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Silva CAM, Graham BG, Webb K, Islam MN, Harton M, de Mello Marques MA, de Carvalho FM, Pinheiro RO, Spencer J, Sarno EN, Pereira GM, Pessolani MCV, de Macedo CS, Belisle JT. Polyunsaturated Fatty Acid-Derived Lipid Mediators as Potential Biomarkers for Leprosy Among Individuals with Asymptomatic Mycobacterium leprae Infection. ACS Infect Dis 2023; 9:1458-1469. [PMID: 37428112 PMCID: PMC10700021 DOI: 10.1021/acsinfecdis.2c00585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
Intra-household contacts (HCs) of leprosy patients are at increased risk of infection by Mycobacterium leprae and about ∼5-10% will develop active disease. A prognostic tool to identify HCs with the greatest risk of progressing to active disease would enhance early leprosy diagnosis and optimize prophylactic intervention. Previous metabolomics studies suggest that host lipid mediators derived from ω-3 and ω-6 polyunsaturated fatty acids (PUFAs) are potential biomarkers for leprosy. In this study, we investigated retrospective sera of leprosy HCs by liquid chromatography-mass spectrometry and enzyme-linked immunoassay to determine whether circulating levels of ω-3 and ω-6 PUFA metabolites were altered in HCs that developed leprosy (HCDL) in comparison to those that did not (HCNDL). Sera were collected from HCs at the time of index case diagnosis and before clinical signs/symptoms of leprosy. Our findings showed that HCDL sera exhibited a distinct metabolic profile in comparison to HCDNL. Specifically, arachidonic acid, leukotriene B4, 11-hydroxyeicosatetraenoic acid, prostaglandin D2, and lipoxin A4 were elevated in HCDL. In contrast, prostaglandin E2 levels were reduced in HCDL. The ω-3 PUFAs, docosahexaenoic acid, eicosapentaenoic acid, and the docosahexaenoic acid-derived resolvin D1 and maresin-1 were also elevated in HCDL individuals compared to HCNDL. Principal component analyses provided further evidence that lipid mediators could serve as an early biomarker for progression to active leprosy. A logistic model identified resolvin D1 and D2, and prostaglandin D2 as having the greatest potential for early detection of HCs that will manifest leprosy.
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Affiliation(s)
- Carlos A. M. Silva
- Mycobacteria Research Laboratories, Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins, CO, USA, 80523
| | - Barbara G. Graham
- Mycobacteria Research Laboratories, Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins, CO, USA, 80523
| | - Kristofor Webb
- Mycobacteria Research Laboratories, Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins, CO, USA, 80523
| | - M. Nurul Islam
- Mycobacteria Research Laboratories, Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins, CO, USA, 80523
| | - Marisa Harton
- Mycobacteria Research Laboratories, Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins, CO, USA, 80523
| | - Maria Angela de Mello Marques
- Mycobacteria Research Laboratories, Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins, CO, USA, 80523
- Cellular Microbiology Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, RJ Brazil, 21040-360
| | - Fernanda Marques de Carvalho
- Cellular Microbiology Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, RJ Brazil, 21040-360
| | - Roberta Olmo Pinheiro
- Leprosy Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, RJ Brazil, 21040-360
| | - John Spencer
- Mycobacteria Research Laboratories, Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins, CO, USA, 80523
| | - Euzenir Nunes Sarno
- Leprosy Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, RJ Brazil, 21040-360
| | - Geraldo M.B. Pereira
- Cellular Microbiology Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, RJ Brazil, 21040-360
| | - Maria Cristina Vidal Pessolani
- Cellular Microbiology Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, RJ Brazil, 21040-360
| | - Cristiana Santos de Macedo
- Cellular Microbiology Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, RJ Brazil, 21040-360
- Center for Technological Development in Health (CDTS), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, RJ Brazil, 21040-361
| | - John T. Belisle
- Mycobacteria Research Laboratories, Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins, CO, USA, 80523
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Marçal PHF, Gama RS, Pereira de Oliveira LB, Martins-Filho OA, Pinheiro RO, Sarno EN, Moraes MO, de Oliveira Fraga LA. Functional biomarker signatures of circulating T-cells and its association with distinct clinical status of leprosy patients and their respective household contacts. Infect Dis Poverty 2020; 9:167. [PMID: 33341111 PMCID: PMC7749990 DOI: 10.1186/s40249-020-00763-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 10/14/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Leprosy is a chronic infectious disease classified into two subgroups for therapeutic purposes: paucibacillary (PB) and multibacillary (MB), closely related to the host immune responses. In this context it is noteworthy looking for immunological biomarkers applicable as complementary diagnostic tools as well as a laboratorial strategy to follow-up leprosy household contacts. METHODS The cross-sectional study enrolled 49 participants, including 19 patients and 30 healthy controls. Peripheral blood mononuclear cells (PBMC) were isolated and incubated in the presence of Mycobacterium leprae bacilli. The cells were prepared for surface (CD4+ and CD8+) and intracytoplasmic cytokine staining (IFN-γ, IL-4 and IL-10). Multiple comparisons amongst groups were carried out by ANOVA, Kruskal-Wallis, Student T or Mann-Whitney test. Comparative analysis of categorical variables was performed by Chi-square. Functional biomarker signature analysis was conducted using the global median values for each biomarker index as the cut-off edge to identify the proportion of subjects with high biomarker levels. RESULTS The cytokine signature analysis demonstrated that leprosy patients presented a polyfunctional profile of T-cells subsets, with increased frequency of IFN-γ+ T-cell subsets along with IL-10+ and IL-4+ from CD4+ T-cells, as compared to health Controls (Venn diagram report). Moreover, statistical analysis was carried out using parametric or non-parametric variance analysis followed by pairwise multiple comparisons, according to the data normality distribution. L(PB) displayed a polyfunctional profile characterized by enhanced percentage of IFN-γ+, IL-10+ and IL-4+ produced by most T-cell subsets, as compared to L(MB) that presented a more restricted cytokine functional profile mediated by IL-10+ and IL-4+ T-cells with minor contribution of IFN-γ produced by CD4+ T-cells. Noteworthy was that HHC(MB) exhibited enhanced frequency of IFN-γ+ T-cells, contrasting with HHC(PB) that presented a cytokine profile limited to IL-10 and IL-4. CONCLUSIONS Our data demonstrated that L(PB) displayed enhanced percentage of IFN-γ+, IL-10+ and IL-4+ as compared to L(MB) that presented functional profile mediated by IL-10+ and IL-4+ T-cells and HHC(MB) exhibited enhanced frequency of IFN-γ+ T-cells, contrasting with HHC(PB). Together, our findings provide additional immunological features associated with leprosy and household contacts. These data provide evidence that biomarkers of immune response can be useful complementary diagnostic/prognostic tools as well as insights that household contacts should be monitored to access putative subclinical infection.
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Affiliation(s)
| | - Rafael Silva Gama
- Universidade Vale do Rio Doce - Univale, Governador Valadares, MG, Brazil
| | | | - Olindo Assis Martins-Filho
- Grupo Integrado de Pesquisas em Biomarcadores, Instituto René Rachou, FIOCRUZ-Minas, Belo Horizonte, MG, Brazil
| | - Roberta Olmo Pinheiro
- Laboratório de Hanseníase, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz -FIOCRUZ-RJ, Rio de Janeiro, RJ, Brazil
| | - Euzenir Nunes Sarno
- Laboratório de Hanseníase, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz -FIOCRUZ-RJ, Rio de Janeiro, RJ, Brazil
| | - Milton Ozório Moraes
- Laboratório de Hanseníase, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz -FIOCRUZ-RJ, Rio de Janeiro, RJ, Brazil
| | - Lucia Alves de Oliveira Fraga
- Núcleo de Pesquisa em Hansenologia, Universidade Federal de Juiz de Fora, Instituto de Ciências da Vida, Campus Governador Valadares, Rua São Paulo, 582 - Centro, Governador Valadares, MG, 30190-002, Brazil.
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Kromer C, Fabri M, Schlapbach C, Schulze MH, Groß U, Schön MP, Buhl T. Diagnosis of mycobacterial skin infections. J Dtsch Dermatol Ges 2019; 17:889-893. [PMID: 31475786 DOI: 10.1111/ddg.13925] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 03/27/2019] [Indexed: 11/29/2022]
Abstract
The diagnosis of cutaneous mycobacterial infections may be challenging. Owing to the broad spectrum of their clinical presentations, mycobacterioses have to be considered as differential diagnoses to many inflammatory dermatoses. Diagnostic measures comprise histology including special staining, cultures and molecular microbiological examinations as well as the detection of cellular immune reactions of the patient by means of interferon-γ release assays and skin testing. Clinicians should know the appropriate use and combination of procedures to diagnose mycobacterioses quickly and correctly and to avoid costs and delays caused by unnecessary examinations. This mini review summarizes advantages, limitations, and pitfalls of diagnostic methods for mycobacterial skin infections.
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Affiliation(s)
- Christian Kromer
- Department of Dermatology, Venereology, and Allergology, University Medical Center, Göttingen, Germany
| | - Mario Fabri
- Department of Dermatology, University of Cologne, Cologne, Germany
| | - Christoph Schlapbach
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Marco H Schulze
- Institute for Medical Microbiology, University Medical Center Göttingen, Germany
| | - Uwe Groß
- Institute for Medical Microbiology, University Medical Center Göttingen, Germany
| | - Michael P Schön
- Department of Dermatology, Venereology, and Allergology, University Medical Center, Göttingen, Germany.,Lower Saxony Institute of Occupational Dermatology, University Medical Center Göttingen, Germany
| | - Timo Buhl
- Department of Dermatology, Venereology, and Allergology, University Medical Center, Göttingen, Germany.,Lower Saxony Institute of Occupational Dermatology, University Medical Center Göttingen, Germany
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Kromer C, Fabri M, Schlapbach C, Schulze MH, Groß U, Schön MP, Buhl T. Diagnose mykobakterieller Hautinfektionen. J Dtsch Dermatol Ges 2019; 17:889-894. [PMID: 31538725 DOI: 10.1111/ddg.13925_g] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 03/27/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Christian Kromer
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - Mario Fabri
- Klinik für Dermatologie und Venerologie, Universität Köln, Köln, Deutschland
| | - Christoph Schlapbach
- Klinik für Dermatologie, Inselspital, Universitätsklinikum Bern, Universität Bern, Bern, Schweiz
| | - Marco H Schulze
- Institut für Medizinische Mikrobiologie, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - Uwe Groß
- Institut für Medizinische Mikrobiologie, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - Michael P Schön
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsmedizin Göttingen, Göttingen, Deutschland.,Niedersächsisches Institut für Berufsdermatologie, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - Timo Buhl
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsmedizin Göttingen, Göttingen, Deutschland.,Niedersächsisches Institut für Berufsdermatologie, Universitätsmedizin Göttingen, Göttingen, Deutschland
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Chen X, You YG, Yuan YH, Yuan LC, Wen Y. Host immune responses induced by specific Mycobacterium leprae antigens in an overnight whole-blood assay correlate with the diagnosis of paucibacillary leprosy patients in China. PLoS Negl Trop Dis 2019; 13:e0007318. [PMID: 31017900 PMCID: PMC6481774 DOI: 10.1371/journal.pntd.0007318] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Accepted: 03/20/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Leprosy, caused by Mycobacterium leprae, affects over 200,000 people annually worldwide and remains endemic in the ethnically diverse, mountainous and underdeveloped southwestern provinces of China. Delayed diagnosis of leprosy persists in China, thus, additional knowledge to support early diagnosis, especially early diagnosis of paucibacillary (PB) patients, based on the host immune responses induced by specific M. leprae antigens is needed. The current study aimed to investigate leprosy patients and controls in Southwest China by comparing supernatants after stimulation with specific M. leprae antigens in an overnight whole-blood assay (WBA) to determine whether host markers induced by specific M. leprae antigens improve the diagnosis or discrimination of PB patients with leprosy. METHODOLOGY/PRINCIPAL FINDINGS Leprosy patients [13 multibacillary (MB) patients and 7 PB patients] and nonleprosy controls [21 healthy household contacts (HHCs), 20 endemic controls (ECs) and 19 tuberculosis (TB) patients] were enrolled in this study. The supernatant levels of ten host markers stimulated by specific M. leprae antigens were evaluated by overnight WBA and multiplex Luminex assays. The diagnostic value in PB patients and ECs and the discriminatory value between PB patients and HHCs or TB patients were evaluated by receiver operator characteristics (ROC) analysis. ML2044-stimulated CXCL8/IL-8 achieved the highest sensitivity of 100%, with a specificity of 73.68%, for PB diagnosis. Compared to single markers, a 3-marker combination model that included ML2044-induced CXCL8/IL-8, CCL4/MIP-1 beta, and IL-6 improved the diagnostic specificity to 94.7% for PB patients. ML2044-stimulated IL-4 and CXCL8/IL-8 achieved the highest sensitivity (85.71% and 100%) and the highest specificity (95.24% and 84.21%) for discriminating PB patients from HHCs and TB patients, respectively. CONCLUSIONS Our findings suggest that the host markers induced by specific M. leprae antigens in an overnight WBA increase diagnostic and discriminatory value in PB patients with leprosy, with a particularly strong association with interleukin 8.
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Affiliation(s)
- Xiaohua Chen
- Beijing Tropical Medicine Research Institute, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory for Research on Prevention and Treatment of Tropical Diseases, Capital Medical University, Beijing, China
- * E-mail: (XC); (YW)
| | - Yuan-Gang You
- Beijing Tropical Medicine Research Institute, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory for Research on Prevention and Treatment of Tropical Diseases, Capital Medical University, Beijing, China
| | - You-Hua Yuan
- Department of Laboratory, Henan Provincial People’s Hospital, Zhengzhou, Henan, China
| | - Lian C. Yuan
- Beijing Tropical Medicine Research Institute, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory for Research on Prevention and Treatment of Tropical Diseases, Capital Medical University, Beijing, China
| | - Yan Wen
- Beijing Tropical Medicine Research Institute, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory for Research on Prevention and Treatment of Tropical Diseases, Capital Medical University, Beijing, China
- * E-mail: (XC); (YW)
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Freitas AA, Hungria EM, Costa MB, Sousa ALOM, Castilho MLO, Gonçalves HS, Pontes MAA, Duthie MS, Stefani MMA. Application of Mycobacterium Leprae-specific cellular and serological tests for the differential diagnosis of leprosy from confounding dermatoses. Diagn Microbiol Infect Dis 2016; 86:163-8. [PMID: 27506457 DOI: 10.1016/j.diagmicrobio.2016.07.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 07/13/2016] [Accepted: 07/21/2016] [Indexed: 10/21/2022]
Abstract
Mycobacterium leprae-specific serological and cell-mediated-immunity/CMI test were evaluated for the differential diagnosis of multibacillary/MB, and paucibacillary/PB leprosy from other dermatoses. Whole-blood assay/WBA/IFNγ stimulated with LID-1 antigen and ELISA tests for IgG to LID-1 and IgM to PGL-I were performed. WBA/LID-1/IFNγ production was observed in 72% PB, 11% MB leprosy, 38% dermatoses, 40% healthy endemic controls/EC. The receiver operating curve/ROC for WBA/LID-1 in PB versus other dermatoses showed 72.5% sensitivity, 61.5% specificity and an area-under-the-curve/AUC=0.75; 74% positive predictive value/PPV, 59% negative predictive value/NPV. Anti PGL-I serology was positive in 67% MB, 8% PB leprosy, 6% of other dermatoses; its sensitivity for MB=66%, specificity=93%, AUC=0.89; PPV=91%, NPV=72%. Anti-LID-1 serology was positive in 87% MB, 7% PB leprosy, all other participants were seronegative; 87.5% sensitivity for MB, 100% specificity, AUC=0.97; PPV=100%, NPV=88%. In highly endemic areas anti-LID-1/PGL-I serology and WBA/LID-1-represent useful tools for the differential diagnosis of leprosy from other confounding dermatoses.
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Affiliation(s)
- Aline Araújo Freitas
- Tropical Pathology and Public Health Institute, Federal University of Goiás, Goiânia, Brazil
| | - Emerith Mayra Hungria
- Tropical Pathology and Public Health Institute, Federal University of Goiás, Goiânia, Brazil
| | - Maurício Barcelos Costa
- Tropical Pathology and Public Health Institute, Federal University of Goiás, Goiânia, Brazil
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Khadge S, Banu S, Bobosha K, van der Ploeg-van Schip JJ, Goulart IM, Thapa P, Kunwar CB, van Meijgaarden KE, van den Eeden SJF, Wilson L, Kabir S, Dey H, Goulart LR, Lobato J, Carvalho W, Bekele Y, Franken KLMC, Aseffa A, Spencer JS, Oskam L, Otttenhoff THM, Hagge DA, Geluk A. Longitudinal immune profiles in type 1 leprosy reactions in Bangladesh, Brazil, Ethiopia and Nepal. BMC Infect Dis 2015; 15:477. [PMID: 26510990 PMCID: PMC4625471 DOI: 10.1186/s12879-015-1128-0] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Accepted: 09/18/2015] [Indexed: 12/30/2022] Open
Abstract
Background Acute inflammatory reactions are a frequently occurring, tissue destructing phenomenon in infectious- as well as autoimmune diseases, providing clinical challenges for early diagnosis. In leprosy, an infectious disease initiated by Mycobacterium leprae (M. leprae), these reactions represent the major cause of permanent neuropathy. However, laboratory tests for early diagnosis of reactional episodes which would significantly contribute to prevention of tissue damage are not yet available. Although classical diagnostics involve a variety of tests, current research utilizes limited approaches for biomarker identification. In this study, we therefore studied leprosy as a model to identify biomarkers specific for inflammatory reactional episodes. Methods To identify host biomarker profiles associated with early onset of type 1 leprosy reactions, prospective cohorts including leprosy patients with and without reactions were recruited in Bangladesh, Brazil, Ethiopia and Nepal. The presence of multiple cyto-/chemokines induced by M. leprae antigen stimulation of peripheral blood mononuclear cells as well as the levels of antibodies directed against M. leprae-specific antigens in sera, were measured longitudinally in patients. Results At all sites, longitudinal analyses showed that IFN-γ-, IP-10-, IL-17- and VEGF-production by M. leprae (antigen)-stimulated PBMC peaked at diagnosis of type 1 reactions, compared to when reactions were absent. In contrast, IL-10 production decreased during type 1 reaction while increasing after treatment. Thus, ratios of these pro-inflammatory cytokines versus IL-10 provide useful tools for early diagnosing type 1 reactions and evaluating treatment. Of further importance for rapid diagnosis, circulating IP-10 in sera were significantly increased during type 1 reactions. On the other hand, humoral immunity, characterized by M. leprae-specific antibody detection, did not identify onset of type 1 reactions, but allowed treatment monitoring instead. Conclusions This study identifies immune-profiles as promising host biomarkers for detecting intra-individual changes during acute inflammation in leprosy, also providing an approach for other chronic (infectious) diseases to help early diagnose these episodes and contribute to timely treatment and prevention of tissue damage. Electronic supplementary material The online version of this article (doi:10.1186/s12879-015-1128-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Saraswoti Khadge
- Mycobacterial Research Laboratories, Anandaban Hospital, Kathmandu, Nepal.
| | - Sayera Banu
- International Center for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh.
| | - Kidist Bobosha
- Dept. of Infectious Diseases, Leiden University Medical Center (LUMC), PO Box 9600, 2300 RC, Leiden, The Netherlands. .,Armauer Hansen Research Institute, Addis Ababa, Ethiopia.
| | | | - Isabela M Goulart
- National Reference Center for Sanitary Dermatology and Leprosy, Faculty of Medicine, Federal University of Uberlandia, Minas Gerais, Brazil.
| | - Pratibha Thapa
- Mycobacterial Research Laboratories, Anandaban Hospital, Kathmandu, Nepal.
| | - Chhatra B Kunwar
- Mycobacterial Research Laboratories, Anandaban Hospital, Kathmandu, Nepal.
| | - Krista E van Meijgaarden
- Dept. of Infectious Diseases, Leiden University Medical Center (LUMC), PO Box 9600, 2300 RC, Leiden, The Netherlands.
| | - Susan J F van den Eeden
- Dept. of Infectious Diseases, Leiden University Medical Center (LUMC), PO Box 9600, 2300 RC, Leiden, The Netherlands.
| | - Louis Wilson
- International Center for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh.
| | - Senjuti Kabir
- International Center for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh.
| | - Hymonti Dey
- International Center for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh.
| | - Luiz R Goulart
- National Reference Center for Sanitary Dermatology and Leprosy, Faculty of Medicine, Federal University of Uberlandia, Minas Gerais, Brazil.
| | - Janaina Lobato
- National Reference Center for Sanitary Dermatology and Leprosy, Faculty of Medicine, Federal University of Uberlandia, Minas Gerais, Brazil.
| | - Washington Carvalho
- National Reference Center for Sanitary Dermatology and Leprosy, Faculty of Medicine, Federal University of Uberlandia, Minas Gerais, Brazil.
| | - Yonas Bekele
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia.
| | - Kees L M C Franken
- Dept. of Infectious Diseases, Leiden University Medical Center (LUMC), PO Box 9600, 2300 RC, Leiden, The Netherlands.
| | - Abraham Aseffa
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia.
| | - John S Spencer
- Dept. of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, USA.
| | - Linda Oskam
- National Reference Center for Sanitary Dermatology and Leprosy, Faculty of Medicine, Federal University of Uberlandia, Minas Gerais, Brazil.
| | - Tom H M Otttenhoff
- Dept. of Infectious Diseases, Leiden University Medical Center (LUMC), PO Box 9600, 2300 RC, Leiden, The Netherlands.
| | - Deanna A Hagge
- Mycobacterial Research Laboratories, Anandaban Hospital, Kathmandu, Nepal.
| | - Annemieke Geluk
- Dept. of Infectious Diseases, Leiden University Medical Center (LUMC), PO Box 9600, 2300 RC, Leiden, The Netherlands.
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Analysis of antigens of Mycobacterium leprae by interaction to sera IgG, IgM, and IgA response to improve diagnosis of leprosy. BIOMED RESEARCH INTERNATIONAL 2014; 2014:283278. [PMID: 25101267 PMCID: PMC4102069 DOI: 10.1155/2014/283278] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 05/21/2014] [Accepted: 06/09/2014] [Indexed: 02/08/2023]
Abstract
Till 2010, several countries have declared less than one leprosy patient among population of 10,000 and themselves feeling as eliminated from leprosy cases. However, new leprosy cases are still appearing from all these countries. In this situation one has to be confident to diagnose leprosy. This review paper highlighted already explored antigens for diagnosis purposes and finally suggested better combinations of protein antigens of M. leprae versus immunoglobulin as detector antibody to be useful for leprosy diagnosis.
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Bobosha K, Tjon Kon Fat EM, van den Eeden SJF, Bekele Y, van der Ploeg-van Schip JJ, de Dood CJ, Dijkman K, Franken KLMC, Wilson L, Aseffa A, Spencer JS, Ottenhoff THM, Corstjens PLAM, Geluk A. Field-evaluation of a new lateral flow assay for detection of cellular and humoral immunity against Mycobacterium leprae. PLoS Negl Trop Dis 2014; 8:e2845. [PMID: 24810599 PMCID: PMC4014418 DOI: 10.1371/journal.pntd.0002845] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Accepted: 03/24/2014] [Indexed: 11/18/2022] Open
Abstract
Background Field-applicable tests detecting asymptomatic Mycobacterium leprae (M. leprae) infection or predicting progression to leprosy, are urgently required. Since the outcome of M. leprae infection is determined by cellular- and humoral immunity, we aim to develop diagnostic tests detecting pro-/anti-inflammatory and regulatory cytokines as well as antibodies against M. leprae. Previously, we developed lateral flow assays (LFA) for detection of cytokines and anti-PGL-I antibodies. Here we evaluate progress of newly developed LFAs for applications in resource-poor settings. Methods The combined diagnostic value of IP-10, IL-10 and anti-PGL-I antibodies was tested using M. leprae-stimulated blood of leprosy patients and endemic controls (EC). For reduction of the overall test-to-result time the minimal whole blood assay time required to detect distinctive responses was investigated. To accommodate LFAs for field settings, dry-format LFAs for IP-10 and anti-PGL-I antibodies were developed allowing storage and shipment at ambient temperatures. Additionally, a multiplex LFA-format was applied for simultaneous detection of anti-PGL-I antibodies and IP-10. For improved sensitivity and quantitation upconverting phosphor (UCP) reporter technology was applied in all LFAs. Results Single and multiplex UCP-LFAs correlated well with ELISAs. The performance of dry reagent assays and portable, lightweight UCP-LF strip readers indicated excellent field-robustness. Notably, detection of IP-10 levels in stimulated samples allowed a reduction of the whole blood assay time from 24 h to 6 h. Moreover, IP-10/IL-10 ratios in unstimulated plasma differed significantly between patients and EC, indicating the feasibility to identify M. leprae infection in endemic areas. Conclusions Dry-format UCP-LFAs are low-tech, robust assays allowing detection of relevant cytokines and antibodies in response to M. leprae in the field. The high levels of IP-10 and the required shorter whole blood assay time, render this cytokine useful to discriminate between leprosy patients and EC. Leprosy is one of the six diseases considered by WHO as a major threat in developing countries and often results in severe, life-long disabilities and deformities due to delayed diagnosis. Early detection of Mycobacterium leprae (M. leprae) infection, followed by effective interventions, is considered vital to interrupt transmission. Thus, field-friendly tests that detect asymptomatic M. leprae infection are urgently required. The clinical outcome after M. leprae infection is determined by the balance of pro- and anti-inflammatory cytokines and antibodies in response to M. leprae. In this study, we developed lateral flow assays (LFA) for detection of pro-inflammatory (IP-10) vs. anti-inflammatory/regulatory (IL-10) cellular immunity as well as antibodies against M. leprae and evaluated these in a field setting in Ethiopia using lightweight, portable readers. We show that detection of IP-10 allowed a significant reduction of the overall test-to-result time from 24 h to 6 h. Moreover, IP-10/IL-10 ratios in unstimulated plasma differed significantly between patients and EC, which can provide means to identify M. leprae infection. Thus, the LFAs are low-tech, robust assays that can be applied in resource-poor settings measuring immunity to M. leprae and can be used as tools for early diagnosis of leprosy leading to timely treatment and reduced transmission.
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Affiliation(s)
- Kidist Bobosha
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Elisa M. Tjon Kon Fat
- Department of Molecular Cell Biology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Yonas Bekele
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | | | - Claudia J. de Dood
- Department of Molecular Cell Biology, Leiden University Medical Center, Leiden, The Netherlands
| | - Karin Dijkman
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands
| | - Kees L. M. C. Franken
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands
| | - Louis Wilson
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands
| | - Abraham Aseffa
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - John S. Spencer
- Department of Microbiology, Immunology & Pathology, Colorado State University, Fort Collins, Colorado, United States of America
| | - Tom H. M. Ottenhoff
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands
| | - Paul L. A. M. Corstjens
- Department of Molecular Cell Biology, Leiden University Medical Center, Leiden, The Netherlands
| | - Annemieke Geluk
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands
- * E-mail:
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Bobosha K, Tang ST, van der Ploeg-van Schip JJ, Bekele Y, Martins MVSB, Lund O, Franken KLMC, Khadge S, Pontes MADA, Gonçalves HDS, Hussien J, Thapa P, Kunwar CB, Hagge DA, Aseffa A, Pessolani MCV, Pereira GMB, Ottenhoff THM, Geluk A. Mycobacterium leprae virulence-associated peptides are indicators of exposure to M. leprae in Brazil, Ethiopia and Nepal. Mem Inst Oswaldo Cruz 2013; 107 Suppl 1:112-23. [PMID: 23283462 DOI: 10.1590/s0074-02762012000900018] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Accepted: 07/03/2012] [Indexed: 12/13/2022] Open
Abstract
Silent transmission of Mycobacterium leprae, as evidenced by stable leprosy incidence rates in various countries, remains a health challenge despite the implementation of multidrug therapy worldwide. Therefore, the development of tools for the early diagnosis of M. leprae infection should be emphasised in leprosy research. As part of the continuing effort to identify antigens that have diagnostic potential, unique M. leprae peptides derived from predicted virulence-associated proteins (group IV.A) were identified using advanced genome pattern programs and bioinformatics. Based on human leukocyte antigen (HLA)-binding motifs, we selected 21 peptides that were predicted to be promiscuous HLA-class I T-cell epitopes and eight peptides that were predicted to be HLA-class II restricted T-cell epitopes for field-testing in Brazil, Ethiopia and Nepal. High levels of interferon (IFN)-γ were induced when peripheral blood mononuclear cells (PBMCs) from tuberculoid/borderline tuberculoid leprosy patients located in Brazil and Ethiopia were stimulated with the ML2055 p35 peptide. PBMCs that were isolated from healthy endemic controls living in areas with high leprosy prevalence (EChigh) in Ethiopia also responded to the ML2055 p35 peptide. The Brazilian EChigh group recognised the ML1358 p20 and ML1358 p24 peptides. None of the peptides were recognised by PBMCs from healthy controls living in non-endemic region. In Nepal, mixtures of these peptides induced the production of IFN-γ by the PBMCs of leprosy patients and EChigh. Therefore, the M. leprae virulence-associated peptides identified in this study may be useful for identifying exposure to M. leprae in population with differing HLA polymorphisms.
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Affiliation(s)
- Kidist Bobosha
- Department of Infectious Diseases, University Medical Center, Leiden, The Netherlands
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Sarno EN, Duppre NC, Sales AM, Hacker MA, Nery JA, de Matos HJ. Leprosy exposure, infection and disease: a 25-year surveillance study of leprosy patient contacts. Mem Inst Oswaldo Cruz 2013; 107:1054-9. [PMID: 23295758 DOI: 10.1590/s0074-02762012000800015] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Accepted: 07/25/2012] [Indexed: 11/21/2022] Open
Abstract
Contact surveillance is a valuable strategy for controlling leprosy. A dynamic cohort study of leprosy contacts was initiated in 1987 at Oswaldo Cruz Foundation. The objective of this work was to review the data on the major risk factors leading up to the infectious stage of the disease, estimate incidence rates of leprosy in the cohort and characterise the risk factors for the disease among the contacts under surveillance. The incidence rate of leprosy among contacts of leprosy patients was estimated at 0.01694 cases per person-year in the first five years of follow-up. The following factors were associated with acquiring the disease: (i) not receiving the BCG vaccine, (ii) a negative Mitsuda reaction and (iii) contact with a patient with a multibacillary clinical form of leprosy. The contacts of index patients who had high bacilloscopic index scores > 1 were at especially high risk of infection. The following factors were associated with infection, which was defined as a seropositive reaction for anti-phenolic glicolipid-1 IgM: (i) young age (< 20 years), (ii) a low measured Mitsuda reaction (< 5 mm) and (iii) contact with an index patient who had a high bacilloscopic index. BCG vaccination and re-vaccination were shown to be protective among household contacts. The main conclusions of this study indicate an urgent need for additional leprosy control strategies in areas with a high incidence of the disease.
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Affiliation(s)
- Euzenir Nunes Sarno
- Laboratório de Hansenologia, Instituto Oswaldo Cruz, Fiocruz, Rio de Janeiro, RJ, Brasil.
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Geluk A, Bobosha K, van der Ploeg-van Schip JJ, Spencer JS, Banu S, Martins MVSB, Cho SN, Franken KLMC, Kim HJ, Bekele Y, Uddin MKM, Hadi SA, Aseffa A, Pessolani MCV, Pereira GMB, Dockrell HM, Ottenhoff THM. New biomarkers with relevance to leprosy diagnosis applicable in areas hyperendemic for leprosy. THE JOURNAL OF IMMUNOLOGY 2012; 188:4782-91. [PMID: 22504648 DOI: 10.4049/jimmunol.1103452] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Leprosy is not eradicable with currently available diagnostics or interventions, as evidenced by its stable incidence. Early diagnosis of Mycobacterium leprae infection should therefore be emphasized in leprosy research. It remains challenging to develop tests based on immunological biomarkers that distinguish individuals controlling bacterial replication from those developing disease. To identify biomarkers for field-applicable diagnostics, we determined cytokines/chemokines induced by M. leprae proteins in blood of leprosy patients and endemic controls (EC) from high leprosy-prevalence areas (Bangladesh, Brazil, Ethiopia) and from South Korea, where leprosy is not endemic anymore. M. leprae-sonicate-induced IFN-γ was similar for all groups, excluding M. leprae/IFN-γ as a diagnostic readout. By contrast, ML2478 and ML0840 induced high IFN-γ concentrations in Bangladeshi EC, which were completely absent for South Korean controls. Importantly, ML2478/IFN-γ could indicate distinct degrees of M. leprae exposure, and thereby the risk of infection and transmission, in different parts of Brazilian and Ethiopian cities. Notwithstanding these discriminatory responses, M. leprae proteins did not distinguish patients from EC in one leprosy-endemic area based on IFN-γ. Analyses of additional cytokines/chemokines showed that M. leprae and ML2478 induced significantly higher concentrations of MCP-1, MIP-1β, and IL-1β in patients compared with EC, whereas IFN-inducible protein-10, like IFN-γ, differed between EC from areas with dissimilar leprosy prevalence. This study identifies M. leprae-unique Ags, particularly ML2478, as biomarker tools to measure M. leprae exposure using IFN-γ or IFN-inducible protein-10, and also shows that MCP-1, MIP-1β, and IL-1β can potentially distinguish pathogenic immune responses from those induced during asymptomatic exposure to M. leprae.
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Affiliation(s)
- Annemieke Geluk
- Department of Infectious Diseases, Leiden University Medical Center, Leiden 2333 ZA, The Netherlands.
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