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Ellis R, Hatherill M, Tait D, Snowden M, Churchyard G, Hanekom W, Evans T, Ginsberg A. Innovative clinical trial designs to rationalize TB vaccine development. Tuberculosis (Edinb) 2015; 95:352-7. [DOI: 10.1016/j.tube.2015.02.036] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Revised: 02/04/2015] [Accepted: 02/06/2015] [Indexed: 12/22/2022]
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52
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Matuka O, Singh TS, Bryce E, Yassi A, Kgasha O, Zungu M, Kyaw K, Malotle M, Renton K, O'Hara L. Pilot study to detect airborne Mycobacterium tuberculosis exposure in a South African public healthcare facility outpatient clinic. J Hosp Infect 2014; 89:192-6. [PMID: 25623206 DOI: 10.1016/j.jhin.2014.11.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 11/19/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Airborne transmission of Mycobacterium tuberculosis remains an occupational health hazard, particularly in crowded and resource-limited healthcare settings. AIM To quantify airborne M. tuberculosis in a busy outpatient clinic in Gauteng, South Africa. METHODS Stationary air samples and samples from healthcare workers (HCWs) were collected in the polyclinic and administrative block. Quantitative real-time polymerase chain reaction (PCR) was used to detect airborne M. tuberculosis. Walkthrough observations and work practices of HCWs were also recorded. FINDINGS In total, M. tuberculosis was detected in 11 of 49 (22.4%) samples: nine of 25 (36%) HCW samples and two of 24 (8.3%) stationary air samples. Samples from five of 10 medical officers (50%) and three of 13 nurses (23%) were positive. Repeat measurements on different days showed variable results. Most of the HCWs (87.5%) with positive results had been in contact with coughing patients and had not worn respiratory masks despite training. CONCLUSION The use of air sampling coupled with quantitative real-time PCR is a simple and effective tool to demonstrate the risk of M. tuberculosis exposure. The findings provide an impetus for hospital management to strengthen infection prevention and control measures for tuberculosis.
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Affiliation(s)
- O Matuka
- National Institute for Occupational Health, National Health Laboratory Service, Johannesburg, South Africa; Department of Clinical Microbiology and Infectious Diseases, School of Pathology, University of Witwatersrand, Johannesburg, South Africa
| | - T S Singh
- National Institute for Occupational Health, National Health Laboratory Service, Johannesburg, South Africa; Department of Clinical Microbiology and Infectious Diseases, School of Pathology, University of Witwatersrand, Johannesburg, South Africa.
| | - E Bryce
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - A Yassi
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - O Kgasha
- National Institute for Occupational Health, National Health Laboratory Service, Johannesburg, South Africa
| | - M Zungu
- National Institute for Occupational Health, National Health Laboratory Service, Johannesburg, South Africa; Department of Public Health Medicine, School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
| | - K Kyaw
- National Institute for Occupational Health, National Health Laboratory Service, Johannesburg, South Africa
| | - M Malotle
- National Institute for Occupational Health, National Health Laboratory Service, Johannesburg, South Africa
| | - K Renton
- National Institute for Occupational Health, National Health Laboratory Service, Johannesburg, South Africa
| | - L O'Hara
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
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Abstract
The progression of the disease that follows infection of guinea pigs with Mycobacterium tuberculosis displays many features of human tuberculosis (TB), and the guinea pig model of TB has been used for more than 100 years as a research tool to understand and describe disease mechanisms. Changes in the bacterial burden and pathology following infection can be readily monitored and used to evaluate the impact of TB interventions. Demonstration of the protective efficacy of vaccines in the low-dose aerosol guinea pig model is an important component of the preclinical data package for novel vaccines in development, and there is a continual need to improve the model to facilitate progression of vaccines to the clinic. Development of better tools with which to dissect the immune responses of guinea pigs is a focus of current research.
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Affiliation(s)
- Simon Clark
- Microbiology Services, Public Health England, Porton Down, Salisbury SP4 0JG, United Kingdom
| | - Yper Hall
- Microbiology Services, Public Health England, Porton Down, Salisbury SP4 0JG, United Kingdom
| | - Ann Williams
- Microbiology Services, Public Health England, Porton Down, Salisbury SP4 0JG, United Kingdom
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54
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Orme IM, Basaraba RJ. The formation of the granuloma in tuberculosis infection. Semin Immunol 2014; 26:601-9. [DOI: 10.1016/j.smim.2014.09.009] [Citation(s) in RCA: 101] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Revised: 09/11/2014] [Accepted: 09/15/2014] [Indexed: 12/13/2022]
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Hillery N, Groessl EJ, Trollip A, Catanzaro D, Jackson L, Rodwell TC, Garfein RS, Lin SYG, Eisenach K, Ganiats TG, Park D, Valafar F, Rodrigues C, Crudu V, Victor TC, Catanzaro A. The Global Consortium for Drug-resistant Tuberculosis Diagnostics (GCDD): design of a multi-site, head-to-head study of three rapid tests to detect extensively drug-resistant tuberculosis. Trials 2014; 15:434. [PMID: 25377177 PMCID: PMC4232628 DOI: 10.1186/1745-6215-15-434] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 10/24/2014] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Drug-resistant tuberculosis (DR-TB) remains a threat to global public health, owing to the complexity and delay of diagnosis and treatment. The Global Consortium for Drug-resistant Tuberculosis Diagnostics (GCDD) was formed to develop and evaluate assays designed to rapidly detect DR-TB, so that appropriate treatment might begin more quickly. This paper describes the methodology employed in a prospective cohort study for head-to-head assessment of three different rapid diagnostic tools. METHODS Subjects at risk of DR-TB were enrolled from three countries. Data were gathered from a combination of patient interviews, chart reviews, and laboratory testing from each site's reference laboratory. The primary outcome of interest was reduction in time from specimen arrival in the laboratory to results of rapid drug susceptibility tests, as compared with current standard mycobacterial growth indicator tube (MGIT) drug susceptibility tests. RESULTS Successful implementation of the trial in diverse multinational populations is explained, in addition to challenges encountered and recommendations for future studies with similar aims or populations. CONCLUSIONS The GCDD study was a head-to-head study of multiple rapid diagnostic assays aimed at improving accuracy and precision of diagnostics and reducing overall time to detection of DR-TB. By conducting a large prospective study, which captured epidemiological, clinical, and biological data, we have produced a high-quality unique dataset, which will be beneficial for analyzing study aims as well as answering future DR-TB research questions. Reduction in detection time for XDR-TB would be a major public health success as it would allow for improved treatment and more successful patient outcomes. Executing successful trials is critical in assessment of these reductions in highly variable populations. TRIAL REGISTRATION ClinicalTrials.gov NCT02170441.
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Affiliation(s)
- Naomi Hillery
- />Department of Family & Preventive Medicine, University of California, San Diego, CA USA
| | - Erik J Groessl
- />Department of Family & Preventive Medicine, University of California, San Diego, CA USA
| | - Andre Trollip
- />Department of Biomedical Sciences, Stellenbosch University, Cape Town, South Africa
| | - Donald Catanzaro
- />Division of Bioinformatics and Medical Informatics, San Diego State University, San Diego, CA USA
| | - Lynn Jackson
- />Department of Medicine, University of California, San Diego, CA USA
| | - Timothy C Rodwell
- />Department of Medicine, University of California, San Diego, CA USA
| | - Richard S Garfein
- />Department of Medicine, University of California, San Diego, CA USA
| | - S-Y Grace Lin
- />California Department of Public Health, Richmond, CA USA
| | - Kathleen Eisenach
- />Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, AR USA
| | - Theodore G Ganiats
- />Department of Family & Preventive Medicine, University of California, San Diego, CA USA
| | - Daniel Park
- />Department of Medicine, University of California, San Diego, CA USA
| | - Faramarz Valafar
- />Division of Bioinformatics and Medical Informatics, San Diego State University, San Diego, CA USA
| | | | - Valeriu Crudu
- />Microbiology and Morphology Laboratory, Institute of Phthisiopneumology, Chisinau, Moldova
| | - Thomas C Victor
- />Department of Biomedical Sciences, Stellenbosch University, Cape Town, South Africa
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56
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Williams CML, Cheah ESG, Malkin J, Patel H, Otu J, Mlaga K, Sutherland JS, Antonio M, Perera N, Woltmann G, Haldar P, Garton NJ, Barer MR. Face mask sampling for the detection of Mycobacterium tuberculosis in expelled aerosols. PLoS One 2014; 9:e104921. [PMID: 25122163 PMCID: PMC4133242 DOI: 10.1371/journal.pone.0104921] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 07/13/2014] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Although tuberculosis is transmitted by the airborne route, direct information on the natural output of bacilli into air by source cases is very limited. We sought to address this through sampling of expelled aerosols in face masks that were subsequently analyzed for mycobacterial contamination. METHODS In series 1, 17 smear microscopy positive patients wore standard surgical face masks once or twice for periods between 10 minutes and 5 hours; mycobacterial contamination was detected using a bacteriophage assay. In series 2, 19 patients with suspected tuberculosis were studied in Leicester UK and 10 patients with at least one positive smear were studied in The Gambia. These subjects wore one FFP30 mask modified to contain a gelatin filter for one hour; this was subsequently analyzed by the Xpert MTB/RIF system. RESULTS In series 1, the bacteriophage assay detected live mycobacteria in 11/17 patients with wearing times between 10 and 120 minutes. Variation was seen in mask positivity and the level of contamination detected in multiple samples from the same patient. Two patients had non-tuberculous mycobacterial infections. In series 2, 13/20 patients with pulmonary tuberculosis produced positive masks and 0/9 patients with extrapulmonary or non-tuberculous diagnoses were mask positive. Overall, 65% of patients with confirmed pulmonary mycobacterial infection gave positive masks and this included 3/6 patients who received diagnostic bronchoalveolar lavages. CONCLUSION Mask sampling provides a simple means of assessing mycobacterial output in non-sputum expectorant. The approach shows potential for application to the study of airborne transmission and to diagnosis.
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Affiliation(s)
- Caroline M. L. Williams
- Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, United Kingdom
| | - Eddy S. G. Cheah
- Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, United Kingdom
| | - Joanne Malkin
- Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, United Kingdom
- Department of Clinical Microbiology, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Hemu Patel
- Department of Clinical Microbiology, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Jacob Otu
- Medical Research Council Unit, Banjul, The Gambia
| | | | | | | | - Nelun Perera
- Department of Clinical Microbiology, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Gerrit Woltmann
- Department of Respiratory Medicine, Glenfield Hospital, Leicester, United Kingdom
| | - Pranabashis Haldar
- Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, United Kingdom
- Department of Respiratory Medicine, Glenfield Hospital, Leicester, United Kingdom
- National Institute of Health Research Respiratory Biomedical Research Unit, Glenfield Hospital, Leicester, United Kingdom
| | - Natalie J. Garton
- Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, United Kingdom
| | - Michael R. Barer
- Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, United Kingdom
- Department of Clinical Microbiology, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
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Abstract
The global health community has set itself the task of eliminating tuberculosis (TB) as a public health problem by 2050. Although progress has been made in global TB control, the current decline in incidence of 2% yr(-1) is far from the rate needed to achieve this. If we are to succeed in this endeavour, new strategies to reduce the reservoir of latently infected persons (from which new cases arise) would be advantageous. However, ascertainment of the extent and risk posed by this group is poor. The current diagnostics tests (tuberculin skin test and interferon-gamma release assays) poorly predict who will develop active disease and the therapeutic options available are not optimal for the scale of the intervention that may be required. In this article, we outline a basis for our current understanding of latent TB and highlight areas where innovation leading to development of novel diagnostic tests, drug regimens and vaccines may assist progress. We argue that the pool of individuals at high risk of progression may be significantly smaller than the 2.33 billion thought to be immune sensitized by Mycobacterium tuberculosis and that identifying and targeting this group will be an important strategy in the road to elimination.
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Affiliation(s)
- H. Esmail
- Department of Medicine, Imperial College, London W2 1PG, UK
- Clinical Infectious Diseases Research Initiative, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Observatory 7925, South Africa
| | - C. E. Barry
- Tuberculosis Research Section, NIAID, NIH, Bethesda, MD 20892, USA
| | - D. B. Young
- Department of Medicine, Imperial College, London W2 1PG, UK
- MRC National Institute for Medical Research, London NW7 1AA, UK
| | - R. J. Wilkinson
- Department of Medicine, Imperial College, London W2 1PG, UK
- Clinical Infectious Diseases Research Initiative, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Observatory 7925, South Africa
- MRC National Institute for Medical Research, London NW7 1AA, UK
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58
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Rodwell TC, Valafar F, Douglas J, Qian L, Garfein RS, Chawla A, Torres J, Zadorozhny V, Kim MS, Hoshide M, Catanzaro D, Jackson L, Lin G, Desmond E, Rodrigues C, Eisenach K, Victor TC, Ismail N, Crudu V, Gler MT, Catanzaro A. Predicting extensively drug-resistant Mycobacterium tuberculosis phenotypes with genetic mutations. J Clin Microbiol 2014; 52:781-9. [PMID: 24353002 PMCID: PMC3957771 DOI: 10.1128/jcm.02701-13] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Accepted: 12/12/2013] [Indexed: 01/20/2023] Open
Abstract
Molecular diagnostic methods based on the detection of mutations conferring drug resistance are promising technologies for rapidly detecting multidrug-/extensively drug-resistant tuberculosis (M/XDR TB), but large studies of mutations as markers of resistance are rare. The Global Consortium for Drug-Resistant TB Diagnostics analyzed 417 Mycobacterium tuberculosis isolates from multinational sites with a high prevalence of drug resistance to determine the sensitivities and specificities of mutations associated with M/XDR TB to inform the development of rapid diagnostic methods. We collected M/XDR TB isolates from regions of high TB burden in India, Moldova, the Philippines, and South Africa. The isolates underwent standardized phenotypic drug susceptibility testing (DST) to isoniazid (INH), rifampin (RIF), moxifloxacin (MOX), ofloxacin (OFX), amikacin (AMK), kanamycin (KAN), and capreomycin (CAP) using MGIT 960 and WHO-recommended critical concentrations. Eight genes (katG, inhA, rpoB, gyrA, gyrB, rrs, eis, and tlyA) were sequenced using Sanger sequencing. Three hundred seventy isolates were INHr, 356 were RIFr, 292 were MOXr/OFXr, 230 were AMKr, 219 were CAPr, and 286 were KANr. Four single nucleotide polymorphisms (SNPs) in katG/inhA had a combined sensitivity of 96% and specificities of 97 to 100% for the detection of INHr. Eleven SNPs in rpoB had a combined sensitivity of 98% for RIFr. Eight SNPs in gyrA codons 88 to 94 had sensitivities of 90% for MOXr/OFXr. The rrs 1401/1484 SNPs had 89 to 90% sensitivity for detecting AMKr/CAPr but 71% sensitivity for KANr. Adding eis promoter SNPs increased the sensitivity to 93% for detecting AMKr and to 91% for detecting KANr. Approximately 30 SNPs in six genes predicted clinically relevant XDR-TB phenotypes with 90 to 98% sensitivity and almost 100% specificity.
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Affiliation(s)
- Timothy C. Rodwell
- Department of Medicine, University of California San Diego, San Diego, California, USA
| | - Faramarz Valafar
- Department of Bioinformatics and Medical Informatics, San Diego State University, San Diego, California, USA
| | - James Douglas
- Department of Microbiology, University of Hawaii Manoa, Honolulu, Hawaii, USA
| | - Lishi Qian
- Department of Microbiology, University of Hawaii Manoa, Honolulu, Hawaii, USA
| | - Richard S. Garfein
- Department of Medicine, University of California San Diego, San Diego, California, USA
| | - Ashu Chawla
- Department of Bioinformatics and Medical Informatics, San Diego State University, San Diego, California, USA
| | - Jessica Torres
- Department of Bioinformatics and Medical Informatics, San Diego State University, San Diego, California, USA
| | - Victoria Zadorozhny
- Department of Bioinformatics and Medical Informatics, San Diego State University, San Diego, California, USA
| | - Min Soo Kim
- Department of Bioinformatics and Medical Informatics, San Diego State University, San Diego, California, USA
| | - Matt Hoshide
- Department of Microbiology, University of Hawaii Manoa, Honolulu, Hawaii, USA
| | - Donald Catanzaro
- Department of Bioinformatics and Medical Informatics, San Diego State University, San Diego, California, USA
| | - Lynn Jackson
- Department of Medicine, University of California San Diego, San Diego, California, USA
| | - Grace Lin
- California Department of Public Health, Microbial Diseases Laboratory, Richmond, California, USA
| | - Edward Desmond
- California Department of Public Health, Microbial Diseases Laboratory, Richmond, California, USA
| | | | - Kathy Eisenach
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Thomas C. Victor
- Department of Biomedical Sciences, Stellenbosch University, Cape Town, South Africa
| | - Nazir Ismail
- National Tuberculosis Reference Laboratory, Johannesburg, South Africa
| | - Valeru Crudu
- Microbiology and Morphology Laboratory, Institute of Phthisiopneumology, Chisinau, Moldova
| | | | - Antonino Catanzaro
- Department of Medicine, University of California San Diego, San Diego, California, USA
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59
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Podell BK, Ackart DF, Obregon-Henao A, Eck SP, Henao-Tamayo M, Richardson M, Orme IM, Ordway DJ, Basaraba RJ. Increased severity of tuberculosis in Guinea pigs with type 2 diabetes: a model of diabetes-tuberculosis comorbidity. THE AMERICAN JOURNAL OF PATHOLOGY 2014; 184:1104-1118. [PMID: 24492198 DOI: 10.1016/j.ajpath.2013.12.015] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Revised: 11/27/2013] [Accepted: 12/05/2013] [Indexed: 01/14/2023]
Abstract
Impaired glucose tolerance and type 2 diabetes were induced in guinea pigs to model the emerging comorbidity of Mycobacterium tuberculosis infection in diabetic patients. Type 2 diabetes mellitus was induced by low-dose streptozotocin in guinea pigs rendered glucose intolerant by first feeding a high-fat, high-carbohydrate diet before M. tuberculosis exposure. M. tuberculosis infection of diabetic guinea pigs resulted in severe and rapidly progressive tuberculosis (TB) with a shortened survival interval, more severe pulmonary and extrapulmonary pathology, and a higher bacterial burden compared with glucose-intolerant and nondiabetic controls. Compared with nondiabetics, diabetic guinea pigs with TB had an exacerbated proinflammatory response with more severe granulocytic inflammation and higher gene expression for the cytokines/chemokines interferon-γ, IL-17A, IL-8, and IL-10 in the lung and for interferon-γ, tumor necrosis factor-α, IL-8, and monocyte chemoattractant protein-1 in the spleen. TB disease progression in guinea pigs with impaired glucose tolerance was similar to that of nondiabetic controls in the early stages of infection but was more severe by day 90. The guinea pig model of type 2 diabetes-TB comorbidity mimics important features of the naturally occurring disease in humans. This model will be beneficial in understanding the complex pathogenesis of TB in diabetic patients and to test new strategies to improve TB and diabetes control when the two diseases occur together.
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Affiliation(s)
- Brendan K Podell
- Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins, Colorado
| | - David F Ackart
- Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins, Colorado
| | - Andres Obregon-Henao
- Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins, Colorado
| | - Sarah P Eck
- Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins, Colorado
| | - Marcela Henao-Tamayo
- Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins, Colorado
| | - Michael Richardson
- Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins, Colorado
| | - Ian M Orme
- Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins, Colorado
| | - Diane J Ordway
- Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins, Colorado
| | - Randall J Basaraba
- Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins, Colorado.
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A review of preclinical animal models utilised for TB vaccine evaluation in the context of recent human efficacy data. Tuberculosis (Edinb) 2013; 94:105-10. [PMID: 24369986 PMCID: PMC3969587 DOI: 10.1016/j.tube.2013.11.003] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Revised: 10/21/2013] [Accepted: 11/13/2013] [Indexed: 01/06/2023]
Abstract
There is an urgent need for an improved TB vaccine. Vaccine development is hindered by the lack of immune correlates and uncertain predictive value of preclinical animal models. As data become available from human efficacy trials, there is an opportunity to evaluate the predictive value of the criteria used to select candidate vaccines. Here we review the efficacy in animal models of the MVA85A candidate vaccine in light of recent human efficacy data and propose refinements to the preclinical models with the aim of increasing their predictive value for human efficacy.
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61
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Obregón-Henao A, Henao-Tamayo M, Orme IM, Ordway DJ. Gr1(int)CD11b+ myeloid-derived suppressor cells in Mycobacterium tuberculosis infection. PLoS One 2013; 8:e80669. [PMID: 24224058 PMCID: PMC3815237 DOI: 10.1371/journal.pone.0080669] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Accepted: 10/05/2013] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Tuberculosis is one of the world's leading killers, stealing 1.4 million lives and causing 8.7 million new and relapsed infections in 2011. The only vaccine against tuberculosis is BCG which demonstrates variable efficacy in adults worldwide. Human infection with Mycobacterium tuberculosis results in the influx of inflammatory cells to the lung in an attempt to wall off bacilli by forming a granuloma. Gr1(int)CD11b(+) cells are called myeloid-derived suppressor cells (MDSC) and play a major role in regulation of inflammation in many pathological conditions. Although MDSC have been described primarily in cancer their function in tuberculosis remains unknown. During M. tuberculosis infection it is crucial to understand the function of cells involved in the regulation of inflammation during granuloma formation. Understanding their relative impact on the bacilli and other cellular phenotypes is necessary for future vaccine and drug design. METHODOLOGY/PRINCIPAL FINDINGS We compared the bacterial burden, lung pathology and Gr1(int)CD11b(+) myeloid-derived suppressor cell immune responses in M. tuberculosis infected NOS2-/-, RAG-/-, C3HeB/FeJ and C57/BL6 mice. Gr-1(+) cells could be found on the edges of necrotic lung lesions in NOS2-/-, RAG-/-, and C3HeB/FeJ, but were absent in wild-type mice. Both populations of Gr1(+)CD11b(+) cells expressed high levels of arginase-1, and IL-17, additional markers of myeloid derived suppressor cells. We then sorted the Gr1(hi) and Gr1(int) populations from M. tuberculosis infected NOS-/- mice and placed the sorted both Gr1(int) populations at different ratios with naïve or M. tuberculosis infected splenocytes and evaluated their ability to induce activation and proliferation of CD4+T cells. Our results showed that both Gr1(hi) and Gr1(int) cells were able to induce activation and proliferation of CD4+ T cells. However this response was reduced as the ratio of CD4(+) T to Gr1(+) cells increased. Our results illustrate a yet unrecognized interplay between Gr1(+) cells and CD4(+) T cells in tuberculosis.
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Affiliation(s)
- Andrés Obregón-Henao
- Mycobacteria Research Laboratories, Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, Colorado, United States of America
| | - Marcela Henao-Tamayo
- Mycobacteria Research Laboratories, Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, Colorado, United States of America
| | - Ian M. Orme
- Mycobacteria Research Laboratories, Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, Colorado, United States of America
| | - Diane J. Ordway
- Mycobacteria Research Laboratories, Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, Colorado, United States of America
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62
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Meyer J, McShane H. The next 10 years for tuberculosis vaccines: do we have the right plans in place? Expert Rev Vaccines 2013; 12:443-51. [PMID: 23560924 PMCID: PMC5425624 DOI: 10.1586/erv.13.19] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The control of TB is a global health priority. Over the last decade, considerable progress has been made in the field of TB vaccines with numerous vaccine candidates entering the clinic and two candidates now in Phase IIb efficacy trials. Nevertheless, the lack of predictive animal models and biomarkers of TB vaccine efficacy prevents rational vaccine down-selection and necessitates prolonged and expensive clinical efficacy trials in target populations. Advances in molecular technology and progress in the development of human as well as animal mycobacterial challenge models make the identification of one or more immune correlates of protection a genuine prospect over the next decade. Moreover, the increasing pace, extent and coordination of global research efforts in TB promises to broaden understanding and inform the next generation of vaccine candidates against TB as well as related globally important pathogens.
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Affiliation(s)
- Joel Meyer
- The Jenner Institute, Old Road Campus Research Building, Roosevelt Drive, Oxford, OX3 7DQ, UK
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63
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Via LE, Weiner DM, Schimel D, Lin PL, Dayao E, Tankersley SL, Cai Y, Coleman MT, Tomko J, Paripati P, Orandle M, Kastenmayer RJ, Tartakovsky M, Rosenthal A, Portevin D, Eum SY, Lahouar S, Gagneux S, Young DB, Flynn JL, Barry CE. Differential virulence and disease progression following Mycobacterium tuberculosis complex infection of the common marmoset (Callithrix jacchus). Infect Immun 2013; 81:2909-19. [PMID: 23716617 PMCID: PMC3719573 DOI: 10.1128/iai.00632-13] [Citation(s) in RCA: 82] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Accepted: 05/23/2013] [Indexed: 11/20/2022] Open
Abstract
Existing small-animal models of tuberculosis (TB) rarely develop cavitary disease, limiting their value for assessing the biology and dynamics of this highly important feature of human disease. To develop a smaller primate model with pathology similar to that seen in humans, we experimentally infected the common marmoset (Callithrix jacchus) with diverse strains of Mycobacterium tuberculosis of various pathogenic potentials. These included recent isolates of the modern Beijing lineage, the Euro-American X lineage, and M. africanum. All three strains produced fulminant disease in this animal with a spectrum of progression rates and clinical sequelae that could be monitored in real time using 2-deoxy-2-[(18)F]fluoro-d-glucose (FDG) positron emission tomography (PET)/computed tomography (CT). Lesion pathology at sacrifice revealed the entire spectrum of lesions observed in human TB patients. The three strains produced different rates of progression to disease, various extents of extrapulmonary dissemination, and various degrees of cavitation. The majority of live births in this species are twins, and comparison of results from siblings with different infecting strains allowed us to establish that the infection was highly reproducible and that the differential virulence of strains was not simply host variation. Quantitative assessment of disease burden by FDG-PET/CT provided an accurate reflection of the pathology findings at necropsy. These results suggest that the marmoset offers an attractive small-animal model of human disease that recapitulates both the complex pathology and spectrum of disease observed in humans infected with various M. tuberculosis strain clades.
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Affiliation(s)
- Laura E. Via
- Tuberculosis Research Section, Laboratory of Clinical Infectious Diseases, National Institute for Allergy and Infectious Disease, National Institutes of Health, Bethesda, Maryland, USA
| | - Danielle M. Weiner
- Tuberculosis Research Section, Laboratory of Clinical Infectious Diseases, National Institute for Allergy and Infectious Disease, National Institutes of Health, Bethesda, Maryland, USA
| | - Daniel Schimel
- Tuberculosis Research Section, Laboratory of Clinical Infectious Diseases, National Institute for Allergy and Infectious Disease, National Institutes of Health, Bethesda, Maryland, USA
| | - Philana Ling Lin
- Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, USA
| | - Emmanuel Dayao
- Tuberculosis Research Section, Laboratory of Clinical Infectious Diseases, National Institute for Allergy and Infectious Disease, National Institutes of Health, Bethesda, Maryland, USA
| | - Sarah L. Tankersley
- Tuberculosis Research Section, Laboratory of Clinical Infectious Diseases, National Institute for Allergy and Infectious Disease, National Institutes of Health, Bethesda, Maryland, USA
| | - Ying Cai
- Tuberculosis Research Section, Laboratory of Clinical Infectious Diseases, National Institute for Allergy and Infectious Disease, National Institutes of Health, Bethesda, Maryland, USA
| | - M. Teresa Coleman
- Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Jaime Tomko
- University of Pittsburgh School of Medicine, Department of Microbiology and Molecular Genetics, Pittsburgh, Pennsylvania, USA
| | | | | | | | - Michael Tartakovsky
- Office of Cyber Infrastructure and Computational Biology, National Institute of Allergy and Infectious Disease, National Institutes of Health, Bethesda, Maryland, USA
| | - Alexander Rosenthal
- Office of Cyber Infrastructure and Computational Biology, National Institute of Allergy and Infectious Disease, National Institutes of Health, Bethesda, Maryland, USA
| | - Damien Portevin
- MRC National Institute for Medical Research, London, United Kingdom
| | - Seok Yong Eum
- International Tuberculosis Research Center, Changwon, South Korea
| | | | - Sebastien Gagneux
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Douglas B. Young
- MRC National Institute for Medical Research, London, United Kingdom
| | - JoAnne L. Flynn
- University of Pittsburgh School of Medicine, Department of Microbiology and Molecular Genetics, Pittsburgh, Pennsylvania, USA
| | - Clifton E. Barry
- Tuberculosis Research Section, Laboratory of Clinical Infectious Diseases, National Institute for Allergy and Infectious Disease, National Institutes of Health, Bethesda, Maryland, USA
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64
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Gonzalez-Juarrero M, Bosco-Lauth A, Podell B, Soffler C, Brooks E, Izzo A, Sanchez-Campillo J, Bowen R. Experimental aerosol Mycobacterium bovis model of infection in goats. Tuberculosis (Edinb) 2013; 93:558-64. [PMID: 23850102 DOI: 10.1016/j.tube.2013.05.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Revised: 05/13/2013] [Accepted: 05/19/2013] [Indexed: 11/30/2022]
Abstract
The use of animal models is essential in testing the efficacy for novel therapies against tuberculosis (TB). Calves and non-human primates are examples of large animal models currently used to test TB vaccine efficacy but these animals are difficult and very expensive to house under high containment conditions. The goat may represent an effective but less expensive alternative for testing prototype vaccines against TB. Goats are susceptible to Mycobacterium bovis, Mycobacterium caprae and Mycobacterium tuberculosis infection. Aerosolized bacteria are the most common source of natural infection in humans and the primary site of natural infection is the respiratory tract. We developed a simple procedure for infecting goats with M. bovis by aerosol exposure. After 8 and 12 weeks of infection the goats were euthanized, post-mortem analysis was performed, and all exposed animals presented TB compatible lesions in the lung and associated lymph nodes. Selected lung lesions and respiratory lymph nodes were evaluated and cultured for bacteriological and histological analysis. The present work shows a reliable new animal model of aerosol infection to be used in the understanding of TB disease and development of new therapies.
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Affiliation(s)
- Mercedes Gonzalez-Juarrero
- Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, CO 80523, United States.
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65
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Dharmadhikari AS, Mphahlele M, Stoltz A, Venter K, Mathebula R, Masotla T, Lubbe W, Pagano M, First M, Jensen PA, van der Walt M, Nardell EA. Surgical face masks worn by patients with multidrug-resistant tuberculosis: impact on infectivity of air on a hospital ward. Am J Respir Crit Care Med 2012; 185:1104-9. [PMID: 22323300 PMCID: PMC3359891 DOI: 10.1164/rccm.201107-1190oc] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2011] [Accepted: 01/31/2012] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Drug-resistant tuberculosis transmission in hospitals threatens staff and patient health. Surgical face masks used by patients with tuberculosis (TB) are believed to reduce transmission but have not been rigorously tested. OBJECTIVES We sought to quantify the efficacy of surgical face masks when worn by patients with multidrug-resistant TB (MDR-TB). METHODS Over 3 months, 17 patients with pulmonary MDR-TB occupied an MDR-TB ward in South Africa and wore face masks on alternate days. Ward air was exhausted to two identical chambers, each housing 90 pathogen-free guinea pigs that breathed ward air either when patients wore surgical face masks (intervention group) or when patients did not wear masks (control group). Efficacy was based on differences in guinea pig infections in each chamber. MEASUREMENTS AND MAIN RESULTS Sixty-nine of 90 control guinea pigs (76.6%; 95% confidence interval [CI], 68-85%) became infected, compared with 36 of 90 intervention guinea pigs (40%; 95% CI, 31-51%), representing a 56% (95% CI, 33-70.5%) decreased risk of TB transmission when patients used masks. CONCLUSIONS Surgical face masks on patients with MDR-TB significantly reduced transmission and offer an adjunct measure for reducing TB transmission from infectious patients.
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Affiliation(s)
- Ashwin S Dharmadhikari
- Division of Pulmonary and Critical Care Medicine, Division of Global Health Equity, Brigham and Women's Hospital, Harvard Medical School, 641 Huntington Avenue, Room 3A03, Boston, MA 02115, USA.
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66
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Dharmadhikari AS, Mphahlele M, Stoltz A, Venter K, Mathebula R, Masotla T, Lubbe W, Pagano M, First M, Jensen PA, van der Walt M, Nardell EA. Surgical Face Masks Worn by Patients with Multidrug-Resistant Tuberculosis. Am J Respir Crit Care Med 2012. [DOI: 10.1164/rccm.201107-1190oc https://www.who.int/emergencies/diseases/novel-coronavirus-2019/question-and-answers-hub/q-a-detail/coronavirus-disease-covid-19-masks] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Ashwin S. Dharmadhikari
- Division of Pulmonary and Critical Care Medicine, and
- Division of Global Health Equity, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Matsie Mphahlele
- South African Medical Research Council, Tuberculosis Epidemiology and Intervention Research Unit, Pretoria, South Africa
| | - Anton Stoltz
- Division of Infectious Diseases, University of Pretoria, Pretoria, South Africa
| | - Kobus Venter
- South African Medical Research Council, Tuberculosis Epidemiology and Intervention Research Unit, Pretoria, South Africa
| | - Rirhandzu Mathebula
- South African Medical Research Council, Tuberculosis Epidemiology and Intervention Research Unit, Pretoria, South Africa
| | - Thabiso Masotla
- South African Medical Research Council, Tuberculosis Epidemiology and Intervention Research Unit, Pretoria, South Africa
| | - Willem Lubbe
- South African Medical Research Council, Tuberculosis Epidemiology and Intervention Research Unit, Pretoria, South Africa
| | | | - Melvin First
- Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts; and
| | - Paul A. Jensen
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Martie van der Walt
- South African Medical Research Council, Tuberculosis Epidemiology and Intervention Research Unit, Pretoria, South Africa
| | - Edward A. Nardell
- Division of Pulmonary and Critical Care Medicine, and
- Division of Global Health Equity, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Lancioni C, Nyendak M, Kiguli S, Zalwango S, Mori T, Mayanja-Kizza H, Balyejusa S, Null M, Baseke J, Mulindwa D, Byrd L, Swarbrick G, Scott C, Johnson DF, Malone L, Mudido-Musoke P, Boom WH, Lewinsohn DM, Lewinsohn DA. CD8+ T cells provide an immunologic signature of tuberculosis in young children. Am J Respir Crit Care Med 2011; 185:206-12. [PMID: 22071329 DOI: 10.1164/rccm.201107-1355oc] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
RATIONALE The immunologic events surrounding primary Mycobacterium tuberculosis infection and development of tuberculosis remain controversial. Young children who develop tuberculosis do so quickly after first exposure, thus permitting study of immune response to primary infection and disease. We hypothesized that M. tuberculosis-specific CD8(+) T cells are generated in response to high bacillary loads occurring during tuberculosis. OBJECTIVES To determine if M. tuberculosis-specific T cells are generated among healthy children exposed to M. tuberculosis and children with tuberculosis. METHODS Enzyme-linked immunosorbent spot assays were used to measure IFN-γ production in response to M. tuberculosis-specific proteins ESAT-6/CFP-10 by peripheral blood mononuclear cells and CD8(+) T cells isolated from Ugandan children hospitalized with tuberculosis (n = 96) or healthy tuberculosis contacts (n = 62). MEASUREMENTS AND MAIN RESULTS The proportion of positive CD8(+) T-cell assays and magnitude of CD8(+) T-cell responses were significantly greater among young (<5 yr) tuberculosis cases compared with young contacts (P = 0.02, Fisher exact test, P = 0.01, Wilcoxon rank-sum, respectively). M. tuberculosis-specific T-cell responses measured in peripheral blood mononuclear cells were equivalent between groups. CONCLUSIONS Among young children, M. tuberculosis-specific CD8(+) T cells develop in response to high bacillary loads, as occurs during tuberculosis, and are unlikely to be found after M. tuberculosis exposure. T-cell responses measured in peripheral blood mononuclear cells are generated after M. tuberculosis exposure alone, and thus cannot distinguish exposure from disease. In young children, IFN-γ-producing M. tuberculosis-specific CD8(+) T cells provide an immunologic signature of primary M. tuberculosis infection resulting in disease.
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Affiliation(s)
- Christina Lancioni
- Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio, USA.
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