Development of a quantitative chemical ionization gas chromatography-mass spectrometry method to detect tuberculostearic acid in body fluids

Tuberculostearic acid incorporated predictive model contributes to the clinical diagnosis of tuberculous meningitis

The conventional confirmation tests of tuberculous meningitis (TBM) are usually low in sensitivity, leading to high TBM mortality. Hence, sensitive methods for indicating the presence of bacilli are required. Tuberculostearic acid (TBSA), a constituent from Mycobacterium tuberculosis had been evaluated as a promising marker, but fails to demonstrate consistent results for definite TBM. This study retrospectively reviewed medical records of 113 TBM suspects, constructing a TBSA-combined scoring system based on multiple factors, which show sensitivity and specificity of 0.8148 and 0.8814, respectively, and the area under the receiver operating characteristic curve of 0.9010. Multivariate analyses revealed four co-predictive factors strongly associated with TBSA: extra-neural tuberculosis, basal meningeal enhancement, CSF glucose/Serum glucose <0.595, and coinfection in CNS (Total). The subsequent machine learning-based validation showed correspondent importance to factors in the TBSA model. This study demonstrates a simple scoring system to facilitate TBM prediction, yield reliable diagnoses and allow timely treatment initiation.

Rapid diagnosis of TB using GC-MS and chemometrics

The search continues for a rapid diagnostic test for TB that has high sensitivity and specificity and is useable in sophisticated environments and in deprived regions with poor infrastructure. We discuss here the modern bioanalytical techniques that can be used to discover biomarkers of infection with Mycobacterium tuberculosis, focusing on techniques using GC. We will also discuss the use of GC-MS to identify volatile organic compounds in the headspace of bacterial culture or in samples of breath, serum or urine. Biomarkers discovered in the 'clean' environment of culture may differ from those in patients. A number of biomarkers have been found in patients, with little consistency in the various studies to date. Reproducibility is difficult; the impressive results found initially with a few patients are rarely repeatable when a larger sample series is tested. Mycobacterial lipids offer promise for distinguishing M. tuberculosis from nontuberculous mycobacteria directly in sputum.

Circulating tuberculostearic acid in tuberculosis patients

Tuberculostearic acid (TBSA), a mycobacterial cell wall constituent, was measured in plasma samples using a highly sensitive high-performance liquid chromatography method. Plasma TBSA concentrations in patients with active tuberculosis (20 [0.5-347] nmol/l; n = 125) were higher than in patients with a variety of non-tuberculous pulmonary and extrapulmonary inflammatory conditions (0.1 [0-29] nmol/l; n = 116) and in healthy controls (0 [0-2] nmol/l; n = 102) (p = < 0.001). The calculated sensitivity, specificity, positive and negative predictive values for tuberculosis were 95.2%, 87.9%, 89.5% and 94.4%, respectively, indicating that assay of plasma TBSA might be a valuable complementary diagnostic tool.

Electron-capture gas chromatographic-chemical ionization mass spectrometric study of sera from people vaccinated with bacille Calmette-Guerin for characteristic metabolites

Serum samples from 26 individuals vaccinated with bacille Calmette-Guerin (BCG) and from 26 controls (10 patients with pulmonary tuberculosis and 16 non BCG-vaccinated healthy individuals) were analyzed by frequency-pulsed electron-capture gas chromatography (FPEC-GC) and chemical ionization gas chromatography-mass spectrometry (CIGC-MS) for the presence of characteristic metabolites. A distinct pattern consisted of tuberculostearic acid (TSA) and a peak, labeled peak 1, was observed in all BCG-vaccinated individuals, whereas only three of 26 controls generated this chromatography profile. TSA was detected in all patients with pulmonary tuberculosis but peak 1 was absent. Sera drawn from 12 individuals 11 to 14 days after BCG vaccination yielded three transitional FPEC-GC profiles. A permanent FPEC-GC profile consisting of TSA and of a full scale peak 1 appeared 28 days to a few months after BCG vaccination. Peak 1 was tentatively identified by CIGC-MS as 9-methyl-hexacosanol. The findings suggest that peak 1 may serve as a marker to detect Mycobacterium bovis BCG and to distinguish individuals infected with M. tuberculosis from individuals vaccinated with BCG.

Improved methods for immunoassay of mycothiol

Improved enzyme-linked immunosorbent assay (ELISA) methods have been developed for the determination of femtomole amounts of mycothiol (MSH), the main low-molecular-weight thiol in mycobacteria. The immunoassays utilize an affinity-purified rabbit polyclonal antibody that is highly specific for the pseudodisaccharide moiety of MSH. MSH was first biotinylated by the thiol-specific reagent 3-(N-maleimidopropionyl)biocytin. The MSH-biotin adduct was then captured with immobilized avidin and detected with anti-MSH antibody (biotin-capture ELISA) or was captured with immobilized anti-MSH antibody and detected with alkaline phosphatase-labelled avidin (MSH-capture ELISA). The MSH-capture ELISA was the most sensitive method, measuring as little as 0.3 fmol of MSH. Methods for biotinylating MSH directly from Mycobacterium spp. are described. The MSH-capture ELISA was tested for the detection of M. avium seeded in human urine or cerebrospinal fluid samples and for screening mutant M. smegmatis strains to detect MSH production.