The Role of Vitamin D in TNF-α Levels in Pulmonary TB Patients

Authors

  • Sahidan Sahidan Department of Medical Laboratory Technology, Poltekkes Kemenkes Bengkulu, Bengkulu City, Bengkulu, Indonesia
  • Wiwit Sulistyasmi Department of Medical Laboratory Technology, Poltekkes Kemenkes Bengkulu, Bengkulu City, Bengkulu, Indonesia
  • Jon Farizal Department of Medical Laboratory Technology, Poltekkes Kemenkes Bengkulu, Bengkulu City, Bengkulu, Indonesia
  • Supri Hartini Department of Medical Laboratory Technology, Poltekkes Kemenkes Kalimantan Timur, Samarinda City, East Kalimantan, Indonesia
  • Sri Ujiani Department of Medical Laboratory Technology, Poltekkes Kemenkes Tanjung Karang, Bandar Lampung, Lampung, Indonesia

DOI:

https://doi.org/10.53770/medica.v8i4.908

Keywords:

Tuberculosis, TNF-α, Vitamin D

Abstract

Tuberculosis (TB) remains a major global health problem, with immune responses particularly tumor necrosis factor-alpha (TNF-α) playing a key role in disease progression. Vitamin D, synthesized through sunlight exposure, has been suggested to modulate immune responses; however, its effect on TNF-α in TB patients remains unclear. This study aimed to evaluate the effect of sunlight exposure on TNF-α levels in patients with pulmonary tuberculosis. A quasi-experimental pre–post study was conducted among 60 TB patients divided into control and intervention groups. TNF-α levels were measured before and after intervention and analyzed using appropriate statistical tests, including the Wilcoxon signed-rank test. The results showed a slight increase in mean TNF-α levels after sunlight exposure; however, the difference was not statistically significant (p = 0.475). Increased variability in TNF-α levels after the intervention suggests heterogeneous individual responses. These findings indicate that sunlight exposure may have a limited effect on TNF-α modulation in TB patients. Further studies with larger sample sizes and comprehensive biomarker assessments are needed to clarify the relationship between sunlight exposure, vitamin D, and immune responses in tuberculosis.

References

Aranow, C. (2011). Vitamin D and the immune system. Journal of investigative medicine, 59(6), 881-886. https://doi.org/10.3899/jrheum.090797

Asad, M., Mahmood, A., & Usman, M. (2020). A machine learning-based framework for Predicting Treatment Failure in tuberculosis: A case study of six countries. Tuberculosis, 123, 101944. https://doi.org/https://doi.org/10.1016/j.tube.2020.101944

Bhargava, A., Benedetti, A., Oxlade, O., Pai, M., & Menzies, D. (2014). Undernutrition and the incidence of tuberculosis in India: national and subnational estimates of the population-attributable fraction related to undernutrition. National Medical Journal of India, 27(3), 128-33. Retrieved from https://pubmed.ncbi.nlm.nih.gov/25668081/

Calder, P. C., Carr, A. C., & Gombart, A. F. (2020). Optimal Nutritional Status for a Well-Functioning Immune System Is an Important Factor to Protect against Viral Infections. Nutrients, 12(1181), 1–10. https://doi.org/10.3390/nu12041181

Fallahi-Sichani, M., Schaller, M. A., Kirschner, D. E., Kunkel, S. L., & Linderman, J. J. (2010). Identification of key processes that control tumor necrosis factor availability in a tuberculosis granuloma. PLoS computational biology, 6(5), e1000778. https://doi.org/10.1371/journal.pcbi.1000778

Farid, S., Dastageer, G., Raquib, O. I., Nath, S. K., Sultana, S., Bm, S., & Haque, R. (2025). Nutritional Status among Tuberculosis Patients at the End of Initial Phase of Treatment. International Journal of Pharmaceutical and Bio-Medical Science, 5(2), 125–130. https://doi.org/10.47191/ijpbms/v5-i2-07

Grant, W. B., Lahore, H., Mcdonnell, S. L., Baggerly, C. A., French, C. B., Aliano, J. L., & Bhattoa, H. P. (2020). Evidence that Vitamin D Supplementation Could Reduce Risk of Influenza and COVID-19 Infections and Deaths. Nutrients, 12(988), 1–19. https://doi.org/10.3390/nu12040988

Kireev, F. D., Lopatnikova, J. A., Alshevskaya, A. A., & Sennikov, S. (2025). Role of Tumor Necrosis Factor in Tuberculosis. Biomolecules, 15(709), 1–32. https://doi.org/10.3390/biom15050709

Lin, P., Chou, C., Ou, S., & Fang, T. (2021). Systematic Review of Nutrition Supplements in Chronic. Nutrients, 13(469), 1–21. https://doi.org/10.3390/nu13020469

Liu, Q., Que, S., Qiu, Y., Tang, M., Liu, S., Yang, G., Wang, Y., Deng, A., Hu, X., Lian, X., & Gao, Q. (2025). Host Immune Response to Mycobacterium tuberculosis Infection : Implications for Vaccine Development. Journal of Inflammation Research Open, 18, 8429–8445. https://doi.org/10.2147/JIR.S517034

Martineau, A. R. (2026). Vitamin D for tuberculosis or acute respiratory infections : lost in translation ? Current Opinion in Infectious Diseases, 39, 147–152. https://doi.org/10.1097/QCO.0000000000001181

Mi, J., Liang, Y., Liang, J., Gong, W., Wang, S., & Zhang, J. (2021). The Research Progress in Immunotherapy of Tuberculosis. Frontiers in Cellular and Infection Microbiology, 11, 1–17. https://doi.org/10.3389/fcimb.2021.763591

Nogueira, M. F., Krishnan, S., Barreto-duarte, B., Ara, M., Queiroz, A. T. L., Ellner, J. J., Salgame, P., Scriba, T. J., & Sterling, T. R. (2022). Diagnostic biomarkers for active tuberculosis : progress and challenges. EMBO Molecular Medicine, 14, 1–13. https://doi.org/10.15252/emmm.202114088

Papagni, R., Pellegrino, C., Di Gennaro, F., Patti, G., Ricciardi, A., Novara, R., ... & Gualano, G. (2022). Impact of vitamin D in prophylaxis and treatment in tuberculosis patients. International journal of molecular sciences, 23(7), 3860. https://doi.org/10.3390/ijms23073860

Rajamanickam, A., Ann Daniel, E., Dasan, B., Thiruvengadam, K., Chandrasekaran, P., Gaikwad, S., ... & Babu, S. (2025). Plasma immune biomarkers predictive of progression to active tuberculosis in household contacts of patients with tuberculosis. The Journal of Infectious Diseases, 231(3), 696-705. https://doi.org/10.1093/infdis/jiae365

Raymond-lezman, J. R., & Riskin, S. I. (2023). Benefits and Risks of Sun Exposure to Maintain Adequate Vitamin D Levels. Cureus, 15(5), 1–11. https://doi.org/10.7759/cureus.38578

Santos-Mena, A., González-Muñiz, O. E., Jacobo-Delgado, Y. M., & Rivas-Santiago, B. (2024). Shedding light on vitamin D in tuberculosis: A comprehensive review of clinical trials and discrepancies. Pulmonary Pharmacology & Therapeutics, 85, 102300. https://doi.org/https://doi.org/10.1016/j.pupt.2024.102300

Silva, D. A. A. D., Silva, M. V. D., Barros, C. C. O., Alexandre, P. B. D., Timóteo, R. P., Catarino, J. S., ... & Rodrigues, V. (2018). TNF-α blockade impairs in vitro tuberculous granuloma formation and down modulate Th1, Th17 and Treg cytokines. PloS one, 13(3), e0194430. https://doi.org/10.1371/journal.pone.0194430

Sinha, P., Davis, J., Saag, L., Wanke, C., Salgame, P., Mesick, J., Jr, C. R. H., & Hochberg, N. S. (2019). Undernutrition and Tuberculosis : Public Health Implications. The Journal of Infectious Diseases, 219, 1–8. https://doi.org/10.1093/infdis/jiy675

Sulistyasmi, W., Almurdi, & Renowati. (2021). Comparing the degree of direct sputum afb smear-positive with the sedimentation in patients suspected of pulmonary tuberculosis. Malaysian Journal of Medicine and Health Sciences, 17(April), 65–67. Retrieved from https://medic.upm.edu.my/upload/dokumen/202104291521232020_0903_17.pdf

Torrelles, J. B., & Sclesinger, L. S. (2018). Integrating Lung Physiology, Immunology and Tuberculosis. HHS Public Access, 25(8), 688–697. https://doi.org/10.1016/j.tim.2017.03.007.Integrating

Vu, A., Glassman, I., Campbell, G., Yeganyan, S., Nguyen, J., Shin, A., & Venketaraman, V. (2024). Host cell death and modulation of immune response against Mycobacterium tuberculosis infection. International Journal of Molecular Sciences, 25(11), 6255. https://doi.org/10.3390/ijms25116255

World Health Organization. (2023). Global Tuberculosis Report 2023. Geneva: World Health Organization. Retrieved from https://www.who.int/publications/i/item/9789240083851

Yuk, J. M., Kim, J. K., Kim, I. S., & Jo, E. K. (2024). TNF in Human Tuberculosis: A Double-Edged Sword. Immune Network, 24(1), 1–19. https://doi.org/10.4110/in.2024.24.e4

Zeng, M., Ran, J., Luo, Y., Zhou, X., Hu, Y., & Tian, X. (2026). The potential role and value of vitamin D in the treatment of tuberculosis. Cellular and Infection Microbiology, 15(1654860), 1–9. https://doi.org/10.3389/fcimb.2025.1654860

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Published

2026-04-30

How to Cite

Sahidan, S., Sulistyasmi, W., Farizal, J., Hartini, S., & Ujiani, S. (2026). The Role of Vitamin D in TNF-α Levels in Pulmonary TB Patients. MEDICA (International Medical Scientific Journal), 8(4), 152–159. https://doi.org/10.53770/medica.v8i4.908