The authors declare no conflicts of interest. “
“It has been proposed that mannose-binding Metformin order lectin (MBL) levels may impact

upon host susceptibility to tuberculosis (TB) infection; however, evidence to date has been conflicting. We performed a literature review and meta-analysis of 17 human trials considering the effect of MBL2 genotype and/or MBL levels and TB infection. No significant association was demonstrated between MBL2 genotype and pulmonary TB infection. However, the majority of studies did not report MBL2 haplotype inclusive of promoter polymorphisms. Serum MBL levels were shown to be consistently elevated in the setting of TB infection. While this may indicate that high MBL levels protect against infection with TB, the increase was also of a degree consistent with the acute-phase reaction. This analysis suggests that the relatively poorly characterized MBL2 genotypes reported are not associated significantly with susceptibility to pulmonary TB infection, but high MBL serum levels may be. Balanced polymorphisms

are the result of beneficial effects of resistance to prevalent infections due to physiological changes consequent on genetic variation. Well-characterized examples in human biology include haemoglobinopathies (sickle-cell and alpha-thalassaemia) and Plasmodium falciparum[1]. One of the most common polymorphisms on a global scale is that involving mannose-binding lectin (MBL), a pattern recognition receptor of the innate immune system. This liver-derived, acute-phase reactant recognizes pathogen-associated molecular patterns, CH5424802 in vitro PLEKHM2 killing microorganisms via activation of the lectin complement pathway and opsonophagocytosis [2,3]. MBL is also involved

in modulation of other inflammatory pathways contributing to autoimmune disease, apoptosis and vascular disease [4]. Despite its manifold effects in innate immune system pathways, there is a high frequency of MBL deficiency that arises due to polymorphisms of the MBL2 gene. The evolutionary advantage of MBL deficiency is unclear. MBL production is controlled by the MBL2 gene, and polymorphisms of the structural regions of the gene or its promoter are associated with relative or absolute serum MBL deficiencies [5]. The presence of key structural and promoter polymorphisms in a detailed MBL2 haplotype is reasonably well correlated with reduced serum MBL levels, and genotypic analyses are used frequently as surrogates for MBL serum levels. The MBL2 structural gene variants, B, C and D, are referred to collectively as O while A is the wild-type. Prior to recognition of the importance of MBL2 promoter polymorphism, MBL deficiency was defined on the basis of structural gene polymorphism alone and variably as the presence of any variant allele, [AO or OO] or compound heterozygosity for variant alleles [OO].