cause cellular
Partnership developed a Global Plan to Stop damage. Antioxidants such as ascorbic acid
Tuberculosis that aims to save 14 million (vitamin C), terminate these chain reactions
lives between 2006 and 2014 [13]. In 2004, (oxidation). Plants and animals maintain
International Journal of Health Sciences and Research (www.ijhsr.org) 82
Volume 14; Issue: 3; March 2024
Dr Anil Batta. Markers of oxidative stress evaluation in people living with pulmonary tuberculosis
complex systems of overlapping peroxidation and antioxidants in Owerri Imo
antioxidants such as glutathione, catalase, State Nigeria. The present study was aimed
and superoxide dismutase produced at investigating the status of
internally or dietary antioxidants such as malondialdehyde and antioxidants to
vitamin A, vitamin C, and vitamin E [17]. provide information that will enhance the
Oxidative stress can be considered as either success rate in the treatment and
a cause or consequence of some diseases, an management of patients with TB.
area of research stimulating drug Pulmonary tuberculosis infection is
development for antioxidant compounds for associated with mortality and morbidity.
use as potential therapies. Free radicals are Knowing the levels of antioxidant markers
responsible for widespread and may be useful for better management of the
indiscriminate oxidation and peroxidation of patients. This will alleviate the suffering of
lipids causing cell death or organ damage. this group of patients. There is a paucity of
Free radicals oxidative stress has been data on the levels of antioxidant markers in
implicated in the pathogenesis of a variety tuberculosis patients in our environment.
of human diseases [18]. When a host tissue Hence, the need to have a data
is challenged by a pathologic insult of either
an immunologic or non-immunological MATERIALS & METHODS
nature, an inflammatory reaction may occur, Subject: A total of 90 individuals (males
with subsequent clearance of the pathologic and females), comprising 30 newly
stimulus by phagocytic cells. Tissue injury diagnosed pulmonary tuberculosis patients
may result from either the direct effects of yet to commence therapy. Thirty old cases
the pathologic agent or as a consequence of on therapy and a control group consisting of
an inflammatory cell influx [15]. Upon 30 healthy individuals of the same age range
recognition of a phagocytic or soluble (35-55 years). Informed consent of the
stimulus, both neutrophils and macrophages participants was obtained and was
experience a “respiratory burst” which is conducted in line with the ethical approval
characterized by an of the Hospital. Blood sample: Five ml of
increase in oxygen consumption and venous blood was collected from all
increased glucose metabolism via hexose subjects, into dried test tubes. These were
monophosphate shunt. In conjunction with spun in a centrifuge to enable fast separation
an increase in oxygen consumption, of serum into a clean dry bijou bottle. The
neutrophils and macrophages secrete both levels of Vitamin C, Vitamin E, glutathione
superoxide (O2-) and hydrogen peroxide peroxidase, catalase, and superoxide
(H2O2) as a defense mechanism [19]. The dismutase in pulmonary tuberculosis were
biological effects of these highly reactive determined using the standard method. Data
compounds are controlled in vivo by a analysis: The results obtained in the study
whole spectrum of antioxidative defense were expressed as mean ± standard
mechanisms: vitamins E and C, carotenoids, deviation. The statistical analysis of data
antioxidant enzymes (superoxide dismutase, was done by using a student’s t-test. The
glutathione peroxidase, and catalase. During level of significance was calculated at
pulmonary inflammation increased amounts p<0.05.
of reactive oxygen species and reactive
nitrogen intermediates are produced as a Statistical Analysis Data analysis: The
consequence of phagocytic respiratory burst results obtained in the study were expressed
[13]. Though pulmonary tuberculosis is a as mean ± standard deviation. The statistical
disease of most common occurrence and is analysis of data was done by using a
widely studied, many questions in this field student’s t-test. The level of significance
remain unanswered. There is a paucity of was calculated at p<0.05.
local reports on the status of lipid
International Journal of Health Sciences and Research (www.ijhsr.org) 83
Volume 14; Issue: 3; March 2024
Dr Anil Batta. Markers of oxidative stress evaluation in people living with pulmonary tuberculosis
RESULT availability of carrier molecules may
Subject: A total of 90 individuals (males influence circulating antioxidant
and females), comprising 30 newly concentrations. Vitamin C is the most
diagnosed pulmonary tuberculosis patients aqueous phase chain breaking antioxidants
yet to commence therapy. Thirty old cases which directly scavenges radicals present in
on therapy and a control group consisting of the aqueous compartment. While vitamin E
30 healthy individuals of the same age range the most important lipid phase chain-
(35-55 years). Informed consent of the breaking antioxidant scavenges radicals in
participants was obtained and was membranes and lipoprotein particles and is
conducted in line with the ethical approval central to the prevention of lipid
of the Hospital. Blood sample: Five ml of peroxidation Both vitamin C and E have a
venous blood was collected from all protective role against oxidative membrane
subjects, into dried test tubes. These were attack [22] Indeed free radicals released
spun in a centrifuge to enable fast separation from mycobacteria tuberculosis patient
of serum into a clean dry bijou bottle. The initiate lipid peroxidation by attacking
levels of Vitamin C, Vitamin E, glutathione polyunsaturated fatty acids in cell
peroxidase, catalase, and superoxide membranes, converting them to lipid
dismutase in pulmonary tuberculosis were peroxides and a variety of secondary
determined using the standard method. Data metabolites. The uncontrolled peroxidation
analysis: The results obtained in the study alters membrane fluidity and permeability.
were expressed as mean ± standard Hence, the lipid peroxides and their
deviation. The statistical analysis of data secondary metabolites such as
was done by using a student’s t-test. The malondialdehydes are then transported
level of significance was calculated at through the circulation by lipoproteins
p<0.05. causing damage to distant tissues [15].
Furthermore, it was observed that there was
DISCUSSION a higher level of MDA in the
In this present study, it was observed that Mycobacterium tuberculosis patients than
the antioxidants vitamins C and E were the healthy individuals. However, the level
significantly depleted in tuberculosis of MDA significantly decreased among
patients when compared with healthy those on antituberculosis therapy, hence
individuals. This is in line with the work of there is a significant decrease in ROS
Madhab et al., [20] which stated that the generation, and the extent of lipid
lower levels of vitamin C and E levels were peroxidation is decreased by
associated with excessive ROS production chemotherapeutic destruction of
and oxidative stress in tuberculosis This Mycobacteria. This is in line with the work
finding also correlates with the work of of Reddy et al.,[16]. Madhab et al., [20]
Reddy et al [16] which stated that the reported low concentration of MDA level in
reduced levels of vitamin C and E were tuberculosis on therapy. The decrease is
linked with the increased radical formation mainly due to decreased disease progression
in tuberculosis. Several factors such as low due to antituberculosis drugs. Hence, this
food intake, nutrient malabsorption, reduced free radical production and reduced
inadequate nutrient release from the liver, MDA. High MDA production is linked with
acute phase response to infection, and increased production of ROS and is also a
inadequate availability of carrier protein marker of the extent of oxidative stress
may influence circulating antioxidant elicited by the immune system. Guler et al
concentrations [21] Several factors such as [23] and Turgut et al [24] reported that
low food intake, nutrient malabsorption and tuberculosis stimulates cellular activation
inadequate nutrient release from the liver, which decreased when treatment was
acute infections and an inadequate effective. Also, it was observed in this study
International Journal of Health Sciences and Research (www.ijhsr.org) 84
Volume 14; Issue: 3; March 2024
Dr Anil Batta. Markers of oxidative stress evaluation in people living with pulmonary tuberculosis
that superoxide dismutase (SOD) and Source of Funding: None
glutathione peroxidase (GPX) were Conflict of Interest: The authors declare no
significantly decreased when compared with conflict of interest.
the control. Also, catalase (CAT) was
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