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Chemaly RF, El Haddad L, Winston DJ, Rowley SD, Mulane KM, Chandrasekar P, Avery RK, Hari P, Peggs KS, Kumar D, Nath R, Ljungman P, Mossad SB, Dadwal SS, Blanchard T, Shah DP, Jiang Y, Ariza-Heredia E. Cytomegalovirus (CMV) Cell-Mediated Immunity and CMV Infection After Allogeneic Hematopoietic Cell Transplantation: The REACT Study. Clin Infect Dis 2020; 71:2365-2374. [PMID: 32076709 PMCID: PMC7713694 DOI: 10.1093/cid/ciz1210] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 01/02/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Cytomegalovirus (CMV) infection remains an important cause of morbidity and mortality in allogeneic hematopoietic cell transplant (allo-HCT) recipients. CMV cell-mediated immunity (CMV-CMI) as determined by a peptide-based enzyme-linked immunospot (ELISPOT) CMV assay may identify patients at risk for clinically significant CMV infection (CS-CMVi). METHODS The CS-CMVi was defined as CMV viremia and/or disease necessitating antiviral therapy. CMV-CMI was characterized as high when the intermediate-early 1 (IE-1) antigen spot counts (SPCs) were >100 (cutoff 1) or when the IE-1 and phosphoprotein 65 antigen SPCs were both >100 SPCs per 250 000 cells (cutoff 2), and a low CMV-CMI when SPCs were below these thresholds. In this prospective multicenter study, we evaluated CMV-CMI every 2 weeks from the pretransplant period until 6 months posttransplantation in 241 allo-HCT recipients with positive CMV serostatus. The primary endpoint was CS-CMVi occurring within 2 weeks of the last measurement of CMV-CMI. RESULTS CS-CMVi occurred in 70 allo-HCT recipients (29%). CMV-CMI was low in patients who experienced CS-CMVi (94%), whereas those who had a high CMV-CMI were less likely to have CS-CMVi (P < .0001). Patients with CS-CMVi had higher all-cause mortality (P = .007), especially those with low CMV-CMI (P = .035). On multivariable analysis, CMV-CMI, sex, race, antithymocyte globulin, and steroid use were independent predictors of CS-CMVi, and the time from transplant to engraftment was the only predictor of mortality. CONCLUSIONS Measurement of CMV-CMI using a novel ELISPOT assay would be useful clinically to monitor allo-HCT recipients and distinguish between those at risk of developing CS-CMVi and requiring antiviral prophylaxis or therapy and those who are protected.
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Affiliation(s)
- Roy F Chemaly
- Department of Infectious Diseases, Infection Control, and Employee Health, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Lynn El Haddad
- Department of Infectious Diseases, Infection Control, and Employee Health, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Drew J Winston
- Ronald Reagan UCLA Medical Center, Los Angeles, California, USA
| | | | - Kathleen M Mulane
- Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Pranatharthi Chandrasekar
- Division of Infectious Diseases, Department of Medicine, Wayne State University, Detroit, Michigan, USA
| | - Robin K Avery
- Division of Infectious Diseases (Transplant Oncology), Johns Hopkins University, Baltimore, Maryland, USA
| | - Parameswaran Hari
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Karl S Peggs
- Department of Haematology, University College London Cancer Institute and University College London Hospitals National Health Service Foundation Trust, London, United Kingdom
| | - Deepali Kumar
- Transplant Infectious Diseases, University Health Network, Toronto, Ontario, Canada
| | - Rajneesh Nath
- Bone Marrow Transplant, Banner MD Anderson Cancer Center, Gilbert, Arizona, USA
| | - Per Ljungman
- Department of Cellular Therapy and Allogeneic Stem Cell Transplantation, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - Sherif B Mossad
- Department of Infectious Diseases, Respiratory Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Sanjeet S Dadwal
- Division of Infectious Diseases, City of Hope, Duarte, California, USA
| | - Ted Blanchard
- Oxford Immunotec USA, Inc, Charlotte, North Carolina, USA
| | - Dimpy P Shah
- Department of Epidemiology and Biostatistics, University of Texas Health, San Antonio, Texas, USA
| | - Ying Jiang
- Department of Infectious Diseases, Infection Control, and Employee Health, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ella Ariza-Heredia
- Department of Infectious Diseases, Infection Control, and Employee Health, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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van Gorkom T, Voet W, Sankatsing SUC, Nijhuis CDM, Ter Haak E, Kremer K, Thijsen SFT. Prospective comparison of two enzyme-linked immunosorbent spot assays for the diagnosis of Lyme neuroborreliosis. Clin Exp Immunol 2020; 199:337-356. [PMID: 31665540 PMCID: PMC7008225 DOI: 10.1111/cei.13393] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2019] [Indexed: 11/08/2022] Open
Abstract
Commercial cellular tests are used to diagnose Lyme borreliosis (LB), but studies on their clinical validation are lacking. This study evaluated the utility of an in‐house and a commercial enzyme‐linked immunosorbent spot (ELISpot) assay for the diagnosis of Lyme neuroborreliosis (LNB). Prospectively, peripheral blood mononuclear cells (PBMCs) were isolated from patients and controls and analysed using an in‐house Borrelia ELISpot assay and the commercial LymeSpot assay. B. burgdorferi B31 whole cell lysate and a mixture of outer surface proteins were used to stimulate the PBMCs and the numbers of interferon‐gamma‐secreting T cells were measured. Results were evaluated using receiver operating characteristic (ROC) curve analysis. Eighteen active and 12 treated LNB patients, 10 healthy individuals treated for an early (mostly cutaneous) manifestation of LB in the past and 47 untreated healthy individuals were included. Both assays showed a poor diagnostic performance with sensitivities, specificities, positive and negative predictive values ranging from 44.4–66.7%, 42.0–72.5%, 21.8–33.3% and 80.5–87.0%, respectively. The LymeSpot assay performed equally poorly when the calculation method of the manufacturer was used. Both the in‐house and the LymeSpot assay are unable to diagnose active LNB or to monitor antibiotic treatment success.
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Affiliation(s)
- T van Gorkom
- Department of Medical Microbiology and Immunology, Diakonessenhuis Hospital, Utrecht, the Netherlands.,Centre for Infectious Diseases Research, Diagnostics and Laboratory Surveillance, Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - W Voet
- Department of Neurology, Diakonessenhuis Hospital, Utrecht, the Netherlands
| | - S U C Sankatsing
- Department of Internal Medicine, Diakonessenhuis Hospital, Utrecht, the Netherlands
| | - C D M Nijhuis
- Centre for Infectious Diseases Research, Diagnostics and Laboratory Surveillance, Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - E Ter Haak
- Centre for Infectious Diseases Research, Diagnostics and Laboratory Surveillance, Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - K Kremer
- Centre for Infectious Diseases Research, Diagnostics and Laboratory Surveillance, Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - S F T Thijsen
- Department of Medical Microbiology and Immunology, Diakonessenhuis Hospital, Utrecht, the Netherlands
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Kumar D, Chin-Hong P, Kayler L, Wojciechowski D, Limaye AP, Osama Gaber A, Ball S, Mehta AK, Cooper M, Blanchard T, MacDougall J, Kotton CN. A prospective multicenter observational study of cell-mediated immunity as a predictor for cytomegalovirus infection in kidney transplant recipients. Am J Transplant 2019; 19:2505-2516. [PMID: 30768834 DOI: 10.1111/ajt.15315] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 01/24/2019] [Accepted: 02/01/2019] [Indexed: 01/25/2023]
Abstract
T cell immunity is essential for the control of cytomegalovirus (CMV) infection after transplantation. We evaluated a CMV-specific peptide-based enzyme-linked immunosorbent spot (ELISPOT) assay to determine whether assay results could predict subsequent CMV events. Adult kidney transplant recipients at 43 centers underwent ELISPOT testing to enumerate interferon gamma (IFN-γ) binding spot-forming units (sfu) after stimulation of cells with an overlapping peptide pool of CMV phosphoprotein 65 (pp65) and immediate early-1 (IE-1) protein at the end of antiviral prophylaxis (EOP) and various time points thereafter. The primary outcome was a CMV event in the first posttransplant year. In 583 kidney transplant recipients (260 seropositive donor [D+]/seronegative recipient [R-] and 277 R+), CMV events occurred in 44 of 368 eligible patients (11.8%) at a median of 227 days (range 92-360) posttransplant. A cutoff value of >40 sfu/2.5 × 105 cells for either IE-1 or pp65 was derived as a threshold for positivity, with a negative predictive value of >97% for CMV events. CMV events were significantly lower in assay positive vs assay negative patients (3.0% vs 19.5%, P < .0001 for pp65). Time to CMV event post-EOP was significantly greater in those with sfu >40 at EOP (P < .0001). In this large, multicenter trial of kidney transplant recipients, we show that an assessment of CMV-specific immunity using a novel ELISPOT assay is able to predict protection from CMV infection.
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Affiliation(s)
- Deepali Kumar
- Transplant Infectious Diseases and Multi-Organ Transplant Program, University Health Network, Toronto, Canada
| | - Peter Chin-Hong
- Division of Infectious Diseases, University of California - San Francisco, San Francisco, California
| | | | - David Wojciechowski
- Division of Nephrology, Massachusetts General Hospital, Boston, Massachusetts
| | - Ajit P Limaye
- University of Washington Medical Center, Seattle, Washington
| | | | | | - Aneesh K Mehta
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia
| | - Matthew Cooper
- Medstar Georgetown Transplant Institute, Washington, District of Columbia
| | | | | | - Camille N Kotton
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts
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Li J, Liu Y, Ma L, Gu L, Wang Q, Xu M, Ma R, Zhang Y, Yang Z, Deng J, Yi X. The performance of T-cell Xtend reagent in increasing blood storage times for interferon gamma release assays. J Clin Lab Anal 2017; 32. [PMID: 28670691 DOI: 10.1002/jcla.22253] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Accepted: 04/10/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND T-cell Xtend (TCX) was introduced to extend the blood storage time for T-SPOT.TB test, a widely used commercial interferon gamma release assay (IGRA) for rapid in vitro tuberculosis. METHODS A total of 99 Uyghur suspected tuberculosis patients were recruited in this study. T-SPOT.TB test was performed with fresh blood (controls), 36 hours delayed blood and delayed and TCX-treated (at 36 hours) blood from each patient, respectively. RESULTS White blood cells and lymphocytes proportion in peripheral blood mononuclear cells s and spot-forming cells in positive control wells decreased significantly in delayed blood samples when compared with controls, while this decrease was not detected in TCX-treated group. In the 58 patients with paired T-SPOT.TB results of three groups of samples, a higher positive rate was observed in TCX-treated group than both in controls and untreated group (41.4% vs 37.9% and 25.9%). The concordance of T-SPOT.TB results between the treated group and controls was 0.856, whereas the agreement between controls and untreated group was unsatisfactory (0.649). In the 23 elderly patients (>70 years old) with paired T-SPOT.TB results of controls and TCX group, treated group showed a non-significant trend toward higher positive rate than controls (43.5% vs 26.1%, P=.22). Meanwhile, TCX treatment reduced the risk of false negative T-SPOT.TB results in the elderly population. CONCLUSION Deterioration of blood sample caused by long storage time can be neutralized by TCX treatment. The results provide data for the utility of TCX in a novel population and in Asian region, and reveal the potential of TCX to improve the accuracy of T-SPOT.TB test in elderly population.
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Affiliation(s)
- Junlian Li
- Department of Clinical Laboratory, Chest Hospital of Xinjiang Uyghur Autonomous Region, Urumqi, Xinjiang, China
| | - Yan Liu
- Department of Clinical Laboratory, Chest Hospital of Xinjiang Uyghur Autonomous Region, Urumqi, Xinjiang, China
| | - Liyamu Ma
- Department of Clinical Laboratory, Chest Hospital of Xinjiang Uyghur Autonomous Region, Urumqi, Xinjiang, China
| | - Libike Gu
- Department of Clinical Laboratory, Chest Hospital of Xinjiang Uyghur Autonomous Region, Urumqi, Xinjiang, China
| | - Quan Wang
- Department of Clinical Laboratory, Chest Hospital of Xinjiang Uyghur Autonomous Region, Urumqi, Xinjiang, China
| | - Miao Xu
- Department of Clinical Laboratory, Chest Hospital of Xinjiang Uyghur Autonomous Region, Urumqi, Xinjiang, China
| | - Ruiying Ma
- Department of Clinical Laboratory, Chest Hospital of Xinjiang Uyghur Autonomous Region, Urumqi, Xinjiang, China
| | - Yali Zhang
- Department of Clinical Laboratory, Chest Hospital of Xinjiang Uyghur Autonomous Region, Urumqi, Xinjiang, China
| | - Zhenping Yang
- Department of Clinical Laboratory, Chest Hospital of Xinjiang Uyghur Autonomous Region, Urumqi, Xinjiang, China
| | - Junjie Deng
- Department of Clinical Laboratory, Chest Hospital of Xinjiang Uyghur Autonomous Region, Urumqi, Xinjiang, China
| | - Xing Yi
- Department of Clinical Laboratory, Chest Hospital of Xinjiang Uyghur Autonomous Region, Urumqi, Xinjiang, China
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