Development, Clinical Validation, and Readiness for Implementation of a Novel Mp1p D4 Poin Diagnosis of Talaromycosist of Care Test for Rapid

摘要 马尔尼菲塔拉霉菌(Talarmycesmarneffei，TM)是一种侵袭性的地方性真菌病，由二相性真菌--马尔尼菲塔拉霉菌引起。 东南亚。TM引起多器官播散性感染，三分之一的患者死于 尽管接受了抗真菌治疗，但仍处于免疫功能低下的状态。患有晚期艾滋病毒疾病的人(AHD，CD4&lt；200 Cells/L)风险最大，占全球确诊病例的90%。在艾滋病高度流行的国家 越南、泰国和中国，TM占艾滋病毒相关住院人数的18% 结核病和隐球菌病是艾滋病死亡的主要原因。减少距菌病的障碍 死亡率是我们对百年文化诊断方法的依赖，这些方法缺乏敏感性，可能会导致 28天，导致治疗延误和更高的死亡率。这一提议的科学前提是 使用一种新的护理点试验(POCT)诊断距菌病(在培养诊断前长达16周)是 因此，这将使早期治疗成为可能，并改善患者的预后。我们将参与多学科合作 团队科学将首创的POC技术从板凳到床边再到政策，我们将铺平道路 采取积极的筛查和治疗战略，以减少东南亚地区的疾病负担和艾滋病毒死亡率。 我们的目标是开发、优化和验证一种新的POCT，用于早期诊断和筛查 距菌病，并收集利益相关者的意见，以便为距菌病筛查的发展提供信息 对患有AHD的人进行治疗。Contact MPI Le和他的同事们已经开发出一种敏感而特异的酶 针对患者血和尿中大量分泌的TM特异性甘露糖蛋白Mp1p的免疫分析(EIA) 在感染期间。她已经证明，Mp1p是一种比血培养更敏感的生物标志物，用于诊断和 可以在血培养阳性之前检测到长达16周的病毒。MPI Chilkoti开创了D4 POCT- 一种独立的免疫分析，可以在&lt；30分钟内量化Mp1p水平。在此，我们建议翻译为 在Mp1p D4 POCT上安装Mp1p EIA，为距菌病提供一种快速、廉价和超敏感的检测方法。 目的1：建立和优化Mp1p D4点护理试验(POCT)，用于早期诊断足底真菌病。 人的血液、血清和尿液。 目的2：确定Mp1p D4 POCT作为症状快速诊断工具的临床应用 并作为两组AHD患者临床前疾病的筛查工具。 目标3：确定实施公共卫生的成本效益、可行性和可接受性 距平霉菌病筛查计划。 影响：这项提议将把一种新的POC技术从“长凳到床边再到政策”转化为一种范式 从被动治疗转变为主动筛选和治疗方法，这将改善个别患者 并在人口层面上减少疾病负担。它将与卫生部门建立重要的伙伴关系 系统和社区，并促进在越南实施距菌病筛查计划。

ABSTRACT Talaromycosis caused by the dimorphic fungus Talaromyces marneffei (Tm) is an invasive mycosis endemic in Southeast Asia. Tm causes a multi-organ disseminated infection that kills one in three affected persons with an immunocompromised condition despite antifungal therapy. Persons with advanced HIV disease (AHD, CD4<200 cells/L) have the greatest risk and account for 90% of diagnosed cases globally. In highly-endemic countries of Vietnam, Thailand, and China, Tm accounts for 18% of HIV-related hospital admissions and surpasses tuberculosis and cryptococcosis as the leading cause of AIDS deaths. An impediment to reducing talaromycosis mortality is our reliance on century-old diagnostic methods of culture which lack sensitivity and can take up to 28 days, leading to treatment delay and higher mortality. The scientific premise of this proposal is that early diagnosis of talaromycosis (up to 16 weeks before culture diagnosis) using a novel point-of-care test (POCT) is achievable, thus would enable early treatment and improve patient outcomes. We will engage multidisciplinary team science to translate a first-in-kind POC technology from bench to bedside to policy, and we will pave a way for an active screen-and-treat strategy to reduce disease burden and HIV mortality in Southeast Asia. Our objective is to develop, optimize, and validate a novel POCT for early diagnosis and for screening of talaromycosis, and to gather inputs from stakeholders to inform the development of a talaromycosis screening program in people with AHD. Contact MPI Le and colleagues have developed a sensitive and specific enzyme immunoassay (EIA) targeting a Tm-specific mannoprotein Mp1p abundantly secreted in patient blood and urine during infection. She has shown that Mp1p is a more sensitive biomarker than blood culture for diagnosis and can be detected up to 16 weeks before blood culture turns positive. MPI Chilkoti has pioneered the D4 POCT— a self-contained immunoassay that can quantify Mp1p levels in <30 minutes. Herein, we propose the translation of the Mp1p EIA onto the Mp1p D4 POCT to provide a rapid, cheap, and ultra-sensitive test for talaromycosis. AIM 1: Develop and optimize a Mp1p D4 point-of-care test (POCT) for early diagnosis of talaromycosis in human blood, serum, and urine. AIM 2: Determine the clinical utility of the Mp1p D4 POCT as a rapid diagnostic tool for symptomatic talaromycosis and as a screening tool for pre-clinical disease in two cohorts of patients with AHD. AIM 3: Determine the cost-effectiveness, feasibility, and acceptability of implementing a public health talaromycosis screening program. Impact: This proposal will translate a novel POC technology from ‘bench to bedside to policy’, forging a paradigm shift from passive treatment to an active screen-and-treat approach that will improve the individual patient outcome and reduce disease burden at the population level. It will build important partnerships with the health system and community and facilitate the implementation of a talaromycosis screening program in Vietnam.