A 30-year-old woman with sarcoidosis has mediastinal lymphadenopathy. Biopsy shows non-necrotising granulomas with multinucleated giant cells. Which of the following cytokines is MOST critical for maintaining granuloma integrity in sarcoidosis?
- A TNF-alpha ✓
- B IL-4
- C IL-17
- D IL-10
Correct answer: A. TNF-alpha
Explanation
TNF-alpha is essential for granuloma formation and maintenance; it promotes macrophage activation and epithelioid cell differentiation. Clinical evidence comes from the observation that anti-TNF therapy (e.g., infliximab, etanercept) can cause granuloma dissolution and reactivation of latent tuberculosis, demonstrating TNF's non-redundant role. IL-4 drives Th2 responses and alternative macrophage activation. IL-10 is anti-inflammatory and actually dampens granuloma formation. IL-17 is involved in neutrophilic inflammation.
Reference: Robbins & Cotran Pathologic Basis of Disease, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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