Development of an enzyme-linked immunosorbent assay for serological diagnosis of tick-borne encephalitis using subviral particles

Epidemiology and pathological mechanisms of tick-borne encephalitis

Tick-borne encephalitis virus (TBEV), a member of the genus Flavivirus within the family Flaviviridae, causes fatal encephalitis with severe sequelae in humans. TBEV is prevalent over a wide area of the Eurasian continent including Europe, Russia, Far-Eastern Asia, and Japan. While it was previously thought that TBEV was not endemic in Japan, the first confirmed case of serologically diagnosed TBE was reported in 1993 in the southern area of Hokkaido Prefecture, Japan. In addition, TBEV has been isolated from dogs, wild rodents and ticks in the area. Our epizootiological survey indicated that endemic foci of TBEV were maintained in Hokkaido and other areas of Honshu. TBEV can be divided into three subtypes based on phylogenetic analyses. The Japanese isolates were classified as the Far Eastern subtype, which causes severe neural disorders with a higher mortality rate up to 30%. However, how viral replication and pathogenicity contribute to the neurological manifestations remains unclear. Recent studies have revealed distinctive mechanisms of TBEV pathogenicity and viral genetic factors associated with virulence. This review discusses the recent findings regarding the epidemiology and pathogenesis of TBEV.

A Sensitive Nano Luciferase Immune Complex Assay System for Highly Sensitive and Specific Detection of Antibodies Against Tick-Borne Encephalitis Virus

Tick-borne encephalitis virus (TBEV) can cause fever, headache, neurological disorders, and/or peripheral flaccid paralysis; therefore, it is a major threat to public health. A rapid, sensitive, and simple method for detecting anti-TBEV antibodies is needed urgently to determine infection and for vaccine evaluation. Here, a luciferase-based immunocomplex assay system (Luc-IC) was developed to detect TBEV antibodies. The system is based on a reporter Nano luciferase (NLuc) that is co-expressed as a fusion protein with viral envelope domain III (ED3) in COS7 cells. The cell supernatant was used directly to detect antigen without the need for a purification step. This simple procedure effectively improved the sensitivity of the assay. Sera from 50 patients with an acute tick-borne encephalitis infection were tested to determine the sensitivity of the NLuc-IC assay. Furthermore, 62 sera from individuals infected with Japanese encephalitis virus, West Nile virus, yellow fever virus, dengue virus, or Zika virus were also tested to determine specificity. The results demonstrated that the assay was 100% sensitive and 100% specific for TBEV antibodies. Thus, this very simple NLuc-IC assay is potentially useful for rapid and accurate diagnosis of TBEV infection in both humans and animals.

Development of a serodiagnostic IgM-ELISA for tick-borne encephalitis virus using subviral particles with strep-tag

Tick-borne encephalitis virus (TBEV) is a zoonotic agent causing severe encephalitis in humans. IgM antibody detection is useful for the serological diagnosis of TBEV infection, because IgM has high specificity for each flavivirus and indicates a recent infection. Commercial IgM-ELISA kits are somewhat expensive and difficulties in their sensitivity have been suggested due to their format and formalin-inactivated antigens. Therefore, the development of an inexpensive IgM-ELISA with high specificity and sensitivity is needed. In this study, a μ-capture ELISA was developed to detect TBEV-specific IgM antibodies using subviral particles (SPs) with strep-tag (strep-SP-IgM-ELISA). The results of our strep-SP-IgM-ELISA were highly correlated with diagnoses made by the neutralization test (sensitivity: 94.1%), and our strep-SP-IgM-ELISA could detect anti-TBEV IgM antibodies in patients who could not be diagnosed with the neutralization test. Besides, 51 of 52 positive samples by a commercial IgM-ELISA were also diagnosed as positive by our strep-SP-IgM-ELISA (98.1%), and our strep-SP-IgM-ELISA could detect anti-TBEV IgM antibodies in all samples that were inconclusive based on the commercial IgM-ELISA. Our strep-SP-IgM-ELISA will be useful for diagnoses in TBE-endemic areas.

[Tick-borne encephalitis]

Tick-borne encephalitis virus (TBEV) belongs to the Flaviviridae family and Flavivirus genus. TBEV is maintained in transmission cycles between Ixodid ticks and wild mammalian hosts, particularly rodents. A wide range of animal species are also infected with TBEV by the bite of infected ticks, and TBEV infection causes fatal encephalitis in humans. TBEV is endemic widely in the Eurasian continent, and more than 10,000 cases of the disease are reported annually. In Japan, the 1st confirmed case of TBE was reported in the southern area of Hokkaido in 1993, and after 20 years, the 2nd to 4th cases were reported in Hokkaido in 2016 and 2017. Our sero-epizootiological survey indicated endemic foci of TBEV are widely distributed in Hokkaido and that those of TBEV or tick-borne flavivirus outside Hokkaido. In this review, I introduced recent topics of TBEV including newly developed diagnostic methods, epidemiology and pathogenesis of TBEV.

Comparison of six commercial tick-borne encephalitis IgM and IgG ELISA kits and the molecular characterization of their antigenic design

Tick-borne encephalitis virus (TBEV) diagnosis is mainly based on the detection of viral-specific antibodies in serum. Several commercial assays are available, but published data on their performance remain unclear. We assessed six IgM and six IgG commercial enzyme-linked immunosorbent assay (ELISA) kits (ELISA-1 through ELISA-6) using 94 samples, including precharacterized TBEV-positive samples (n=50) and -negative samples (n=44). The six manufacturers showed satisfactory sensitivity and specificity and high overall agreement for both IgM and IgG. Three manufacturers showed better reproducibility and were the most sensitive (100%) and specific (95.5-98.1%) for both IgM and IgG. Two of them were also in agreement with the clinical interpretation in more than 90% of the cases. All the assays use inactivated virus as antigen, with strains showing approximately 94% homology at the amino acid level. The antigenic format of the assays was discussed to further improve this TBEV diagnostic tool.

Tick-borne encephalitis in Japan, Republic of Korea and China

Tick-borne encephalitis virus (TBEV) causes mild or moderate febrile illness in humans that may progress to encephalitis, leading to severe long-term complications and sometimes death. TBEV is prevalent in the Eurasian continent and has been isolated in China, Japan and Republic of Korea (ROK). The TBEV isolates from Japan are of the Far-Eastern subtype; in ROK, the isolates are of the Western subtype; and all TBEV isolates in China are of the Far-Eastern subtype, except one strain that was identified most recently as the Siberian subtype. TBE is endemic to the northeast, northwest and southeast of China; only two confirmed TBE cases have been reported in Japan to date; and no TBE case has been confirmed in ROK. For TBE patients in China, the onset of disease is acute with no biphasic course for disease presentation. The clinical spectrum of disease phenotypes may be wider than currently understood, since serological evidence suggests the presence of TBEV infections in healthy people, indicating that asymptomatic or unspecific manifestations of TBEV infection may exist. The current treatment for TBE is supportive care. In China, vaccines against TBEV have been developed and are available with demonstrated immunogenicity and safety, although efficacy data are lacking. No vaccines are available in ROK or Japan.

Molecular diagnosis of flaviviruses

The genus Flavivirus includes major pathogens such as dengue, yellow fever, Japanese encephalitis, West Nile and tick-borne encephalitis viruses. Molecular amplification assays for the diagnosis of flaviviruses have been developed in the last decades. These assays were formerly based on reverse transcriptase PCR, while in recent years the real-time reverse transcriptase PCR format has taken a predominant role. In this article, we focus on the more recent developments for the molecular diagnosis of flaviviruses, with special attention to those based on new methodologies such as nucleic acid sequence-based amplification or loop-mediated isothermal amplification techniques. These new approaches may provide a good profile of sensitivity and specificity and offer a real chance to implement flavivirus molecular diagnosis in clinical and point-of-care settings.

Serological versus PCR methods for the detection of tick-borne encephalitis virus infections in humans

Tick-borne encephalitis (TBE) virus is the most important flaviviral etiological agent affecting the CNS in Europe and Asia, where it has a significant impact on public health. Current laboratory diagnosis is based mainly on the detection of specific IgM and IgG antibodies in serum and cerebrospinal fluid by serological methods. However, recent developments in PCR methods could reveal that molecular diagnostics may play a more important role than previously described, especially for the early differential diagnosis of TBE. This review considers the recent developments in TBE diagnostics. The advantages and disadvantages of both serological and molecular methods are presented. Moreover, the results of quality control assessment studies for serological and PCR diagnosis of TBE infections are discussed, showing the need for some laboratories to improve their test systems with regards to sensitivity and specificity. Both diagnostic techniques will continue to be valuable approaches in clinical diagnosis and TBE research.