Inflammation and dyslipidaemia in combined diabetes and tuberculosis; a cohort study

Abstract

Diabetes mellitus (DM) increases tuberculosis (TB) susceptibility and worsens outcomes. Since inflammation and lipid metabolism are implicated in both diseases, we examined if combined TB and DM (TB-DM) increases inflammation or dyslipidaemia. In plasma from individuals with DM (n = 96), TB (n = 93), and TB-DM (n = 91), we measured 92 inflammatory proteins and 250 primarily lipid-related metabolites, repeating measurements after two months of TB treatment. Inflammation was primarily driven by TB, but higher in TB-DM. In TB-DM, the proteins osteoprotegerin (OPG), signaling lymphocytic activation molecule (SLAMF1), adenosine deaminase (ADA), interleukin-10 receptor subunit beta (IL-10RB), and tumor necrosis factor receptor superfamily member 9 (TNFSR9) were differentially abundant, and IL-17A/C predicted treatment failure. Disease severity correlated with inflammation and dyslipidaemia. Inflammation decreased with TB treatment, both in TB and TB-DM. Dyslipidaemia was primarily driven by DM, but more pro-atherogenic in TB-DM, with elevated VLDL and apolipoprotein B (ApoB). Despite TB treatment, pro-atherogenicity persisted. Stronger inflammation and dyslipidaemia may account for worse disease outcomes in TB-DM and warrant further action to prevent cardiovascular events.