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In silico designing of a recombinant multi-epitope antigen for leprosy diagnosis. J Genet Eng Biotechnol 2022; 20:128. [PMID: 36053342 PMCID: PMC9440174 DOI: 10.1186/s43141-022-00411-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 08/25/2022] [Indexed: 11/29/2022]
Abstract
Background Leprosy
is caused by Mycobacterium leprae and Mycobacterium lepromatosis. Most of the affected population lives in low-income countries and may take up to 10 years to show any clinical signs, which is how physicians diagnose it. However, due to progressive cell damage, early diagnosis is very important. The best way to confirm leprosy is through bacilloscopic, which only confirms the diagnosis and has low accuracy or PCR, that requires specialized operators and is expensive. Since the bacteria are fastidious and do not grow in any culture media, therefore, diagnosing leprosy in the lab is still a challenge. In this concern, a recombinant multi-epitope protein can be a beneficial strategy in the management of the diagnosis, as diverse immunogenic epitopes are precisely selected to detect specific antibodies. Therefore, the purposes of the present study were to select immunogenic epitopes from different relevant proteins, with immunogenic properties, and then to construct a recombinant multi-epitope protein that accuses the presence of the antibodies in the early stages of the disease, making it more than appropriate to be applied as a diagnostic tool. Results We selected 22 common proteins from both species and, using bioinformatics tools, predicted B and T cell epitopes. After multiple filtering and analyzing, we ended up with 29 epitopes {MHC-I (total 18) and MHC-II (total 11)} from 10 proteins, which were then merged into one construct. Its secondary and tertiary structures were also predicted and refined to comprise the amino acid residues in the best conformation possible. The multi-epitope protein construct was stable, non-host homologous, non-allergic, non-toxic, and elicit humoral and cellular responses. It has conformational B cell epitopes and potential to elicit IFN-γ, IL-4, and IL-10 secretion. Conclusions This novel recombinant multi-epitope protein constructed using the common epitopes from M. leprae and M. lepromatosis has a huge immunological potential, is stable, and can be lyophilized to be used in ELISA plates or even in biosensors, which are user-friendly diagnosis tools, facilitating translation into human sample tests. Supplementary Information The online version contains supplementary material available at 10.1186/s43141-022-00411-7.
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2
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Deps P, Collin SM, de Andrade VLG. Hansen's disease case detection in Brazil: a backlog of undiagnosed cases due to COVID-19 pandemic. J Eur Acad Dermatol Venereol 2022; 36:e754-e755. [PMID: 35680545 PMCID: PMC9347646 DOI: 10.1111/jdv.18307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 05/30/2022] [Indexed: 11/30/2022]
Affiliation(s)
- P Deps
- Department of Social Medicine, Federal University of Espírito Santo, Vitória, Brazil.,Postgraduate Programme in Infectious Diseases, Federal University of Espírito Santo, Vitória, Brazil
| | - S M Collin
- Department of Social Medicine, Federal University of Espírito Santo, Vitória, Brazil.,Postgraduate Programme in Infectious Diseases, Federal University of Espírito Santo, Vitória, Brazil
| | - V L G de Andrade
- Secretaria de Estado da Saúde do Espírito Santo (SESA), Vitória, Brazil
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Marçal PHF, de Souza MLM, Gama RS, de Oliveira LBP, de Souza Gomes M, do Amaral LR, Pinheiro RO, Sarno EN, Moraes MO, Fairley JK, Martins-Filho OA, de Oliveira Fraga LA. Algorithm design for a cytokine release assay of antigen-specific in vitro stimuli of circulating leukocytes to classify leprosy patients and household contacts. Open Forum Infect Dis 2022; 9:ofac036. [PMID: 35169594 PMCID: PMC8842339 DOI: 10.1093/ofid/ofac036] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 01/27/2022] [Indexed: 11/13/2022] Open
Abstract
Background Immunological biomarkers have often been used as a complementary approach to support clinical diagnosis in several infectious diseases. The lack of commercially available laboratory tests for conclusive early diagnosis of leprosy has motivated the search for novel methods for accurate diagnosis. In the present study, we describe an integrated analysis of a cytokine release assay using a machine learning approach to create a decision tree algorithm. This algorithm was used to classify leprosy clinical forms and monitor household contacts. Methods A model of Mycobacterium leprae antigen-specific in vitro assay with subsequent cytokine measurements by enzyme-linked immunosorbent assay was employed to measure the levels of tumor necrosis factor (TNF), interferon-γ, interleukin 4, and interleukin 10 (IL-10) in culture supernatants of peripheral blood mononuclear cells from patients with leprosy, healthy controls, and household contacts. Receiver operating characteristic curve analysis was carried out to define each cytokine’s global accuracy and performance indices to identify clinical subgroups. Results Data demonstrated that TNF (control culture [CC]: AUC = 0.72; antigen-stimulated culture [Ml]: AUC = 0.80) and IL-10 (CC: AUC = 0.77; Ml: AUC = 0.71) were the most accurate biomarkers to classify subgroups of household contacts and patients with leprosy, respectively. Decision tree classifier algorithms for TNF analysis categorized subgroups of household contacts according to the operational classification with moderate accuracy (CC: 79% [48/61]; Ml: 84% [51/61]). Additionally, IL-10 analysis categorized leprosy patients’ subgroups with moderate accuracy (CC: 73% [22/30] and Ml: 70% [21/30]). Conclusions Together, our findings demonstrated that a cytokine release assay is a promising method to complement clinical diagnosis, ultimately contributing to effective control of the disease.
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Affiliation(s)
| | - Márcio Luís Moreira de Souza
- Programa Multicêntrio de Bioquímica e Biologia Molecular-Núcleo de Pesquisa em Hansenologia – Universidade Federal de Juiz de Fora, Instituto de Ciências da Vida, Campus Governador Valadares, MG, Brazil
| | - Rafael Silva Gama
- Universidade Vale do Rio Doce – Univale, Governador Valadares, MG, Brazil
| | | | - Matheus de Souza Gomes
- Laboratório de Bioinformática e Análises Moleculares, Universidade Federal de Uberlândia, INGEB/FACOM, Campus Patos de Minas, Patos de Minas, MG, Brazil
| | - Laurence Rodrigues do Amaral
- Laboratório de Bioinformática e Análises Moleculares, Universidade Federal de Uberlândia, INGEB/FACOM, Campus Patos de Minas, Patos de Minas, 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
| | - Jessica K Fairley
- Division of Infectious Diseases, Department of Medicine, Emory University, School of Medicine, Atlanta, GA, United States of America
| | | | - Lucia Alves de Oliveira Fraga
- Programa Multicêntrio de Bioquímica e Biologia Molecular-Núcleo de Pesquisa em Hansenologia – Universidade Federal de Juiz de Fora, Instituto de Ciências da Vida, Campus Governador Valadares, MG, Brazil
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4
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BCG-induced immunity profiles in household contacts of leprosy patients differentiate between protection and disease. Vaccine 2021; 39:7230-7237. [PMID: 34688497 DOI: 10.1016/j.vaccine.2021.10.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 08/26/2021] [Accepted: 10/12/2021] [Indexed: 11/20/2022]
Abstract
Leprosy is an infectious disease caused by Mycobacterium leprae leading to irreversible disabilities along with social exclusion. Leprosy is a spectral disease for which the clinical outcome after M. leprae infection is determined by host factors. The spectrum spans from anti-inflammatory T helper-2 (Th2) immunity concomitant with large numbers of bacteria as well as antibodies against M. leprae antigens in multibacillary (MB) leprosy, to paucibacillary (PB) leprosy characterised by strong pro-inflammatory, Th1 as well as Th17 immunity. Despite decades of availability of adequate antibiotic treatment, transmission of M. leprae is unabated. Since individuals with close and frequent contact with untreated leprosy patients are particularly at risk to develop the disease themselves, prophylactic strategies currently focus on household contacts of newly diagnosed patients. It has been shown that BCG (re)vaccination can reduce the risk of leprosy. However, BCG immunoprophylaxis in contacts of leprosy patients has also been reported to induce PB leprosy, indicating that BCG (re)vaccination may tip the balance between protective immunity and overactivation immunity causing skin/nerve tissue damage. In order to identify who is at risk of developing PB leprosy after BCG vaccination, amongst individuals who are chronically exposed to M. leprae, we analyzed innate and adaptive immune markers in whole blood of household contacts of newly diagnosed leprosy patients in Bangladesh, some of which received BCG vaccination. As controls, individuals from the same area without known contact with leprosy patients were similarly assessed. Our data show the added effect of BCG vaccination on immune markers on top of the effect already induced by M. leprae exposure. Moreover, we identified BCG-induced markers that differentiate between protective and disease prone immunity in those contacts.
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Swain SS, Sahoo G, Mahapatra PK, Panda SK. Disease burden and current therapeutical status of leprosy with special emphasis on phytochemicals. Curr Top Med Chem 2021; 22:1611-1625. [PMID: 34503409 DOI: 10.2174/1568026621666210909162435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 08/05/2021] [Accepted: 08/28/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Leprosy (Hansen's disease) is a neglected tropical disease affecting millions of people globally. The combined formulations of dapsone, rifampicin and clofazimine (multidrug therapy, MDT) is only supportive in the early stage of detection, while "reemergence" is a significant problem. There is still a need to develop newer antileprosy molecules either of natural or (semi)synthetic origin. OBJECTIVE The review intends to present the latest developments in the disease prevalence, available therapeutic interventions and the possibility of identifying new molecules from phytoextracts. METHODS Literature on the use of plant extracts and their active components to treat leprosy was searched. Selected phytoconstituents were subjected to molecular docking study on both wild and mutant types of the Mycobacterium leprae. Since the M. leprae dihydropteroate synthase (DHPS) is not available in the protein data bank (PDB), it was modelled by the homology model method and validated with the Ramachandran plot along with other bioinformatics approaches. Two mutations were introduced at codons 53 (Thr to Ile) and 55 (Pro to Leu) for docking against twenty-five selected phytoconstituents reported from eight plants that recorded effective anti-leprosy activity. The chemical structure of phytochemicals and the standard dapsone structure were retrieved from the PubChem database and prepared accordingly for docking study with the virtual-screening platform of PyRx-AutoDock 4.1. RESULTS Based on the docking score (kcal/mol), most of the phytochemicals exhibited a higher docking score than dapsone. Asiaticoside, an active saponin (-11.3, -11.2 and -11.2 kcal/mol), was proved to be the lead phytochemical against both wild and mutant types DHPS. Some other useful phytoconstituents include echinocystic acid (-9.6, -9.5 and -9.5 kcal/mol), neobavaisoflavone (-9.2, -9.0 and -9.0 kcal/mol), boswellic acid (-8.90, -8.90 and -8.90 kcal/mol), asiatic acid (-8.9, -8.8 and -8.9 kcal/mol), corylifol A (-8.8, 8.0, and -8.0), etc. Overall, the computational predictions support the previously reported active phytoextracts of Centella asiatica (L.) Urban, Albizia amara (Roxb.) Boivin, Boswellia serrata Roxb. and Psoralea corylifolia L. to be effective against leprosy. CONCLUSION A very small percentage of well-known plants have been evaluated scientifically for antileprosy activity. Further in vivo experiments are essential to confirm anti-leprosy properties of such useful phytochemicals.
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Affiliation(s)
- Shasank Sekhar Swain
- Division of Microbiology & NCDs, ICMR-Regional Medical Research Centre, Bhubaneswar-751023, Odisha. India
| | - Gunanidhi Sahoo
- Department of Zoology, Utkal University, Vani Vihar, Bhubaneswar-751004, Odisha. India
| | | | - Sujogya Kumar Panda
- Department of Zoology, Utkal University, Vani Vihar, Bhubaneswar-751004, Odisha. India
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6
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Barreto da Silveira IGDO, da Silva Neto JA, da Silva Ferreira J, Silva TS, Holanda ISA. Detection of Mycobacterium leprae DNA in clinical and environmental samples using serological analysis and PCR. Mol Biol Rep 2021; 48:6887-6895. [PMID: 34463915 DOI: 10.1007/s11033-021-06691-5] [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: 01/25/2021] [Accepted: 08/24/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Leprosy is a chronic infectious disease caused by Mycobacterium leprae and persists as a serious public health problem in Brazil. This microorganism is inculturable, making it difficult to diagnose and elucidate details of its transmission chain. Thus, this study aimed to analyze the dynamics of environmental transmission of M. leprae in a case-control study in the city of Mossoró, Brazil. METHODS AND RESULTS Data of clinical, epidemiological, bacilloscopic, and serological evaluation of 22 newly diagnosed patients were compared, with molecular results of detection of specific genome regions RLEP and 16S rRNA of M. leprae in samples of the nasal swab, saliva, and house dust of these individuals and their controls (44 household contacts and 44 peridomiciliar contacts). The rapid serological tests evaluated, ML flow (IgM ND-O-BSA) and OrangeLife® (IgM and IgG anti NDO-LID 1) showed similar results, with greater positivity among paucibacillaries by OrangeLife® (54.5%). Positivity for nasal swab and saliva in multibacillary patients with RLEP primer was 16.7% and 33.3%, respectively. There was no detection of bacterial DNA in house dust or among paucibacillaries. The OrangeLife® test indicated that the lower the amount of windows, the more transmission in the house (3.79 more chances). Having a history of leprosy cases in the family increased the risk by 2.89 times, and being over 60 years of age gave 3.6 times more chances of acquiring the disease. PCR positivity was higher among all clinical samples using the M. leprae RLEP region than 16S rRNA. CONCLUSIONS In this study, the serological and PCR analysis were capable of detecting M. leprae DNA in clinical samples but not in the environmental samples. Close monitoring of patients and household contacts appears an effective measure to reduce the transmission of leprosy in endemic areas.
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Affiliation(s)
- Ismênia Glauce de Oliveira Barreto da Silveira
- Departamento de Ciências Agronômicas e Florestais, Centro de Ciências Vegetais, Universidade Federal Rural do Semi-Árido, Av. Francisco Mota, 572, Costa e Silva, Caixa-postal: 137, Mossoró, RN, CEP 59625-900, Brazil
| | - Jorge Alves da Silva Neto
- Departamento de Ciências Agronômicas e Florestais, Centro de Ciências Vegetais, Universidade Federal Rural do Semi-Árido, Av. Francisco Mota, 572, Costa e Silva, Caixa-postal: 137, Mossoró, RN, CEP 59625-900, Brazil
| | - Jéssica da Silva Ferreira
- Multiuser Molecular Biology Laboratory, Department of Animal Parasitology, Institute of Veterinary Medicine, Federal Rural University of Rio de Janeiro, Seropédica, Brazil
- Laboratory of Molecular Biology Applied to Mycobacteria, Oswaldo Cruz Institute, FIOCRUZ, Rio de Janeiro, Brazil
| | - Tatiane Severo Silva
- Departamento de Ciências Agronômicas e Florestais, Centro de Ciências Vegetais, Universidade Federal Rural do Semi-Árido, Av. Francisco Mota, 572, Costa e Silva, Caixa-postal: 137, Mossoró, RN, CEP 59625-900, Brazil.
| | - Ioná Santos Araújo Holanda
- Departamento de Ciências Agronômicas e Florestais, Centro de Ciências Vegetais, Universidade Federal Rural do Semi-Árido, Av. Francisco Mota, 572, Costa e Silva, Caixa-postal: 137, Mossoró, RN, CEP 59625-900, Brazil
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7
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Pierneef L, van Hooij A, Taal A, Rumbaut R, Nobre ML, van Brakel W, Geluk A. Detection of anti-M. leprae antibodies in children in leprosy-endemic areas: A systematic review. PLoS Negl Trop Dis 2021; 15:e0009667. [PMID: 34449763 PMCID: PMC8428563 DOI: 10.1371/journal.pntd.0009667] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 09/09/2021] [Accepted: 07/20/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Leprosy elimination primarily targets transmission of Mycobacterium leprae which is not restricted to patients' households. As interruption of transmission is imminent in many countries, a test to detect infected asymptomatic individuals who can perpetuate transmission is required. Antibodies directed against M. leprae antigens are indicative of M. leprae infection but cannot discriminate between active and past infection. Seroprevalence in young children, however, reflects recent M. leprae infection and may thus be used to monitor transmission in an area. Therefore, this literature review aimed to evaluate what has been reported on serological tests measuring anti-M. leprae antibodies in children without leprosy below the age of 15 in leprosy-endemic areas. METHODS AND FINDINGS A literature search was performed in the databases Pubmed, Infolep, Web of Science and The Virtual Health Library. From the 724 articles identified through the search criteria, 28 full-text articles fulfilled all inclusion criteria. Two additional papers were identified through snowballing, resulting in a total of 30 articles reporting data from ten countries. All serological tests measured antibodies against phenolic glycolipid-I or synthetic derivatives thereof, either quantitatively (ELISA or UCP-LFA) or qualitatively (ML-flow or NDO-LID rapid test). The median seroprevalence in children in endemic areas was 14.9% and was stable over time if disease incidence remained unchanged. Importantly, seroprevalence decreased with age, indicating that children are a suitable group for sensitive assessment of recent M. leprae infection. However, direct comparison between areas, solely based on the data reported in these studies, was impeded by the use of different tests and variable cut-off levels. CONCLUSIONS Quantitative anti-PGL-I serology in young children holds promise as a screening test to assess M. leprae infection and may be applied as a proxy for transmission and thereby as a means to monitor the effect of (prophylactic) interventions on the route to leprosy elimination.
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Affiliation(s)
- Louise Pierneef
- Dept. Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands
| | - Anouk van Hooij
- Dept. Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Raisa Rumbaut
- National Leprosy Program, Ministry of Public Health of Cuba, Havana, Cuba
| | - Mauricio Lisboa Nobre
- Giselda Trigueiro Hospital and Institute of Tropical Medicine of Rio Grande do Norte, Federal University of Rio Grande do Norte, Natal, Brazil
| | | | - Annemieke Geluk
- Dept. Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands
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da Silva MB, Li W, Bouth RC, Gobbo AR, Messias ACC, Moraes TMP, Jorge EVO, Barreto JG, Filho FB, Conde GAB, Frade MAC, Salgado CG, Spencer JS. Latent leprosy infection identified by dual RLEP and anti-PGL-I positivity: Implications for new control strategies. PLoS One 2021; 16:e0251631. [PMID: 33984058 PMCID: PMC8118453 DOI: 10.1371/journal.pone.0251631] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 04/30/2021] [Indexed: 11/20/2022] Open
Abstract
The number of new cases of leprosy reported worldwide has remained essentially unchanged for the last decade despite continued global use of free multidrug therapy (MDT) provided to any diagnosed leprosy patient. In order to more effectively interrupt the chain of transmission, new strategies will be required to detect those with latent disease who contribute to furthering transmission. To improve the ability to diagnose leprosy earlier in asymptomatic infected individuals, we examined the combined use of two well-known biomarkers of M. leprae infection, namely the presence of M. leprae DNA by PCR from earlobe slit skin smears (SSS) and positive antibody titers to the M. leprae-specific antigen, Phenolic Glycolipid I (anti-PGL-I) from leprosy patients and household contacts living in seven hyperendemic cities in the northern state of Pará, Brazilian Amazon. Combining both tests increased sensitivity, specificity and accuracy over either test alone. A total of 466 individuals were evaluated, including 87 newly diagnosed leprosy patients, 52 post-treated patients, 296 household contacts and 31 healthy endemic controls. The highest frequency of double positives (PGL-I+/RLEP+) were detected in the new case group (40/87, 46%) with lower numbers for treated (12/52, 23.1%), household contacts (46/296, 15.5%) and healthy endemic controls (0/31, 0%). The frequencies in these groups were reversed for double negatives (PGL-I-/RLEP-) for new cases (6/87, 6.9%), treated leprosy cases (15/52, 28.8%) and the highest in household contacts (108/296, 36.5%) and healthy endemic controls (24/31, 77.4%). The data strongly suggest that household contacts that are double positive have latent disease, are likely contributing to shedding and transmission of disease to their close contacts and are at the highest risk of progressing to clinical disease. Proposed strategies to reduce leprosy transmission in highly endemic areas may include chemoprophylactic treatment of this group of individuals to stop the spread of bacilli to eventually lower new case detection rates in these areas.
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Affiliation(s)
- Moises Batista da Silva
- Laboratório de Dermato-Imunologia, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belem, Pará, Brazil
| | - Wei Li
- Colorado State University, Department of Microbiology, Immunology and Pathology, Mycobacteria Research Laboratories, Fort Collins, CO, Unites States of America
| | - Raquel Carvalho Bouth
- Laboratório de Dermato-Imunologia, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belem, Pará, Brazil
| | - Angélica Rita Gobbo
- Laboratório de Dermato-Imunologia, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belem, Pará, Brazil
| | - Ana Caroline Cunha Messias
- Laboratório de Dermato-Imunologia, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belem, Pará, Brazil
| | - Tania Mara Pires Moraes
- Instituto de Saúde Coletiva, Universidade Federal do Oeste do Pará (UFOPA), Santarém, Pará, Brazil
| | - Erika Vanessa Oliveira Jorge
- Laboratório de Dermato-Imunologia, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belem, Pará, Brazil
| | - Josafá Gonçalves Barreto
- Laboratório de Dermato-Imunologia, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belem, Pará, Brazil
- Spatial Epidemiology Laboratory, Universidade Federal do Pará—Campus Castanhal, Castanhal, Pará, Brazil
| | - Fred Bernardes Filho
- Division of Dermatology, Department of Internal Medicine of Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | | | - Marco Andrey Cipriani Frade
- Division of Dermatology, Department of Internal Medicine of Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Claudio Guedes Salgado
- Laboratório de Dermato-Imunologia, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belem, Pará, Brazil
| | - John Stewart Spencer
- Colorado State University, Department of Microbiology, Immunology and Pathology, Mycobacteria Research Laboratories, Fort Collins, CO, Unites States of America
- * E-mail:
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Loop-mediated isothermal amplification (LAMP) assay targeting RLEP for detection of Mycobacterium leprae in leprosy patients. Int J Infect Dis 2021; 107:145-152. [PMID: 33864913 DOI: 10.1016/j.ijid.2021.04.041] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 04/11/2021] [Accepted: 04/12/2021] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Leprosy is a chronic infectious disease caused by Mycobacterium leprae and it remains a significant health problem in several parts of the world. Early and accurate diagnosis of this disease is therefore essential. Previously published loop-mediated isothermal amplification (LAMP) protocols for detecting mycobacterial species used conventional primers targeting the 16S rRNA, gyrB and insertion sequence genes. METHODS In this study, we conducted a LAMP assay for leprosy and compared it with quantitative polymerase chain reaction (q-PCR) and conventional PCR assays to determine the efficiency, sensitivity and specificity of each technique. We chose conserved sequence RLEP as a suitable molecular target for assays. RESULTS The LAMP assay provided rapid and accurate results, confirming leprosy in 91/110 clinical skin tissue samples from leprosy patients and amplifying the target pathogen in <60 min at 65 °C. The assay was more sensitive than conventional PCR and more straightforward and faster than the q-PCR assay. CONCLUSIONS The LAMP assay has the potential for developing quicker, more accessible visual methods for the detection of M. leprae, which will enable early diagnosis and treatment and prevent further infection in endemic areas.
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Jaiswal AK, Tiwari S, Jamal SB, Oliveira LDC, Sales-Campos H, Andrade-Silva LE, Oliveira CJF, Ghosh P, Barh D, Azevedo V, Soares SC, Rodrigues VR, da Silva MV. Reverse vaccinology and subtractive genomics approaches for identifying common therapeutics against Mycobacterium leprae and Mycobacterium lepromatosis. J Venom Anim Toxins Incl Trop Dis 2021; 27:e20200027. [PMID: 33889182 PMCID: PMC8040911 DOI: 10.1590/1678-9199-jvatitd-2020-0027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 12/09/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Mycobacterium leprae and Mycobacterium lepromatosis are gram-positive bacterial pathogens and the causative agents of leprosy in humans across the world. The elimination of leprosy cannot be achieved by multidrug therapy alone, and highlights the need for new tools and drugs to prevent the emergence of new resistant strains. METHODS In this study, our contribution includes the prediction of vaccine targets and new putative drugs against leprosy, using reverse vaccinology and subtractive genomics. Six strains of Mycobacterium leprae and Mycobacterium lepromatosis (4 and 2 strains, respectively) were used for comparison taking Mycobacterium leprae strain TN as the reference genome. Briefly, we used a combined reverse vaccinology and subtractive genomics approach. RESULTS As a result, we identified 12 common putative antigenic proteins as vaccine targets and three common drug targets against Mycobacterium leprae and Mycobacterium lepromatosis. Furthermore, the docking analysis using 28 natural compounds with three drug targets was done. CONCLUSIONS The bis-naphthoquinone compound Diospyrin (CID 308140) obtained from indigenous plant Diospyros spp. showed the most favored binding affinity against predicted drug targets, which can be a candidate therapeutic target in the future against leprosy.
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Affiliation(s)
- Arun Kumar Jaiswal
- Graduate Program in Bioinformatics, Institute of Biological Sciences, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
- Department of Immunology, Microbiology and Parasitology, Institute of Biological Sciences and Natural Sciences, Federal University of Triângulo Mineiro (UFTM), Uberaba, MG, Brazil
| | - Sandeep Tiwari
- Graduate Program in Bioinformatics, Institute of Biological Sciences, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Syed Babar Jamal
- Department of Biological Sciences, National University of Medical Sciences, Rawalpindi, Punjab, Pakistan
| | - Letícia de Castro Oliveira
- Graduate Program in Bioinformatics, Institute of Biological Sciences, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
- Department of Immunology, Microbiology and Parasitology, Institute of Biological Sciences and Natural Sciences, Federal University of Triângulo Mineiro (UFTM), Uberaba, MG, Brazil
| | - Helioswilton Sales-Campos
- Department of Immunology, Microbiology and Parasitology, Institute of Biological Sciences and Natural Sciences, Federal University of Triângulo Mineiro (UFTM), Uberaba, MG, Brazil
- Institute of Tropical Pathology and Public Health, Federal University of Goias (UFG), Goiânia, Goiás, Brazil
| | - Leonardo Eurípedes Andrade-Silva
- Infectious Disease Department, Institute of Health Sciences, Federal University of Triângulo Mineiro (UFTM), Uberaba, MG, Brazil
| | - Carlo Jose Freire Oliveira
- Department of Immunology, Microbiology and Parasitology, Institute of Biological Sciences and Natural Sciences, Federal University of Triângulo Mineiro (UFTM), Uberaba, MG, Brazil
| | - Preetam Ghosh
- Department of Computer Science, Virginia Commonwealth University, Richmond, VA, USA
| | - Debmalya Barh
- Centre for Genomics and Applied Gene Technology, Institute of Integrative Omics and Applied Biotechnology (IIOAB), Nonakuri, Purba Medinipur, West Bengal, India
| | - Vasco Azevedo
- Graduate Program in Bioinformatics, Institute of Biological Sciences, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Siomar C. Soares
- Department of Immunology, Microbiology and Parasitology, Institute of Biological Sciences and Natural Sciences, Federal University of Triângulo Mineiro (UFTM), Uberaba, MG, Brazil
| | - Virmondes Rodrigues Rodrigues
- Department of Immunology, Microbiology and Parasitology, Institute of Biological Sciences and Natural Sciences, Federal University of Triângulo Mineiro (UFTM), Uberaba, MG, Brazil
| | - Marcos Vinicius da Silva
- Department of Immunology, Microbiology and Parasitology, Institute of Biological Sciences and Natural Sciences, Federal University of Triângulo Mineiro (UFTM), Uberaba, MG, Brazil
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11
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van Hooij A, Tió-Coma M, Verhard EM, Khatun M, Alam K, Tjon Kon Fat E, de Jong D, Sufian Chowdhury A, Corstjens P, Richardus JH, Geluk A. Household Contacts of Leprosy Patients in Endemic Areas Display a Specific Innate Immunity Profile. Front Immunol 2020; 11:1811. [PMID: 32849645 PMCID: PMC7431626 DOI: 10.3389/fimmu.2020.01811] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 07/07/2020] [Indexed: 12/28/2022] Open
Abstract
Leprosy is a chronic infectious disease, caused by Mycobacterium leprae, that can lead to severe life-long disabilities. The transmission of M. leprae is continuously ongoing as witnessed by the stable new case detection rate. The majority of exposed individuals does, however, not develop leprosy and is protected from infection by innate immune mechanisms. In this study the relation between innate immune markers and M. leprae infection as well as the occurrence of leprosy was studied in household contacts (HCs) of leprosy patients with high bacillary loads. Serum proteins associated with innate immunity (ApoA1, CCL4, CRP, IL-1Ra, IL-6, IP-10, and S100A12) were determined by lateral flow assays (LFAs) in conjunction with the presence of M. leprae DNA in nasal swabs (NS) and/or slit-skin smears (SSS). The HCs displayed ApoA1 and S100A12 levels similar to paucibacillary patients and could be differentiated from endemic controls based on the levels of these markers. In the 31 households included the number (percentage) of HCs that were concomitantly diagnosed with leprosy, or tested positive for M. leprae DNA in NS and SSS, was not equally divided. Specifically, households where M. leprae infection and leprosy disease was not observed amongst members of the household were characterized by higher S100A12 and lower CCL4 levels in whole blood assays of HCs in response to M. leprae. Lateral flow assays provide a convenient diagnostic tool to quantitatively measure markers of the innate immune response and thereby detect individuals which are likely infected with M. leprae and at risk of developing disease or transmitting bacteria. Low complexity diagnostic tests measuring innate immunity markers can therefore be applied to help identify who should be targeted for prophylactic treatment.
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Affiliation(s)
- Anouk van Hooij
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, Netherlands
| | - Maria Tió-Coma
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, Netherlands
| | - Els M Verhard
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, Netherlands
| | - Marufa Khatun
- Rural Health Program, The Leprosy Mission International Bangladesh, Dhaka, Bangladesh
| | - Khorshed Alam
- Rural Health Program, The Leprosy Mission International Bangladesh, Dhaka, Bangladesh
| | - Elisa Tjon Kon Fat
- Department Cell and Chemical Biology, Leiden University Medical Center, Leiden, Netherlands
| | - Danielle de Jong
- Department Cell and Chemical Biology, Leiden University Medical Center, Leiden, Netherlands
| | - Abu Sufian Chowdhury
- Rural Health Program, The Leprosy Mission International Bangladesh, Dhaka, Bangladesh
| | - Paul Corstjens
- Department Cell and Chemical Biology, Leiden University Medical Center, Leiden, Netherlands
| | - Jan Hendrik Richardus
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Annemieke Geluk
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, Netherlands
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12
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Duthie MS, Pena MT, Khandhar AP, Picone A, MacMIllen Z, Truman RW, Adams LB, Reed SG. Development of LepReact, a defined skin test for paucibacillary leprosy and low-level M. leprae infection. Appl Microbiol Biotechnol 2020; 104:3971-3979. [PMID: 32157423 DOI: 10.1007/s00253-020-10505-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 02/19/2020] [Accepted: 02/28/2020] [Indexed: 11/26/2022]
Abstract
The persistence of new leprosy cases in endemic areas such as India, Brazil, Bangladesh, and the Philippines has encouraged studies of chemoprophylaxis among contacts of patients. Epidemiological screening tools to enable early detection of infected individuals in endemic populations would be critical to target individuals most in need of intervention. Despite decades of attempts, however, there still are no tests available for the early detection of low-level infection with Mycobacterium leprae. In this report, we describe the development of a leprosy skin test using M. leprae-specific antigens. We selected the chimeric LID-1 fusion protein, formulated to achieve maximum performance at a minimal dose, as a skin test candidate based on its ability to elicit delayed-type hypersensitivity (DTH) reactions in M. leprae immune guinea pigs in a sensitive and specific manner, i.e., with no cross-reactivity observed with other mycobacterial species. Importantly, evaluations in armadillos indicated that intradermal inoculation of formulated LID-1 could distinguish uninfected from M. leprae-infected animals manifesting with symptoms distinctly similar to the PB presentation of patients. Together, our data provide strong proof-of-concept for developing an antigen-specific skin test to detect low-level M. leprae infection. Such a test could, when applied with appropriate use of chemo- and/or immunoprophylaxis, be instrumental in altering the evolution of clinical disease and M. leprae transmission, thus furthering the objective of zero leprosy.
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Affiliation(s)
- Malcolm S Duthie
- Host Directed Therapeutics (HDT) Biocorp, 1616 Eastlake Ave E, Seattle, WA, 98102, USA.
- Infectious Disease Research Institute, Seattle, WA, USA.
| | - Maria T Pena
- National Hansens Disease Program, Baton Rouge, LA, USA
| | | | | | | | | | - Linda B Adams
- National Hansens Disease Program, Baton Rouge, LA, USA
| | - Steven G Reed
- Host Directed Therapeutics (HDT) Biocorp, 1616 Eastlake Ave E, Seattle, WA, 98102, USA
- Infectious Disease Research Institute, Seattle, WA, USA
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13
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Barbosa MDS, de Sousa IBA, Simionatto S, Borsuk S, Marchioro SB. Recombinant polypeptide of Mycobacterium leprae as a potential tool for serological detection of leprosy. AMB Express 2019; 9:201. [PMID: 31848766 PMCID: PMC6917672 DOI: 10.1186/s13568-019-0928-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Accepted: 12/07/2019] [Indexed: 12/11/2022] Open
Abstract
Current prevention methods for the transmission of Mycobacterium leprae, the causative agent of leprosy, are inadequate as suggested by the rate of new leprosy cases reported. Simple large-scale detection methods for M. leprae infection are crucial for early detection of leprosy and disease control. The present study investigates the production and seroreactivity of a recombinant polypeptide composed of various M. leprae protein epitopes. The structural and physicochemical parameters of this construction were assessed using in silico tools. Parameters like subcellular localization, presence of signal peptide, primary, secondary, and tertiary structures, and 3D model were ascertained using several bioinformatics tools. The resultant purified recombinant polypeptide, designated rMLP15, is composed of 15 peptides from six selected M. leprae proteins (ML1358, ML2055, ML0885, ML1811, ML1812, and ML1214) that induce T cell reactivity in leprosy patients from different hyperendemic regions. Using rMLP15 as the antigen, sera from 24 positive patients and 14 healthy controls were evaluated for reactivity via ELISA. ELISA-rMLP15 was able to diagnose 79.17% of leprosy patients with a specificity of 92.86%. rMLP15 was also able to detect the multibacillary and paucibacillary patients in the same proportions, a desirable addition in the leprosy diagnosis. These results summarily indicate the utility of the recombinant protein rMLP15 in the diagnosis of leprosy and the future development of a viable screening test.
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14
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Chen X, You YG, Yuan YH, Yuan LC, Zhang Y, Yan W. Evaluation of antigen-specific immune responses for leprosy diagnosis in a hyperendemic area in China. PLoS Negl Trop Dis 2018; 12:e0006777. [PMID: 30248098 PMCID: PMC6152862 DOI: 10.1371/journal.pntd.0006777] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 08/23/2018] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To evaluate antigen-specific immune responses for leprosy diagnosis in a hyperendemic area in China. METHODS Eighty-three leprosy patients and 161 non-leprosy controls were enrolled from Hani-yi Autonomous Prefecture of Honghe, Yunnan Province, China. Leprosy patients were divided into multibacillary (MB, n = 38), paucibacillary (PB, n = 23), and post-multi-drug therapy (MDT, n = 22) groups. Controls were divided into the following groups: healthy household contacts (HHC, n = 119), tuberculosis (TB, n = 11), and endemic controls (EC, n = 31). The NDO-LID Rapid Test, M. leprae antigen-specific ELISA and antigen-specific IFN-γ secretion in a whole blood assay (WBA) were used to evaluate these subjects. RESULTS The NDO-LID Rapid Test achieved higher positive response rates in MB than in PB patients[94.7%(36/38) vs 65.2%(15/23)], and these rates were higher than those observed by ELISA using anti-LID-1[92.1%(35/38) vs 52.2%(12/23)], anti-NDO-LID[92.1%(35/38) vs 47.8% (11/23)], and anti-ND-O-BSA[89.5%(34/38) vs 60.9%(14/23)]. However, the NDO-LID Rapid Test also showed a higher positive response rate in the EC group (33.3%,10/31), which was higher than the rates observed for anti-NDO-LID (12.9%,4/31) and anti-ND-O-BSA (16.1%,5/31). M. leprae antigen-specific ELISA demonstrated relatively high specificity (86.84-97.37%) but low sensitivity (15.97-72.73%) in discriminating between leprosy patients and non-leprosy controls by ROC curve analysis. In contrast, M. leprae antigen-specific IFN-γ secretion detection achieved higher positive response rates in PB than in MB patients (positive ratio of MB vs PB: 40% vs 56% for LID-1, 28.6% vs 47.8% for ML89, 31.4% vs 60.7% for ML2044, and 31.4 vs 47.8% for ML2028) and could distinguish MB from EC when stimulated with ML89(AUC = 0.6664) and PB fromTB when stimulated with ML2044 and ML2028(AUC = 0.7549 and 0.7372, respectively). CONCLUSION The NDO-LID Rapid Test and M. leprae antigen-specific ELISA are useful tools to assist in the diagnosis of leprosy patients, especially MB patients, although the former had higher sensitivity but lower specificity than the latter. M. leprae antigen-specific IFN-γ release assessed by WBA has diagnostic value for distinguishing PB from TB but not for distinguishing PB from HHC or EC. Screening novel M. leprae-specific antigens, combining different M. leprae antigens and a multi-cytokine analyte model may be needed for more effective diagnosis of leprosy.
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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
| | - 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
- Henan Provincial People's Hospital, Zhengzhou, China
| | - Lian Chao 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
| | - Ying Zhang
- Department of Molecular Microbiology and Immunology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States of America
| | - Wen Yan
- 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
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15
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Blok DJ, de Vlas SJ, Geluk A, Richardus JH. Minimum requirements and optimal testing strategies of a diagnostic test for leprosy as a tool towards zero transmission: A modeling study. PLoS Negl Trop Dis 2018; 12:e0006529. [PMID: 29799844 PMCID: PMC5991769 DOI: 10.1371/journal.pntd.0006529] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 06/07/2018] [Accepted: 05/15/2018] [Indexed: 11/29/2022] Open
Abstract
Background The availability of a diagnostic test to detect subclinical leprosy cases is crucial to interrupt the transmission of M. leprae. In this study we assessed the minimum sensitivity level of such a (hypothetical) diagnostic test and the optimal testing strategy in order to effectively reduce the new case detection rate (NCDR) of leprosy. Methods and findings We used the individual-based model SIMCOLEP, and based it on previous quantification using COLEP data, a cohort study of leprosy cases in Bangladesh. The baseline consisted of treatment with Multidrug therapy of clinically diagnosed leprosy cases, passive case detection and household contact tracing. We examined the use of a leprosy diagnostic test for subclinical leprosy in four strategies: testing in 1) household contacts, 2) household contacts with a 3-year follow-up, 3) a population survey with coverage 50%, and 4) a population survey (100%). For each strategy, we varied the test sensitivity between 50% and 100%. All analyses were conducted for a high, medium, and low (i.e. 25, 5 and 1 per 100,000) endemic setting over a period of 50 years. In all strategies, the use of a diagnostic test further reduces the NCDR of leprosy compared to the no test strategy. A substantial reduction could already be achieved at a test sensitivity as low as 50%. In a high endemic setting, a NCDR of 10 per 100,000 could be reached within 8–10 years in household contact testing, and 2–6 years in a population testing. Testing in a population survey could also yield the highest number of prevented new cases, but requires a large number needed to test and treat. In contrast, household contact testing has a smaller impact on the NCDR but requires a substantially lower number needed to test and treat. Conclusions A diagnostic test for subclinical leprosy with a sensitivity of at least 50% could substantially reduce M. leprae transmission. To effectively reduce NCDR in the short run, a population survey is preferred over household contact tracing. However, this is only favorable in high endemic settings. The annual number of new leprosy cases has been stable in the past decade, indicating that transmission has not been yet been interrupted. As current control seems to be insufficient to bring down the number of cases, there is a need for novel tools to interrupt transmission. A diagnostic that permitted diagnosis of subclinical cases will likely be fundamental to achieve elimination and ultimately eradication. In this study we assessed the minimum sensitivity level of such a (hypothetical) diagnostic test and the optimal testing strategy in order to effectively reduce the new case detection rate (NCDR) of leprosy. We showed that a diagnostic test for subclinical leprosy could substantially reduce the NCDR in a high, medium and low endemic population. A significant impact could already be achieved at a test sensitivity level of 50%. To effectively reduce the NCDR in the short run, a population survey is preferred over household contact tracing. However, this is only favorable in high endemic settings, as in medium and low endemic settings testing in a population survey requires many more people to be tested and treated to prevent one new leprosy case.
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Affiliation(s)
- David J. Blok
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- * E-mail:
| | - Sake J. de Vlas
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Annemieke Geluk
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands
| | - Jan Hendrik Richardus
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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16
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Fürst T, Cavaliero A, Lay S, Dayer C, Chan S, Smrekar A, So V, Barth-Jaeggi T, Steinmann P. Retrospective active case finding in Cambodia: An innovative approach to leprosy control in a low-endemic country. Acta Trop 2018; 180:26-32. [PMID: 29289558 DOI: 10.1016/j.actatropica.2017.12.031] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 11/20/2017] [Accepted: 12/27/2017] [Indexed: 11/19/2022]
Abstract
Currently, leprosy control relies on the clinical diagnosis of leprosy and the subsequent administration of multidrug therapy (MDT). However, many health workers are not familiar with the cardinal signs of leprosy, particularly in low-endemic settings including Cambodia. In response, a new approach to early diagnosis was developed in the country, namely retrospective active case finding (RACF) through small mobile teams. In the frame of RACF, previously diagnosed leprosy patients are traced and their contacts screened through "drives". According to the available records, 984 of the 1,463 (67.3%) index patients diagnosed between 2001 and 2010 and registered in the national leprosy database were successfully traced in the period 2012-2015. Migration (8.4%), death (6.7%), operational issues (1.6%) and unidentified other issues (16.0%) were the main reasons for non-traceability. A total of 17,134 contacts of traced index patients (average: 2.2 household members and 15.2 neighbors) and another 7,469 contacts of the untraced index patients could be screened. Among them, 264 new leprosy patients were diagnosed. In the same period, 1,097 patients were diagnosed through the routine passive case detection system. No change was observed in the relation between the rate at which new patients were identified and the number of years since the diagnosis of the index patient. Similar to leprosy patients diagnosed through passive case detection, the leprosy patients detected through RACF were predominantly adult males. However, the fraction of PB leprosy patients was higher among the patients diagnosed through RACF, suggesting relatively earlier diagnosis. It appears that RACF is a feasible option and effective in detecting new leprosy patients among contacts of previously registered patients. However, a well-maintained national leprosy database is essential for successful contact tracing. Hence, passive case detection in the frame of routine leprosy surveillance is a precondition for efficient RACF as the two systems are mutually enhancing. Together, the two approaches may offer an interesting option for countries with low numbers of leprosy patients but evidence of ongoing transmission. The impact on leprosy transmission could be further increased by the administration of single dose rifampicin as post-exposure prophylaxis to eligible contacts.
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Affiliation(s)
- Thomas Fürst
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland; Imperial College London, London, United Kingdom
| | | | - Sambath Lay
- National Leprosy Elimination Programme, Phnom Penh, Cambodia
| | - Chrystel Dayer
- Campagne Internationale de L'Ordre de Malte Contre la Lèpre (CIOMAL), Geneva, Switzerland and Phnom Penh, Cambodia
| | - Saren Chan
- Campagne Internationale de L'Ordre de Malte Contre la Lèpre (CIOMAL), Geneva, Switzerland and Phnom Penh, Cambodia
| | - Ajda Smrekar
- Campagne Internationale de L'Ordre de Malte Contre la Lèpre (CIOMAL), Geneva, Switzerland and Phnom Penh, Cambodia
| | - Visal So
- National Leprosy Elimination Programme, Phnom Penh, Cambodia; Campagne Internationale de L'Ordre de Malte Contre la Lèpre (CIOMAL), Geneva, Switzerland and Phnom Penh, Cambodia
| | - Tanja Barth-Jaeggi
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Peter Steinmann
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland.
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17
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Marçal PHF, Fraga LADO, Mattos AMMD, Menegati L, Coelho ADCO, Pinheiro RO, Sarno EN, Duthie MS, Teixeira HC. Utility of immunoglobulin isotypes against LID-1 and NDO-LID for, particularly IgG1, confirming the diagnosis of multibacillary leprosy. Mem Inst Oswaldo Cruz 2018. [PMID: 29513821 PMCID: PMC5851060 DOI: 10.1590/0074-02760170467] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Leprosy remains a health problem in many countries, with difficulties in
diagnosis resulting in delayed treatment and more severe disabilities.
Antibodies against several Mycobacterium leprae antigens
have, however, shown value as diagnostic and/or prognostic markers. OBJECTIVES The objective of this study was to evaluate serum immunoglobulin (Ig) IgM
and IgG subclass reactivity against three M. leprae
specific antigens: NDO-HSA, a conjugate formed by natural octyl disaccharide
bound to human serum albumin; LID-1, the fusion protein product of the
ml0405 and ml2331 genes; and NDO-LID, a combination of LID-1 and NDO. METHODS Sera from healthy controls, paucibacillary (PB) and multibacillary (MB)
leprosy patients, and their respective household contacts, were evaluated
for the presence of antigen-specific IgM, IgG, and IgG subclass antibodies
by enzyme-linked immunosorbent assay (ELISA). The sensitivity and
specificity of each ELISA were evaluated by receiver operating
characteristic (ROC) curve analysis. FINDINGS Our data confirm that serum IgM antibodies against NDO-HSA and IgG
antibodies against LID-1, as well as IgG/M antibodies against NDO-LID, are
markedly increased in MB patients. For the first time, our data reveal a
selective increase in IgG1 and IgG3 antibodies against LID-1 and NDO-LID in
MB patients, demonstrating that these antibody isotypes are suitable for
differentiation between MB and PB patients. ROC curve analysis indicates an
improved capacity for diagnosing MB leprosy patients using the detection of
IgG antibodies, particularly the IgG1 isotype, specific to LID-1 and NDO-LID
over the performance levels attained with NDO-HSA. CONCLUSIONS Our findings indicate that serological tests based on the detection of
antigen-specific IgG1 antibodies are a useful tool to differentiate MB from
PB patients, and indicate the enhanced performance of the LID-1 and NDO-LID
antigens in the serodiagnosis of leprosy.
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Affiliation(s)
- Pedro Henrique Ferreira Marçal
- Departamento de Parasitologia, Microbiologia e Imunologia, Instituto de Ciências Biológicas, Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brasil
| | | | - Ana Márcia Menezes de Mattos
- Departamento de Parasitologia, Microbiologia e Imunologia, Instituto de Ciências Biológicas, Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brasil
| | - Laura Menegati
- Departamento de Parasitologia, Microbiologia e Imunologia, Instituto de Ciências Biológicas, Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brasil
| | | | - Roberta Olmo Pinheiro
- Laboratório de Hanseníase, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz-Fiocruz, Rio de Janeiro, RJ, Brasil
| | - Euzenir Nunes Sarno
- Laboratório de Hanseníase, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz-Fiocruz, Rio de Janeiro, RJ, Brasil
| | | | - Henrique Couto Teixeira
- Departamento de Parasitologia, Microbiologia e Imunologia, Instituto de Ciências Biológicas, Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brasil
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18
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Richardus RA, van der Zwet K, van Hooij A, Wilson L, Oskam L, Faber R, van den Eeden SJF, Pahan D, Alam K, Richardus JH, Geluk A. Longitudinal assessment of anti-PGL-I serology in contacts of leprosy patients in Bangladesh. PLoS Negl Trop Dis 2017; 11:e0006083. [PMID: 29228004 PMCID: PMC5746281 DOI: 10.1371/journal.pntd.0006083] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 12/28/2017] [Accepted: 10/30/2017] [Indexed: 12/23/2022] Open
Abstract
Background Despite elimination efforts, the number of Mycobacterium leprae (M. leprae) infected individuals who develop leprosy, is still substantial. Solid evidence exists that individuals living in close proximity to patients are at increased risk to develop leprosy. Early diagnosis of leprosy in endemic areas requires field-friendly tests that identify individuals at risk of developing the disease before clinical manifestation. Such assays will simultaneously contribute to reduction of current diagnostic delay as well as transmission. Antibody (Ab) levels directed against the M.leprae-specific phenolic glycolipid I (PGL-I) represents a surrogate marker for bacterial load. However, it is insufficiently defined whether anti-PGL-I antibodies can be utilized as prognostic biomarkers for disease in contacts. Particularly, in Bangladesh, where paucibacillary (PB) patients form the majority of leprosy cases, anti-PGL-I serology is an inadequate method for leprosy screening in contacts as a directive for prophylactic treatment. Methods Between 2002 and 2009, fingerstick blood from leprosy patients’ contacts without clinical signs of disease from a field-trial in Bangladesh was collected on filter paper at three time points covering six years of follow-up per person. Analysis of anti-PGL-I Ab levels for 25 contacts who developed leprosy during follow-up and 199 contacts who were not diagnosed with leprosy, was performed by ELISA after elution of bloodspots from filter paper. Results Anti-PGL-I Ab levels at intake did not significantly differ between contacts who developed leprosy during the study and those who remained free of disease. Moreover, anti-PGL-I serology was not prognostic in this population as no significant correlation was identified between anti-PGL-I Ab levels at intake and the onset of leprosy. Conclusion In this highly endemic population in Bangladesh, no association was observed between anti-PGL-I Ab levels and onset of disease, urging the need for an extended, more specific biomarker signature for early detection of leprosy in this area. Trial registration ClinicalTrials.gov ISRCTN61223447 Leprosy is an infectious disease caused by the bacterium Mycobacterium leprae, which causes skin and nerve damage. Despite worldwide efforts to eliminate leprosy, the number of infected individuals who develop leprosy, is still substantial. Household contacts of new leprosy patients are especially at risk. Early diagnosis of leprosy is key in preventing lifelong handicaps as well as transmission. This requires field-friendly tests that identify individuals at risk of developing the disease before they develop clinical symptoms so that they can receive (prophylactic) treatment. Measuring antibody levels directed against the M.leprae-specific phenolic glycolipid I (PGL-I) provides an indication of the bacterial load. To identify whether anti-PGL-I Ab levels correlate with the development of leprosy in contacts of newly diagnosed leprosy cases, we analyzed these levels in 25 contacts who developed leprosy during 6 years of follow-up and 199 contacts who were not diagnosed with leprosy at 3 time points in 6 years. This study showed that anti-PGL-I Ab levels at intake did not significantly differ between contacts who developed leprosy during the study and those who remained free of disease. Therefore, anti-PGL-I Ab levels alone do not represent a practical tool for prediction of which household contacts will develop leprosy in an endemic area such as Bangladesh, with high levels of patients with paucibacillary leprosy. This stresses the need for a diagnostic test composed of a biomarker signature consisting of multiple biomarkers.
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Affiliation(s)
- Renate A. Richardus
- Department of Infectious Diseases Leiden University Medical Center, Leiden, The Netherlands
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Konrad van der Zwet
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Anouk van Hooij
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Louis Wilson
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Linda Oskam
- KIT Biomedical Research, Royal Tropical Institute, Amsterdam, The Netherlands
| | - Roel Faber
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | | | - David Pahan
- Rural Health Program, The Leprosy Mission International Bangladesh, Nilphamari, Bangladesh
| | - Khorshed Alam
- Rural Health Program, The Leprosy Mission International Bangladesh, Nilphamari, Bangladesh
| | - Jan Hendrik Richardus
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Annemieke Geluk
- Department of Infectious Diseases Leiden University Medical Center, Leiden, The Netherlands
- * E-mail:
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Carvalho APM, Coelho ADCO, Correa-Oliveira R, Lana FCF. Specific antigen serologic tests in leprosy: implications for epidemiological surveillance of leprosy cases and household contacts. Mem Inst Oswaldo Cruz 2017; 112:609-616. [PMID: 28902286 PMCID: PMC5572446 DOI: 10.1590/0074-02760160505] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Accepted: 05/15/2017] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND There is a lack of straightforward tests for field application and known biomarkers for predicting leprosy progression in infected individuals. OBJECTIVE The aim was to analyse the response to infection by Mycobacterium leprae based on the reactivity of specific antigens: natural disaccharide linked to human serum albumin via an octyl (NDOHSA), a semisynthetic phenolic glycolipid-I (PGL-I); Leprosy Infectious Disease Research Institute Diagnostic-1 (LID-1) and natural disaccharide octyl - Leprosy Infectious Disease Research Institute Diagnostic-1 (NDOLID). METHODS The study population consisted of 130 leprosy cases diagnosed between 2010 and 2015 and 277 household contacts. An enzyme-linked immunosorbent assay (ELISA) was used to analyse the reactivity of antibodies against NDOHSA, LID-1 and NDOLID. The samples and controls were tested in duplicate, and the antibody titer was expressed as an ELISA index. Data collection was made by home visits with application of questionnaire and dermatological evaluation of all household contacts to identify signs and symptoms of leprosy. FINDINGS Significant differences in the median ELISA results were observed among leprosy cases in treatment, leprosy cases that had completed treatment and household contacts. Higher proportions of seropositivity were observed in leprosy cases in treatment. Seropositivity was also higher in multibacillary in relation to paucibacillary, with the difference reaching statistical significance. Lower titers were observed among cases with a longer treatment time or discharge. For household contacts, the differences according to the clinical characteristics of the leprosy index case were less pronounced than expected. Other factors, such as the endemicity of leprosy, exposure outside the residence and genetic characteristics, appeared to have a greater influence on the seropositivity. MAIN CONCLUSIONS Serologic tests could be used as auxiliary tools for determining the operational classification, in addition to identifying infected individuals and as a strategy for surveillance of household contacts.
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Affiliation(s)
- Ana Paula Mendes Carvalho
- Universidade Federal de Minas Gerais, Escola de Enfermagem, Programa de Pós-Graduação em Enfermagem, Belo Horizonte, MG, Brasil
| | | | - Rodrigo Correa-Oliveira
- Universidade Federal de Minas Gerais, Escola de Enfermagem, Programa de Pós-Graduação em Enfermagem, Belo Horizonte, MG, Brasil.,Fundação Oswaldo Cruz-Fiocruz, Centro de Pesquisas René Rachou, Laboratório de Imunologia Celular e Molecular, Belo Horizonte, MG, Brasil
| | - Francisco Carlos Félix Lana
- Universidade Federal de Minas Gerais, Escola de Enfermagem, Departamento de Enfermagem Materno-Infantil e Saúde Pública, Programa de Pós-Graduação em Enfermagem, Belo Horizonte, MG, Brasil
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Steinmann P, Reed SG, Mirza F, Hollingsworth TD, Richardus JH. Innovative tools and approaches to end the transmission of Mycobacterium leprae. THE LANCET. INFECTIOUS DISEASES 2017; 17:e298-e305. [DOI: 10.1016/s1473-3099(17)30314-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 03/26/2017] [Accepted: 04/06/2017] [Indexed: 12/23/2022]
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Medley GF, Crump RE, Lockwood DNJ. Interpreting data in policy & control: The case of leprosy. Indian J Med Res 2017; 145:1-3. [PMID: 28574007 PMCID: PMC5460554 DOI: 10.4103/ijmr.ijmr_2027_16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Graham F Medley
- Department of Global Health & Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Ron E Crump
- Warwick Infectious Disease Epidemiology Research, School of Life Sciences, The University of Warwick, Coventry, UK
| | - Diana N J Lockwood
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
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Barreto JG, Frade MAC, Bernardes Filho F, da Silva MB, Spencer JS, Salgado CG. Leprosy in Children. Curr Infect Dis Rep 2017; 19:23. [PMID: 28444521 DOI: 10.1007/s11908-017-0577-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW This manuscript aims to review the cutting-edge developments regarding to the diagnosis, management, and prevention of leprosy in children. RECENT FINDINGS Leprosy transmission still occurs continuously in some endemic areas in the world. Leprosy in children below 15 years old is a robust indicator of active source of infection in the community where they live. A special focus on children to reduce disabilities and reduce transmission is one of the core areas of interventions of the global leprosy strategy 2016-2020. Ongoing research is trying to develop better diagnostic tests and to advance chemoprophylaxis and immunoprophylaxis approaches. Early diagnosis in children can be hard because of the wide range of clinical aspects of the skin lesions and mainly due to the difficulty of performing the clinical peripheral nerve evaluation. We must maintain leprosy expertise and improve the health professionals training for leprosy diagnosis, since we still have a long journey to reach leprosy elimination.
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Affiliation(s)
- Josafá Gonçalves Barreto
- Spatial Epidemiology Laboratory, Federal University of Pará, Campus Castanhal, Avenida dos Universitários, s/n, Bairro Jaderlândia Castanhal, Pará, CEP: 68746-360, Brazil.
| | - Marco Andrey Cipriani Frade
- Divison of Dermatology of Internal Medicine, Department of Ribeirão Preto Medical School, University of São Paulo, Av. Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, São Paulo, CEP: 14.049.900, Brazil
| | - Fred Bernardes Filho
- Divison of Dermatology of Internal Medicine, Department of Ribeirão Preto Medical School, University of São Paulo, Av. Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, São Paulo, CEP: 14.049.900, Brazil
| | - Moises Batista da Silva
- Dermato-Immunology Laboratory, Federal University of Pará, Av. João Paulo II, 113 - Bairro Dom Aristides, Marituba, Pará, CEP: 67200-000, Brazil
| | - John Stewart Spencer
- Department of Microbiology, Immunology and Pathology, Colorado State University, 1682 Campus Delivery, Fort Collins, CO, 80523-1682, USA
| | - Claudio Guedes Salgado
- Dermato-Immunology Laboratory, Federal University of Pará, Av. João Paulo II, 113 - Bairro Dom Aristides, Marituba, Pará, CEP: 67200-000, Brazil
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Quantitative lateral flow strip assays as User-Friendly Tools To Detect Biomarker Profiles For Leprosy. Sci Rep 2016; 6:34260. [PMID: 27682181 PMCID: PMC5041085 DOI: 10.1038/srep34260] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 09/08/2016] [Indexed: 01/08/2023] Open
Abstract
Leprosy is a debilitating, infectious disease caused by Mycobacterium leprae. Despite the availability of multidrug therapy, transmission is unremitting. Thus, early identification of M. leprae infection is essential to reduce transmission. The immune response to M. leprae is determined by host genetics, resulting in paucibacillary (PB) and multibacillary (MB) leprosy associated with dominant cellular or humoral immunity, respectively. This spectral pathology of leprosy compels detection of immunity to M. leprae to be based on multiple, diverse biomarkers. In this study we have applied quantitative user friendly lateral flow assays (LFAs) for four immune markers (anti-PGL-I antibodies, IL-10, CCL4 and IP-10) for whole blood samples from a longitudinal BCG vaccination field-trial in Bangladesh. Different biomarker profiles, in contrast to single markers, distinguished M. leprae infected from non-infected test groups, patients from household contacts (HHC) and endemic controls (EC), or MB from PB patients. The test protocol presented in this study merging detection of innate, adaptive cellular as well as humoral immunity, thus provides a convenient tool to measure specific biomarker profiles for M. leprae infection and leprosy utilizing a field-friendly technology.
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