Reversion of the ELISPOT test after treatment in Gambian tuberculosis cases.
Reversion of the ELISPOT test after treatment in Gambian tuberculosis cases.
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DOI：
10.1186/1471-2334-6-66
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发表时间：
2006-03-30
影响因子：
3.7
通讯作者：
Brookes RH
中科院分区：
文献类型：
--
作者：
Aiken AM;Hill PC;Fox A;McAdam KP;Jackson-Sillah D;Lugos MD;Donkor SA;Adegbola RA;Brookes RH
需要新的工具来改善结核病的诊断和治疗，包括提高比较新治疗策略的能力。ELISPOT检测使用结核分枝杆菌特异性抗原，以产生对病原体的免疫应答的精确定量读数。我们假设冈比亚的结核病患者在成功治疗后ELISPOT计数会减少。我们招募了冈比亚成人痰涂片和培养阳性结核病ELISPOT检测和HIV检测，并随访他们一年后重复检测和记录治疗结果。我们用ESAT-6、CFP-10和纯化蛋白衍生物（PPD）作为刺激抗原。我们在23名志愿者中通过间隔一周的2次测试，比较受试者内和受试者间的差异，证实了我们的检测方法的可靠性。我们在诊断时和12个月后对89例患者进行了ELISPOT检测。招募时，70/85例HIV阴性患者（82%）为ESAT-6或CFP-10（EC）ELISPOT阳性，77例（90%）为PPD ELISPOT阳性。82例（96%）成功完成治疗：44例（55%; p < 0.001）在12个月时为EC ELISPOT阴性，17例（21%; p = 0.051）为PPD ELISPOT阴性。60例（73%）治愈病例CFP-10 ELISPOT计数降低，64例（78%）ESAT-6 ELISPOT计数降低，58例（70%）PPD ELISPOT计数降低。CFP-10、ESAT-6和PPD的平均下降分别为25、44和47 SFU/2 × 105个细胞（所有均为p < 0.001）。4例HIV阳性患者中有3例治愈，所有3例均接受了ELISPOT逆转;所有4例未治愈受试者（3例HIV阴性，1例HIV阳性）在12个月时均为ESAT-6、CFP-10和PPD ELISPOT阳性。成功的结核病治疗伴随着M。结核特异性抗原ELISPOT计数。ELISPOT有可能作为结核病治疗结果的替代指标。需要进一步研究治疗后T细胞的衰变动力学。
New tools are required to improve tuberculosis (TB) diagnosis and treatment, including enhanced ability to compare new treatment strategies. The ELISPOT assay uses Mycobacterium tuberculosis-specific antigens to produce a precise quantitative readout of the immune response to pathogen. We hypothesized that TB patients in The Gambia would have reduced ELISPOT counts after successful treatment. We recruited Gambian adults with sputum smear and culture positive tuberculosis for ELISPOT assay and HIV test, and followed them up one year later to repeat testing and document treatment outcome. We used ESAT-6, CFP-10 and Purified Protein Derivative (PPD) as stimulatory antigens. We confirmed the reliability of our assay in 23 volunteers through 2 tests one week apart, comparing within and between subject variation. We performed an ELISPOT test at diagnosis and 12 months later in 89 patients. At recruitment, 70/85 HIV-negative patients (82%) were ESAT-6 or CFP-10 (EC) ELISPOT positive, 77 (90%) were PPD ELISPOT positive. Eighty-two cases (96%) successfully completed treatment: 44 (55%; p < 0.001) were EC ELISPOT negative at 12 months, 17 (21%; p = 0.051) were PPD ELISPOT negative. Sixty (73%) cured cases had a CFP-10 ELISPOT count decrease, 64 (78%) had an ESAT-6 ELISPOT count decrease, 58 (70%) had a PPD ELISPOT count decrease. There was a mean decline of 25, 44 and 47 SFU/2 × 105 cells for CFP-10, ESAT-6 and PPD respectively (p < 0.001 for all). Three of 4 HIV positive patients were cured, all 3 underwent ELISPOT reversion; all 4 not cured subjects (3 HIV-negative, 1 HIV positive) were ESAT-6, CFP-10 and PPD ELISPOT positive at 12 months. Successful tuberculosis treatment is accompanied by a significant reduction in the M. tuberculosis-specific antigen ELISPOT count. The ELISPOT has potential as a proxy measure of TB treatment outcome. Further investigation into the decay kinetics of T-cells with treatment is warranted.