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Mulinari ACDP, Sardella IG, da Silva VMC, Matteelli A, Carvalho ACC, Saad MHF. PPE59 antibodies in tuberculous patients and potential use for diagnosis when assayed with other rapid biomarkers. Mem Inst Oswaldo Cruz 2024; 119:e230183. [PMID: 39292107 PMCID: PMC11404981 DOI: 10.1590/0074-02760230183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 06/26/2024] [Indexed: 09/19/2024] Open
Abstract
BACKGROUND PPE 59, which is absent from bacillus Calmette Guérin (BCG) strains, seems to induce a humoral immune response in patients with tuberculosis (TB). Additional studies are needed to better evaluate this protein in immune response to tuberculosis. OBJECTIVES To evaluate the response of antibodies to PPE59 in TB individuals, its combination with IgG response to other, previously tested mycobacterial antigens (Ag) and with sputum smear microbiology (SM) results. METHODS We have cloned and expressed the rv3429 gene that encodes PPE59, then IgG, IgM, and IgA against PPE59 antigens measured by enzyme-linked immunosorbent assay (ELISA) in 212 sera samples obtained from the following subject cohorts: TB residents from Italy (79) and in Brazil (52); and an all-Brazilian cohort of 55 patients with other respiratory disorders; 10 patients infected with non-tuberculous mycobacteria, and 16 asymptomatic subjects. Drawing on results from a previous study(17) of serum samples from Brazilian subjects tested for IgG by ELISA against mycobacterial antigens ESAT-6, 16kDa, MT10.3, MPT-64 and 38kDa, the results were analysed in combination with those of the PPE59 and SM tests. FINDINGS Keeping the specificity rate at 97%, the overall PPE59 IgA sensitivity was 42.7%, while IgG and IgM showed lower performance (p < 0.0001). Combining PPE59 IgA/16kDa IgG results increased sensitivity to 71%, and even higher rates when the results were combined with SM results (86.5%, p = 0.001), at 88.9% specificity. Positive IgA was associated with pulmonary image alterations of high TB probability (p < 0.05). MAIN CONCLUSIONS Tests with TB patients found a moderate frequency of positivity for PPE59 IgA. However, the higher level of sensitivity attained in combination with PPE59 IgA/16kDa IgG/SM results unheard of before, although imperfect, suggests that this may be a potential additional tool for rapid detection of TB in low-resource areas.
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Affiliation(s)
- Ana Carla de Paulo Mulinari
- Fundação Oswaldo Cruz-Fiocruz, Instituto Oswaldo Cruz, Laboratório de Microbiologia Celular, Rio de Janeiro, RJ, Brasil
| | - Isabela Gama Sardella
- Fundação Oswaldo Cruz-Fiocruz, Instituto Oswaldo Cruz, Laboratório de Microbiologia Celular, Rio de Janeiro, RJ, Brasil
| | - Vania Maria C da Silva
- Universidade Federal do Rio de Janeiro, Faculdade de Medicina, Rio de Janeiro, RJ, Brasil
| | - Alberto Matteelli
- Università degli Studi di Brescia, Clinic of Infectious and Tropical Diseases, Spedali Civili di Brescia, Italy
| | - Anna Cristina C Carvalho
- Fundação Oswaldo Cruz-Fiocruz, Instituto Oswaldo Cruz, Laboratório de Inovações em Terapias, Educação e Bioprodutos, Rio de Janeiro, RJ, Brasil
| | - Maria Helena Féres Saad
- Fundação Oswaldo Cruz-Fiocruz, Instituto Oswaldo Cruz, Laboratório de Microbiologia Celular, Rio de Janeiro, RJ, Brasil
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Fei B, Zhou L, Zhang Y, Luo L, Chen Y. Application value of tissue tuberculosis antigen combined with Xpert MTB/RIF detection in differential diagnoses of intestinal tuberculosis and Crohn's disease. BMC Infect Dis 2021; 21:498. [PMID: 34049506 PMCID: PMC8161674 DOI: 10.1186/s12879-021-06210-8] [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: 05/30/2019] [Accepted: 05/19/2021] [Indexed: 01/28/2023] Open
Abstract
Background The purpose of this study was to examine the value of Xpert MTB/RIF assay and detection of additional Mycobacterium tuberculosis complex (MTBC) species antigens from intestinal tissue samples in differentiating intestinal tuberculosis (ITB) from Crohn’s disease (CD). Methods Several clinical specimens of intestinal tissue obtained by either endoscopic biopsy or surgical excision were used for mycobacteriologic solid cultures,Xpert MTB/RIF assays, immunohistochemistry, and histological examinations. Four antigens (38KDa, ESAT-6, MPT64, and Ag85 complex) of MTBC in the intestinal tissue were detected by immunohistochemical analysis. Results The study included 42 patients with ITB and 46 with CD. Perianal lesions and longitudinal ulcers were more common in patients with CD, while caseating granuloma and annular ulcers were more common in patients with ITB. The positive rate of MTBC detected by Xpert MTB/RIF in intestinal tissues of patients with ITB was 33.33%, which was significantly higher than that in patients with CD and that detected using acid-fast staining smears. It was also higher than that detected by tissue MTBC culture, but the difference was not statistically significant. The positive MPT64 expression rate in patients with ITB was 40.48%, which was significantly higher than that observed in patients with CD. The sensitivity of parallelly combined detection of tuberculosis protein MPT64 and Xpert MTB/RIF in diagnosing ITB was 50.0%. Conclusions The detection of Xpert MTB/RIF in intestinal tissue is a rapid and useful method for establishing an early diagnosis of ITB. The detection of MTBC using Xpert MTB/RIF and MPT64 antigen in intestinal tissues has a definitive value in the differential diagnosis ofITB and CD. The combination of these two methods can improve the detection sensitivity.
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Affiliation(s)
- Baoying Fei
- Department of Gastroenterology, Tongde Hospital of Zhejiang Province, 234 Gucui Road, Hangzhou, 310012, Zhejiang, China.
| | - Lin Zhou
- Departments of Minimally Invasive Surgery, Tuberculous Experimental Center, Hangzhou Red Cross Hospital, Hangzhou, 310003, Zhejiang, China
| | - Yu Zhang
- Department of Gastroenterology, Zhejiang Province People's Hospital, Hangzhou, 310014, Zhejiang, China
| | - Linhe Luo
- Department of Gastroenterology, Tongde Hospital of Zhejiang Province, 234 Gucui Road, Hangzhou, 310012, Zhejiang, China
| | - Yuanyuan Chen
- Tuberculosis Diagnosis and Treatment Center, Hangzhou Red Cross Hospital, Hangzhou, 310003, Zhejiang, China
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Jaganath D, Rajan J, Yoon C, Ravindran R, Andama A, Asege L, Mwebe SZ, Katende J, Nakaye M, Semitala FC, Khan IH, Cattamanchi A. Evaluation of multi-antigen serological screening for active tuberculosis among people living with HIV. PLoS One 2020; 15:e0234130. [PMID: 32497095 PMCID: PMC7272080 DOI: 10.1371/journal.pone.0234130] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 05/19/2020] [Indexed: 11/18/2022] Open
Abstract
Better triage tests for screening tuberculosis (TB) disease are needed for people living with HIV (PLHIV). We performed the first evaluation of a previously-validated 8-antigen serological panel to screen PLHIV for pulmonary TB in Kampala, Uganda. We selected a random 1:1 sample with and without TB (defined by sputum culture) from a cohort of PLHIV initiating antiretroviral therapy. We used a multiplex microbead immunoassay and an ensemble machine learning classifier to determine the area under the receiver operating characteristic curve (AUC) for Ag85A, Ag85B, Ag85C, Rv0934-P38, Rv3881, Rv3841-BfrB, Rv3873, and Rv2878c. We then assessed the performance with the addition of four TB-specific antigens ESAT-6, CFP-10, Rv1980-MPT64, and Rv2031-HSPX, and every antigen combination. Of 262 participants (median CD4 cell-count 152 cells/μL [IQR 65-279]), 138 (53%) had culture-confirmed TB. The 8-antigen panel had an AUC of 0.53 (95% CI 0.40-0.66), and the additional 4 antigens did not improve performance (AUC 0.51, 95% CI 0.39-0.64). When sensitivity was restricted to ≥90% for the 8- and 12-antigen panel, specificity was 2.2% (95% CI 0-17.7%) and 8.1% (95% CI 0-23.9%), respectively. A three-antigen combination (Rv0934-P38, Ag85A, and Rv2031-HSPX) outperformed both panels, with an AUC of 0.60 (95% CI 0.48-0.73), 90% sensitivity (95% CI 78.2-96.7%) and 29.7% specificity (95% CI 15.9-47%). The multi-antigen panels did not achieve the target accuracy for a TB triage test among PLHIV. We identified a new combination that improved performance for TB screening in an HIV-positive sample compared to an existing serological panel in Uganda, and suggests an approach to identify novel antigen combinations specifically for screening TB in PLHIV.
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Affiliation(s)
- Devan Jaganath
- Department of Pediatrics, Division of Pediatric Infectious Diseases, University of California, San Francisco, CA, United States of America
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of California, San Francisco, CA, United States of America
- Department of Medicine, Center for Tuberculosis, University of California, San Francisco, CA, United States of America
| | - Jayant Rajan
- Department of Medicine, Division of Experimental Medicine, University of California, San Francisco, CA, United States of America
| | - Christina Yoon
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of California, San Francisco, CA, United States of America
- Department of Medicine, Center for Tuberculosis, University of California, San Francisco, CA, United States of America
| | - Resmi Ravindran
- Department of Pathology and Laboratory Medicine, University of California, Davis, CA, United States of America
| | - Alfred Andama
- Infectious Disease Research Collaboration, Kampala, Uganda
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Lucy Asege
- Infectious Disease Research Collaboration, Kampala, Uganda
| | | | - Jane Katende
- Infectious Disease Research Collaboration, Kampala, Uganda
| | - Martha Nakaye
- Infectious Disease Research Collaboration, Kampala, Uganda
| | - Fred C. Semitala
- Infectious Disease Research Collaboration, Kampala, Uganda
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
- Makerere University Joint AIDS Program (MJAP), Kampala, Uganda
| | - Imran H. Khan
- Department of Pathology and Laboratory Medicine, University of California, Davis, CA, United States of America
| | - Adithya Cattamanchi
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of California, San Francisco, CA, United States of America
- Department of Medicine, Center for Tuberculosis, University of California, San Francisco, CA, United States of America
- Department of Medicine, Center for Vulnerable Populations, University of California, San Francisco, CA, United States of America
- Curry International Tuberculosis Center, University of California, San Francisco, CA, United States of America
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Naidoo N, Pillay B, Bubb M, Pym A, Chiliza T, Naidoo K, Ndung'u T, Kasprowicz VO, Pillay M. Evaluation of a synthetic peptide for the detection of anti-Mycobacterium tuberculosis curli pili IgG antibodies in patients with pulmonary tuberculosis. Tuberculosis (Edinb) 2018; 109:80-84. [PMID: 29559125 DOI: 10.1016/j.tube.2018.01.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 01/11/2018] [Accepted: 01/30/2018] [Indexed: 01/30/2023]
Abstract
Tuberculosis (TB) remains a serious threat in underdeveloped areas. Mycobacterium tuberculosis curli pili (MTP), a virulence factor, is a potential biomarker for a reliable point of care (POC) test and was evaluated for its ability to react with Immunoglobulin G (IgG) in TB patients. An MTP synthetic peptide in a slot blot assay was used to screen serum/plasma samples (n = 65) in 3 separate cohorts, including 40 TB positive (16 HIV co-infected), 20 TB negative/HIV negative patients and 5 healthy volunteers. Forty samples were true positives (HIV positive, n = 16), 23 true negatives (HIV negative) and 2 false positives (HIV negative). The McNemar test demonstrated a 3.08% accuracy estimate (CI: -2.1% - 3.08%). This confirms that MTP is expressed during infection, including HIV-TB co-infection, is likely to be suitable for the design of a POC test and supports the validation of MTP for TB detection in larger patient populations.
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Affiliation(s)
- Natasha Naidoo
- Medical Microbiology, University of KwaZulu-Natal, South Africa
| | | | - Martin Bubb
- National Bioproducts Institute, South Africa
| | - Alexander Pym
- Africa Health Research Institute, University of KwaZulu-Natal, South Africa
| | - Thamsanqa Chiliza
- Discipline of Microbiology, University of KwaZulu-Natal, South Africa
| | - Kogieleum Naidoo
- South African Medical Research Council HIV-TB Pathogenesis and Treatment Research Unit, Centre for the AIDS Programme of Research in South Africa (CAPRISA), Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban, South Africa
| | - Thumbi Ndung'u
- Africa Health Research Institute, University of KwaZulu-Natal, South Africa; Ragon Institute of MGH, MIT and Harvard, USA; HIV Pathogenesis Programme, University of KwaZulu-Natal, South Africa; Max Planck Institute for Infection Biology, Germany
| | - Victoria O Kasprowicz
- Africa Health Research Institute, University of KwaZulu-Natal, South Africa; HIV Pathogenesis Programme, University of KwaZulu-Natal, South Africa
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