The role of melatonin in the formation of tuberculotic inflammation, forecast regarding the influence on the effectiveness of treatment in the conditions of the COVID­-19 pandemic (literature review)

Objective — to study the role of melatonin in the formation of tuberculous inflammation and the prospects of its influence on increasing the effectiveness of treatment in the conditions of the COVID-19 pandemic, by conducting an analysis of information from available sources of literature on the selected topic. 
Materials and methods. The research was carried out for the period from December 2021 to September 2022. Access to various full-text and abstract databases was used as the main source of research. 
Results and discussion. A large number of studies carried out so far prove the connection between the influence of melatonin and tuberculosis inflammation, since tuberculosis infection can be associated with seasonal changes in the immune system, and these processes are correlated and accompanied by fluctuations in the level of melatonin. Th1-type specific cellular immunity is responsible for protective immunity in tuberculosis, while the Th2-type response underlies the progressive nature of inflammation. T-lymphocytes and macrophages have been shown to have receptors for melatonin, and they are also target cells for its immunomodulatory function. Melatonin has been shown to regulate gene expression of several immu­nomodulatory cytokines, including TNF-α, transforming growth factor-β, and macrophage stem cell factor.Thus, the conducted narrowly differentiated analysis based on available literature sources allows us to predict that melatonin can stimulate the Th1 immune response in TB and may have an immunoprotective effect on the Th1-type subtype of the delayed-type immune response during the acute phase of mycobac­terial inflammation. 
Conclusions. The analysis of the tuberculosis situation in Bukovina indicates a tendency towards an increase in the incidence rate in 2021 compared to 2020. The same dynamics are maintained in the first half of 2022. At the same time, no significant changes in the mortality rate were found. The above analysis of the main indicators of epidemiology indicates the sufficient importance of the problem of tuberculosis for the coming years, and therefore, the search for methods of increasing the effectiveness of the treatment of this pathology, especially under the conditions of multiple and extended drug resistance, is an important task of modern phthisiology. The analysis of the available data base accumulated to date on the role of melatonin in the pathophysiology of the formation of an inflammatory reaction in the lungs and its influence on the clinical course and effectiveness of anti-tuberculosis therapy is a promising scientific direction of research. The appointment of melatonin along with traditional methods of treatment of tuberculosis can have a positive effect on increasing the effectiveness of anti-tuberculosis therapy in patients with the pulmonary form of tuberculosis.