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Arya R, Jit BP, Kumar V, Kim JJ. Exploring the Potential of Exosomes as Biomarkers in Tuberculosis and Other Diseases. Int J Mol Sci 2024; 25:2885. [PMID: 38474139 DOI: 10.3390/ijms25052885] [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: 01/01/2024] [Revised: 02/23/2024] [Accepted: 02/29/2024] [Indexed: 03/14/2024] Open
Abstract
Tuberculosis (TB) is a major cause of morbidity and mortality and remains an important public health issue in developing countries worldwide. The existing methods and techniques available for the diagnosis of TB are based on combinations of laboratory (chemical and biological), radiological, and clinical tests. These methods are sophisticated and laborious and have limitations in terms of sensitivity, specificity, and accuracy. Clinical settings need improved diagnostic biomarkers to accurately detect biological changes due to pathogen invasion and pharmacological responses. Exosomes are membrane-bound vesicles and mediators of intercellular signaling processes that play a significant role in the pathogenesis of various diseases, such as tuberculosis, and can act as promising biomarkers for the monitoring of TB infection. Compared to conventional biomarkers, exosome-derived biomarkers are advantageous because they are easier to detect in different biofluids, are more sensitive and specific, and may be useful in tracking patients' reactions to therapy. This review provides insights into the types of biomarkers, methods of exosome isolation, and roles of the cargo (proteins) present in exosomes isolated from patients through omics studies, such as proteomics. These findings will aid in developing new prognostic and diagnostic biomarkers and could lead to the identification of new therapeutic targets in the clinical setting.
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Affiliation(s)
- Rakesh Arya
- Department of Biotechnology, Yeungnam University, Gyeongsan 38541, Republic of Korea
| | - Bimal Prasad Jit
- Department of Biochemistry, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Vijay Kumar
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Jong Joo Kim
- Department of Biotechnology, Yeungnam University, Gyeongsan 38541, Republic of Korea
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2
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McNally E, Ross C, Gleeson LE. The tuberculous pleural effusion. Breathe (Sheff) 2023; 19:230143. [PMID: 38125799 PMCID: PMC10729824 DOI: 10.1183/20734735.0143-2023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 11/06/2023] [Indexed: 12/23/2023] Open
Abstract
Pleural tuberculosis (TB) is a common entity with similar epidemiological characteristics to pulmonary TB. It represents a spectrum of disease that can variably self-resolve or progress to TB empyema with severe sequelae such as chronic fibrothorax or empyema necessitans. Coexistence of and progression to pulmonary TB is high. Diagnosis is challenging, as pleural TB is paucibacillary in most cases, but every effort should be made to obtain microbiological diagnosis, especially where drug resistance is suspected. Much attention has been focussed on adjunctive investigations to support diagnosis, but clinicians must be aware that apparent diagnostic accuracy is affected both by the underlying TB prevalence in the population, and by the diagnostic standard against which the specified investigation is being evaluated. Pharmacological treatment of pleural TB is similar to that of pulmonary TB, but penetration of the pleural space may be suboptimal in complicated effusions. Evidence for routine drainage is limited, but evacuation of the pleural space is indicated in complicated disease. Educational aims To demonstrate that pleural TB incorporates a wide spectrum of disease, ranging from self-resolving lymphocytic effusions to severe TB empyema with serious sequelae.To emphasise the high coexistence of pulmonary TB with pleural TB, and the importance of obtaining sputum for culture (induced if necessary) in all cases.To explore the significant diagnostic challenges posed by pleural TB, and consequently the frequent lack of information about drug sensitivity prior to initiating treatment.To highlight the influence of underlying TB prevalence in the population on the diagnostic accuracy of adjunctive investigations for the diagnosis of pleural TB.To discuss concerns around penetration of anti-TB medications into the pleural space and how this can influence decisions around treatment duration in practice.
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Affiliation(s)
- Emma McNally
- Department of Respiratory Medicine, St James's Hospital, Dublin, Ireland
| | - Clare Ross
- Department of Respiratory Medicine, Imperial NHS Healthcare Trust, London, UK
| | - Laura E. Gleeson
- Department of Respiratory Medicine, St James's Hospital, Dublin, Ireland
- Department of Clinical Medicine, Trinity College Dublin School of Medicine, St James's Hospital, Dublin, Ireland
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3
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Dass M, Kaur M, Aittan S, Sharma P, Punia S, Muthumohan R, Anthwal D, Gupta RK, Mahajan G, Kumari P, Sharma N, Taneja RS, Sharma LK, Shree R, Tyagi JS, Lal V, Haldar S. MPT51 and MPT64-based antigen detection assay for the diagnosis of extrapulmonary tuberculosis from urine samples. Diagn Microbiol Infect Dis 2023; 107:115973. [PMID: 37348159 DOI: 10.1016/j.diagmicrobio.2023.115973] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 04/26/2023] [Accepted: 04/27/2023] [Indexed: 06/24/2023]
Abstract
In view of WHO's "End-TB" strategy, we developed a non-invasive, urine-based ELISA, targeting 2 Mycobacterium tuberculosis antigens namely MPT51 and MPT64 for extrapulmonary TB (EPTB) diagnosis. Suspected EPTB patients (n = 137) [Pleural TB, Abdominal TB and Tuberculous meningitis] were categorized in "Definite" EPTB (n = 10) [Xpert-MTB/RIF and/or culture-positive], "Probable" EPTB (n = 77) and "Non-EPTB" (n = 50) groups using defined composite reference standards. ROC-curves were generated using ELISA results of "Definite" EPTB and "Non-EPTB" groups for both antigens independently and cut-off values were selected to provide 86.3% (95%CI:73.3-94.2) specificity for MPT51 and 92% (95%CI:80.8-97.8) for MPT64. The sensitivity of MPT51-ELISA and MPT64-ELISA was 70% (95%CI:34.7-93.3) and 90% (95%CI:55.5-99.7) for "Definite" EPTB group and 32.5% (95%CI:22.2-44.1) and 30.8% (95%CI:20.8-42.2) for "Probable" EPTB group, respectively. Combining the results of both ELISAs showed a 100% (95%CI:69.1-100) sensitivity in "Definite" EPTB group and 41.6% (95%CI:30.4-53.4) in "Probable" EPTB group, with an 80% (95%CI:66.3-89.9) specificity. The results demonstrated the potential of urine-based ELISAs as screening tests for EPTB diagnosis.
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Affiliation(s)
- Manisha Dass
- Department of Experimental Medicine and Biotechnology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Mohinder Kaur
- Department of Experimental Medicine and Biotechnology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Simran Aittan
- Department of Experimental Medicine and Biotechnology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pratibha Sharma
- Department of Experimental Medicine and Biotechnology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sachin Punia
- Department of Experimental Medicine and Biotechnology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rajagopalan Muthumohan
- Centre for Biodesign and Diagnostics, Translational Health Science and Technology Institute, NCR Biotech Science Cluster, Faridabad, India
| | - Divya Anthwal
- Department of Experimental Medicine and Biotechnology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rakesh K Gupta
- Department of Experimental Medicine and Biotechnology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Gargi Mahajan
- Department of Experimental Medicine and Biotechnology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pooja Kumari
- Department of Biotechnology, All India Institute of Medical Sciences, New Delhi, India
| | - Neera Sharma
- Department of Biochemistry, Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Rajesh S Taneja
- Department of Medicine, Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Lokesh K Sharma
- Department of Biochemistry, Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Ritu Shree
- Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Jaya S Tyagi
- Department of Biotechnology, All India Institute of Medical Sciences, New Delhi, India
| | - Vivek Lal
- Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sagarika Haldar
- Department of Experimental Medicine and Biotechnology, Post Graduate Institute of Medical Education and Research, Chandigarh, India; Centre for Biodesign and Diagnostics, Translational Health Science and Technology Institute, NCR Biotech Science Cluster, Faridabad, India.
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4
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Chauhan NK, Anand A, Sharma A, Dhiman K, Gosain TP, Singh P, Singh P, Khan E, Chattopadhyay G, Kumar A, Sharma D, Ashish, Sharma TK, Singh R. Structural and Functional Characterization of Rv0792c from Mycobacterium tuberculosis: Identifying Small Molecule Inhibitor against HutC Protein. Microbiol Spectr 2023; 11:e0197322. [PMID: 36507689 PMCID: PMC9927256 DOI: 10.1128/spectrum.01973-22] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
In order to adapt in host tissues, microbial pathogens regulate their gene expression through a variety of transcription factors. Here, we have functionally characterized Rv0792c, a HutC homolog from Mycobacterium tuberculosis. In comparison to the parental strain, a strain of M. tuberculosis with a Rv0792c mutant was compromised for survival upon exposure to oxidative stress and infection in guinea pigs. RNA sequencing analysis revealed that Rv0792c regulates the expression of genes involved in stress adaptation and virulence of M. tuberculosis. Solution small-angle X-ray scattering (SAXS) data-steered model building confirmed that the C-terminal region plays a pivotal role in dimer formation. Systematic evolution of ligands by exponential enrichment (SELEX) resulted in the identification of single-strand DNA (ssDNA) aptamers that can be used as a tool to identify small-molecule inhibitors targeting Rv0792c. Using SELEX and SAXS data-based modeling, we identified residues essential for Rv0792c's aptamer binding activity. In this study, we also identified I-OMe-Tyrphostin as an inhibitor of Rv0792c's aptamer and DNA binding activity. The identified small molecule reduced the growth of intracellular M. tuberculosis in macrophages. The present study thus provides a detailed shape-function characterization of a HutC family of transcription factor from M. tuberculosis. IMPORTANCE Prokaryotes encode a large number of GntR family transcription factors that are involved in various fundamental biological processes, including stress adaptation and pathogenesis. Here, we investigated the structural and functional role of Rv0792c, a HutC homolog from M. tuberculosis. We demonstrated that Rv0792c is essential for M. tuberculosis to adapt to oxidative stress and establish disease in guinea pigs. Using a systematic evolution of ligands by exponential enrichment (SELEX) approach, we identified ssDNA aptamers from a random ssDNA library that bound to Rv0792c protein. These aptamers were thoroughly characterized using biochemical and biophysical assays. Using SAXS, we determined the structural model of Rv0792c in both the presence and absence of the aptamers. Further, using a combination of SELEX and SAXS methodologies, we identified I-OMe-Tyrphostin as a potential inhibitor of Rv0792c. Here we provide a detailed functional characterization of a transcription factor belonging to the HutC family from M. tuberculosis.
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Affiliation(s)
- Neeraj Kumar Chauhan
- Translational Health Science and Technology Institutegrid.464764.3, Faridabad, Haryana, India
| | - Anjali Anand
- Translational Health Science and Technology Institutegrid.464764.3, Faridabad, Haryana, India
| | - Arun Sharma
- Translational Health Science and Technology Institutegrid.464764.3, Faridabad, Haryana, India
| | - Kanika Dhiman
- Institute of Microbial Technologygrid.417641.1, Council of Scientific and Industrial Research, Chandigarh, India
| | - Tannu Priya Gosain
- Translational Health Science and Technology Institutegrid.464764.3, Faridabad, Haryana, India
| | - Prashant Singh
- Institute of Microbial Technologygrid.417641.1, Council of Scientific and Industrial Research, Chandigarh, India
| | - Padam Singh
- Translational Health Science and Technology Institutegrid.464764.3, Faridabad, Haryana, India
| | - Eshan Khan
- Department of Biosciences and Biomedical Engineering, Indian Institute of Technology Indoregrid.450280.b, Indore, India
| | | | - Amit Kumar
- Department of Biosciences and Biomedical Engineering, Indian Institute of Technology Indoregrid.450280.b, Indore, India
| | - Deepak Sharma
- Institute of Microbial Technologygrid.417641.1, Council of Scientific and Industrial Research, Chandigarh, India
| | - Ashish
- Institute of Microbial Technologygrid.417641.1, Council of Scientific and Industrial Research, Chandigarh, India
| | - Tarun Kumar Sharma
- Translational Health Science and Technology Institutegrid.464764.3, Faridabad, Haryana, India
| | - Ramandeep Singh
- Translational Health Science and Technology Institutegrid.464764.3, Faridabad, Haryana, India
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5
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Kumari P, Dhiman A, Lavania S, Sharma P, Rath D, Anthwal D, Gupta RK, Kochar A, Sharma N, Gadpayle A, Taneja R, Sharma L, Haldar S, Sharma TK, Tyagi JS. Assessment of DNA aptamers targeting GlcB and HspX antigens for application in the diagnosis of abdominal tuberculosis. Tuberculosis (Edinb) 2022; 134:102206. [DOI: 10.1016/j.tube.2022.102206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 03/31/2022] [Accepted: 04/03/2022] [Indexed: 02/07/2023]
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6
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Khan A, Singh R, Sharma S, Singh V, Sheoran A, Soni A, Dhull V, Gill PS, Yadav A, Chaudhary D, Gupta MC, Mehta PK. Diagnosis of osteoarticular tuberculosis by immuno-PCR assay based on mycobacterial antigen 85 complex detection. Lett Appl Microbiol 2021; 74:17-26. [PMID: 34592012 DOI: 10.1111/lam.13567] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 09/11/2021] [Accepted: 09/14/2021] [Indexed: 01/22/2023]
Abstract
Diagnosis of osteoarticular tuberculosis (OATB) exhibits serious challenges owing to paucibacillary nature of specimens and localization of disease at sites that are difficult to access. We recently developed indirect immuno-PCR (I-PCR) and real-time I-PCR (RT-I-PCR) assays for the detection of mycobacterial antigen 85 complex (Ag85) in OATB patients. Detection limits for the purified Ag85 protein were found to be 1 and 41 fg ml-1 by I-PCR and RT-I-PCR, respectively, which were at least 105 -fold lower than respective ELISA. While spiking synovial fluids of non-TB control subjects with the purified Ag85 protein, LODs of 100 and 120 fg ml-1 were obtained by I-PCR and RT-I-PCR, respectively, thus demonstrating the sample matrix effect. Sensitivities of 87·5 and 70·5% were observed in bodily fluids of confirmed (n = 8) and clinically suspected (n = 51) OATB cases, respectively, by I-PCR, with a specificity of 93·9% (n = 33). Markedly, the sensitivities obtained by I-PCR/RT-I-PCR were significantly higher (P < 0·05-0·01) than ELISA and GeneXpert assay (n = 30). However, no substantial difference in sensitivity was observed between the I-PCR and RT-I-PCR assays. After further improving the accuracy of I-PCR, this test may lead to development of an attractive diagnostic kit.
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Affiliation(s)
- A Khan
- Centre for Biotechnology, Maharshi Dayanand University (MDU), Rohtak, India
| | - R Singh
- Department of Orthopaedics, University of Health Sciences (UHS), Rohtak, India
| | - S Sharma
- Department of Microbiology, UHS, Rohtak, India
| | - V Singh
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - A Sheoran
- Department of Statistics, Ramanujan College, University of Delhi, New Delhi, India
| | - A Soni
- Centre for Biotechnology, Maharshi Dayanand University (MDU), Rohtak, India.,Department of Biotechnology, Deenbandhu Chhotu Ram University of Science and Technology Murthal, Sonepat, India
| | - V Dhull
- Department of Biotechnology Engineering, University Institute of Engineering & Technology, MDU, Rohtak, India
| | - P S Gill
- Department of Microbiology, UHS, Rohtak, India
| | - A Yadav
- Department of Microbiology, UHS, Rohtak, India
| | - D Chaudhary
- Pulmonary and Critical Care Medicine, UHS, Rohtak, India
| | - M C Gupta
- Department of Pharmacology, UHS, Rohtak, India
| | - P K Mehta
- Centre for Biotechnology, Maharshi Dayanand University (MDU), Rohtak, India
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7
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Yang QY, Zhang YT, Xiao JN, Liang YS, Ji P, Wang SJ, Wang Y, Chen Y. Age-Related Immunoreactivity Profiles to Diverse Mycobacterial Antigens in BCG-Vaccinated Chinese Population. Front Immunol 2021; 11:608220. [PMID: 33584683 PMCID: PMC7878369 DOI: 10.3389/fimmu.2020.608220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 12/11/2020] [Indexed: 11/13/2022] Open
Abstract
Long-term immunoreactivity to mycobacterial antigens in Bovis Calmette-Guérin (BCG)-vaccinated population is not well investigated. Herein, 361 volunteer healthy donors (HDs) with neonatal BCG vaccination from Shanghai region (China) were enrolled. They were subdivided into ESAT-6/CFP10- (E6C10-) and ESAT-6/CFP10+ (E6C10+) groups based on gamma-interferon release assays (IGRAs). Three mycobacterial antigens, including Rv0934, Rv3006, and Rv3841, were subjected to the determination of immunoreactivity by ELISPOT assay. The immunoreactivities to three mycobacterial antigens were firstly compared among TB patients (N=39), E6C10+ HDs (N=78, 21.61% of HDs) and E6C10- HDs (N=283, 78.39% of HDs). It was revealed that Rv3006 was dominant upon M.tb infection, while Rv3841 was likely to be more responsive upon latent TB infection. In E6C10- population, the immunoreactivity to Rv3841 maintained along with aging, whereas those to Rv3006 and Rv0934 attenuated in E6C10- HDs older than 45 years old. Our study implies the shift of dominant antigens at different infection statuses, providing the clues for the selection of mycobacterial antigens in vaccine development and precision revaccination in the future.
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Affiliation(s)
- Qing-Yuan Yang
- Department of Microbiology and Immunology, Shanghai Institute of Immunology, Shanghai Jiao Tong Unviersity School of Medicine, Shanghai, China
| | - Yu-Tong Zhang
- Department of Microbiology and Immunology, Shanghai Institute of Immunology, Shanghai Jiao Tong Unviersity School of Medicine, Shanghai, China
| | - Jia-Ni Xiao
- Department of Microbiology and Immunology, Shanghai Institute of Immunology, Shanghai Jiao Tong Unviersity School of Medicine, Shanghai, China
| | - Yu-Shuo Liang
- Department of Microbiology and Immunology, Shanghai Institute of Immunology, Shanghai Jiao Tong Unviersity School of Medicine, Shanghai, China
| | - Ping Ji
- Department of Microbiology and Immunology, Shanghai Institute of Immunology, Shanghai Jiao Tong Unviersity School of Medicine, Shanghai, China
| | - Shu-Jun Wang
- Department of Microbiology and Immunology, Shanghai Institute of Immunology, Shanghai Jiao Tong Unviersity School of Medicine, Shanghai, China
| | - Ying Wang
- Department of Microbiology and Immunology, Shanghai Institute of Immunology, Shanghai Jiao Tong Unviersity School of Medicine, Shanghai, China.,Key Laboratory of Parasite and Vector Biology, Ministry of Health, School of Global Health, Chinese Center for Tropical Diseases Research, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yingying Chen
- Department of Microbiology and Immunology, Shanghai Institute of Immunology, Shanghai Jiao Tong Unviersity School of Medicine, Shanghai, China
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Mohd Amiruddin M, Ang GY, Yu CY, Falero-Diaz G, Otero O, Reyes F, Camacho F, Chin K, Sarmiento M, Norazmi M, Acosta A, Yean Yean C. Development of an immunochromatographic lateral flow dipstick for the detection of Mycobacterium tuberculosis 16 kDa antigen (Mtb-strip). J Microbiol Methods 2020; 176:106003. [DOI: 10.1016/j.mimet.2020.106003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 06/27/2020] [Accepted: 07/13/2020] [Indexed: 01/05/2023]
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Utility of circulating cell-free Mycobacterium tuberculosis DNA for the improved diagnosis of abdominal tuberculosis. PLoS One 2020; 15:e0238119. [PMID: 32845896 PMCID: PMC7449497 DOI: 10.1371/journal.pone.0238119] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 08/09/2020] [Indexed: 12/13/2022] Open
Abstract
Abdominal tuberculosis (ATB) continues to pose a major diagnostic challenge for clinicians due to its nonspecific clinical presentation, variable anatomical location and lack of sensitive diagnostic tools. In spite of the development of several assays till date; no single test has proved to be adequate for ATB diagnosis. In this study, we for the first time report the detection of circulating cell-free Mycobacterium tuberculosis (M. tuberculosis) DNA (cfMTB-DNA) in ascitic fluid (AF) samples and its utility in ATB diagnosis. Sixty-five AF samples were included in the study and processed for liquid culture, cytological, biochemical and molecular assays. A composite reference standard (CRS) was formulated to categorize the patients into 'Definite ATB' (M. tuberculosis culture positive, n = 2), 'Probable ATB' (n = 16), 'Possible ATB' (n = 13) and 'Non-TB' category (n = 34). Two molecular assays were performed, namely, the novel cfMTB-DNA qPCR assay targeting M. tuberculosis devR gene and Xpert MTB/RIF assay (Xpert), and their diagnostic accuracy was assessed using CRS as reference standard. Clinical features such as fever, loss of weight, abdominal distension and positive Mantoux were found to be strongly associated with ATB disease (p<0.05). cfMTB-DNA qPCR had a sensitivity of 66.7% (95% CI:40.9,86.7) with 97.1% specificity (95% CI:84.7,99.9) in 'Definite ATB' and 'Probable ATB' group collectively. The sensitivity increased to 70.9% (95% CI:51.9,85.8) in the combined 'Definite', 'Probable' and 'Possible' ATB group with similar specificity. The cfMTB-DNA qPCR assay performed significantly better than the Xpert assay which demonstrated a poor sensitivity of ≤16.7% with 100% (95% CI:89.7,100) specificity (p<0.001). We conclude that cfMTB-DNA qPCR assay is an accurate molecular test that can provide direct evidence of M. tuberculosis etiology and has promise to pave the way for improving ATB diagnosis.
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Peláez EC, Estevez MC, Mongui A, Menéndez MC, Toro C, Herrera-Sandoval OL, Robledo J, García MJ, Portillo PD, Lechuga LM. Detection and Quantification of HspX Antigen in Sputum Samples Using Plasmonic Biosensing: Toward a Real Point-of-Care (POC) for Tuberculosis Diagnosis. ACS Infect Dis 2020; 6:1110-1120. [PMID: 32233503 DOI: 10.1021/acsinfecdis.9b00502] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Advancements that occurred during the last years in the diagnosis of Mycobacterium tuberculosis (Mtb), the causative agent of tuberculosis infection, have prompted increased survival rates of patients. However, limitations related to the inefficiency of an early detection still remain; some techniques and laboratory methods do not have enough specificity and most instruments are expensive and require handling by trained staff. In order to contribute to a prompt and effective diagnosis of tuberculosis, we report the development of a portable, user-friendly, and low-cost biosensor device for its early detection. By using a label-free surface plasmon resonance (SPR) biosensor, we have established a direct immunoassay for the direct detection and quantification of the heat shock protein X (HspX) of Mtb, a well-established biomarker of this pathogen, directly in pretreated sputum samples. The method relies on highly specific monoclonal antibodies that are previously immobilized on the plasmonic sensor surface. This technology allows for the direct detection of the biomarker without amplification steps, showing a limit of detection (LOD) of 0.63 ng mL-1 and a limit of quantification (LOQ) of 2.12 ng mL-1. The direct analysis in pretreated sputum shows significant differences in the HspX concentration in patients with tuberculosis (with concentration levels in the order of 116-175 ng mL-1) compared with non-tuberculosis infected patients (values below the LOQ of the assay).
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Affiliation(s)
- Enelia Cristina Peláez
- Nanobiosensors and Bioanalytical Applications Group (NanoB2A), Catalan Institute of Nanoscience and Nanotechnology (ICN2), CSIC, CIBER-BBN and BIST, Campus UAB, 08193 Barcelona, Spain
- Centro de Investigación y Desarrollo Tecnológico de la Industria Electro Electrónica y TIC (CIDEI), Calle 45a BIS # 19-09 Floor 2, Bogotá, DC, Colombia
- Corporación CorpoGen, Departamento Biotecnología Molecular, Carrera 4 # 20-41, Bogotá, DC, Colombia
- Research Cluster on Converging Sciences and Technology (NBIC), Universidad Central, Calle 21 #4-40, Bogotá, DC, Colombia
| | - Maria Carmen Estevez
- Nanobiosensors and Bioanalytical Applications Group (NanoB2A), Catalan Institute of Nanoscience and Nanotechnology (ICN2), CSIC, CIBER-BBN and BIST, Campus UAB, 08193 Barcelona, Spain
| | - Alvaro Mongui
- Corporación CorpoGen, Departamento Biotecnología Molecular, Carrera 4 # 20-41, Bogotá, DC, Colombia
| | - M-Carmen Menéndez
- Departamento de Medicina Preventiva, Salud Pública y Microbiología, Facultad de Medicina, Universidad Autónoma de Madrid, St Arzobispo Morcillo s/n, 28029 Madrid, Spain
| | - Carlos Toro
- Department of Microbiology, La Paz University Hospital, IdiPaz, St/Paseo de la Castellana 261, 28046 Madrid, Spain
| | - Oscar L. Herrera-Sandoval
- Centro de Investigación y Desarrollo Tecnológico de la Industria Electro Electrónica y TIC (CIDEI), Calle 45a BIS # 19-09 Floor 2, Bogotá, DC, Colombia
- Research Cluster on Converging Sciences and Technology (NBIC), Universidad Central, Calle 21 #4-40, Bogotá, DC, Colombia
| | - Jaime Robledo
- Corporación para Investigaciones Biológicas (CIB), Laboratorio de Micobacterias, Carrera 72A 78B-141, 050034 Medellín, Colombia
| | - Maria J. García
- Departamento de Medicina Preventiva, Salud Pública y Microbiología, Facultad de Medicina, Universidad Autónoma de Madrid, St Arzobispo Morcillo s/n, 28029 Madrid, Spain
| | - Patricia Del Portillo
- Corporación CorpoGen, Departamento Biotecnología Molecular, Carrera 4 # 20-41, Bogotá, DC, Colombia
| | - Laura M. Lechuga
- Nanobiosensors and Bioanalytical Applications Group (NanoB2A), Catalan Institute of Nanoscience and Nanotechnology (ICN2), CSIC, CIBER-BBN and BIST, Campus UAB, 08193 Barcelona, Spain
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12
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Garg RK. Microbiological diagnosis of tuberculous meningitis: Phenotype to genotype. Indian J Med Res 2019; 150:448-457. [PMID: 31939388 PMCID: PMC6977359 DOI: 10.4103/ijmr.ijmr_1145_19] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Indexed: 11/22/2022] Open
Abstract
Tuberculous meningitis (TBM) is a commonly encountered central nervous system infection. Characteristic clinical, imaging and cerebrospinal fluid parameters help clinicians to make a prompt presumptive diagnosis that enables them to start empirical anti-tuberculosis treatment. There are several close mimic to TBM, such as partially treated pyogenic meningitis, fungal meningitis, sarcoidosis, meningeal metastases and meningeal lymphomatosis. Microbiological confirmation instils a sense of confidence amongst treating physicians. With conventional phenotypic methods (cerebrospinal fluid microscopy and culture), in more than 50 per cent patients, microbiological confirmation is not achieved. Moreover, these methods take a long time before providing conclusive results. Negative result does not rule out Mycobacterium tuberculosis infection of the brain. Genotypic methods, such as IS 6110 polymerase chain reaction and automated Xpert M. tuberculosis/rifampicin (MTB/RIF) assay system improved the TBM diagnostics, as results are rapidly available. Xpert MTB/RIF assay, in addition, detects rifampicin resistance. Xpert MTB/RIF Ultra is advanced technology which has higher (60-70%) sensitivity and is being considered a game-changer in the diagnostics of TBM. A large number of TBM cases remain unconfirmed. The situation of TBM diagnostics will remain grim, if low-cost technologies are not widely available. Till then, physicians continue to rely on their clinical acumen to start empirical anti-tuberculosis treatment.
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Affiliation(s)
- Ravindra Kumar Garg
- Department of Neurology, King George Medical University, Lucknow, Uttar Pradesh, India
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Dhiman A, Kumar C, Mishra SK, Sikri K, Datta I, Sharma P, Singh TP, Haldar S, Sharma N, Bansal A, Ahmad Y, Kumar A, Sharma TK, Tyagi JS. Theranostic Application of a Novel G-Quadruplex-Forming DNA Aptamer Targeting Malate Synthase of Mycobacterium tuberculosis. MOLECULAR THERAPY. NUCLEIC ACIDS 2019; 18:661-672. [PMID: 31704587 PMCID: PMC6849348 DOI: 10.1016/j.omtn.2019.09.026] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 08/29/2019] [Accepted: 09/27/2019] [Indexed: 12/28/2022]
Abstract
The successful management of tuberculosis (TB) requires efficient diagnosis and treatment. Further, the increasing prevalence of drug-resistant TB highlights the urgent need to develop novel inhibitors against both drug-susceptible and drug-resistant forms of disease. Malate synthase (MS), an enzyme of the glyoxylate pathway, plays a vital role in mycobacterial persistence, and therefore it is considered as an attractive target for novel anti-TB drug development. Recent studies have also ascribed an adhesin function to MS and established it as a potent diagnostic biomarker. In this study, a panel of Mycobacterium tuberculosis (Mtb) MS-specific single-stranded DNA aptamers was identified by Systematic Evolution of Ligands by EXponential enrichment (SELEX). The best-performing G-quadruplex-forming 44-mer aptamer, MS10, was optimized post-SELEX to generate an 11-mer aptamer, MS10-Trunc. This aptamer was characterized by various biochemical, biophysical, and in silico techniques. Its theranostic activity toward Mtb was established using enzyme inhibition, host cell binding, and invasion assays. MS10-Trunc aptamer exhibited high affinity for MS (equilibrium dissociation constant [KD] ∼19 pM) and displayed robust inhibition of MS enzyme activity with IC50 of 251.1 nM and inhibitor constant (Ki) of 230 nM. This aptamer blocked mycobacterial entry into host cells by binding to surface-associated MS. In addition, we have also demonstrated its application in the detection of tuberculous meningitis (TBM) in patients with sensitivity and specificity each of >97%.
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Affiliation(s)
- Abhijeet Dhiman
- Department of Biotechnology, All India Institute of Medical Sciences, New Delhi 110029, India; Faculty of Pharmacy, Uttarakhand Technical University, Dehradun 248007, Uttarakhand, India
| | - Chanchal Kumar
- Department of Biotechnology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Subodh Kumar Mishra
- Discipline of Biosciences and Biomedical Engineering, Indian Institute of Technology Indore, Simrol, Indore 453552, India
| | - Kriti Sikri
- Department of Biotechnology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Ishara Datta
- Department of Biotechnology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Pradeep Sharma
- Department of Biophysics, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Tej P Singh
- Department of Biophysics, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Sagarika Haldar
- Department of Experimental Medicine and Biotechnology, PGIMER, Sector 12, Chandigarh 160012, India; Multidisciplinary Clinical and Translational Research Group, Translational Health Science and Technology Institute, Faridabad, Haryana 121001, India
| | - Neera Sharma
- Department of Biochemistry, Dr. Ram Manohar Lohia Hospital, New Delhi 110001, India
| | - Anjali Bansal
- Department of Pediatrics, Dr. Ram Manohar Lohia Hospital, New Delhi 110001, India
| | - Yusra Ahmad
- Faculty of Pharmacy, Uttarakhand Technical University, Dehradun 248007, Uttarakhand, India
| | - Amit Kumar
- Discipline of Biosciences and Biomedical Engineering, Indian Institute of Technology Indore, Simrol, Indore 453552, India
| | - Tarun Kumar Sharma
- Multidisciplinary Clinical and Translational Research Group, Translational Health Science and Technology Institute, Faridabad, Haryana 121001, India.
| | - Jaya Sivaswami Tyagi
- Department of Biotechnology, All India Institute of Medical Sciences, New Delhi 110029, India; Multidisciplinary Clinical and Translational Research Group, Translational Health Science and Technology Institute, Faridabad, Haryana 121001, India.
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A Systematic Review and Meta-analysis of the Diagnostic Accuracy of Nucleic Acid Amplification Tests for Tuberculous Meningitis. J Clin Microbiol 2019; 57:JCM.01113-18. [PMID: 30944198 DOI: 10.1128/jcm.01113-18] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
The diagnosis of tuberculous meningitis (TBM) is difficult and poses a significant challenge to physicians worldwide. Recently, nucleic acid amplification (NAA) tests have shown promise for the diagnosis of TBM, although their performance has been variable. We undertook a systematic review and meta-analysis to evaluate the diagnostic accuracy of NAA tests with cerebrospinal fluid (CSF) samples against that of culture as the reference standard or a combined reference standard (CRS) for TBM. We searched the Embase, PubMed, Web of Science, and Cochrane Library databases for the relevant records. The QUADAS-2 tool was used to assess the quality of the studies. Diagnostic accuracy measures (i.e., sensitivity and specificity) were pooled with a random-effects model. All statistical analyses were performed with STATA (version 14 IC; Stata Corporation, College Station, TX, USA), Meta-DiSc (version 1.4 for Windows; Cochrane Colloquium, Barcelona, Spain), and RevMan (version 5.3; The Nordic Cochrane Centre, the Cochrane Collaboration, Copenhagen, Denmark) software. Sixty-three studies comprising 1,381 cases of confirmed TBM and 5,712 non-TBM controls were included in the final analysis. These 63 studies were divided into two groups comprising 71 data sets (43 in-house tests and 28 commercial tests) that used culture as the reference standard and 24 data sets (21 in-house tests and 3 commercial tests) that used a CRS. Studies which used a culture reference standard had better pooled summary estimates than studies which used CRS. The overall pooled estimates of sensitivity, specificity, positive likelihood ratio (PLR), and negative likelihood ratio (NLR) of the NAA tests against culture were 82% (95% confidence interval [CI], 75 to 87%), 99% (95% CI, 98 to 99%), 58.6 (95% CI, 35.3 to 97.3), and 0.19 (95% CI, 0.14 to 0.25), respectively. The pooled sensitivity, specificity, PLR, and NLR of NAA tests against CRS were 68% (95% CI, 41 to 87%), 98% (95% CI, 95 to 99%), 36.5 (95% CI, 15.6 to 85.3), and 0.32 (95% CI, 0.15 to 0.70), respectively. The analysis has demonstrated that the diagnostic accuracy of NAA tests is currently insufficient for them to replace culture as a lone diagnostic test. NAA tests may be used in combination with culture due to the advantage of time to result and in scenarios where culture tests are not feasible. Further work to improve NAA tests would benefit from the availability of standardized reference standards and improvements to the methodology.
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Das R, Dhiman A, Mishra SK, Haldar S, Sharma N, Bansal A, Ahmad Y, Kumar A, Tyagi JS, Sharma TK. Structural switching electrochemical DNA aptasensor for the rapid diagnosis of tuberculous meningitis. Int J Nanomedicine 2019; 14:2103-2113. [PMID: 30988611 PMCID: PMC6440448 DOI: 10.2147/ijn.s189127] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background Tuberculous meningitis (TBM) is the most devastating manifestation of extra-pulmonary tuberculosis. About 33% of TBM patients die due to very late diagnosis of the disease. Conventional diagnostic methods based on signs and symptoms, cerebrospinal fluid (CSF) smear microscopy or liquid culture suffer from either poor sensitivity or long turnaround time (up to 8 weeks). Therefore, in order to manage the disease efficiently, there is an urgent and unmet need for a rapid and reliable diagnostic test. Methods In the current study, to address the diagnostic challenge of TBM, a highly rapid and sensitive structural switching electrochemical aptasensor was developed by combining the electrochemical property of methylene blue (MB) with the molecular recognition ability of a ssDNA aptamer. To demonstrate the clinical diagnostic utility of the developed aptasensor, a blinded study was performed on 81 archived CSF specimens using differential pulse voltammetry. Results The electrochemical aptasensor developed in the current study can detect as low as 10 pg HspX in CSF background and yields a highly discriminatory response (P<0.0001) for TBM and not-TBM categories with ~95% sensitivity and ~97.5% specificity and has the ability to deliver sample-to-answer in ≤30 minutes. Conclusion In summary, we demonstrate a new aptamer-based electrochemical biosensing strategy by exploiting the target-induced structural switching of H63 SL-2 M6 aptamer and electroactivity of aptamer-tagged MB for the detection of HspX in CSF samples for the diagnosis of TBM. Further, the clinical utility of this sensor could be extended for the diagnosis of other forms of tuberculosis in the near future.
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Affiliation(s)
- Ritu Das
- AptaBharat Innovation Pvt. Ltd., Faridabad, India,
| | - Abhijeet Dhiman
- Department of Biotechnology, All India Institute of Medical Sciences (AIIMS), New Delhi, India, .,Faculty of Pharmacy, Uttarakhand Technical University (UTU), Dehradun, India
| | - Subodh Kumar Mishra
- Discipline of Biosciences and Biomedical Engineering, Indian Institute of Technology Indore, Simrol, India
| | - Sagarika Haldar
- Center for Biodesign and Diagnostics, Translational Health Science and Technology Institute, Faridabad, India, , .,Department of Experimental Medicine and Biotechnology, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | | | | | - Yusra Ahmad
- Faculty of Pharmacy, Uttarakhand Technical University (UTU), Dehradun, India
| | - Amit Kumar
- Discipline of Biosciences and Biomedical Engineering, Indian Institute of Technology Indore, Simrol, India
| | - Jaya Sivaswami Tyagi
- Department of Biotechnology, All India Institute of Medical Sciences (AIIMS), New Delhi, India, .,Center for Biodesign and Diagnostics, Translational Health Science and Technology Institute, Faridabad, India, ,
| | - Tarun Kumar Sharma
- AptaBharat Innovation Pvt. Ltd., Faridabad, India, .,Center for Biodesign and Diagnostics, Translational Health Science and Technology Institute, Faridabad, India, ,
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Long F, Kong M, Wu S, Zhang W, Liao Q, Peng Z, Nan L, Liu Y, Wang M, He C, Wu Y, Lu X, Kang M. Development and validation of an advanced fragment analysis-based assay for the detection of 22 pathogens in the cerebrospinal fluid of patients with meningitis and encephalitis. J Clin Lab Anal 2019; 33:e22707. [PMID: 30666716 PMCID: PMC6818557 DOI: 10.1002/jcla.22707] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Revised: 09/10/2018] [Accepted: 10/07/2018] [Indexed: 02/05/2023] Open
Abstract
Background Meningitis and encephalitis (ME) are central nervous system (CNS) infections mainly caused by bacteria, mycobacteria, fungi, viruses, and parasites that result in high morbidity and mortality. The early, accurate diagnosis of pathogens in the cerebrospinal fluid (CSF) and timely medication are associated with better prognosis. Conventional methods, such as culture, microscopic examination, serological detection, CSF routine analysis, and radiological findings, either are time‐consuming or lack sensitivity and specificity. Methods To address these clinical needs, we developed an advanced fragment analysis (AFA)‐based assay for the multiplex detection of 22 common ME pathogens, including eight viruses, 11 bacteria, and three fungi. The detection sensitivity of each target was evaluated with a recombinant plasmid. The limits of detection of the 22 pathogens ranged from 15 to 120 copies/reaction. We performed a retrospective study to analyze the pathogens from the CSF specimens of 170 clinically diagnosed ME patients using an AFA‐based assay and compared the results with culture (bacteria and fungi), microscopic examination (fungi), polymerase chain reaction (PCR) (Mycobacterium tuberculosis), and Sanger sequencing (virus) results. Results The sensitivity of the AFA assay was 100% for 10 analytes. For Cryptococcus neoformans, the sensitivity was 63.6%. The overall specificity was 98.2%. The turnaround time was reduced to 4‐6 hours from the 3‐7 days required using conventional methods. Conclusions In conclusion, the AFA‐based assay provides a rapid, sensitive, and accurate method for pathogen detection from CSF samples.
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Affiliation(s)
- Fang Long
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Mimi Kong
- Ningbo HEALTH Gene Technologies Co., Ltd., Ningbo, China
| | - Siying Wu
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Weili Zhang
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Quanfeng Liao
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Zaisheng Peng
- Enshi Tujia and Miao Autonomous Prefecture Center for Disease Control and Prevention, Enshi, China
| | - Li Nan
- Ningbo HEALTH Gene Technologies Co., Ltd., Ningbo, China
| | - Ya Liu
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Minjin Wang
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Chao He
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Yong Wu
- Ningbo HEALTH Gene Technologies Co., Ltd., Ningbo, China
| | - Xiaojun Lu
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Mei Kang
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, China
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Sharma S, Sheoran A, Gupta KB, Yadav A, Varma-Basil M, Sreenivas V, Chaudhary D, Mehta PK. Quantitative detection of a cocktail of mycobacterial MPT64 and PstS1 in tuberculosis patients by real-time immuno-PCR. Future Microbiol 2019; 14:223-233. [PMID: 30663893 DOI: 10.2217/fmb-2018-0284] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
AIM There is an urgent need to design a reliable diagnostic test for tuberculosis (TB). METHODS Real-time immuno-PCR (RT-I-PCR) assay was devised for the quantitative detection of a cocktail of mycobacterial MPT64 (Rv1980c) and PstS1 (Rv0934) in TB patients. RESULTS A broad dynamic range of 0.95 pg/ml-95 ng/ml of MPT64+PstS1 was detected in TB patients. In smear-positive (n = 59) and smear-negative (n = 42) pulmonary TB cases, sensitivities of 93.2 and 83.3% were observed, respectively with 92.8% specificity, whereas a sensitivity of 77.9% and a specificity of 91.3% were observed in extrapulmonary TB cases (n = 86). Furthermore, significantly reduced MPT64+PstS1 concentrations (p < 0.001) were noticed in patients on therapy by RT-I-PCR as compared with untreated patients. CONCLUSION Our RT-I-PCR assay revealed high sensitivity especially for the rapid diagnosis of smear-negative pulmonary TB and paucibacillary extrapulmonary TB samples, which could also monitor the dynamics of disease in patients on therapy.
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Affiliation(s)
- Suman Sharma
- Centre for Biotechnology, Maharshi Dayanand University, Rohtak-124001, India
| | - Abhishek Sheoran
- Department of Statistics, Ramanujan College, University of Delhi, New Delhi-110019, India
| | - Krishna B Gupta
- Department of TB & Respiratory Medicine, University of Health Sciences, Rohtak-124001, India
| | - Aparna Yadav
- Department of Microbiology, University of Health Sciences, Rohtak-124001, India
| | - Mandira Varma-Basil
- Microbiology Department, Vallabhbhai Patel Chest Institute, University of Delhi, New Delhi-110007, India
| | - Vishnubhatla Sreenivas
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi-110029, India
| | - Dhruva Chaudhary
- Department of Pulmonary & Critical Care Medicine, University of Health Sciences, Rohtak-124001, India
| | - Promod K Mehta
- Centre for Biotechnology, Maharshi Dayanand University, Rohtak-124001, India
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18
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Lavania S, Das R, Dhiman A, Myneedu VP, Verma A, Singh N, Sharma TK, Tyagi JS. Aptamer-Based TB Antigen Tests for the Rapid Diagnosis of Pulmonary Tuberculosis: Potential Utility in Screening for Tuberculosis. ACS Infect Dis 2018; 4:1718-1726. [PMID: 30350564 DOI: 10.1021/acsinfecdis.8b00201] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Pulmonary tuberculosis is the most common manifestation of tuberculosis, and to this day, sputum smear microscopy remains the most widely used diagnostic test in resource-limited settings despite its suboptimal sensitivity. Here we report the development of two DNA aptamer-based diagnostic tests, namely aptamer linked immobilized sorbent assay (Aptamer ALISA) and electrochemical sensor (ECS), for the direct detection of a TB biomarker HspX in sputum. First we compared the performance of Aptamer ALISA with anti-HspX polyclonal antibody-based enzyme linked immunosorbent assay (Antibody ELISA) in a blinded study of 314 sputum specimens. Aptamer ALISA displayed a high sensitivity of 94.1% (95% CI 86.8-98%) as compared to 68.2% sensitivity (95% CI 57.2-77.9%) of Antibody ELISA ( p-value < 0.05) using culture as the reference standard without compromising test specificity of 100%. Out of nine smear-negative culture-positive samples, six were positive by Aptamer ALISA and only two were detected by Antibody ELISA. ALISA detected as positive 80 of 85 culture-positive TB as compared to 57 of 81 diagnosed as TB by X-ray ( p-value < 0.0001). These findings demonstrate the superiority of the aptamer-based test over smear microscopy, antibody-based ELISA, and chest X-ray for TB detection ( p-value < 0.0001 for all). Further, we have developed a ∼30 min point-of-care ECS test that discriminates between tuberculous and nontuberculous sputum with a sensitivity of ∼92.3% and specificity of 91.2%. The tests developed in the current study cost ∼$1-3/test and have potential utility in active case finding in high-risk groups and screening for pulmonary TB among presumptive TB subjects.
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Affiliation(s)
- Surabhi Lavania
- Department of Biotechnology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
- School of Biotechnology, Gautam Buddha University, Yamuna Express-way, Greater Noida, Uttar Pradesh 201308, India
| | - Ritu Das
- AptaBharat Innovation Private Limited, Translational Health Science and Technology Institute Incubator, Faridabad, Haryana 121001, India
| | - Abhijeet Dhiman
- Department of Biotechnology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
- Faculty of Pharmacy, Uttarakhand Technical University (UTU), Dehradun, Uttarakhand 248007, India
| | - Vithal Prasad Myneedu
- Department of Microbiology, National Institute of Tuberculosis and Respiratory Diseases, Mehrauli, New Delhi 110030, India
| | - Ajoy Verma
- Department of Microbiology, National Institute of Tuberculosis and Respiratory Diseases, Mehrauli, New Delhi 110030, India
| | - Nagendra Singh
- School of Biotechnology, Gautam Buddha University, Yamuna Express-way, Greater Noida, Uttar Pradesh 201308, India
| | - Tarun Kumar Sharma
- AptaBharat Innovation Private Limited, Translational Health Science and Technology Institute Incubator, Faridabad, Haryana 121001, India
- Center for Bio-design and Diagnostics, Translational Health Science and Technology Institute, NCR Biotech Science Cluster, Third Milestone, Faridabad-Gurugram Express-way, PO box # 04, Faridabad 121001, India
| | - Jaya Sivaswami Tyagi
- Department of Biotechnology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
- Center for Bio-design and Diagnostics, Translational Health Science and Technology Institute, NCR Biotech Science Cluster, Third Milestone, Faridabad-Gurugram Express-way, PO box # 04, Faridabad 121001, India
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Kumari P, Lavania S, Tyagi S, Dhiman A, Rath D, Anthwal D, Gupta RK, Sharma N, Gadpayle AK, Taneja RS, Sharma L, Ahmad Y, Sharma TK, Haldar S, Tyagi JS. A novel aptamer-based test for the rapid and accurate diagnosis of pleural tuberculosis. Anal Biochem 2018; 564-565:80-87. [PMID: 30352198 DOI: 10.1016/j.ab.2018.10.019] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 10/17/2018] [Accepted: 10/17/2018] [Indexed: 12/30/2022]
Abstract
Pleural tuberculosis (pTB) is diagnosed by using a composite reference standard (CRS) since microbiological methods are grossly inadequate and an accurate diagnostic test remains an unmet need. The present study aimed to evaluate the utility of Mycobacterium tuberculosis (Mtb) antigen and DNA-based tests for pTB diagnosis. Patients were classified as 'Definite TB', 'Probable TB' and 'Non-TB' disease according to the CRS. We assessed the performance of in-house antigen detection assays, namely antibody-based Enzyme-Linked ImmunoSorbent Assay (ELISA) and aptamer-based Aptamer-Linked Immobilized Sorbent Assay (ALISA), targeting Mtb HspX protein and DNA-based tests namely, Xpert MTB/RIF and in-house devR-qPCR. ROC curves were generated for the combined group of 'Definite TB' and 'Probable TB' vs. 'Non-TB' disease group and cut-off values were derived to provide specificity of ≥98%. The sensitivity of ALISA was ∼93% vs. ∼24% of ELISA (p-value ≤0.0001). devR-qPCR exhibited a sensitivity of 50% vs. ∼22% of Xpert (p-value ≤0.01). This novel aptamer-based ALISA test surpasses the sensitivity criterion and matches the specificity requirement spelt out in the 'Target product profile' for extrapulmonary tuberculosis samples by Unitaid (Sensitivity ≥80%, Specificity 98%). The superior performance of the aptamer-based ALISA test indicates its translational potential to bridge the existing gap in pTB diagnosis.
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Affiliation(s)
- Pooja Kumari
- Department of Biotechnology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Surabhi Lavania
- Department of Biotechnology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Shaifali Tyagi
- Center for Bio-design and Diagnostics, Translational Health Science and Technology Institute, NCR Biotech Science Cluster, 3rd Milestone, Faridabad, Gurgaon Expressway, PO box #04, Faridabad, 121001, India
| | - Abhijeet Dhiman
- Department of Biotechnology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India; Faculty of Pharmacy, Uttarakhand Technical University, Dehradun, Uttarakhand, India
| | - Deepak Rath
- Dr. Ram Manohar Lohia Hospital, New Delhi, 110001, India
| | - Divya Anthwal
- Center for Bio-design and Diagnostics, Translational Health Science and Technology Institute, NCR Biotech Science Cluster, 3rd Milestone, Faridabad, Gurgaon Expressway, PO box #04, Faridabad, 121001, India
| | - Rakesh Kumar Gupta
- Center for Bio-design and Diagnostics, Translational Health Science and Technology Institute, NCR Biotech Science Cluster, 3rd Milestone, Faridabad, Gurgaon Expressway, PO box #04, Faridabad, 121001, India
| | - Neera Sharma
- Dr. Ram Manohar Lohia Hospital, New Delhi, 110001, India
| | - A K Gadpayle
- Dr. Ram Manohar Lohia Hospital, New Delhi, 110001, India
| | - R S Taneja
- Dr. Ram Manohar Lohia Hospital, New Delhi, 110001, India
| | - Lokesh Sharma
- Dr. Ram Manohar Lohia Hospital, New Delhi, 110001, India
| | - Yusra Ahmad
- Faculty of Pharmacy, Uttarakhand Technical University, Dehradun, Uttarakhand, India
| | - Tarun Kumar Sharma
- Center for Bio-design and Diagnostics, Translational Health Science and Technology Institute, NCR Biotech Science Cluster, 3rd Milestone, Faridabad, Gurgaon Expressway, PO box #04, Faridabad, 121001, India; AptaBharat Innovation Pvt. Ltd., Translational Health Science and Technology Institute Incubator, NCR Biotech Science Cluster, 3rd Milestone, Faridabad, Gurgaon Expressway, PO box #04, Faridabad, 121001, India.
| | - Sagarika Haldar
- Center for Bio-design and Diagnostics, Translational Health Science and Technology Institute, NCR Biotech Science Cluster, 3rd Milestone, Faridabad, Gurgaon Expressway, PO box #04, Faridabad, 121001, India.
| | - Jaya Sivaswami Tyagi
- Department of Biotechnology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India; Center for Bio-design and Diagnostics, Translational Health Science and Technology Institute, NCR Biotech Science Cluster, 3rd Milestone, Faridabad, Gurgaon Expressway, PO box #04, Faridabad, 121001, India.
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Diagnostic accuracy of nucleic acid amplification based assays for tuberculous meningitis: A meta-analysis. J Infect 2018; 77:302-313. [DOI: 10.1016/j.jinf.2018.04.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 04/26/2018] [Accepted: 04/28/2018] [Indexed: 11/18/2022]
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Generation and application of DNA aptamers against HspX for accurate diagnosis of tuberculous meningitis. Tuberculosis (Edinb) 2018; 112:27-36. [PMID: 30205966 DOI: 10.1016/j.tube.2018.07.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 07/05/2018] [Accepted: 07/08/2018] [Indexed: 11/20/2022]
Abstract
Tuberculous meningitis (TBM) is the most severe manifestation of tuberculosis and its diagnosis remains a challenge even today due to the lack of an adequate test. HspX antigen of Mycobacterium tuberculosis was previously established as a reliable diagnostic biomarker for TBM in an ELISA test format using anti-HspX polyclonal antibodies. Towards overcoming the limitations of batch-to-batch variation and challenges of scalability in antibody generation, we utilized Systematic Evolution of Ligands by EXponential enrichment (SELEX) to develop high affinity DNA aptamers against HspX as an alternative diagnostic reagent. Post-SELEX optimization of the best-performing aptamer candidate, H63, established its derivative H63 SL-2 M6 to be superior to its parent. Aptamer H63 SL-2 M6 displayed a specific and high affinity interaction with HspX (Kd ∼9.0 × 10-8 M). In an Aptamer Linked Immobilized Sorbent Assay (ALISA), H63 SL-2 M6 significantly differentiated between cerebrospinal fluid specimens from TBM and non-TBM subjects (n = 87, ***p < 0.0001) with ∼100% sensitivity and ∼91% specificity. Notably, ALISA exhibited comparable performance with previously reported antibody-based ELISA and qPCR. Altogether, our findings establish the utility of HspX aptamer for the reliable diagnosis of TBM and pave the way for developing an aptamer-based point-of-care test for TBM.
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Zhang W, Shu Q, Zhao Z, Fan J, Lyon CJ, Zelazny AM, Hu Y. Antigen 85B peptidomic analysis allows species-specific mycobacterial identification. Clin Proteomics 2018; 15:1. [PMID: 29321721 PMCID: PMC5757288 DOI: 10.1186/s12014-017-9177-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 11/28/2017] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Nontuberculous mycobacteria (NTM)-mediated infections are a growing cause of worldwide morbidity, but lack of rapid diagnostics for specific NTM species can delay the initiation of appropriate treatment regimens. We thus examined whether mass spectrometry analysis of an abundantly secreted mycobacterial antigen could identify specific NTM species. METHODS We analyzed predicted tryptic peptides of the major mycobacterial antigen Ag85B for their capacity to distinguish Mycobacterium tuberculosis and three NTM species responsible for the majority of pulmonary infections caused by slow-growing mycobacterial species. Next, we analyzed trypsin-digested culture supernatants of these four mycobacterial species by liquid chromatography-tandem mass spectrometry (LC-MS/MS) to detect candidate species-specific Ag85B peptides, the identity of which were validated by LC-MS/MS performed in parallel reaction monitoring mode. RESULTS Theoretical tryptic digests of the Ag85B proteins of four common mycobacterial species produced peptides with distinct sequences, including two peptides that could each identify the species origin of each Ag85B protein. LC-MS/MS analysis of trypsinized culture supernatants of these four species detected one of these species-specific signature peptides in each sample. Subsequent LC-MS/MS analyses confirmed these results by targeting these species-specific Ag85B peptides. CONCLUSIONS LC-MS/MS analysis of Ag85B peptides from trypsin-digested mycobacterial culture supernatants can rapidly detect and identify common mycobacteria responsible for most pulmonary infections caused by slow-growing mycobacteria, and has the potential to rapidly diagnose pulmonary infections caused by these mycobacteria through direct analysis of clinical specimens.
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Affiliation(s)
- Wei Zhang
- Department of Respiratory Medicine, Shengjing Hospital of China Medical University, 36 Sanhao Street, Shenyang, 110004 Liaoning Province China
| | - Qingbo Shu
- Virginia G. Piper Biodesign Center for Personalized Diagnostics, Arizona State University Biodesign Institute, Tempe, AZ 85287 USA
| | - Zhen Zhao
- Department of Laboratory Medicine, Clinical Center, National Institutes of Health, Bethesda, MD 20892 USA
| | - Jia Fan
- Virginia G. Piper Biodesign Center for Personalized Diagnostics, Arizona State University Biodesign Institute, Tempe, AZ 85287 USA
| | - Christopher J. Lyon
- Virginia G. Piper Biodesign Center for Personalized Diagnostics, Arizona State University Biodesign Institute, Tempe, AZ 85287 USA
| | - Adrian M. Zelazny
- Department of Laboratory Medicine, Clinical Center, National Institutes of Health, Bethesda, MD 20892 USA
| | - Ye Hu
- Virginia G. Piper Biodesign Center for Personalized Diagnostics, Arizona State University Biodesign Institute, Tempe, AZ 85287 USA
- School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ 85287 USA
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Tyagi S, Sharma N, Tyagi JS, Haldar S. Challenges in pleural tuberculosis diagnosis: existing reference standards and nucleic acid tests. Future Microbiol 2017; 12:1201-1218. [PMID: 28972418 DOI: 10.2217/fmb-2017-0028] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Pleural tuberculosis (pTB) is a grave form of extrapulmonary tuberculosis. Microbiological tests are usually found to be inadequate for pTB diagnosis. The absence of a uniform 'composite reference standard' is challenging; therefore, diagnosis is usually performed using a combination of diversified criteria. Nucleic acid tests vary in diagnostic accuracy and have not yet been integrated into clinical decision making. This review assesses the varied criteria used for pTB classification and the challenges afflicting pleural fluid-based DNA diagnostic tests, namely, PCR and Xpert® MTB/RIF. In the 58 studies (PCR: n = 33; Xpert: n = 25) analyzed, reference standards were heterogeneous and PCR/Xpert pooled sensitivity values (range: 0-100%) were inadequate. However, the consistent high specificity of Xpert (range: 90-100%) indicated its utility as a 'rule-in' test. There is an urgent need to evaluate existing and new molecular tests in well-designed studies to accurately assess their utility for pTB diagnosis. To conclude, rapid and accurate tests are warranted for pTB diagnosis.
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Affiliation(s)
- Shaifali Tyagi
- Center for Bio-design & Diagnostics, Translational Health Science & Technology Institute, NCR Biotech Science Cluster, 3rd Milestone, Faridabad - Gurgaon Expressway, PO Box No 04, Faridabad 121001, India
| | - Neera Sharma
- Department of Biochemistry, Dr RML Hospital, New Delhi 110001, India
| | - Jaya Sivaswami Tyagi
- Center for Bio-design & Diagnostics, Translational Health Science & Technology Institute, NCR Biotech Science Cluster, 3rd Milestone, Faridabad - Gurgaon Expressway, PO Box No 04, Faridabad 121001, India.,Department of Biotechnology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Sagarika Haldar
- Center for Bio-design & Diagnostics, Translational Health Science & Technology Institute, NCR Biotech Science Cluster, 3rd Milestone, Faridabad - Gurgaon Expressway, PO Box No 04, Faridabad 121001, India
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Anselmo LMP, Feliciano C, Mauad F, do Nascimento MP, Pocente RC, Silva JM, Bollela VR. A predictive score followed by nucleic acid amplification for adult tuberculous meningitis diagnosis in Southern Brazil. J Neurol Sci 2017; 379:253-258. [DOI: 10.1016/j.jns.2017.06.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Revised: 06/12/2017] [Accepted: 06/13/2017] [Indexed: 11/30/2022]
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Immuno-PCR, a new technique for the serodiagnosis of tuberculosis. J Microbiol Methods 2017; 139:218-229. [PMID: 28527886 DOI: 10.1016/j.mimet.2017.05.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 05/16/2017] [Accepted: 05/16/2017] [Indexed: 12/18/2022]
Abstract
Rapid and accurate diagnosis of tuberculosis (TB) is essential to control the disease. The conventional microbiological tests have limitations and there is an urgent need to devise a simple, rapid and reliable point-of-care (POC) test. The failure of TB diagnostic tests based on antibody detection due to inconsistent and imprecise results has stimulated renewed interest in the development of rapid antigen detection methods. However, the World Health Organization (WHO) has emphasized to continue research for designing new antibody-based detection tests with improved accuracy. Immuno-polymerase chain reaction (I-PCR) combines the simplicity and versatility of enzyme-linked immunosorbent assay (ELISA) with the exponential amplification capacity and sensitivity of PCR thus leading to several-fold increase in sensitivity in comparison to analogous ELISA. In this review, we have described the serodiagnostic potential of I-PCR assays for an early diagnosis of TB based on the detection of potential mycobacterial antigens and circulating antibodies in body fluids of TB patients.
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26
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Sharma S, Raj A, Singh N, Dahiya B, Sheoran A, Gupta KB, Mehta PK. Development of real-time immuno-PCR for the quantitative detection of mycobacterial PstS1 in tuberculosis patients. J Microbiol Methods 2016; 132:134-138. [PMID: 27940201 DOI: 10.1016/j.mimet.2016.12.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 12/06/2016] [Accepted: 12/06/2016] [Indexed: 11/15/2022]
Abstract
A novel indirect real-time immuno-polymerase chain reaction (RT-I-PCR) assay, an evolution of I-PCR, was developed for the quantitative detection of Mycobacterium tuberculosis PstS1 (Rv0934) with a wide dynamic range of 10ng/mL to 1pg/mL in body fluids of tuberculosis (TB) patients, which may monitor the dynamics of disease.
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Affiliation(s)
- Suman Sharma
- Centre for Biotechnology, Maharshi Dayanand University (MDU), Rohtak 124001, Haryana, India
| | - Ankush Raj
- Centre for Biotechnology, Maharshi Dayanand University (MDU), Rohtak 124001, Haryana, India
| | - Netrapal Singh
- Centre for Biotechnology, Maharshi Dayanand University (MDU), Rohtak 124001, Haryana, India
| | - Bhawna Dahiya
- Centre for Biotechnology, Maharshi Dayanand University (MDU), Rohtak 124001, Haryana, India
| | - Abhishek Sheoran
- Department of Statistics, Amity Institute of Applied Sciences, Amity University, Noida 201303, India
| | - Krishna B Gupta
- Department of TB & Respiratory Medicine, University of Health Sciences (UHS), Rohtak 124001, India
| | - Promod K Mehta
- Centre for Biotechnology, Maharshi Dayanand University (MDU), Rohtak 124001, Haryana, India.
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27
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Yaghoubi A, Aryan E, Zare H, Alami S, Teimourpour R, Meshkat Z. Design and Construction of a Cloning Vector Containing the hspX Gene of Mycobacterium tuberculosis. Rep Biochem Mol Biol 2016; 5:46-50. [PMID: 28070534 PMCID: PMC5214683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 04/10/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Tuberculosis (TB) is a major cause of death worldwide. Finding an effective vaccine against TB is the best way to control it. Several vaccines against this disease have been developed but none are completely protective. The aim of this study was to design and construct a cloning vector containing the Mycobacterium tuberculosis (M. tuberculosis) heat shock protein X (hspX). METHODS First, an hspX fragment was amplified by PCR and cloned into plasmid pcDNA3.1(+) and recombinant vector was confirmed. RESULTS A 435 bp hspX fragment was isolated. The fragment was 100% homologous with hspX of M. tuberculosis strain H37Rv in GenBank. CONCLUSION In this study, the cloning vector pcDNA3.1(+), containing a 435-bp hspX fragment of M. tuberculosis, was constructed. This could be used as a DNA vaccine to induce immune responses in animal models in future studies.
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Affiliation(s)
- Atieh Yaghoubi
- Antimicrobial Resistance Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ehsan Aryan
- Antimicrobial Resistance Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hosna Zare
- Antimicrobial Resistance Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Shadi Alami
- Antimicrobial Resistance Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Roghayeh Teimourpour
- Department of Microbiology, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Zahra Meshkat
- Antimicrobial Resistance Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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Abstract
Central nervous system (CNS) infections are potentially life threatening if not diagnosed and treated early. The initial clinical presentations of many CNS infections are non-specific, making a definitive etiologic diagnosis challenging. Nucleic acid in vitro amplification-based molecular methods are increasingly being applied for routine microbial detection. These methods are a vast improvement over conventional techniques with the advantage of rapid turnaround and higher sensitivity and specificity. Additionally, molecular methods performed on cerebrospinal fluid samples are considered the new gold standard for diagnosis of CNS infection caused by pathogens, which are otherwise difficult to detect. Commercial diagnostic platforms offer various monoplex and multiplex PCR assays for convenient testing of targets that cause similar clinical illness. Pan-omic molecular platforms possess potential for use in this area. Although molecular methods are predicted to be widely used in diagnosing and monitoring CNS infections, results generated by these methods need to be carefully interpreted in combination with clinical findings. This review summarizes the currently available armamentarium of molecular assays for diagnosis of central nervous system infections, their application, and future approaches.
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29
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Saw SH, Tan JL, Chan XY, Chan KG, Ngeow YF. Chromosomal rearrangements and protein globularity changes in Mycobacterium tuberculosis isolates from cerebrospinal fluid. PeerJ 2016; 4:e2484. [PMID: 27688977 PMCID: PMC5036109 DOI: 10.7717/peerj.2484] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 08/24/2016] [Indexed: 01/07/2023] Open
Abstract
Background Meningitis is a major cause of mortality in tuberculosis (TB). It is not clear what factors promote central nervous system invasion and pathology but it has been reported that certain strains of Mycobacterium tuberculosis (Mtb) might have genetic traits associated with neurotropism. Methods In this study, we generated whole genome sequences of eight clinical strains of Mtb that were isolated from the cerebrospinal fluid (CSF) of patients presenting with tuberculous meningitis (TBM) in Malaysia, and compared them to the genomes of H37Rv and other respiratory Mtb genomes either downloaded from public databases or extracted from local sputum isolates. We aimed to find genomic features that might be distinctly different between CSF-derived and respiratory Mtb. Results Genome-wide comparisons revealed rearrangements (translocations, inversions, insertions and deletions) and non-synonymous SNPs in our CSF-derived strains that were not observed in the respiratory Mtb genomes used for comparison. These rearranged segments were rich in genes for PE (proline-glutamate)/PPE (proline-proline-glutamate), transcriptional and membrane proteins. Similarly, most of the ns SNPs common in CSF strains were noted in genes encoding PE/PPE proteins. Protein globularity differences were observed among mycobacteria from CSF and respiratory sources and in proteins previously reported to be associated with TB meningitis. Transcription factors and other transcription regulators featured prominently in these proteins. Homologs of proteins associated with Streptococcus pneumoniae meningitis and Neisseria meningitidis virulence were identified in neuropathogenic as well as respiratory mycobacterial spp. examined in this study. Discussion The occurrence of in silico genetic differences in CSF-derived but not respiratory Mtb suggests their possible involvement in the pathogenesis of TBM. However, overall findings in this comparative analysis support the postulation that TB meningeal infection is more likely to be related to the expression of multiple virulence factors on interaction with host defences than to CNS tropism associated with specific genetic traits.
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Affiliation(s)
- Seow Hoon Saw
- Department of Pre-Clinical Sciences, Faculty of Medicine and Health Sciences, Universiti Tunku Abdul Rahman, Bandar Sungai Long, Malaysia.,Department of Biomedical Science, Faculty of Science, Universiti Tunku Abdul Rahman, Kampar, Perak, Malaysia
| | - Joon Liang Tan
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,Faculty of Information Science and Technology, Multimedia University, Melaka, Malaysia
| | - Xin Yue Chan
- Division of Genetics and Molecular Biology, Institute of Biological Sciences, Faculty of Science, University of Malaya, Kuala Lumpur, Malaysia
| | - Kok Gan Chan
- Division of Genetics and Molecular Biology, Institute of Biological Sciences, Faculty of Science, University of Malaya, Kuala Lumpur, Malaysia
| | - Yun Fong Ngeow
- Department of Pre-Clinical Sciences, Faculty of Medicine and Health Sciences, Universiti Tunku Abdul Rahman, Bandar Sungai Long, Malaysia.,Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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30
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Wang T, Feng GD, Pang Y, Liu JY, Zhou Y, Yang YN, Dai W, Zhang L, Li Q, Gao Y, Chen P, Zhan LP, Marais BJ, Zhao YL, Zhao G. High rate of drug resistance among tuberculous meningitis cases in Shaanxi province, China. Sci Rep 2016; 6:25251. [PMID: 27143630 PMCID: PMC4855176 DOI: 10.1038/srep25251] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 04/12/2016] [Indexed: 11/18/2022] Open
Abstract
The clinical and mycobacterial features of tuberculous meningitis (TBM) cases in China are not well described; especially in western provinces with poor tuberculosis control. We prospectively enrolled patients in whom TBM was considered in Shaanxi Province, northwestern China, over a 2-year period (September 2010 to December 2012). Cerebrospinal fluid specimens were cultured for Mycobacterium tuberculosis; with phenotypic and genotypic drug susceptibility testing (DST), as well as genotyping of all positive cultures. Among 350 patients included in the study, 27 (7.7%) had culture-confirmed TBM; 84 (24.0%) had probable and 239 (68.3%) had possible TBM. DST was performed on 25/27 (92.3%) culture positive specimens; 12/25 (48.0%) had "any resistance" detected and 3 (12.0%) were multi-drug resistant (MDR). Demographic and clinical features of drug resistant and drug susceptible TBM cases were similar. Beijing was the most common genotype (20/25; 80.0%) with 9/20 (45%) of the Beijing strains exhibiting drug resistance; including all 3 MDR strains. All (4/4) isoniazid resistant strains had mutations in the katG gene; 75% (3/4) of strains with phenotypic rifampicin resistance had mutations in the rpoB gene detected by Xpert MTB/RIF®. High rates of drug resistance were found among culture-confirmed TBM cases; most were Beijing strains.
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Affiliation(s)
- Ting Wang
- Department of Neurology, Xijing Hospital, the Fourth Military Medical University, no.169 Changle West Road, Xi’an, Shaanxi, 710032, P.R.China
- Department of Neurology, Kunming Medical University affiliated Yan’an Hospital, 245 Renming East Road, Kunming, Yunnan, 650200, P.R.China
| | - Guo-Dong Feng
- Department of Neurology, Xijing Hospital, the Fourth Military Medical University, no.169 Changle West Road, Xi’an, Shaanxi, 710032, P.R.China
| | - Yu Pang
- National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, no.155 Changbai Road, Beijing, 102206, P.R.China
| | - Jia-Yun Liu
- Department of Inspection, Xijing Hospital, Fourth Military Medical University, no.169 Changle West Road, Xi’an, Shaanxi, 710032, P.R.China
| | - Yang Zhou
- National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, no.155 Changbai Road, Beijing, 102206, P.R.China
| | - Yi-Ning Yang
- Department of Neurology, Xijing Hospital, the Fourth Military Medical University, no.169 Changle West Road, Xi’an, Shaanxi, 710032, P.R.China
| | - Wen Dai
- Department of Neurology, Xijing Hospital, the Fourth Military Medical University, no.169 Changle West Road, Xi’an, Shaanxi, 710032, P.R.China
| | - Lin Zhang
- Department of Neurology, Xijing Hospital, the Fourth Military Medical University, no.169 Changle West Road, Xi’an, Shaanxi, 710032, P.R.China
| | - Qiao Li
- Department of Neurology, Xijing Hospital, the Fourth Military Medical University, no.169 Changle West Road, Xi’an, Shaanxi, 710032, P.R.China
| | - Yu Gao
- Department of Neurology, Xijing Hospital, the Fourth Military Medical University, no.169 Changle West Road, Xi’an, Shaanxi, 710032, P.R.China
| | - Ping Chen
- Department of Neurology, Xijing Hospital, the Fourth Military Medical University, no.169 Changle West Road, Xi’an, Shaanxi, 710032, P.R.China
| | - Li-Ping Zhan
- Department of Neurology, Kunming Medical University affiliated Yan’an Hospital, 245 Renming East Road, Kunming, Yunnan, 650200, P.R.China
| | - Ben J Marais
- The Children’s Hospital at Westmead and the Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Australia
| | - Yan-Lin Zhao
- National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, no.155 Changbai Road, Beijing, 102206, P.R.China
| | - Gang Zhao
- Department of Neurology, Xijing Hospital, the Fourth Military Medical University, no.169 Changle West Road, Xi’an, Shaanxi, 710032, P.R.China
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MA J, XIA D, HU J, FU R, XU L, ZHANG Y, ZHANG M, LI B, YANG J, WEN Y. Predictive Role of Serum Tumor Markers in Diagnosis of Pulmonary Tuberculosis. IRANIAN JOURNAL OF PUBLIC HEALTH 2016; 45:435-40. [PMID: 27252912 PMCID: PMC4888170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The diagnosis of pulmonary tuberculosis (PTB) is complicated and time-consuming currently. There was association of PTB with serum tumor markers. In this study we aimed to evaluate the predictive role of serum CA125, CA199 and CEA as diagnostic tools for PTB. METHODS This study was designed as a case-control study with 565 subjects who visited the Yijishan Hospital from Jun to Dec in 2014.This case-control study matched as for age and sex with 113 cases and 452 controls. Serum CA125, CA199 and CEA levels were detected by electrochemiluminescence instrument. The area under the curve (AUC) of the receiver operating characteristic (ROC) curve was performed to evaluate the diagnostic value on PTB. RESULTS Serum levels of CA125, CA199 and CEA in PTB patients were significantly higher than those in control group (P<0.001). There was no significantly different of three tumor markers between initial treatment group and retreatment group. The logistic regression analysis showed that CA125 was an impact factor to PTB. The ROC analysis revealed that AUC of CA125 was 0.966 (95%CI: 0.951-0.981), the sensitivity, specificity in serum and cut-off were 95.6%, 85.0% and 10.30 U/ml, respectively. CONCLUSION The serum CA125 has potential good diagnostic performance for PTB.
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Affiliation(s)
- Jingjing MA
- Dept. of Preventive Medicine, School of Public Health, Wannan Medical College, Wuhu City, China
| | - Dan XIA
- Dept. of Preventive Medicine, School of Public Health, Wannan Medical College, Wuhu City, China
| | - Jing HU
- Dept. of Preventive Medicine, School of Public Health, Wannan Medical College, Wuhu City, China
| | - Rui FU
- Dept. of Preventive Medicine, School of Public Health, Wannan Medical College, Wuhu City, China
| | - Lijun XU
- Dept. of Preventive Medicine, School of Public Health, Wannan Medical College, Wuhu City, China
| | - Ying ZHANG
- Dept. of Preventive Medicine, School of Public Health, Wannan Medical College, Wuhu City, China
| | - Mengying ZHANG
- Dept. of Preventive Medicine, School of Public Health, Wannan Medical College, Wuhu City, China
| | - Benhe LI
- Dept. of Preventive Medicine, School of Public Health, Wannan Medical College, Wuhu City, China
| | - Jianghua YANG
- Dept. of Infectious Diseases, Yijishan Hospital, Wuhu City, China
| | - Yufeng WEN
- Dept. of Preventive Medicine, School of Public Health, Wannan Medical College, Wuhu City, China,Corresponding Author:
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Singh N, Sreenivas V, Sheoran A, Sharma S, Gupta KB, Khuller GK, Mehta PK. Serodiagnostic potential of immuno-PCR using a cocktail of mycobacterial antigen 85B, ESAT-6 and cord factor in tuberculosis patients. J Microbiol Methods 2016; 120:56-64. [DOI: 10.1016/j.mimet.2015.11.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 11/24/2015] [Accepted: 11/24/2015] [Indexed: 01/15/2023]
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Singh N, Sreenivas V, Gupta KB, Chaudhary A, Mittal A, Varma-Basil M, Prasad R, Gakhar SK, Khuller GK, Mehta PK. Diagnosis of pulmonary and extrapulmonary tuberculosis based on detection of mycobacterial antigen 85B by immuno-PCR. Diagn Microbiol Infect Dis 2015; 83:359-64. [PMID: 26422085 DOI: 10.1016/j.diagmicrobio.2015.08.015] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 08/24/2015] [Accepted: 08/28/2015] [Indexed: 11/30/2022]
Abstract
We developed a novel indirect sandwich immuno-polymerase chain reaction (I-PCR) assay for the detection of mycobacterial antigen 85B (Ag85B, 30kDa, Rv1886c) in pulmonary tuberculosis (PTB) and extrapulmonary tuberculosis (EPTB) patients. The amino-modified reporter DNA was covalently attached with the antidetection antibody through a heterobifunctional cross-linking agent succinimidyl 4-[N-maleimidomethyl]-cyclohexane-1-carboxylate. The detection limit of Ag85B by I-PCR was found to be 1 femtogram (fg)/mL, which was 10(6)-fold lower than an analogous enzyme-linked immunosorbent assay (ELISA). The sensitivities of 85% and 77% with I-PCR and 77.6% and 62.5% with ELISA were observed in smear-positive and smear-negative PTB patients, respectively, with high specificity. On the other hand, sensitivities of 84% and 63.7% with I-PCR and 68% and 47.5% with ELISA were observed in confirmed and clinically suspected EPTB cases, respectively, with high specificity.
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Affiliation(s)
- Netrapal Singh
- Centre for Biotechnology, Maharshi Dayanand University, Rohtak 124001, Haryana, India
| | - Vishnubhatla Sreenivas
- Department of Biostatistics, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India
| | - Krishna B Gupta
- Department of TB & Respiratory Medicine, University of Health Sciences (UHS), Rohtak 124001, India
| | - Anil Chaudhary
- Rajan Babu Institute of Pulmonary Medicine and Tuberculosis (RBIPMT), Delhi 110009, India
| | - Anshu Mittal
- Vallabhbhai Patel Chest Institute (VPCI), University of Delhi, Delhi 110007, India
| | - Mandira Varma-Basil
- Vallabhbhai Patel Chest Institute (VPCI), University of Delhi, Delhi 110007, India
| | - Rajendra Prasad
- Vallabhbhai Patel Chest Institute (VPCI), University of Delhi, Delhi 110007, India
| | - Surender K Gakhar
- Centre for Biotechnology, Maharshi Dayanand University, Rohtak 124001, Haryana, India
| | - Gopal K Khuller
- Department of Biochemistry, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Promod K Mehta
- Centre for Biotechnology, Maharshi Dayanand University, Rohtak 124001, Haryana, India.
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Nayak K, Jing L, Russell RM, Davies DH, Hermanson G, Molina DM, Liang X, Sherman DR, Kwok WW, Yang J, Kenneth J, Ahamed SF, Chandele A, Murali-Krishna K, Koelle DM. Identification of novel Mycobacterium tuberculosis CD4 T-cell antigens via high throughput proteome screening. Tuberculosis (Edinb) 2015; 95:275-87. [PMID: 25857935 DOI: 10.1016/j.tube.2015.03.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Revised: 02/24/2015] [Accepted: 03/01/2015] [Indexed: 10/23/2022]
Abstract
Elicitation of CD4 IFN-gamma T cell responses to Mycobacterium tuberculosis (MTB) is a rational vaccine strategy to prevent clinical tuberculosis. Diagnosis of MTB infection is based on T-cell immune memory to MTB antigens. The MTB proteome contains over four thousand open reading frames (ORFs). We conducted a pilot antigen identification study using 164 MTB proteins and MTB-specific T-cells expanded in vitro from 12 persons with latent MTB infection. Enrichment of MTB-reactive T-cells from PBMC used cell sorting or an alternate system compatible with limited resources. MTB proteins were used as single antigens or combinatorial matrices in proliferation and cytokine secretion readouts. Overall, our study found that 44 MTB proteins were antigenic, including 27 not previously characterized as CD4 T-cell antigens. Antigen truncation, peptide, NTM homology, and HLA class II tetramer studies confirmed malate synthase G (encoded by gene Rv1837) as a CD4 T-cell antigen. This simple, scalable system has potential utility for the identification of candidate MTB vaccine and biomarker antigens.
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Affiliation(s)
- Kaustuv Nayak
- ICGEB-Emory Vaccine Center, International Center for Genetic Engineering and Biotechnology, Aruna Asaf Ali Marg, New Delhi 110067, India.
| | - Lichen Jing
- Department of Medicine, Division of Infectious Diseases, University of Washington, Box 358061, Seattle, WA 98195, USA.
| | - Ronnie M Russell
- Department of Medicine, Division of Infectious Diseases, University of Washington, Box 358061, Seattle, WA 98195, USA.
| | - D Huw Davies
- Department of Medicine, Division of Infectious Diseases, University of California, Room 376D Med-Surg II, Irvine, CA 92697-4068, USA; Antigen Discovery, Inc., 1 Technology Drive Suite E309, Irvine, CA 92618, USA.
| | - Gary Hermanson
- Antigen Discovery, Inc., 1 Technology Drive Suite E309, Irvine, CA 92618, USA.
| | - Douglas M Molina
- Antigen Discovery, Inc., 1 Technology Drive Suite E309, Irvine, CA 92618, USA.
| | - Xiaowu Liang
- Antigen Discovery, Inc., 1 Technology Drive Suite E309, Irvine, CA 92618, USA.
| | - David R Sherman
- Seattle Biomedical Research Institute, 307 Westlake Ave. North, No. 500, Seattle, WA 98109, USA; Department of Global Health, University of Washington, Box 359931, Seattle, WA 98195, USA.
| | - William W Kwok
- Benaroya Research Institute at Virginia Mason, 1201 9th Ave., Seattle, WA, 98101, USA.
| | - Junbao Yang
- Benaroya Research Institute at Virginia Mason, 1201 9th Ave., Seattle, WA, 98101, USA.
| | - John Kenneth
- Division of Infectious Diseases, St. John's Research Institute, St. John's National Academy of Health Sciences, Sarjapur Road, Koramangala 2 Block, Bangaluru, Karnataka 560034, India.
| | - Syed F Ahamed
- Division of Infectious Diseases, St. John's Research Institute, St. John's National Academy of Health Sciences, Sarjapur Road, Koramangala 2 Block, Bangaluru, Karnataka 560034, India.
| | - Anmol Chandele
- ICGEB-Emory Vaccine Center, International Center for Genetic Engineering and Biotechnology, Aruna Asaf Ali Marg, New Delhi 110067, India; Emory Vaccine Center, 1510 Clifton Road, Atlanta, GA 30329, USA.
| | - Kaja Murali-Krishna
- ICGEB-Emory Vaccine Center, International Center for Genetic Engineering and Biotechnology, Aruna Asaf Ali Marg, New Delhi 110067, India; Emory Vaccine Center, 1510 Clifton Road, Atlanta, GA 30329, USA; Department of Pediatrics, Emory University, 1760 Haygood Drive, Atlanta, GA 30322, USA.
| | - David M Koelle
- Department of Medicine, Division of Infectious Diseases, University of Washington, Box 358061, Seattle, WA 98195, USA; Department of Global Health, University of Washington, Box 359931, Seattle, WA 98195, USA; Benaroya Research Institute at Virginia Mason, 1201 9th Ave., Seattle, WA, 98101, USA; Department of Laboratory Medicine, University of Washington, Box 358070, Seattle, WA 98195, USA; Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, 1100 Eastlake Ave. East, Seattle, WA 98109, USA.
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Abstract
INTRODUCTION Tuberculous meningitis (TBM) is the most severe form of infection caused by Mycobacterium tuberculosis, causing death or disability in more than half of those affected. The aim of this review is to examine recent advances in our understanding of TBM, focussing on the diagnosis and treatment of this devastating condition. SOURCES OF DATA Papers on TBM published between 1891 and 2014 and indexed in the NCBI Pubmed. The following search terms were used: TBM, diagnosis, treatment and outcome. AREAS OF AGREEMENT The diagnosis of TBM remains difficult as its presentation is non-specific and may mimic other causes of chronic meningoencephalitis. Rapid recognition of TBM is crucial, however, as delays in initiating treatment are associated with poor outcome. The laboratory diagnosis of TBM is hampered by the low sensitivity of cerebrospinal fluid microscopy and the slow growth of M. tuberculosis in conventional culture systems. The current therapy of TBM is based on the treatment of pulmonary tuberculosis, which may not be ideal. The combination of TBM and HIV infection poses additional management challenges because of the need to treat both infections and the complications associated with them. AREAS OF CONTROVERSY The pathogenesis of TBM remains incompletely understood limiting the development of interventions to improve outcome. The optimal therapy of TBM has not been established in clinical trials, and increasing antimicrobial resistance threatens successful treatment of this condition. The use of adjunctive anti-inflammatory agents remains controversial, and their mechanism of action remains incompletely understood. The role of surgical intervention is uncertain and may not be available in areas where TBM is common. GROWING POINTS Laboratory methods to improve the rapid diagnosis of TBM are urgently required. Clinical trials of examining the use of high-dose rifampicin and/or fluoroquinolones are likely to report in the near future. AREAS TIMELY FOR DEVELOPING RESEARCH The use of biomarkers to improve the rapid diagnosis of TBM warrants further investigation. The role of novel antituberculosis drugs, such as bedaquiline and PA-824, in the treatment of TBM remains to be explored. Human genetic polymorphisms may explain the heterogeneity of response to anti-inflammatory therapies and could potentially be used to tailor therapy.
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Affiliation(s)
- M E Török
- Department of Medicine, University of Cambridge, Addenbrooke's Hospital, Box 157, Hills Road, Cambridge CB2 0QQ, UK Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge CB2 0QQ, UK Public Health England, Clinical Microbiology and Public Health Laboratory, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK
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Tucci P, González-Sapienza G, Marin M. Pathogen-derived biomarkers for active tuberculosis diagnosis. Front Microbiol 2014; 5:549. [PMID: 25368609 PMCID: PMC4202705 DOI: 10.3389/fmicb.2014.00549] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 10/01/2014] [Indexed: 12/22/2022] Open
Abstract
Tuberculosis (TB) is an infectious disease caused by members of Mycobacterium tuberculosis complex. Despite the availability of effective treatments, TB remains a major public health concern in most low and middle-income countries, representing worldwide the second leading cause of death from an infectious disease. Inadequate case detection and failures to classify the disease status hamper proper TB control. The limitations of the conventional diagnostic methods have encouraged much research activities in this field, but there is still an urgent need for an accurate point of care test for active TB diagnosis. A rapid, precise, and inexpensive TB diagnostic test would allow an earlier implementation of an appropriate treatment and the reduction of disease transmission. Pathogen-derived molecules present in clinical specimens of affected patients are being validated for that purpose. This short review aims to summarize the available data regarding biomarkers derived from M. tuberculosis, and their current usage in active TB diagnosis.
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Affiliation(s)
- Paula Tucci
- Sección Bioquímica, Facultad de Ciencias, Universidad de la República Montevideo, Uruguay
| | - Gualberto González-Sapienza
- Cátedra de Inmunología, DEPBIO, Instituto de Higiene, Facultad de Química, Universidad de la República Montevideo, Uruguay
| | - Monica Marin
- Sección Bioquímica, Facultad de Ciencias, Universidad de la República Montevideo, Uruguay
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Li D, Zhang C, Lu N, Mu L, He Y, Xu L, Yang J, Fan Y, Kang Y, Yang C. Cloning and characterization of Clp protease proteolytic subunit 2 and its implication in clinical diagnosis of tuberculosis. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2014; 7:5674-5682. [PMID: 25337208 PMCID: PMC4203179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 08/20/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To clone, express, and characterize Mycobacterium tuberculosis (Mtb) ClpP2, and evaluated the potential usage of ClpP2 in clinical diagnosis of tuberculosis. METHODS Mtb ClpP2 was cloned into recombinant plasmid pET32a (+) and transformed into E. coli BL21 (DE3). SDS-PAGE and Western blot analysis were performed to detect the expression of the recombinant protein. The immunogenicity of Mtb ClpP2 was assessed with epitope prediction and antibody titer assay. Quantitative real-time PCR was performed to detect the influence of stress conditions on ClpP2 expression. ClpP2 antigen and antibody in patients with pulmonary diseases were detected by indirect ELISA. ROC curve was constructed to assess the diagnostic accuracy of Mtb ClpP2 for tuberculosis. RESULTS We had cloned and expressed recombinant Mtb ClpP2 in E. coli. Our results showed that Mtb ClpP2 had potent immunogenicity, and our own prepared polyclonal antibody could be used in detection and diagnostic tests. Results from Western blot showed that ClpP2 was mainly located in M. bovis BCG cytoplasm, and real-time PCR indicated that stress conditions could enhance the mRNA expression of ClpP2. Indirect ELISA suggested that, in tuberculosis patients, both the levels of ClpP2 antigen and antibody were increased, and the positive rates of ClpP2 were elevated. ROC curve had demonstrated satisfactory sensitivity and specificity of ClpP2-based diagnosis for tuberculosis. CONCLUSION Our results suggest that Mtb ClpP2 antigens would be used as a biomarker in tuberculosis pathogenesis. These findings highlight the feasibility of the application of Mtb ClpP2 in the clinical diagnosis of tuberculosis.
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Affiliation(s)
- Dairong Li
- Department of Respiratory Disease, The First Affiliated Hospital of Chongqing Medical UniversityChongqing 400016, China
- Department of Pathology, Chongqing Medical UniversityChongqing 400016, China
| | - Chunyan Zhang
- Department of Pathogenic Organisms, Chongqing Medical UniversityChongqing 400016, China
- Molecular Medicine and Cancer Research Center, Chongqing Medical UniversityChongqing 400016, China
| | - Nan Lu
- Molecular Medicine and Cancer Research Center, Chongqing Medical UniversityChongqing 400016, China
| | - Liuqing Mu
- Department of Pathogenic Organisms, Chongqing Medical UniversityChongqing 400016, China
- Molecular Medicine and Cancer Research Center, Chongqing Medical UniversityChongqing 400016, China
| | - Yonglin He
- Department of Pathogenic Organisms, Chongqing Medical UniversityChongqing 400016, China
- Molecular Medicine and Cancer Research Center, Chongqing Medical UniversityChongqing 400016, China
| | - Lei Xu
- Department of Pathogenic Organisms, Chongqing Medical UniversityChongqing 400016, China
- Molecular Medicine and Cancer Research Center, Chongqing Medical UniversityChongqing 400016, China
| | - Jing Yang
- Department of Pathogenic Organisms, Chongqing Medical UniversityChongqing 400016, China
- Molecular Medicine and Cancer Research Center, Chongqing Medical UniversityChongqing 400016, China
| | - Yu Fan
- Department of Pathogenic Organisms, Chongqing Medical UniversityChongqing 400016, China
- Molecular Medicine and Cancer Research Center, Chongqing Medical UniversityChongqing 400016, China
| | - Yuexi Kang
- Department of Pathogenic Organisms, Chongqing Medical UniversityChongqing 400016, China
- Molecular Medicine and Cancer Research Center, Chongqing Medical UniversityChongqing 400016, China
| | - Chun Yang
- Department of Pathogenic Organisms, Chongqing Medical UniversityChongqing 400016, China
- Molecular Medicine and Cancer Research Center, Chongqing Medical UniversityChongqing 400016, China
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Tasbiti AH, Bahrmand A, Shokrgozar MA, Ghanei M, Ghanaie M, Fateh A, Karimi A, Yari S. Evaluation of antigen detection test (chromatographic immunoassay): potential to replace the antibody assay using purified 45-kDa protein for rapid diagnosis of tuberculosis. J Clin Lab Anal 2013; 28:70-6. [PMID: 24375567 DOI: 10.1002/jcla.21646] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Accepted: 06/03/2013] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The current strategy for combating tuberculosis (TB) is based on the early detection and treatment of patients to halt transmission. The present study was conducted to evaluate the diagnostic potential of three Mycobacterium tuberculosis antigens, 45-kDa, A60, and sonicated MTB antigen (SmTB-Ag), as antibody/antigen detection methods for the rapid and accurate diagnosis of TB. METHODS The SmTB-Ag and 45-kDa antigens were purified and A60 antigen was supplied by Anda-Biologicals, France. The 45-kDa and A60 antigens (for antibody detection procedures) and SmTB-Ag (for antigen detection test) were tested in the same study subjects. ELISA and immunochromatographic (rapid) test were performed on 201 sputum and serum samples. Ninety-eight samples from TB patients and 103 samples from control individuals were studied. RESULTS The mean absorbance value of antibodies against 45-kDa antigen in the TB patients were (1.17 ± 0.44, CI 1.09-1.26), significantly higher than in the non-TB group, (0.8 ± 0.28, CI 0.74-0.85, P < 0.05). The sensitivities of tests using two antigens, 84% for the 45-kDa antigen and 65% for the A60 antigen, were lower than SmTB-Ag(93%). The rapid test yielded 93% sensitivity and 92% specificity. CONCLUSION Findings highlighted the importance of antigen detection as a diagnostic tool. The rapid test evaluated in this study may be useful for diagnosis of TB.
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Abstract
PURPOSE OF REVIEW Early diagnosis and treatment of tuberculous meningitis (TBM) saves lives, but current laboratory diagnostic tests lack sensitivity and the best treatment regimens are uncertain. This article reviews the advances towards better TBM diagnosis and treatments made over the last 2 years. RECENT FINDINGS A modified Ziehl-Neelsen stain, interferon-gamma release assays and Mycobacterium tuberculosis antigen detection assays have all shown promise as new TBM diagnostic tests. HIV-associated TBM carries an especially grave prognosis and there are new data describing the optimal timing of antiretroviral treatment initiation and the clinical predictors of TBM immune reconstitution inflammatory syndrome. The pharmacokinetic and pharmacodynamic properties of different fluoroquinolones for TBM treatment have been compared, and there are intriguing new data to suggest higher doses of rifampicin given intravenously may improve the survival. Finally, there are preliminary data to suggest that the beneficial effect of adjunctive corticosteroids on TBM survival may be augmented by aspirin and predicted by a polymorphism in a gene responsible for eicosanoid synthesis. SUMMARY Much remains to be done to improve the outcome from TBM. There have been important advances in the treatment, which may influence treatment guidelines in the near future, but there remains an urgent need for better diagnostic tests.
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Abstract
Tuberculous meningitis is especially common in young children and people with untreated HIV infection, and it kills or disables roughly half of everyone affected. Childhood disease can be prevented by vaccination and by giving prophylactic isoniazid to children exposed to infectious adults, although improvements in worldwide tuberculosis control would lead to more effective prevention. Diagnosis is difficult because clinical features are non-specific and laboratory tests are insensitive, and treatment delay is the strongest risk factor for death. Large doses of rifampicin and fluoroquinolones might improve outcome, and the beneficial effect of adjunctive corticosteroids on survival might be augmented by aspirin and could be predicted by screening for a polymorphism in LTA4H, which encodes an enzyme involved in eicosanoid synthesis. However, these advances are insufficient in the face of drug-resistant tuberculosis and HIV co-infection. Many questions remain about the best approaches to prevent, diagnose, and treat tuberculous meningitis, and there are still too few answers.
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