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* From the National Sanatorium Miyazakihigashi Hospital (Drs. Ashitani and Kumamoto), Miyazaki, Japan; and the Third Department of Internal Medicine (Drs. Mukae, Hiratsuka, Nakazato, and Matsukaura), Miyazaki Medical College, Miyazaki, Japan.
Correspondence to: Hiroshi Mukae, MD, Third Department of Internal Medicine, Miyazaki Medical College, Kihara 5200, Kiyotake, Miyazaki 889-1692, Japan; e-mail: hmukae{at}post.miyazaki-med.ac.jp
Study objectives: To investigate the roles of human
-defensin (HAD), human ß-defensin (HBD)-1, and HBD-2, novel
antimicrobial peptides, in patients with Mycobacterium
avium-intracellulare infection (MAI).
Patients: The study included 25 patients (10 men) with MAI who visited our hospital between June 1998 and August 1999.
Measurements and results: In patients with pulmonary MAI, we measured HAD and HBD-1, and HBD-2 levels in plasma and in BAL fluid (BALF) by radioimmunoassay. Plasma concentrations of HAD and HBD-2 in those patients were higher than those in control subjects, whereas HBD-1 levels were similar to those in the control subjects. High levels of HAD and HBD-2, but not HBD-1, also were observed in the BALF of MAI patients. There was a positive correlation between HAD and interleukin (IL)-8 concentrations in the BALF of patients with MAI. BALF HBD-2 concentrations also correlated positively with those of plasma HBD-2 and BALF IL-1ß in MAI patients. Patients with cavity formation on the chest roentgenogram had higher HAD and HBD-2 levels in their BALF than those of patients without cavity formation. Treatment with clarithromycin combined with two or three other antibiotics, including ethambutol, rifampicin, ofloxacin, or ciprofloxacin, for at least 6 months resulted in a significant fall in plasma HBD-2 concentrations in responders, but not in nonresponders.
Conclusion: Our findings suggest that HAD and HBD-2 may participate in host defense and local remodeling of the respiratory tract in patients with MAI and that plasma HBD-2 levels may be a useful marker of disease activity in patients with pulmonary MAI.
Key Words: -defensin • ß-defensin • Mycobacterium avium-intracellulare infection
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