A Field Evaluation of the Hardy TB MODS Kit? for the Rapid Phenotypic Diagnosis of Tuberculosis and Multi-Drug Resistant Tuberculosis

Background

Even though the WHO-endorsed, non-commercial MODS assay offers rapid, reliable TB liquid culture and phenotypic drug susceptibility testing (DST) at lower cost than any other diagnostic, uptake has been patchy. In part this reflects misperceptions about in-house assay quality assurance, but user convenience of one-stop procurement is also important. A commercial MODS kit was developed by Hardy Diagnostics (Santa Maria, CA, USA) with PATH (Seattle, WA, USA) to facilitate procurement, simplify procedures through readymade media, and enhance safety with a sealing silicone plate lid. Here we report the results from a large-scale field evaluation of the MODS kit in a government service laboratory.

Methods & Findings

2446 sputum samples were cultured in parallel in Lowenstein-Jensen (LJ), conventional MODS and in the MODS kit. MODS kit DST was compared with conventional MODS (direct) DST and proportion method (indirect) DST. 778 samples (31.8%) were Mycobacterium tuberculosis culture-positive. Compared to conventional MODS the sensitivity, specificity, positive, and negative predictive values (95% confidence intervals) of the MODS Kit were 99.3% (98.3–99.8%), 98.3% (97.5–98.8%), 95.8% (94.0–97.1%), and 99.7% (99.3–99.9%). Median (interquartile ranges) time to culture-positivity (and rifampicin and isoniazid DST) was 10 (9–13) days for conventional MODS and 8.5 (7–11) for MODS Kit (p<0.01). Direct rifampicin and isoniazid DST in MODS kit was almost universally concordant with conventional MODS (97.9% agreement, 665/679 evaluable samples) and reference indirect DST (97.9% agreement, 687/702 evaluable samples).

Conclusions

MODS kit delivers performance indistinguishable from conventional MODS and offers a convenient, affordable alternative with enhanced safety from the sealing silicone lid. The availability in the marketplace of this platform, which conforms to European standards (CE-marked), readily repurposed for second-line DST in the near future, provides a fresh opportunity for improving equity of access to TB diagnosis and first and second-line DST in settings where the need is greatest.     

Oh sister,where art thou? Spatial population structure and the evolution of an altruistic defence trait

The evolution of parasite virulence and host defences is affected by population structure. This effect has been confirmed in studies focusing on large spatial scales, whereas the importance of local structure is not well understood. Slavemaking ants are social parasites that exploit workers of another species to rear their offspring. Enslaved workers of the host species Temnothorax longispinosus have been found to exhibit an effective post‐enslavement defence behaviour: enslaved workers were observed killing a large proportion of the parasites’ offspring. As enslaved workers do not reproduce, they gain no direct fitness benefit from this ‘rebellion’ behaviour. However, there may be an indirect benefit: neighbouring host nests that are related to ‘rebel’ nests can benefit from a reduced raiding pressure, as a result of the reduction in parasite nest size due to the enslaved workers’ killing behaviour. We use a simple mathematical model to examine whether the small‐scale population structure of the host species could explain the evolution of this potentially altruistic defence trait against slavemaking ants. We find that this is the case if enslaved host workers are related to nearby host nests. In a population genetic study, we confirm that enslaved workers are, indeed, more closely related to host nests within the raiding range of their resident slavemaker nest, than to host nests outside the raiding range. This small‐scale population structure seems to be a result of polydomy (e.g. the occupation of several nests in close proximity by a single colony) and could have enabled the evolution of ‘rebellion’ by kin selection.     

Genetic diversification of the chestnut blight fungus Cryphonectria parasitica and its associated hypovirus in Germany

Chestnut blight in south-western Germany was first reported in 1992 and is since expanding in distribution. Here we investigated the invasion history of Cryphonectria parasitica and its associated hypovirus. For this, we characterized 284 isolates collected between 1992 and 2012 for hypovirulence, vegetative compatibility (vc), mating type, and microsatellite haplotype. A total of 27 haplotypes and 15 vc types were observed, although the C. parasitica population analyzed is currently dominated to 50 % by one haplotype and to 64 % by the vc type EU-2. Structure analysis indicated two divergent genetic pools. Over 66 % of the haplotypes belonged to a pool probably originating from northern Italy. Further diversification is expected due to ongoing sexual recombination, but also to new migration and additional introductions. Cryphonectria hypovirus 1 (CHV-1) was found in four of five C. parasitica populations from Baden-Württemberg. Genetic analysis of the 35 CHV-1 isolates obtained revealed that they all belong to the German subtype, although they have clearly diverged from the first German hypovirus isolated in 1992. Our study suggests that C. parasitica has been introduced into Germany several times from two different gene pools, whereas the hypovirus most probably has a single origin.     

Glucuronidation of the mycotoxins alternariol and alternariol-9-methyl ether in vitro: chemical structures of glucuronides and activities of human UDP-glucuronosyltransferase isoforms

Alternariol (AOH) and alternariol-9-methyl ether (AME) are major toxins produced by fungi of the genus Alternaria and are frequently found in various food items. Because AOH has three hydroxyl groups and AME two, the formation of various glucuronides must be expected. When AOH was incubated with hepatic and intestinal microsomes from rats, pigs and humans in the presence of uridine diphosphate glucuronic acid, two glucuronides were detected and tentatively identified as AOH-3-O-glucuronide and AOH-9-O-glucuronide. Under the same conditions, AME yielded predominantly AME-3-O-glucuronide and only small amounts of AME-7-O-glucuronide. The activities of all microsomes for the glucuronidation of AOH and AME were in the same range. Nine out of ten recombinant human UDP-glucuronosyltransferases (UGTs) were able to glucuronidate AOH, and eight out of ten UGTs had activity for AME. These data suggest that AOH and AME are readily glucuronidated in hepatic and extrahepatic tissues, implying that glucuronidation constitutes a major metabolic pathway in the disposition of these mycotoxins. Presented at the Mycotoxin Workshop, Utrecht, Netherlands, April 28–30, 2008     

How Subdiffusion Changes the Kinetics of Binding to a Surface

Under molecular crowding conditions, biopolymers have been reported to subdiffuse, ?r²(t)? ? t^α, with 0 < α < 1. Here we study the exchange dynamics of such a subdiffusing particle with a reactive boundary using a continuous time random walk approach. We derive the generalized boundary condition and consider the unbinding from the boundary. An ensuing weak ergodicity breaking has profound consequences for material exchange between the boundary and bulk. We discuss the effects in biological contexts such as gene regulation or membrane-bulk exchange processes. We also suggest various methods to experimentally probe the subdiffusive behavior.     

Die Ultrastruktur der Sklerotienentwicklung von Typhula incarnata

Die Sklerotien von Typhula incarnata sind aus einer einschichtigen pseudoparenchymatischen Rinde und einer plectenchymatischen Medulla aufgebaut. Die Differenzierung verschiedener Zellwandtypen wurde detailliert mit TEM-Untersuchungen verfolgt. Bemerkenswert sind besonders die schrittweise Einlagerung von melaninartiger Substanz in die Cuticula, welche als einzige Sklerotialstruktur von Trichoderma viride nicht abgebaut werden kann. Ferner wurden in den Medullazellen bisher unbekannte linsenförmige Zellwandappositionen gefunden, die wohl als Kohlehydratspeicher für die karpogene Keimung dienen.     

Metabolic activation of xenobiotic stilbene estrogens

Certain stilbene estrogens, in particular diethylstilbestrol, are established carcinogens in animals and in humans. The question is raised whether the formation of reactive metabolites is part of the carcinogenic mechanism of these compounds. Some aspects of the oxidative metabolism are briefly reviewed, with special emphasis on peroxidase-mediated metabolic activation. The interaction of the reactive intermediates with nucleic acids and proteins is described and examples of the induction of genetic damage in several short-term assays are given. From the available data it is concluded that metabolic activation may play a role in the process of neoplastic cell transformation induced by stilbene estrogens.     

Molecular Modeling of Immunoglobulin Superfamily Proteins: CTLA-4 (CD152) - Comparison of a Predicted and Experimentally Determined Three-Dimensional Structure

The CD28 and CTLA-4 (CD152) receptors on T cells recognize CD80 and CD86 ligands on antigen presenting cells. These interactions provide and control costimulatory signals required for effective T cell activation. CD28 and CTLA-4 belong to the immunoglobulin superfamily (IgSF) and contain a single extracellular ligand binding domain. The three-dimensional (3D) structure of the binding domain of CTLA-4 was modeled previously using a combination of structure-based sequence comparison, IgSF consensus residue analysis, conformational search, and inverse folding calculations. Recently, the 3D structure of CTLA-4 was determined by NMR. Comparison of the modeled and experimentally determined CTLA-4 structure has made it possible to assess the accuracy of our predictions. We found that the overall accuracy of the model was sound and sufficient for a meaningful application of the model in experimental studies. Major errors in the model are limited to the conformation and position of some loops. Our studies on CTLA-4 provide an example for the opportunities and limitations of comparative protein modeling in the presence of low sequence similarity.Electronic Supplementary Material available.