Metformin associated inflammation levels regulation in type 2 diabetes mellitus-tuberculosis coinfection patients - A case report

Abstract

IFN-γ elevation is one of the indicators of successful treatment in active tuberculosis (TB) infection due to macrophage and Th-1 activation in inducing autophagy process. However, IL-10 also inhibits interferon-mediated mycobactericid activities by blocking IFN-γ; signaling pathways in autophagy. Therefore, ratio IFN-γ/IL-10 has to be greater than 1 (>1) then IFN-γ remains has anti-mycobacterium. Metformin (MET) is a potent combination drug to elevate anti-TB efficacy and able to regulate inflammation. In this study, an observational clinical study was done in diabetes mellitus (DM)-TB co-infection outpatients at Surabaya Paru Hospital. This study evaluated how MET therapy; affected inflammation. MET was used at least 2 months, accompanying with insulin and; anti-TB and as comparison to non MET group. The result in this study MET increased both pro-inflammatory and anti-inflammatory cytokines, thus MET may consider as adjunct therapy in DM-TB coinfection patients due; to its ability in Th-1 and Th-2 immuno-regulating response, especially to enhance IFN-γ; and to reduce insulin associated IL-10 upregulation.

Keywords: Metformin; Ratio interferon gamma and interleukin-10; Type 2 diabetes mellitus-tuberculosis co-infection.