High ESAT-6 Expression in Granuloma Necrosis Type of Tuberculous Lymphadenitis

Wida Purbaningsih, Djatnika Setiabudi, Herri S. Sastramihardja, Ida Parwati

Abstract


A granuloma is one of host cellular immune response form to intracellular and persistent pathogens, and result in the aggregation of several activated immune cells. Intracellular pathogens manipulate host immune responses to avoid immune reactions. M. tuberculosis is the intracellular and persister pathogen, which can stimulate granuloma formation. The formation this granulomas still have different opinions, whether it is the host's way to isolate M. tuberculosis, or how these pathogens are to escape immune responses. Early secretory antigenic target (ESAT)-6 is a typical secretory protein produced by the locus of the gene region of difference (RD)-1 M. tuberculosis. ESAT-6 plays a role in the immunopathogenesis of tuberculosis. This study aims to compare ESAT-6 antigen expression from M. tuberculosis between granulomas with necrosis and granulomas without necrosis. This study was an analytic observation study with a cross-sectional design. Forty-six lymph node paraffin blocks from tuberculous lymphadenitis patients in Department of Anatomical Pathology, Dr. Hasan Sadikin General Hospital, Bandung in 2017 were made in preparations and stained by hematoxylin eosin to assess the presence of necrosis in granulomas, immunohistochemical using ESAT-6 antibodies, then it was quantified using histoscore. Histoscore for ESAT-6 not normally distributed, so it uses Mann-Whitney test used. The results showed that there were 31 granulomas with necrosis (histoscore mean=27.6%) and 15 granulomas without necrosis (histoscore mean=15.1%), there was a significant difference with p<0.05 (p=0.03). The conclusion of this study there is a high histoscore ESAT-6 expression in granuloma type of necrosis tuberculous lymphadenitis.

 

EKPRESI ESAT-6 TINGGI PADA GRANULOMA LIMFADENITIS TUBERKULOSIS TIPE NEKROSIS

Granuloma merupakan salah satu bentuk respons imun seluler pejamu terhadap patogen intraseluler. Patogen intraseluler memanipulasi respons imun pejamu untuk menghindari reaksi imun. M. tuberculosis adalah patogen intraseluler dan persister yang dapat menstimulasi pembentukan granuloma. Terbentuknya granuloma masih memberikan pendapat yang berbeda, apakah merupakan cara tubuh untuk mengisolasi M. tuberculosis atau cara patogen ini untuk menghindari respons imun. Early secretory antigenic target (ESAT)-6 adalah protein sekretori khas yang dihasilkan oleh lokus gen region of difference (RD)-1 M. tuberculosis. ESAT-6 berperan dalam imunopatogenesis tuberkulosis. Penelitian ini bertujuan menganalisis perbedaan ekspresi antigen ESAT-6 M. tuberculosis antara granuloma dengan nekrosis dan granuloma tanpa nekrosis. Penelitian ini merupakan penelitian observasi analitik dengan desain cross sectional. Blok parafin kelenjar getah bening didapat dari pasien yang didiagnosis limfadenitis tuberkulosis di Departemen Patologi Anatomi, RSUP Dr. Hasan Sadikin Bandung pada tahun 2017. Blok parafin tersebut dibuat blangko preparat dan diwarnai dengan hematoksilin eosin untuk menilai nekrosis pada granuloma serta imunohistokimia menggunakan antibodi ESAT-6. Kemudian, sediaan preparat imunohistokimia tersebut dikuantifikasi menggunakan metode histoscore sehingga didapatkan data berupa nilai skor dari pewarnaan ESAT-6. Selanjutnya, dilakukan uji beda antara histoscore granuloma dengan nekrosis dan granuloma tanpa nekrosis tersebut dianalisis karena nilai skor ESAT-6 berdistribusi tidak normal sehingga menggunakan uji Mann-Whitney. Hasil penelitian menunjukkan terdapat 31 granuloma dengan nekrosis (histoscore rerata=27,6%) dan 15 granuloma tanpa nekrosis (histoscore rerata=15,1%), serta terdapat perbedaan signifikan dengan p<0,05 (p=0,03). Simpulan, ekspresi ESAT-6 tinggi pada granuloma limfadenitis tuberkulosis dengan nekrosis.


Keywords


ESAT-6; granuloma; necrosis; nekrosis

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DOI: https://doi.org/10.29313/gmhc.v6i2.3987

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