结核分枝杆菌分泌蛋白Ag85B、Hsp16.3和ESAT6在血清学检测中 的初步应用

目的:探讨结核分枝杆菌分泌蛋白Hsp16.3、Ag85B以及融合蛋白ESAT6-CFP10、Ag85B-Hsp16.3和Ag85B-ESAT6用于TB病人血清学检测的意义。方法:将已构建的含5种目的基因的表达载体(pProEXHTb-Hsp16.3、pProEXHTa-Ag85B、pProEXHTb-ESAT6-CFP10、pProEXHTa-Ag85B-Hsp16.3、pProEXHTa-Ag85B-ESAT6),分别转入宿主菌E.coli DH5α中,诱导表达后分别获得Hsp16.3、Ag85B、ESAT6-CFP10、Ag85B-Hsp16.3和Ag85B-ESAT6五种蛋白,采用Ni2+亲和层析柱进行纯化,并用透析方法进行目的蛋白的复性。将经过复性的5种蛋白分别作为抗原,采用间接ELISA方法检测待测的血清样本,经OPD显色,测定各孔OD490值并判定结果。结果:五种蛋白被成功纯化并复性,通过ELISA方法共检测了22例TB病人血清、10例非结核病人血清和6例正常对照血清,Hsp16.3、Ag85B、ESAT6-CFP10、Ag85B-Hsp16.3和Ag85B-ESAT6这5种抗原的灵敏度分别为36.4%、90.9%、77.3%、95.5%、100%,特异性分别为100%、75%、100%、93.8%、93.8%。统计分析显示,ESAT6-CFP10和Ag85B、Ag85B-Hsp16.3、Ag85B-ESAT6这三种蛋白ELISA检测的结果无差异,而与Hsp16.3和痰涂片检测结果有显著差异。结论:Ag85B-Hsp16.3和Ag85B-ESAT6可作为结核分枝杆菌ELISA检测的初选抗原。     

结核分枝杆菌融合蛋白Ag85B-Hsp16.3、Ag85B-ESAT6 和分泌蛋白 Hsp16.3 体外对人肝癌细胞HepG-2 的作用*

目的:探讨结核分枝杆菌融合蛋白Ag85B-Hsp16.3、Ag85B-ESAT6及分泌蛋白Hsp16.3对人肝癌细胞HepG-2的作用。方法:将已构建的含3种目的基因的表达载体pProEXHTa-Ag85B-Hsp16.3、pProEXHTa-Ag85B-ESAT6和pProEXHTb-Hsp16.3,分别转入宿主菌E.coliDH5α中,诱导表达后分别获得Ag85B-Hsp16.3、Ag85B-ESAT6和Hsp16.3三种蛋白,采用Ni2+亲和层析柱进行纯化,并用透析方法进行目的蛋白的复性。复性的蛋白按照不同浓度和作用时间分别与肝癌细胞HepG-2反应,用MTT法检测细胞生长情况。结果:三种蛋白被成功纯化并复性。MTT数据统计分析显示,终浓度10μg/ml的三种蛋白对HepG-2细胞生长没有明显作用,当三种蛋白的终浓度分别为20、40、80μg/ml时均能够抑制HepG-2细胞的生长,并且抑制作用随着蛋白终浓度的增大以及作用时间的延长而增强。不同类别的蛋白抑制作用没有明显差别。结论:结核分枝杆菌的部分分泌蛋白能够抑制肝癌细胞HepG-2的生长。     

结核分枝杆菌融合蛋白Ag85B-Hsp16．3、Ag85B-ESAT6和分泌蛋白Hspl6．3体外对人肝癌细胞HepG-2的作用

目的：探讨结核分枝杆菌融合蛋白Ag85B-Hspl6．3、Ag85B-ESAT6及分泌蛋白Hspl6-3对人肝癌细胞HepG-2的作用。方法：将已构建的含3种目的基因的表达载体pProEXHTa-Ag85B-Hspl6．3、pProEXHTa-Ag85B-ESAT6和pProEXHTb-Hspl6．3,分别转入宿主菌EcoliDH5α中,诱导表达后分别获得Ag85B-Hspl6．3、Ag85B-ESAT6和Hspl6．3三种蛋白,采用Ni^2＋亲和层析柱进行纯化,并用透析方法进行目的蛋白的复性。复性的蛋白按照不同浓度和作用时间分别与肝癌细胞HepG-2反应,用MTT法检测细胞生长情况。结果：三种蛋白被成功纯化并复性。MTT数据统计分析显示,终浓度101xg／ml的三种蛋白对HepG-2细胞生长没有明显作用,当三种蛋白的终浓度分别为20、40、801μg／ml时均能够抑制HepG-2细胞的生长,并且抑制作用随着蛋白终浓度的增大以及作用时间的延长而增强。不同类别的蛋白抑制作用没有明显差别。结论：结核分枝杆菌的部分分泌蛋白能够抑制肝癌细胞HepG-2的生长。     

Poly I∶C联合BCG-CpG复合佐剂对结核亚单位疫苗免疫效果的影响

目的探讨聚肌胞苷酸(Poly I∶C)联合BCG-CpG复合佐剂(BCG-CpG-DNA+Al,简称BC02)对结核亚单位疫苗的免疫效果是否有增强作用。方法 BALB/c小鼠分成5组,3组分别免疫含有不同剂量poly I∶C(10、25、50μg/剂)的结核亚单位疫苗(Ag85b+ESAT6-CFP10)/(BC02+poly I∶C)3针,间隔10 d;2组分别免疫PBS或(Ag85b+ESAT6-CFP10)/BC02作为对照。末次免疫后第7 d,分离脾淋巴细胞,进行抗原特异性的IFN-γELISPOT检测、ELISA检测和淋巴细胞增殖检测以评价细胞免疫应答。豚鼠分成4组,1组免疫含有50μg poly I∶C/剂的新亚单位疫苗(Ag85b+ESAT6-CFP10)/(BC02+poly I∶C)3针,间隔10 d;3组分别免疫(Ag85b+ESAT6-CFP10)/BC02疫苗、生理盐水和BCG作为对照。末次免疫30 d后,每只豚鼠皮下攻击250 CFU结核分枝杆菌。41 d后,解剖豚鼠,进行肝、脾、肺脏器综合病变评分和脾菌计数以评价保护力。结果含不同剂量poly I∶C的(Ag85b+ESAT6-CFP10)/(BC02+poly I∶C)疫苗免疫组小鼠的脾淋巴细胞分别经Ag85b和ESAT6-CFP10多肽刺激后,分泌IFN-γ的抗原特异性T细胞频数、IFN-γ分泌量和细胞增殖指数均较(Ag85b+ESAT6-CFP10)/(BC02)组大幅度提高,且应答强度与poly I∶C呈现较为明显的量效关系。(Ag85b+ESAT6-CFP10)/(BC02+poly I∶C)组豚鼠脏器综合病变指数(27.5±20.4)和脾菌分离数[(4.22±0.59)log10CFU]均低于(Ag85b+ESAT6-CFP10)/BC02组[35.8±27.3,(5.19±0.66)log10CFU],其中脾菌分离数的差异有显著统计学意义(P=0.003 0)。结论 Poly I∶C佐剂对结核亚单位疫苗(Ag85b+ESAT6-CFP10)/BC02诱导的细胞免疫应答和抗结核保护力均有一定的增强效果。     

结核分枝杆菌组合DNA疫苗的免疫效果

以编码结核分枝杆菌分泌蛋白Ag85B、ESAT 6和MPT6 3的基因为插入片段 ,构建核酸疫苗联合免疫小鼠。以原核表达纯化的抗原为检测物 ,检测了抗原特异性的抗体和γ 干扰素的形成。研究表明 ,组合核酸疫苗第 3次免疫后 2 1天 ,实验小鼠血清中Ag85B抗体滴度达到 10 5以上 ,Ag85B抗原刺激产生的特异性γ 干扰素达到 (17.0± 7.0 )u/ml。组合疫苗虽然没有提高小鼠血清中ESAT 6及MPT6 3蛋白的特异性抗体滴度 ,但仍显著刺激产生了两种特异性的 γ 干扰素。攻毒实验表明 ,经组合疫苗免疫后小鼠肺部结核杆菌数量显著下降。肺部切片显示 ,免疫小鼠病理状况较对照组有明显改善。因此 ,研究提示Ag85B等组合核酸疫苗具有较好的结核病预防效果。     

结核分枝杆菌CFP10、ESAT6、Ag85A和Ag85B抗原真核共表达载体的构建与表达

CFP10、ESAT6、Ag85A和Ag85B是结核分枝杆菌的主要免疫优势抗原。为了构建一种可同时表达这4种抗原的真核多基因共表达载体pcDNA-CFP10-ESAT6-Ag85A-Ag85B(pcDNA-CEAB),并利用HEK 293T细胞对其体外表达进行检测。采用酶切、连接的方法,将CFP10和ESAT6编码基因以(Gly4Ser)3蛋白Linker连接,插入至质粒pcDNA3.1(+)多克隆位点CMV启动子与加尾信号BGH pA之间,使两者融合表达,将Ag85A和Ag85B编码基因以内部核糖体进入位点(Internal ribosome entry site,IRES)序列连接,并赋予RSV启动子和加尾信号BGH pA,使两者在RSV启动子作用下独立表达。重组质粒经酶切及测序验证后转染至HEK 293T细胞中进行体外表达实验,48 h后提取总蛋白,利用CFP10、ESAT6、Ag85A和Ag85B特异性抗体进行Western blotting检测。结果显示多基因共表达载体pcDNA-CEAB在真核细胞HEK 293T中得到表达,且CFP10、ESAT6、Ag85A和Ag85B抗原能被相应的特异性抗体所识别,表明质粒pcDNA-CEAB构建正确,这为进一步研究其免疫原性和免疫保护效果奠定了基础。     

结核分枝杆菌ESAT6-CFP10融合蛋白对小鼠巨噬细胞自噬功能的影响

目的研究结核分枝杆菌（MTB）ESAT6-CFP10融合蛋白对小鼠巨噬细胞自噬功能的影响。方法H37Rv菌株感染小鼠巨噬细胞后加入纯化的重组ESAT6-CFP10融合蛋白,通过透射电镜检测自噬体的形成。提取细胞总RNA和蛋白,以实时定量RT-PCR及Western blot方法检测自噬相关基因（atg）分子水平和蛋白表达水平。结果ESAT6-CFP10融合蛋白可抑制小鼠巨噬细胞自噬体的形成,并导致atg分子表达水平下降,其中atg8表达量下降最为明显。结论MTB ESAT6-CFP10融合蛋白通过调控atg分子表达水平影响小鼠巨噬细胞自噬功能。     

结核分枝杆菌热休克蛋白Hsp16.3及其合成肽在小鼠体内诱导的免疫应答

目的比较结核分枝杆菌Hsp16.3和Hsp16.3合成肽在小鼠体内诱导的免疫应答及保护力。方法80只BALB/c小鼠随机分5组共免疫3次,间隔2周。分别于0、2、4、6、8周采集血液,ELISA法检测在抗原Hsp16.3和Hsp16.3合成肽包被时血清中的抗体浓度及第8周时血清中的抗体滴度。末次免疫完成后4周,取每组8只免疫小鼠分离脾淋巴细胞,用Hsp16.3和Hsp16.3合成肽分别刺激后,MTT法测定脾淋巴细胞的增殖指数,     

结核分枝杆菌多表位诊断抗原的制备

将结核分枝杆菌(Mycobacterium tuberculosis,Mtb)多个B细胞预测表位串联表达(命名为B102),并初步评价其作为诊断抗原的血清学诊断价值。将MtbPstS1、ESAT6、CFP10、Ag85B、Ag85A及PPE54等6个蛋白的11个B细胞预测表位串联,加入合适的连接臂后全基因合成;将多表位片段插入带有TRX标签的表达质粒中,在大肠杆菌BL21(DE3)中诱导表达,并利用Ni~(2+)-Chelating亲和层析和DEAE阴离子交换层析纯化目的蛋白;利用Western blotting (WB)技术对目的蛋白抗原性进行鉴定,并建立Mtb抗体检测竞争法ELISA技术,初步评价此方法对阴阳血清样本的鉴别能力。目的蛋白以包涵体形式存在,其表达量约占菌体总蛋白的31.25%,经纯化及复性后蛋白B102可溶性存在,浓度为3.124mg/mL,纯度为96.71%;WB实验表明目的蛋白能与Mtb阳性血清相应抗体发生反应。对60份Mtb阳性血清及60份Mtb阴性血清进行检测得出其灵敏度为90.00%,特异性为93.33%,阳性预测值为93.10%,阴性预测值为90.32%,符合率为91.67%,McNemer检验的结果提示与"金标准"诊断结果无差异,Kappa=0.833,提示两种方法诊断结果一致性优异。原核表达与层析纯化可以获取抗原性优异的Mtb多表位诊断抗原,作为诊断抗原可以应用于Mtb的血清学检测中。     

结核分枝杆菌Rv1886c的原核表达及其免疫生物学特性

【目的】Rv1886c基因编码的Ag85B是结核分枝杆菌(Mycobacterium tuberculosis,M.tb)感染早期的分泌蛋白,本研究对其所诱导的免疫应答特性进行了探索。【方法】对Ag85B进行原核表达和鉴定,并通过夹心ELISA、间接ELISA及ELISPOT方法测定其诱导的细胞免疫和体液免疫应答水平。【结果】SDS-PAGE及Western blot鉴定结果表明,以包涵体形式表达的Ag85B蛋白,经变性、复性后能与结核病人的抗血清及免疫重组李斯特菌LM-Ag85B的小鼠抗血清发生特异性反应,表明His-Ag85B融合蛋白具有较好的免疫活性。将纯化的Ag85B蛋白皮下免疫C57BL/6小鼠,夹心ELISA的测定结果表明,Ag85B蛋白免疫组诱导小鼠产生的特异性IFN-γ水平显著高于IL-4的水平(P0.001),呈现Th1型细胞免疫应答趋势;以结核菌素PPD作为包被抗原,通过间接ELISA测定的血清抗体效价达到1∶6400,表明Ag85B也能诱导有效的体液免疫应答。此外,以尾静脉途径初次免疫小鼠42天时,ELISPOT测定结果显示,结核分枝杆菌H37Rv诱导小鼠产生Ag85B240-259特异性的IFN-γ水平极显著高于卡介苗(BCG)免疫组(P0.001)。【结论】Ag85B蛋白能激发小鼠产生较强的Th1型细胞免疫应答和较好的体液免疫应答;BCG单次免疫后诱导小鼠产生的Ag85B特异的细胞免疫应答水平较低。本研究为揭示结核分枝杆菌的致病机理、新型疫苗的研制和早期诊断试剂的开发奠定了基础。     

Immune responses and protective efficacy induced by 85B antigen and early secreted antigenic target-6 kDa antigen fusion protein secreted by recombinant bacille Calmette-Guérin

In an attempt to improve immune responses and protective efficacy, we constructed two recombinant bacille Calmette-Guérin (rBCG) strains expressing an 85B antigen (Ag85B) and early secreted antigenic target-6 kDa antigen (ESAT6) of Mycobacterium tuberculosis (MTB) fusion protein. Both rBCG strains have the same protein insertion but in a different order (Ag85B-ESAT6 and ESAT6-Ag85B). The cultured supernatant of rBCG strains and the sera from the mice immunized with the fusion protein Ag85B-ESAT6 or ESAT6-Ag85B formed a band with a fraction size of 37 kDa, equalivalent to the sum of Ag85B and ESAT6. Six weeks after BALB/c mice were immunized with BCG or rBCG, spleen lymphocytes showed significant proliferation in response to culture filtrate protein of MTB. Compared with the BCG group, mice vaccinated with rBCG elicited a high level increase of immunoglobulin G antibodies to culture filtrate protein in the serum. The gamma-interferon levels in the lymphocyte culture medium supernatants increased remarkably in the rBCG1 group, significantly higher than that of the BCG immunized group (p<0.05). Four weeks after vaccination, mice were infected with M. tuberculosis H37Rv and a dramatic reduction in the numbers of MTB colony forming units in the spleens and lungs was observed in the two rBCG immunization groups. Although these rBCG strains were more immunogenic, their protective effect was comparable to the classical BCG strain, and there were no significant differences between two rBCG groups (p>0.05).     

Immune responses and protective efficacy of the gene vaccine expressing Ag85B and ESAT6 fusion protein from Mycobacterium tuberculosis

Genetic immunity is a new promising approach for the development of novel tuberculosis vaccines. In this study, it is shown that DNA vaccines expressing the fusion protein of antigen 85B (Ag85B) and early secreted antigenic target 6-kDa antigen (ESAT6) can induce high levels of specific IgG2a antibody subtype in the mice. With the prolongation of postimmunization time, the levels of IgG2a antibody decrease gradually. Although a high-level specific IgG2a antibody subtype is also elicited by classical BCG, the ratio of antibody subtypes IgG2a to IgG1 changes 4 weeks after immunization, and IgG1 is gradually shifted to the main antibody subtype. DNA vaccines also elicit cellular immunity as shown by specific spleen lymphocytes proliferation to Ag85B or ESAT6 protein and the production of high levels of IFN-gamma and IL-2, which is similar to that elicited by BCG. Vaccination of mice with DNA vaccines expressing the fusion protein Ag85B-ESAT6 results in a significant level of protection against the subsequent high-dose challenge with virulent Mycobacterium tuberculosis (MTB) H37Rv. Dramatic reduction in the number of MTB colony-forming units in the spleens and lungs is observed. Pathological examination showed that recombinant plasmid and BCG groups have only minor damage and organizational structures that are kept relatively complete, while in the control group, spleens and lungs are damaged seriously. Therefore, although the reducing degree of mycobacterial loads in the organ of mice immunized with recombinant plasmid is not more than that of BCG, through the analysis of pathological changes, we may conclude that the protective effect provided by DNA vaccine expressing the Ag85B-ESAT6 fusion protein is equivalent to that afforded by the classical BCG.     

Cytokine profiles in tuberculosis patients and healthy subjects in response to complex and single antigens of Mycobacterium tuberculosis

Peripheral blood mononuclear cells (PBMC) were obtained from tuberculosis (TB) patients and Mycobacterium bovis bacillus Calmette-Guerin vaccinated healthy subjects. PBMC were tested for secretion of tumor necrosis factor-alpha (TNF-alpha), interferon-gamma (IFN-gamma), interleukin-5 (IL-5) and IL-10 in response to complex (whole cells, culture filtrate and cell walls), single secreted (Ag85B, ESAT6, MPT64, PstS and MPT70) and single cytosolic (DnaK, GroES and GroEL) antigens of Mycobacterium tuberculosis. In the absence of antigens, detectable concentrations of TNF-alpha, IFN-gamma and IL-10 were secreted by PBMC of both donor groups, but the concentrations of only IL-10 were significantly higher (P=0.015) in TB patients than in healthy subjects. In the presence of complex antigens, PBMC secreted IFN-gamma and TNF-alpha in response to all three preparations, whereas IL-10 was secreted in response to whole cells and cell walls only. In the presence of single antigens, IFN-gamma was secreted in response to Ag85B, ESAT6 and MPT64 in TB patients and ESAT6 in healthy donors. Except for GroEL and DnaK, single antigens did not induce TNF-alpha and IL-10 secretion from PBMC in either donor group. The secretion of IFN-gamma, but not IL-10, in the presence of Ag85B, ESAT6 and MPT64 supports their potential as subunit vaccine candidates against TB.     

Synthetic Peptides are Better Than Native Antigens for Development of ELISA Assay for Diagnosis of Tuberculosis

Immunodiagnosis of both pulmonary tuberculosis (PTB) and extrapulmonary tuberculosis has remained challenging. In the present work, in-house developed synthetic peptide based antibody detection assay was assessed and validated with antigen based assay for effective diagnosis of tuberculosis (TB). The study population included both tuberculous meningitis (TBM) (n = 60) admitted to Neurology IPD wards of our Institute hospital and PTB cases (n = 57) recruited from high TB endemic zones. Peptides of five highly immunogenic Mycobacterium tuberculosis (MTB) proteins (Ag85B, 45 kDa, HSP-16, CFP-10 and ESAT-6) were designed and synthesized. The designed peptides were evaluated in samples of both TBM and PTB cases, respectively, using in-house developed antibody detection method. The developed tests were further compared and validated with MTB native proteins based antibody detection ELISA. Sensitivity and specificity of peptide assay were significantly higher or almost similar (p < 0.05) in TBM and PTB as compared to native proteins based ELISA. Among all peptides, diagnostic reliability of Ag 85B peptide A1 was higher for both forms of TB. Peptide-based antibody assay is cost effective, simple and may be interchangeable with conventional Antigen based ELISA assays for effective diagnosis of TB in the developing world.     

三重表达肺结核DNA疫苗在细胞水平的检测

目的 检测共表达siRNA、抗原基因与hIL-12的新型肺结核DNA疫苗在人胚肾293细胞中表达。方法 在已构建含有靶向抗调亡基因Mcl-1L的siRNA、结核分枝杆菌抗原基因Ag85B-ESAT6 (PVAE)、hIL-12的新型肺结核DNA疫苗pVAX-siRNA-PVAE-IL-12基础之上,将抗原基因与增强型绿色荧光蛋白（EGFP）基因融合,得到真核表达重组质粒pVAX1-siRNA-PVAE-EGFP-hIL12。并将siRNA单元用靶向EGFP基因的siEGFP代替,得到pVAX1-siEGFP-PVAE-EGFP-hIL12重组表达载体。用重组质粒转染人胚肾细胞293,分别观察融合抗原基因与siEGFP的表达。以ELISA测定培养细胞上清中hIL-12的表达。结果 经酶切鉴定和测序证实肺结核DNA疫苗改造成功。转染细胞中检测到绿色荧光,证实抗原表达。对照组检测到siEGFP的表达。转染48 h后检测出细胞上清中hIL-12的量为1571.63 pg/mL;72 h后检测出细胞上清中hIL-12的量为2392.25pg/mL。结论 已构建的肺结核质粒DNA疫苗能在真核细胞中有效表达siRNA、抗原基因与hIL-12。为进一步研究该DNA疫苗抗肺结核的免疫治疗和基因治疗效果打下基础。     

Immunoreactivity of five antigens of Mycobacterium tuberculosis in patients attending a public health care facility in an area with high endemicity for TB

The objective of this study was to evaluate people attending a primary health clinic in Rio de Janeiro, Brazil for immunoreactivity to five Mycobacterium tuberculosis antigens, as these antigens are markers of immune response and factors associated with active TB. The serum antibody titers of different categories of patients (defined by microbiological and radiological characteristics and by response to therapy on follow‐up) to 38 kDa, 16 kDa, MPT64, ESAT‐6 and MT10.3 antigens were determined blind with ELISA. Positive tests to each antigen were defined with ROC analysis. OR were calculated for factors associated with humoral response in patients with active TB. A total of 201 patients underwent serological testing. Patients with confirmed active TB responded more frequently to MPT64 (44%), 16 kDa (37.7%) and 38 kDa (36.1%). ESAT‐6 and MT10.3 were also able to distinguish people in TB groups from controls. TB infected subjects responded less frequently to ESAT‐6 and MT10.3 (3.7% and 11%, respectively). Sensitivity and specificity to all antigens combined were 58.4% and 60.7%, respectively. Reactivity to 38 kDa and to MPT64 was more likely among alcohol users OR 2.61 (95%CI;1.05–6.94) and OR 3.27 (95%CI;1.33–8.15), respectively. 16 kDa antigen elicited a more protective response among smokers, OR 0.29 (95%CI; 0.10–0.83). It was concluded that reactivity to all antigens tested represented markers of active disease. ESAT‐6 and MT10.3 could not be identified as markers of TB infection in this community. Sensitivity was higher to all antigens combined, but at a cost of lower specificity. Interestingly, among factors associated with positive immunoreactivity, alcohol use and smoking seem to polarize the humoral response in different directions. This finding deserves further investigation.     

The diagnostic accuracy of urine-based Xpert MTB/RIF in HIV-infected hospitalized patients who are smear-negative or sputum scarce

Background

Hospitals in sub-Saharan Africa are inundated with HIV-infected patients and tuberculosis (TB) is the commonest opportunistic infection in this sub-group. Up to one third of TB-HIV co-infected patients fail to produce a sputum sample (sputum scarce) and diagnosis is thus often delayed or missed. We investigated the sensitivity of urine-based methods (Xpert MTB/RIF, LAM strip test and LAM ELISA) in such patients.

Methodology/Principal Findings

281 HIV-infected hospitalised patients with clinically suspected TB provided a spot urine sample. The reference standard was culture positivity for Mycobacterium tuberculosis on ≥1 sputum or extra-pulmonary sample. MTB/RIF was performed using 1 ml of both unprocessed and, when possible, concentrated urine. Each unconcentrated urine sample was also tested using the Clearview LAM ELISA and Alere LAM strip test. 42% (116/242) of patients had culture-proven TB. 18% (20/54) were sputum scarce. In sputum-scarce patients, the sensitivity of urine MTB/RIF and LAM ELISA was 40% (95%CI: 22–61) and 60% (95%CI: 39–78), respectively. Urine MTB/RIF specificity was 98% (95%CI: 95–100). Combined sensitivity of urine LAM ELISA and MTB/RIF was better than MTB/RIF alone [MTB/RIF and LAM: 70% (95%CI: 48–85) vs. MTB/RIF: 40% (95%CI: 22–61), p = 0.03]. Significant predictors of urine MTB/RIF positivity were CD4<50 cells/ml (p = 0.001), elevated protein-to-creatinine ratio (p<0.001) and LAM ELISA positivity (p<0.001). Urine centrifugation and pelleting significantly increased the sensitivity of MTB/RIF over unprocessed urine in paired samples [42% (95%CI: 26–58) vs. 8% (95%CI: 0–16), p<0.001]. Urine MTB/RIF-generated C_T values correlated poorly with markers of bacillary burden (smear grade and time-to-positivity).

Conclusions/Significance

This preliminary study indicates that urine-based MTB/RIF, alone or in combination with LAM antigen detection, may potentially aid the diagnosis of TB in HIV-infected patients with advanced immunosuppression when sputum-based diagnosis is not possible. Concentration of urine prior to MTB/RIF-testing significantly improves sensitivity.