Comparative evaluation of the diagnostic significance of circulating immune complexes and antibodies to phosphatidylinositomannosides in pulmonary tuberculosis by enzyme-linked immunosorbent assay

Serum immune complexes as diagnostic and therapeutic markers in lymphatic filariasis

In the present study we examined the utility of measuring antigen-specific soluble immune complexes (ICs) for the differential diagnosis and therapeutic monitoring of Bancroftian filariasis. Antigen-specific ICs were detected in significantly elevated levels in 90% of lymphatic filarial subjects suffering from disease manifestations, and very low levels in 8-10% of microfilaria (MF) carriers. The high incidence of antigen-specific ICs in the circulation of filarial subjects with clinical manifestations in contrast to the negligible presence in MF carriers facilitates serological differentiation of these two important stages of lymphatic filarial infection. A sudden spurt in circulating levels of antigen-specific ICs was recorded in all MF carriers on diethylcarbamazine (DEC) therapy, and the magnitude of the increase correlated positively with the pretreatment levels of circulating MF. Thus, it is evident from the present study that circulating ICs (CICs) are potential serological markers for both the differential diagnosis of filarial infection and therapeutic monitoring of MF carriers.

Clinical value of specific detection of immune complex-bound antibodies in pulmonary tuberculosis

Two actively secreted (38 and 30 kDa) and 1 cytosolic (16 kDa) antigens were purified from Mycobacterium tuberculosis culture filtrate and cytosol, respectively, using a combination of chromatographic and electrophoretic methods. One recombinant antigen (27 kDa) overexpressed in Escherichia coli was also isolated. The diagnostic test characteristics of circulating immune complex (CIC)-bound antibodies to purified protein antigens, singly and in combination, were evaluated in patients with pulmonary tuberculosis. The individual antigens ranged in their sensitivity from 73% to 88%, while considering the IgG response. Addition of IgA results improved the sensitivity. The combination of IgG results for 38, 30, and 16 kDa offered >95% sensitivity and specificity for the smear- and culture-positive tuberculosis, as well as for the smear-negative, culture-positive group. CIC-bound antibodies promise to be a better diagnostic tool than serum antibodies.

Immunoglobulin G, A, and M responses in serum and circulating immune complexes elicited by the 16-kilodalton antigen of Mycobacterium tuberculosis

The 16-kDa cytosolic antigen of M. tuberculosis was purified to homogeneity by molecular sieving chromatography, and the diagnostic potential of the antigen was evaluated in various categories of patients by enzyme-linked immunosorbent assay (ELISA). The immunoglobulin G (IgG), IgA, and IgM antibody levels to 16-kDa antigen were estimated in the two polar groups, namely, smear- and culture-positive pulmonary tuberculosis (S(+)C(+)) patients and healthy subjects (HS). Sensitivities of 62, 52 and 11% with specificities of 100, 97, and 95% were obtained for the three isotypes, respectively. The total number of positives by a combination of the three isotypes was analyzed in the polar groups, and the sensitivity improved to 83% with a specificity of 93%. Even when a combination of IgG and IgA alone was considered, the sensitivity was 82% with a specificity of 97%. Polyethylene glycol precipitation of the circulating immune complex (CIC) in sera was carried out. The CIC-bound antibodies to 16-kDa antigen were assessed by ELISA in the S(+)C(+), S(-)C(+), and S(-)C(-) categories of patients. Measuring the IgG-IgA-IgM combination positivities of the CIC-bound antibodies gave sensitivities of 97.5, 100, and 45.3%, respectively. The specificity of the assay with these combinations was maintained at 95.4%.