The Role of Oxidative Stress in TB Meningitis and Therapeutic Options

Diseases, 2024 · DOI: 10.3390/diseases12030050 · Published: February 29, 2024

Simple Explanation

Meningitis, an inflammation of the membranes surrounding the brain and spinal cord, can be caused by infections or injuries. This inflammation disrupts the blood-brain barrier and alters the structure of the central nervous system. Tuberculous meningitis (TBM) involves a complex interplay of harmful molecules, including reactive oxygen species, which suggests new treatment possibilities. Alternative treatments focus on reducing oxidative stress and ferroptosis, a process of iron-dependent cell death. This review highlights alternative treatments targeting oxidative stress-induced TBM and ferroptosis, providing potential avenues for intervention in the pathogenesis of this complex condition.

Study Duration

Not specified

Participants

Not specified

Evidence Level

Review

Key Findings

1
Tuberculous meningitis (TBM) can cause seizures due to elevated cerebral metabolic rate of oxygen consumption (CMRO2) and the presence of polyunsaturated fatty acids (PUFAs), rendering the brain parenchyma vulnerable to lipid peroxidation and free radical injury.
2
Mycobacterium tuberculosis (Mtb) produces antioxidant enzymes that neutralize ROS, and mycolic acid in the cell wall of Mtb acts as a protective shield against ROS, serving as a barrier amid oxidative stress conditions within the CNS.
3
Adjunctive corticosteroid treatment is accompanied by immunosuppression and does not completely avert disease morbidity, it manages exacerbated inflammation and mitigates the pathogenesis of TBM.

Research Summary

This comprehensive review has elucidated the distinct features and clinical progressions of tuberculous meningitis (TBM) and non-tuberculous meningitis (NTM), shedding light on the challenges in their diagnosis and treatment. The role of oxidative stress in tuberculosis, specifically the interplay of reactive oxygen species (ROS), ferroptosis, and reactive nitrogen species (RNS), has been explored, providing insights into potential therapeutic interventions. The complexity of TBM necessitates a continuous exploration of alternative therapies targeting oxidative stress-induced pathways. Iron chelators, glutathione therapy, and saffron supplementation emerge as potential avenues for further investigation.

Practical Implications

Improved Diagnostic Methods

Refining diagnostic methods for TBM will allow for earlier and more accurate identification of the disease.

Innovative Treatment Combinations

Exploring innovative treatment combinations, including fluoroquinolones and corticosteroids, can improve patient outcomes.

Alternative Therapies

Evaluating the safety and efficacy of alternative therapies, such as iron chelators, glutathione therapy, and saffron supplementation, can provide new avenues for treating TBM.

Study Limitations

1
Diagnostic difficulties of TBM
2
Inconsistent reporting practices of TBM’s global incidence and mortality
3
Data variation due to different study designs, inclusion criteria, and TBM definitions

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