Validation of Biomarkers of Pediatric TB and further development for use in diagnosis of childhood TB

项目概要/摘要 儿童结核病（TB）（肺部和弥漫性形式）的诊断是 由于目前的测试依赖于从痰或唾液中培养致病细菌， 胃吸出物。结核分枝杆菌的培养可能需要几周时间， 很难从幼儿身上获得适当的样本。即使是最好的 目前的方法，儿童结核病的明确诊断仅在20-30%的儿童中实现。 临床诊断为结核病的儿童。缺乏准确和快速的诊断测试 导致许多儿童延误治疗，相反，儿童过度治疗 也很常见。因此，迫切需要改进 儿童结核病的诊断测试。 作为检测致病性分枝杆菌的替代方法， 血蛋白或血细胞中基因的激活模式（蛋白或基因标记 或生物标志物）是用于诊断许多感染的有前景的方法。我们的成员 一个财团先前研究了大量特征明确的结核病儿童， 一系列与儿童结核病症状相似的其他感染。我们已经确定 候选蛋白质和基因“签名”，这可能是有用的诊断儿童 TB.我们的建议是提出六个有前途的蛋白质和基因签名（三个基于 基于蛋白质和三个基于表达基因的变化），以进一步验证 在四个非洲国家建立了疑似结核病儿童队列， 儿童结核病的负担（南非、马拉维、肯尼亚和冈比亚）。 利用从4,000多名特征明确的儿童结核病嫌疑人中获得的样本， 六个候选生物标志物将首先使用与检测相同的技术进行验证。 原始生物标志物，然后使用更简单的技术， 患者进行分析。为了确保只有最准确和可复制的 生物标志物，我们将在至少三个不同的生物标志物中验证每个生物标志物。 国家队。我们将使用先进的统计方法来选择最 准确的生物标志物，可以作为临床使用的测试进行开发。 为了将有前途的生物标志物转化为甚至可以应用于临床测试 在资源贫乏的环境中，我们将使用新技术来检测蛋白质和基因， 将作为诊断测试的基础进行验证的签名。

Project summary / abstract The diagnosis of tuberculosis (TB) (both pulmonary and disseminated forms) in children is extremely difficult as current tests rely on culture of the causative bacteria from sputum or gastric aspirates. Culture of Mycobacterium tuberculosis may take several weeks and obtaining appropriate samples from young children is difficult. Even with the best available current methods a definitive diagnosis of childhood TB is only achieved in 20-30% of children clinically diagnosed as having TB. Lack of accurate and rapid diagnostic tests results in delayed treatment for many children, and conversely over-treatment of children who may not actually have TB is also common. There is thus an urgent need for improved diagnostic tests for childhood TB. As an alternative to detecting the causative Mycobacterium, identification of changes in blood proteins or the pattern of activation of genes in blood cells (protein or gene signatures or biomarkers) is a promising method for diagnosing many infections. The members of our consortium have previously studied well-characterised large groups of children with TB, and a range of other infections with similar symptoms to childhood TB. We have identified candidate protein and gene “signatures” which may be useful in the diagnosis of childhood TB. Our proposal is to take forward six promising protein and gene signatures (three based on proteins and three based on changes in expressed genes) for further validation in well established cohorts of children with suspected TB in four African countries which have high burdens of childhood TB (South Africa, Malawi, Kenya and The Gambia). Using available samples from over 4,000 well characterised child TB suspects, each of the six candidate biomarkers will be validated first using the same technology as used to detect the original biomarker and then using simpler technology which enables large numbers of patients to be analysed. In order to ensure that only the most accurate and reproducible biomarkers are taken forward, we will validate each biomarker in at least three different country cohorts. We will use sophisticated statistical methodology to select the most accurate biomarkers which can be taken forward for development as tests for clinical use. In order to translate promising biomarkers to clinical tests which can be applied even in resource poor settings we will use novel technology to detect the protein and gene signatures which will be validated as the basis of a diagnostic test.