Diagnostic 'omics' for active tuberculosis.
Diagnostic 'omics' for active tuberculosis.
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DOI：
10.1186/s12916-016-0583-9
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发表时间：
2016-03-23
期刊：
影响因子：
9.3
通讯作者：
Noursadeghi M
中科院分区：
文献类型：
--
作者：
Haas CT;Roe JK;Pollara G;Mehta M;Noursadeghi M
治疗活动性结核病（TB）的决定取决于对微生物进行的微生物检测，或在具有高人口暴露风险的人群中发现与TB相容的疾病的证据。结核菌素皮试和外周血γ-干扰素释放试验不能区分活动性结核与已清除或潜伏感染。分枝杆菌的微生物培养是缓慢的。此外，抗酸杆菌的培养和显微镜检查的灵敏度以及通过PCR进行的核酸检测通常由于难以从疾病部位获得样品而受到损害。因此，我们需要对容易获得的临床样本进行敏感和快速的检测，这些检测可用于评估暴露于TB的患者，区分TB与其他传染性、炎症性或自身免疫性疾病，并在开始抗逆转录病毒治疗之前识别HIV-1感染患者的亚临床TB。我们讨论了外周血转录组学、蛋白质组学和代谢组学的评价，以开发下一代活动性结核病的快速诊断方法。我们对迄今为止发表的旨在区分活动性结核病与健康志愿者、潜伏感染患者和其他疾病患者的研究进行了编目。我们确定了这些研究的局限性和在临床实践中采用的障碍。在这样做的过程中，我们的目标是开发一个框架，以指导我们的方法来发现和开发活动性结核病的诊断生物标志物。
The decision to treat active tuberculosis (TB) is dependent on microbiological tests for the organism or evidence of disease compatible with TB in people with a high demographic risk of exposure. The tuberculin skin test and peripheral blood interferon-γ release assays do not distinguish active TB from a cleared or latent infection. Microbiological culture of mycobacteria is slow. Moreover, the sensitivities of culture and microscopy for acid-fast bacilli and nucleic acid detection by PCR are often compromised by difficulty in obtaining samples from the site of disease. Consequently, we need sensitive and rapid tests for easily obtained clinical samples, which can be deployed to assess patients exposed to TB, discriminate TB from other infectious, inflammatory or autoimmune diseases, and to identify subclinical TB in HIV-1 infected patients prior to commencing antiretroviral therapy. We discuss the evaluation of peripheral blood transcriptomics, proteomics and metabolomics to develop the next generation of rapid diagnostics for active TB. We catalogue the studies published to date seeking to discriminate active TB from healthy volunteers, patients with latent infection and those with other diseases. We identify the limitations of these studies and the barriers to their adoption in clinical practice. In so doing, we aim to develop a framework to guide our approach to discovery and development of diagnostic biomarkers for active TB.