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Mohapatra A, Gaikwad U, Ganga RT, Sharma P. Diagnostic accuracy of Lipoarabinomannan detection by lateral flow assay in pleural tuberculosis. BMC Infect Dis 2024; 24:178. [PMID: 38336640 PMCID: PMC10858539 DOI: 10.1186/s12879-024-09088-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 02/02/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Lipoarabinomannan (LAM) antigen serves as an attractive biomarker to diagnose Tuberculosis (TB). Given the limitations of current diagnostic modalities for Pleural TB, current study evaluated LAM's potential to serve as a point-of-care test to diagnose pleural TB. METHODS A cross sectional, diagnostic accuracy study was conducted during February to November 2021 in a tertiary care hospital in India. LAM antigen detection was performed on pleural fluid as well as early morning urine specimen of suspected pleural TB patients by "Alere/ Abott Determine TB LAM" lateral flow assay (LAM-LFA). The results were compared to microbiological reference standards/MRS (Mycobacterial culture or NAAT) and Composite reference standards/CRS (MRS plus Clinico-radiological diagnosis). RESULTS A total of 170 subjects were included in the analysis, including 26 with Definite TB, 22 with Probable TB, and 122 with No TB. Compared to MRS and CRS, the sensitivity (61.54% & 45.83%) and positive predictive value (PPV) (57.14 & 78.57%) of Pleural LAM-LFA testing were found to be suboptimal, whereas the specificity (91.67% & 95.08%) and negative predictive value (NPV) (92.96% & 81.69%) of the assay were found to be good. Urinary LAM-LFA performed even worse than pleural LAM-LFA, except for its higher specificity against MRS and CRS (97.2% and 98.3%, respectively). Specificity and PPV of pleural LAM detection increased to 100% when analysed in a subgroup of patients with elevated ADA levels (receiver operating curve analysis-derived cut off value > 40 IU/ml). CONCLUSION Detection of LAM antigen by LFA directly from pleural fluid was found to be a useful test to predict absence of the disease if the test is negative rather than using as a POCT for diagnosis.
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Affiliation(s)
- Atish Mohapatra
- Department of Microbiology, All India Institute of Medical Sciences Raipur, Tatibandh, G E Road, Raipur, 492099, India
| | - Ujjwala Gaikwad
- Department of Microbiology, All India Institute of Medical Sciences Raipur, Tatibandh, G E Road, Raipur, 492099, India.
| | - Ranganath T Ganga
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Raipur Tatibandh, G E Road, Raipur, 492099, India
| | - Pratibha Sharma
- Department of Microbiology, Shri Balaji Institute of Medical Sciences, Mowa, Raipur, Chhattisgarh, 492001, India
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2
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Peng L, Dai L, Zhu M, Fang T, Sun H, Shao Y, Cai L. Developing a method to detect lipoarabinomannan in pleural fluid and assessing its diagnostic efficacy for tuberculous pleural effusion. Heliyon 2023; 9:e18949. [PMID: 37600371 PMCID: PMC10432692 DOI: 10.1016/j.heliyon.2023.e18949] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 07/25/2023] [Accepted: 08/03/2023] [Indexed: 08/22/2023] Open
Abstract
Objectives The diagnosis of tuberculosis pleural effusion (TPE) remains challenging, traditional diagnostic tests have limited diagnostic efficacy. This study aimed to assess the diagnostic performance of pleural fluid (PF) lipoarabinomannan (LAM) in TPE. Methods A diagnostic method for PF LAM (LAM-PF) was established using LEDBIO's AIMLAM kit. The diagnostic performance of LAM-PF was evaluated in 162 HIV-negative patients with suspected TPE. Results The LAM-PF method established in this study exhibited good linearity and recovery rate, with a limit of detection (LOD) of 2.90 pg/mL. Using a cut-off value of 5.33 pg/mL, the sensitivity and specificity of LAM-PF in diagnosing TPE (n = 128) were 47.7% and 100.0%, respectively. The sensitivity in patients with probable TPE (n = 29) and definite TPE (n = 99) were 41.4% and 49.5%, respectively. LAM-PF displayed a significantly higher sensitivity in probable TPE compared to other tuberculosis detection methods. Combined testing of adenosine deaminase (ADA)and LAM increased the detection sensitivity of TPE to 68.0%, and the area under the curve was 0.84 (0.77-0.89). Conclusion This study successfully established a method for detecting LAM in PF, which exhibited favorable diagnostic performance for TPE, particularly in challenging cases of probable TPE. Combined detection of LAM and ADA in PF significantly improves TPE diagnostic efficiency.
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Affiliation(s)
| | | | - Mingzhi Zhu
- Clinical Laboratory Center, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Tingting Fang
- Clinical Laboratory Center, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Haiqiong Sun
- Clinical Laboratory Center, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Yanqin Shao
- Clinical Laboratory Center, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Long Cai
- Clinical Laboratory Center, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
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3
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Rajput S, Pink D, Findlay S, Woolner E, Lewis JD, McDermott MT. Application of Surface-Enhanced Raman Spectroscopy to Guide Therapy for Advanced Prostate Cancer Patients. ACS Sens 2022; 7:827-838. [PMID: 35271265 DOI: 10.1021/acssensors.1c02551] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
A critical unmet need for advanced prostate cancer (PCa) patients is optimizing systemic treatments to maximize the benefit for individuals. The response of patients with metastatic castration-resistant prostate cancer (mCRPC) to androgen receptor (AR)-directed hormonal treatments (i.e., enzalutamide and abiraterone) is mediated by the expression of a molecular variant of the androgen receptor called androgen receptor variant 7 (AR-V7). Detection and measurement of AR-V7 in mCRPC patients will lead to more informed PCa treatment. Herein, we demonstrate a quantitative nanoparticle-enhanced sandwich antibody assay for the successful ex vivo measurement of AR-V7 protein in serum from mCRPC patients. The nanoparticles are constructed as extrinsic Raman spectroscopy labels (ERLs), and surface-enhanced Raman spectroscopy (SERS) is used for assay readout. Our approach does not require specialized specimen collection materials, circulating tumor cell enrichment, or pretreatment of serum. Calibration of our assay is accomplished by expressing AR-V7 in an appropriate cell line as AR-V7 is not commercially available. We demonstrate a linear calibration curve from cell lysate and correlate lysate protein with mRNA from cultured prostate cancer cells. Finally, we demonstrate a novel pilot-scale application for clinical use by quantitatively measuring AR-V7 in serum of seven advanced PCa patients. Distinct separation of PCa patients by AR-V7 status (positive or negative) was observed. Together, the presence and amount of AR-V7 in serum offer predictive and prognostic value to inform selection between two classes of systemic treatments (i.e., hormones or taxanes). Triaging patients that are AR-V7-positive to other systemic treatments (e.g., taxane-based chemotherapy) can improve progression-free survival and overall survival.
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Affiliation(s)
- Sunil Rajput
- Department of Chemistry, University of Alberta, Edmonton, Alberta, Canada T6G 2G2
| | - Desmond Pink
- Department of Oncology, University of Alberta, Edmonton, Alberta, Canada T6G 2G2
| | - Scott Findlay
- Department of Oncology, University of Alberta, Edmonton, Alberta, Canada T6G 2G2
| | - Emma Woolner
- Department of Oncology, University of Alberta, Edmonton, Alberta, Canada T6G 2G2
| | - John D. Lewis
- Department of Oncology, University of Alberta, Edmonton, Alberta, Canada T6G 2G2
| | - Mark T. McDermott
- Department of Chemistry, University of Alberta, Edmonton, Alberta, Canada T6G 2G2
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Hassanain WA, Johnson CL, Faulds K, Graham D, Keegan N. Recent advances in antibiotic resistance diagnosis using SERS: focus on the “ Big 5” challenges. Analyst 2022; 147:4674-4700. [DOI: 10.1039/d2an00703g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
SERS for antibiotic resistance diagnosis.
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Affiliation(s)
- Waleed A. Hassanain
- Department of Pure and Applied Chemistry, Technology and Innovation Centre, University of Strathclyde, Glasgow, G1 1RD, UK
| | - Christopher L. Johnson
- Translational and Clinical Research Institute, Newcastle University, Newcastle-Upon-Tyne, NE2 4HH, UK
| | - Karen Faulds
- Department of Pure and Applied Chemistry, Technology and Innovation Centre, University of Strathclyde, Glasgow, G1 1RD, UK
| | - Duncan Graham
- Department of Pure and Applied Chemistry, Technology and Innovation Centre, University of Strathclyde, Glasgow, G1 1RD, UK
| | - Neil Keegan
- Translational and Clinical Research Institute, Newcastle University, Newcastle-Upon-Tyne, NE2 4HH, UK
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5
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Flores J, Cancino JC, Chavez-Galan L. Lipoarabinomannan as a Point-of-Care Assay for Diagnosis of Tuberculosis: How Far Are We to Use It? Front Microbiol 2021; 12:638047. [PMID: 33935997 PMCID: PMC8081860 DOI: 10.3389/fmicb.2021.638047] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 03/22/2021] [Indexed: 12/13/2022] Open
Abstract
Tuberculosis (TB) is still a severe public health problem; the current diagnostic tests have limitations that delay treatment onset. Lipoarabinomannan (LAM) is a glycolipid that is a component of the cell wall of the bacillus Mycobacterium tuberculosis, the etiologic agent of TB. This glycolipid is excreted as a soluble form in urine. The World Health Organization has established that the design of new TB diagnostic methods is one of the priorities within the EndTB Strategy. LAM has been suggested as a biomarker to develop diagnostic tests based on its identification in urine, and it is one of the most prominent candidates to develop point-of-care diagnostic test because urine samples can be easily collected. Moreover, LAM can regulate the immune response in the host and can be found in the serum of TB patients, where it probably affects a wide variety of host cell populations, consequently influencing the quality of both innate and adaptive immune responses during TB infection. Here, we revised the evidence that supports that LAM could be used as a tool for the development of new point-of-care tests for TB diagnosis, and we discussed the mechanisms that could contribute to the low sensitivity of diagnostic testing.
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Affiliation(s)
- Julio Flores
- Laboratory of Integrative Immunology, Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas, Mexico City, Mexico.,Laboratory of Immunomicrobiology, Department of Microbiology, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Mexico City, Mexico
| | - Juan Carlos Cancino
- Laboratory of Immunomicrobiology, Department of Microbiology, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Mexico City, Mexico
| | - Leslie Chavez-Galan
- Laboratory of Integrative Immunology, Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas, Mexico City, Mexico
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6
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Amin AG, De P, Graham B, Calderon RI, Franke MF, Chatterjee D. Urine lipoarabinomannan in HIV uninfected, smear negative, symptomatic TB patients: effective sample pretreatment for a sensitive immunoassay and mass spectrometry. Sci Rep 2021; 11:2922. [PMID: 33536495 PMCID: PMC7859189 DOI: 10.1038/s41598-021-82445-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 01/20/2021] [Indexed: 12/12/2022] Open
Abstract
Our study sought to determine whether urine lipoarabinomannan (LAM) could be validated in a sample cohort that consisted mainly of HIV uninfected individuals that presented with tuberculosis symptoms. We evaluated two tests developed in our laboratory, and used them on clinical samples from Lima, Peru where incidence of HIV is low. ELISA analysis was performed on 160 samples (from 140 adult culture-confirmed TB cases and 20 symptomatic TB-negative child controls) using 100 μL of urine after pretreatment with Proteinase K. Two different mouse monoclonal antibodies-CS35 and CHCS9-08 were used individually for capture of urine LAM. Among cases, optical density (OD450) values had a positive association with higher bacillary loads. The 20 controls had negative values (below the limit of detection). The assay correctly identified all samples (97-100% accuracy confidence interval). For an alternate validation of the ELISA results, we analyzed all 160 urine samples using an antibody independent chemoanalytical approach. Samples were called positive only when LAM surrogates-tuberculostearic acid (TBSA) and D-arabinose (D-ara)-were found to be present in similar amounts. All TB cases, including the 40 with a negative sputum smear had LAM in detectable quantities in urine. None of the controls had detectable amounts of LAM. Our study shows that urinary LAM detection is feasible in HIV uninfected, smear negative TB patients.
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Affiliation(s)
- Anita G Amin
- Mycobacteria Research Laboratory, Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, CO, 80523, USA
| | - Prithwiraj De
- Mycobacteria Research Laboratory, Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, CO, 80523, USA
| | - Barbara Graham
- Mycobacteria Research Laboratory, Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, CO, 80523, USA
| | - Roger I Calderon
- Socios en Salud Sucursal Peru, Lima, 15001, Peru
- Programa Academico de Tuberculose, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, 21941-590, Brazil
| | - Molly F Franke
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, 02115, USA
| | - Delphi Chatterjee
- Mycobacteria Research Laboratory, Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, CO, 80523, USA.
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7
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Fan M, Andrade GFS, Brolo AG. A review on recent advances in the applications of surface-enhanced Raman scattering in analytical chemistry. Anal Chim Acta 2019; 1097:1-29. [PMID: 31910948 DOI: 10.1016/j.aca.2019.11.049] [Citation(s) in RCA: 199] [Impact Index Per Article: 39.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 11/18/2019] [Accepted: 11/20/2019] [Indexed: 12/13/2022]
Abstract
This review is focused on recent developments of surface-enhanced Raman scattering (SERS) applications in Analytical Chemistry. The work covers advances in the fabrication methods of SERS substrates, including nanoparticles immobilization techniques and advanced nanopatterning with metallic features. Recent insights in quantitative and sampling methods for SERS implementation and the development of new SERS-based approaches for both qualitative and quantitative analysis are discussed. The advent of methods for pre-concentration and new approaches for single-molecule SERS quantification, such as the digital SERS procedure, has provided additional improvements in the analytical figures-of-merit for analysis and assays based on SERS. The use of metal nanostructures as SERS detection elements integrated in devices, such as microfluidic systems and optical fibers, provided new tools for SERS applications that expand beyond the laboratory environment, bringing new opportunities for real-time field tests and process monitoring based on SERS. Finally, selected examples of SERS applications in analytical and bioanalytical chemistry are discussed. The breadth of this work reflects the vast diversity of subjects and approaches that are inherent to the SERS field. The state of the field indicates the potential for a variety of new SERS-based methods and technologies that can be routinely applied in analytical laboratories.
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Affiliation(s)
- Meikun Fan
- Faculty of Geosciences and Environmental Engineering, Southwest Jiaotong University, Chengdu, Sichuan, 610031, China
| | - Gustavo F S Andrade
- Centro de Estudos de Materiais, Departamento de Química, Instituto de Ciências Exatas, Universidade Federal de Juiz de Fora, Campus Universitário s/n, CEP 36036-900, Juiz de Fora, Brazil
| | - Alexandre G Brolo
- Department of Chemistry, University of Victoria, PO Box 3055, Victoria, BC, V8W 3V6, Canada; Centre for Advanced Materials and Related Technology, University of Victoria, V8W 2Y2, Canada.
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8
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Broger T, Tsionksy M, Mathew A, Lowary TL, Pinter A, Plisova T, Bartlett D, Barbero S, Denkinger CM, Moreau E, Katsuragi K, Kawasaki M, Nahid P, Sigal GB. Sensitive electrochemiluminescence (ECL) immunoassays for detecting lipoarabinomannan (LAM) and ESAT-6 in urine and serum from tuberculosis patients. PLoS One 2019; 14:e0215443. [PMID: 30998715 PMCID: PMC6472883 DOI: 10.1371/journal.pone.0215443] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 04/02/2019] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) infection was responsible for an estimated 1.3 million deaths in 2017. Better diagnostic tools are urgently needed. We sought to determine whether accurate TB antigen detection in blood or urine has the potential to meet the WHO target product profiles for detection of active TB. MATERIALS AND METHODS We developed Electrochemiluminescence (ECL) immunoassays for Lipoarabinomannan (LAM) and ESAT-6 detection with detection limits in the pg/ml range and used them to compare the concentrations of the two antigens in the urine and serum of 81 HIV-negative and -positive individuals with presumptive TB enrolled across diverse geographic sites. RESULTS LAM and ESAT-6 overall sensitivities in urine were 93% and 65% respectively. LAM and ESAT-6 overall sensitivities in serum were 55% and 46% respectively. Overall specificity was ≥97% in all assays. Sensitivities were higher in HIV-positive compared to HIV-negative patients for both antigens and both sample types, with signals roughly 10-fold higher on average in urine than in serum. The two antigens showed similar concentration ranges within the same sample type and correlated. CONCLUSIONS LAM and ESAT-6 can be detected in the urine and serum of TB patients, regardless of the HIV status and further gains in clinical sensitivity may be achievable through assay and reagent optimization. Accuracy in urine was higher with current methods and has the potential to meet the WHO accuracy target if the findings can be transferred to a point-of-care TB test.
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Affiliation(s)
| | - Michael Tsionksy
- Meso Scale Diagnostics, LLC., Rockville, Maryland, United States of America
| | - Anu Mathew
- Meso Scale Diagnostics, LLC., Rockville, Maryland, United States of America
| | - Todd L. Lowary
- Department of Chemistry and Alberta Glycomics Centre, University of Alberta, Edmonton, Alberta, Canada
| | - Abraham Pinter
- Public Health Research Institute Center, New Jersey Medical School, Rutgers University, Newark, New Jersey, United States of America
| | - Tatiana Plisova
- Meso Scale Diagnostics, LLC., Rockville, Maryland, United States of America
| | - Daniel Bartlett
- Meso Scale Diagnostics, LLC., Rockville, Maryland, United States of America
| | - Simone Barbero
- Meso Scale Diagnostics, LLC., Rockville, Maryland, United States of America
| | | | | | | | | | - Payam Nahid
- University of California, San Francisco, California, United States of America
| | - George B. Sigal
- Meso Scale Diagnostics, LLC., Rockville, Maryland, United States of America
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9
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Correia-Neves M, Fröberg G, Korshun L, Viegas S, Vaz P, Ramanlal N, Bruchfeld J, Hamasur B, Brennan P, Källenius G. Biomarkers for tuberculosis: the case for lipoarabinomannan. ERJ Open Res 2019; 5:00115-2018. [PMID: 30775376 PMCID: PMC6368998 DOI: 10.1183/23120541.00115-2018] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 11/05/2018] [Indexed: 02/07/2023] Open
Abstract
Tuberculosis (TB) is considered the most onerous of infectious diseases according to recent reports from the World Health Organization. Available tests for TB diagnosis present severe limitations, and a reliable point-of-care (POC) diagnostic test does not exist. Neither is there a test to discern between the different stages of TB, and in particular to predict which patients with Mycobacterium tuberculosis infection and no clinical signs are more at risk of advancing to overt disease. We here review the usefulness of mycobacterial lipoarabinomannan (LAM) as a diagnostic marker for active and latent TB and, also, aspects of the immune response to LAM relevant to such tests. There is a high potential for urinary LAM-based POC tests for the diagnosis of active TB. Some technical challenges to optimised sensitivity of the test will be detailed. A method to quantify LAM in urine or serum should be further explored as a test of treatment effect. Recent data on the immune response to LAM suggest that markers for host response to LAM should be investigated for a prognostic test to recognise individuals at the greatest risk of disease activation. There is a high potential for a urinary LAM-based point-of-care test to diagnose TB. Markers for host response to LAM should be explored to identify those at highest risk of developing active TB.http://ow.ly/FyCs30n4uFE
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Affiliation(s)
- Margarida Correia-Neves
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's, PT Government Associate Laboratory, Braga/Guimarães, Portugal.,Division of Infectious Diseases, Dept of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Gabrielle Fröberg
- Division of Infectious Diseases, Dept of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.,Dept of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | | | - Sofia Viegas
- Instituto Nacional de Saúde, Ministério da Saúde, Maputo, Mozambique
| | - Paula Vaz
- Instituto Nacional de Saúde, Ministério da Saúde, Maputo, Mozambique.,Fundação Ariel Glaser Contra o SIDA Pediátrico, Maputo, Mozambique
| | - Nehaben Ramanlal
- Fundação Ariel Glaser Contra o SIDA Pediátrico, Maputo, Mozambique
| | - Judith Bruchfeld
- Division of Infectious Diseases, Dept of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.,Dept of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Beston Hamasur
- Biopromic AB, Solna, Sweden.,Dept of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | - Patrick Brennan
- Dept of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, CO, USA
| | - Gunilla Källenius
- Division of Infectious Diseases, Dept of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
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Owens NA, Young CC, Laurentius LB, De P, Chatterjee D, Porter MD. Detection of the tuberculosis biomarker mannose-capped lipoarabinomannan in human serum: Impact of sample pretreatment with perchloric acid. Anal Chim Acta 2019; 1046:140-147. [PMID: 30482291 PMCID: PMC6275550 DOI: 10.1016/j.aca.2018.09.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 09/11/2018] [Accepted: 09/16/2018] [Indexed: 11/18/2022]
Abstract
The development of an accurate and rapid diagnostic test for tuberculosis (TB) to use at point of need is vital to efforts aimed at reducing the global burden from this disease. This paper builds on our previous studies of mannose-capped lipoarabinomannan (ManLAM) as a serum biomarker for active TB infection by means of a heterogeneous immunoassay. That work found that complexation with components in serum (e.g., proteins) sterically hindered the capture and/or labeling of ManLAM in an immunoassay at levels <10 ng mL-1, compromising the clinical utility of this biomarker for detection of active TB infection. We also showed that the acidification of ManLAM-containing serum samples with perchloric acid improved the detectability of ManLAM by 250× by complex disruption when compared to measurements of untreated serum. The present study examined what effects the PCA treatment of serum samples may have on the recovery and structural integrity of ManLAM, owing to its potential susceptibility to acid hydrolysis. Recovery was assessed with an enzyme-linked immunosorbent assay (ELISA). The possible impact of acid hydrolysis on the ManLAM structure was investigated by gas chromatography-mass spectrometry and carbohydrate chemical degradation methods. The ELISA study indicated that while the signal strength for ManLAM in the serum spike-in experiments was significantly stronger after PCA pretreatment when compared to untreated human serum, it was only ∼20% of the ManLAM measured in physiological buffer. This loss in detectability was shown by structural analysis to arise mainly from the acid-induced degradation of the arabinan domains of ManLAM that are targeted by antibodies used for antigen capture and/or tagging. The implications of these findings in terms of the detection of this important biomarker for TB are also discussed.
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Affiliation(s)
- Nicholas A Owens
- Department of Chemistry, University of Utah, Salt Lake City, UT, 84112, USA; Nano Institute of Utah, University of Utah, Salt Lake City, UT, 84112, USA
| | - Colin C Young
- Department of Chemical Engineering, University of Utah, Salt Lake City, UT, 84112, USA; Nano Institute of Utah, University of Utah, Salt Lake City, UT, 84112, USA
| | - Lars B Laurentius
- Nano Institute of Utah, University of Utah, Salt Lake City, UT, 84112, USA
| | - Prithwiraj De
- Mycobacteria Research Laboratories, Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, CO, 80523, USA
| | - Delphi Chatterjee
- Mycobacteria Research Laboratories, Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, CO, 80523, USA
| | - Marc D Porter
- Department of Chemistry, University of Utah, Salt Lake City, UT, 84112, USA; Department of Chemical Engineering, University of Utah, Salt Lake City, UT, 84112, USA; Department of Bioengineering, University of Utah, Salt Lake City, UT, 84112, USA; Department of Pathology, University of Utah, Salt Lake City, UT, 84112, USA; Nano Institute of Utah, University of Utah, Salt Lake City, UT, 84112, USA.
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11
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Incipient and Subclinical Tuberculosis: a Clinical Review of Early Stages and Progression of Infection. Clin Microbiol Rev 2018; 31:31/4/e00021-18. [PMID: 30021818 DOI: 10.1128/cmr.00021-18] [Citation(s) in RCA: 291] [Impact Index Per Article: 48.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Tuberculosis (TB) is the leading infectious cause of mortality worldwide, due in part to a limited understanding of its clinical pathogenic spectrum of infection and disease. Historically, scientific research, diagnostic testing, and drug treatment have focused on addressing one of two disease states: latent TB infection or active TB disease. Recent research has clearly demonstrated that human TB infection, from latent infection to active disease, exists within a continuous spectrum of metabolic bacterial activity and antagonistic immunological responses. This revised understanding leads us to propose two additional clinical states: incipient and subclinical TB. The recognition of incipient and subclinical TB, which helps divide latent and active TB along the clinical disease spectrum, provides opportunities for the development of diagnostic and therapeutic interventions to prevent progression to active TB disease and transmission of TB bacilli. In this report, we review the current understanding of the pathogenesis, immunology, clinical epidemiology, diagnosis, treatment, and prevention of both incipient and subclinical TB, two emerging clinical states of an ancient bacterium.
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12
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Owens NA, Laurentius LB, Porter MD, Li Q, Wang S, Chatterjee D. Handheld Raman Spectrometer Instrumentation for Quantitative Tuberculosis Biomarker Detection: A Performance Assessment for Point-of-Need Infectious Disease Diagnostics. APPLIED SPECTROSCOPY 2018; 72:1104-1115. [PMID: 29664331 DOI: 10.1177/0003702818770666] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Techniques for the detection of disease biomarkers are key components in the protection of human health. While work over the last few decades has redefined the low-level measurement of disease biomarkers, the translation of these capabilities from the formal clinical setting to point-of-need (PON) usage has been much more limited. This paper presents the results of experiments designed to examine the potential utility of a handheld Raman spectrometer as a PON electronic reader for a sandwich immunoassay based on surface-enhanced Raman scattering (SERS). In so doing, the study herein used a recently developed procedure for the SERS detection of phospho-myo-inositol-capped lipoarabinomannan (PILAM) as a means to compare the performance of laboratory-grade and handheld instrumentation and, therefore, gauge the utility of the handheld instrument for PON deployment. Phospho-myo-inositol-capped lipoarabinomannan is a non-pathogenic simulant for mannose-capped lipoarabinomannan (ManLAM), which is an antigenic marker found in serum and other body fluids of individuals infected with tuberculosis (TB). The results of the measurements with the field-portable spectrometer were then compared to those obtained for the same samples when using a much more sensitive benchtop Raman spectrometer. The results, albeit under different operational settings for the two spectrometers (e.g., signal integration time), are promising in that the limit of detection found for PILAM spiked in human serum when using the handheld system (0.18 ng/mL) approached that of the benchtop instrument (0.032 ng/mL). This work also: (1) identified potential adaptations (e.g., optimization of the plasmonically enhanced response for measurement by the handheld unit through a change in the excitation wavelength) to tighten the gap in performance; and (2) briefly examined the next steps and potential processes required to move this immunoassay platform closer to PON utility.
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Affiliation(s)
- Nicholas A Owens
- 1 Department of Chemistry, University of Utah, Salt Lake City, UT, USA
| | - Lars B Laurentius
- 2 Nano Institute of Utah, University of Utah, Salt Lake City, UT, USA
| | - Marc D Porter
- 1 Department of Chemistry, University of Utah, Salt Lake City, UT, USA
- 2 Nano Institute of Utah, University of Utah, Salt Lake City, UT, USA
- 3 Department of Chemical Engineering, University of Utah, Salt Lake City, UT, USA
| | - Qun Li
- 4 B&W Tek, Inc., Newark, DE, USA
| | | | - Delphi Chatterjee
- 5 Mycobacteria Research Laboratories, Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, CO, USA
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13
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Detection of lipoarabinomannan in urine and serum of HIV-positive and HIV-negative TB suspects using an improved capture-enzyme linked immuno absorbent assay and gas chromatography/mass spectrometry. Tuberculosis (Edinb) 2018; 111:178-187. [PMID: 30029905 DOI: 10.1016/j.tube.2018.06.004] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 05/25/2018] [Accepted: 06/05/2018] [Indexed: 11/22/2022]
Abstract
TB diagnosis and treatment monitoring in resource limited regions rely heavily on serial sputum smear microscopy and bacterial culture. These microbiological methods are time-consuming, expensive and lack adequate sensitivity. The WHO states that improved TB diagnosis and treatment is imperative to achieve an end to the TB epidemic by 2030. Commercially available lipoarabinomannan (LAM) detection tools perform at low sensitivity that are highly dependent on the underlying immunological status of the patient; those with advanced HIV infection perform well. In this study, we have applied two novel strategies towards the sensitive diagnosis of TB infection based on LAM: Capture ELISA to detect LAM in paired urine and serum samples using murine and human monoclonal antibodies, essentially relying on LAM as an 'immuno-marker'; and, secondly, detection of α-d-arabinofuranose and tuberculostearic acid (TBSA)- 'chemical-markers' unique to mycobacterial cell wall polysaccharides/lipoglycans by our recently developed gas chromatography/mass spectrometry (GC/MS) method. Blinded urine specimens, with microbiologically confirmed active pulmonary TB or non TB (HIV+/HIV-) were tested by the aforementioned assays. LAM in patient urine was detected in a concentration range of 3-28 ng/mL based on GC/MS detection of the two LAM-surrogates, d-arabinose and tuberculostearic acid (TBSA) correctly classifying TB status with sensitivity > 99% and specificity = 84%. The ELISA assay had high sensitivity (98%) and specificity (92%) and the results were in agreement with GC/MS analysis. Both tests performed well in their present form particularly for HIV-negative/TB-positive urine samples. Among the HIV+/TB+ samples, 52% were found to have >10 ng/mL urinary LAM. The detected amounts of LAM present in the urine samples also appears to be associated with the gradation of the sputum smear, linking elevated LAM levels with higher mycobacterial burden (odds ratio = 1.08-1.43; p = 0.002). In this small set, ELISA was also applied to parallel serum samples confirming that serum could be an additional reservoir for developing a LAM-based immunoassay for diagnosis of TB.
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Choudhary A, Patel D, Honnen W, Lai Z, Prattipati RS, Zheng RB, Hsueh YC, Gennaro ML, Lardizabal A, Restrepo BI, Garcia-Viveros M, Joe M, Bai Y, Shen K, Sahloul K, Spencer JS, Chatterjee D, Broger T, Lowary TL, Pinter A. Characterization of the Antigenic Heterogeneity of Lipoarabinomannan, the Major Surface Glycolipid of Mycobacterium tuberculosis, and Complexity of Antibody Specificities toward This Antigen. THE JOURNAL OF IMMUNOLOGY 2018; 200:3053-3066. [PMID: 29610143 PMCID: PMC5911930 DOI: 10.4049/jimmunol.1701673] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 02/16/2018] [Indexed: 12/17/2022]
Abstract
Lipoarabinomannan (LAM), the major antigenic glycolipid of Mycobacterium tuberculosis, is an important immunodiagnostic target for detecting tuberculosis (TB) infection in HIV-1–coinfected patients, and is believed to mediate a number of functions that promote infection and disease development. To probe the human humoral response against LAM during TB infection, several novel LAM-specific human mAbs were molecularly cloned from memory B cells isolated from infected patients and grown in vitro. The fine epitope specificities of these Abs, along with those of a panel of previously described murine and phage-derived LAM-specific mAbs, were mapped using binding assays against LAM Ags from several mycobacterial species and a panel of synthetic glycans and glycoconjugates that represented diverse carbohydrate structures present in LAM. Multiple reactivity patterns were seen that differed in their specificity for LAM from different species, as well as in their dependence on arabinofuranoside branching and nature of capping at the nonreducing termini. Competition studies with mAbs and soluble glycans further defined these epitope specificities and guided the design of highly sensitive immunodetection assays capable of detecting LAM in urine of TB patients, even in the absence of HIV-1 coinfection. These results highlighted the complexity of the antigenic structure of LAM and the diversity of the natural Ab response against this target. The information and novel reagents described in this study will allow further optimization of diagnostic assays for LAM and may facilitate the development of potential immunotherapeutic approaches to inhibit the functional activities of specific structural motifs in LAM.
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Affiliation(s)
- Alok Choudhary
- Public Health Research Institute, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, NJ 07103
| | - Deendayal Patel
- Public Health Research Institute, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, NJ 07103
| | - William Honnen
- Public Health Research Institute, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, NJ 07103
| | - Zhong Lai
- Public Health Research Institute, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, NJ 07103
| | - Raja Sekhar Prattipati
- Public Health Research Institute, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, NJ 07103
| | - Ruixiang Blake Zheng
- Alberta Glycomics Centre and Department of Chemistry, University of Alberta, Edmonton, Alberta T6G 2G2, Canada
| | - Ying-Chao Hsueh
- Public Health Research Institute, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, NJ 07103
| | - Maria Laura Gennaro
- Public Health Research Institute, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, NJ 07103
| | - Alfred Lardizabal
- Global Tuberculosis Institute, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, NJ 07103
| | - Blanca I Restrepo
- University of Texas Health Science Center at Houston, School of Public Health at Brownsville, Brownsville, TX 78520
| | | | - Maju Joe
- Alberta Glycomics Centre and Department of Chemistry, University of Alberta, Edmonton, Alberta T6G 2G2, Canada
| | - Yu Bai
- Alberta Glycomics Centre and Department of Chemistry, University of Alberta, Edmonton, Alberta T6G 2G2, Canada
| | - Ke Shen
- Alberta Glycomics Centre and Department of Chemistry, University of Alberta, Edmonton, Alberta T6G 2G2, Canada
| | - Kamar Sahloul
- Alberta Glycomics Centre and Department of Chemistry, University of Alberta, Edmonton, Alberta T6G 2G2, Canada
| | - John S Spencer
- Mycobacteria Research Laboratories, Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins, CO 80523; and
| | - Delphi Chatterjee
- Mycobacteria Research Laboratories, Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins, CO 80523; and
| | - Tobias Broger
- Foundation for Innovative New Diagnostics, Geneva 1202, Switzerland
| | - Todd L Lowary
- Alberta Glycomics Centre and Department of Chemistry, University of Alberta, Edmonton, Alberta T6G 2G2, Canada
| | - Abraham Pinter
- Public Health Research Institute, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, NJ 07103;
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15
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Crawford AC, Laurentius LB, Mulvihill TS, Granger JH, Spencer JS, Chatterjee D, Hanson KE, Porter MD. Detection of the tuberculosis antigenic marker mannose-capped lipoarabinomannan in pretreated serum by surface-enhanced Raman scattering. Analyst 2018; 142:186-196. [PMID: 27924983 DOI: 10.1039/c6an02110g] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The ability to detect tuberculosis (TB) continues to be a global health care priority. This paper describes the development and preliminary assessment of the clinical accuracy of a heterogeneous immunoassay that integrates a serum pretreatment process with readout by surface-enhanced Raman scattering (SERS) for the low-level detection of mannose-capped lipoarabinomannan (ManLAM). ManLAM is a major virulence factor in the infectious pathology of Mycobacterium tuberculosis (Mtb) that has been found in the serum and other body fluids of infected patients. The effectiveness of ManLAM as a TB diagnostic marker, however, remains unproven for reasons not yet well understood. As reported herein, we have found that (1) ManLAM complexes with proteins and possibly other components in serum; (2) these complexes have a strongly detrimental impact on the ability to detect ManLAM using an immunoassay; (3) a simple pretreatment step can disrupt this complexation; and (4) disruption by pretreatment improves detection by 250×. We also describe the results from a preliminary assessment on the utility of serum pretreatment by running immunoassays on archived specimens from 24 TB-positive patients and 10 healthy controls. ManLAM was measurable in 21 of the 24 TB-positive specimens, but not in any of the 10 control specimens. These findings, albeit for a very small specimen set, translate to a clinical sensitivity of 87.5% and a clinical specificity of 100%. Together, these results both provide much needed evidence for the clinical utility of ManLAM as a TB marker, and demonstrate the potential utility of our overall approach to serve as a new strategy for the development of diagnostic tests for this disease.
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Affiliation(s)
- Alexis C Crawford
- Department of Chemistry, University of Utah, Salt Lake City, UT 84112, USA and Nano Institute of Utah, University of Utah, Salt Lake City, UT 84112, USA.
| | - Lars B Laurentius
- Nano Institute of Utah, University of Utah, Salt Lake City, UT 84112, USA.
| | | | - Jennifer H Granger
- Nano Institute of Utah, University of Utah, Salt Lake City, UT 84112, USA.
| | - John S Spencer
- Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins, CO 80523, USA
| | - Delphi Chatterjee
- Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins, CO 80523, USA
| | - Kimberly E Hanson
- Departments of Internal Medicine and Pathology, University of Utah School of Medicine, Salt Lake City, UT 84112, USA
| | - Marc D Porter
- Department of Chemistry, University of Utah, Salt Lake City, UT 84112, USA and Nano Institute of Utah, University of Utah, Salt Lake City, UT 84112, USA. and Department of Chemical Engineering, University of Utah, Salt Lake City, UT 84112, USA and Department of Bioengineering, University of Utah, Salt Lake City, UT 84112, USA and Department of Pathology, University of Utah, Salt Lake City, UT 84112, USA
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