Serologically active glycolipid families from Mycobacterium bovis BCG. II. Serologic studies on human sera

The role of antibodies in Bacille Calmette Guérin-mediated immune responses and protection against tuberculosis in humans: A systematic review

BACKGROUND

The mechanisms underlying Bacille Calmette-Guérin (BCG) vaccine's protective effects against tuberculosis (TB) are incompletely understood but are proposed to involve a predominantly cell-mediated process. However, there is increasing evidence for the involvement of antibodies in the control of Mycobacteria tuberculosis and in the immune response to BCG.

METHODS

We did a systematic review of studies investigating anti-BCG antibodies in individuals with active or latent TB, and in the response to BCG vaccination.

RESULTS

Of 1417 articles screened, 70 were relevant, comprising 52 investigating anti-BCG antibodies in TB and 18 investigating the anti-BCG antibody response to BCG-vaccination. Individuals with active TB have higher levels of anti-BCG antibodies compared with individuals with latent TB or healthy individuals. Antibodies to BCG are present after BCG vaccination. There is some evidence for the in utero transfer of maternal anti-BCG antibodies to infants.

CONCLUSIONS

BCG vaccination induces a humoral response. Antibodies targeted against BCG and its antigens may play a role in protection against active TB.

Glycolipids of Mycobacterium tuberculosis strain H37Rv are potential serological markers for diagnosis of active tuberculosis

A simple and cost-effective diagnostic tool (TB Screen Test) for the screening of patients with pulmonary and extrapulmonary tuberculosis and for differentiation of those individuals from individuals without tuberculosis, other common infections, and healthy controls has been developed. The serological responses of purified mycobacterial glycolipid antigens were examined by a liposome agglutination assay. The assay was able to detect very low antiglycolipid antibody concentrations in the infected individuals. The sera from the tuberculosis patient group had significantly higher concentrations of antiglycolipid antibody than the sera from uninfected control subjects, with 94% sensitivity and 98.3% specificity. Glycolipids of Mycobacterium tuberculosis H37Rv antigens were isolated, purified, and characterized. After interchelation with liposome particles, these purified antigens specifically bound to the antiglycolipid antibodies present in the sera of patients with tuberculosis, resulting in the formation of a blue agglutination. This protocol clearly differentiates healthy controls and M. bovis BCG-vaccinated subjects from those with active tuberculosis. The resultant diagnostic tool, the TB Screen Test, is more economical and rapid (4 min) than other currently available products and can be used for the mass screening of a heavily afflicted population.

Screening of synthetic trehalose 6,6'-diesters and trehalose 6-monoesters as potential immunoreactants for the serodiagnosis of tuberculosis

The absence of serological cross-reactivity between trehalose 2,3-diester (DAT, formerly SL-IV) and synthetic trehalose 6,6'-diesters and trehalose 6-monoesters was established by ELISA testing using polyclonal immune sera raised in rabbits sensitized with "DAT". From the screening of fifteen synthetic trehalose 6,6'- and 6-esters, "mirror" pseudo cord factor no. 1, "mirror" amides no. 5 and 6, cord factor analogues 7 and 8 and trehalose 6-monoesters 10 and 11 were selected for future, more extensive serological analysis. Paired comparisons of analogues among these fifteen substances showed that serodiagnostic discrimination power was more a function of the carbon chain length of their substituent groups--as well as of their position--than of the "mirror" constitution of the molecules. More exhaustive testing of these seven compounds is needed to select the synthetic product most efficient in the ELISA serodiagnosis of tuberculosis.

Evaluation of synthetic pseudo cord-factor-like glycolipids for the serodiagnosis of tuberculosis

A number of glycolipids were evaluated in an ELISA test for their serodiagnostic usefulness in tuberculosis. One hundred and twelve (112) sera belonging to bacteriologically confirmed TB patients, patients with pathologies other than tuberculosis and healthy individuals were examined against several synthetic "mirror" pseudo cord factors (analogues of trehalose-6,6'-dimycolate or TDM) using natural cord factor and another recently described natural glycolipid (SL-IV) of Mycobacterium tuberculosis as control antigens. Analysis of the results shows that all synthetic "mirror" pseudo cord factors, except one with a short 8-carbon chain, were better recognized by the sera of tuberculosis patients than natural cord factor, with sensitivity and specificity values in the ELISA test similar to those reported for M. tuberculosis species-specific SL-IV. Of all antigens tested in this study, BDA. TDA, a bis(N,N-dioctadecylamide) of "trehalose dicarboxylic acid", [(alpha-D-glucopyranosyluronic acid) (alpha-D-glucopyranosiduranic acid)], showed the highest serodiagnostic discriminating power (93% sensitivity and specificity). We postulate that either these artificial molecules are cross-reactants of similarly structured native glycolipids of M. tuberculosis or that they bear closer resemblance to actual phagosome-lysosome-modified antigens than to native mycobacterial ones.

Serodiagnosis of tuberculosis using an ELISA with antigen 5 and a hemagglutination assay with glycolipid antigens. Results in patients with newly diagnosed pulmonary tuberculosis ranging in extent of disease from minimal to extensive

Hemagglutination tests with three glycolipid antigens, A1, B1, and C, and ELISA with antigen 5 were done on serum from Chinese patients with pulmonary tuberculosis and from normal subjects in Hong Kong. Tests with all four antigens were of similar efficiency, giving positive results in 30 to 52% of 88 smear-positive patients, in 16 to 22% of 37 smear-negative, culture-positive patients, in 5 to 13% of 76 culture-negative patients with radiologically active disease, in 5 to 11% of 217 culture-negative patients with inactive disease, and in 1 to 4% of 140 normal subjects. If tests were combined so that an overall positive was scored when all tests were positive, there was worse discrimination between patients and normal subjects; however, as suggested by the poor correlation between the results with pairs of the tests, better discrimination was obtained if an overall positive was scored when any of the tests was positive. A positive result in any of the four tests was found in 22% of all cases, including 58% of smear-positive patients, 32% of smear-negative, culture-positive patients, and 0.7% of normal subjects.

Studies on the efficiency of absorbed bovine PPD in tuberculin and serological tests

The passive haemagglutination, enzyme-linked immunosorbent assay and indirect fluorescent antibody tests were applied to study the non-specific reactions in experimentally infected guinea pigs and tuberculin positive bovines. These cross-reactions were greatly decreased after absorption of either sera with avian PPD or bovine PPD antigen with anti-avian PPD serum. The use of both absorbed sera and antigen raised the specificity of PHA and ELISA to 100%. The use of absorbed sera rendered the IFA specific in 95%. The absorption has reduced the sensitivity of ELISA, IFA and PHA by 14, 27 and 29%, respectively.

Serology of tuberculosis. III. Crossed immunoelectrophoretic analysis of sera from tuberculosis and leprosy patients with antigens from BCG

Sera from tuberculous and leprous patients have been examined for antibody reactivities against components of BCG sonicate (BCGS) antigen. A crossed immunoelectrophoresis with intermediate gel reference system was used in which more than 40 components of BCGS could be identified. Forty (74.1%) out of 54 tuberculous sera and 68 (90.7%) out of 75 leprous sera reacted with at least 1 component of BCGS. While tuberculous sera reacted with 9 distinct components of BCGS, leprous sera reacted with at least 12. Components of BCGS precipitated by tuberculous sera were not specific as they were also precipitated by leprous sera. Overall, non-specific antibody responses were found to be dominant among tuberculous sera and by comparison, the reactivity of leprous sera with BCGS components was of a higher magnitude. Among tuberculous sera, precipitating activity was maximal among those taken from chronic treated cases with relapse followed by those obtained from treated and untreated new cases. Some components of BCGS to which both tuberculous and leprous sera showed strong reactivity have been characterized. It is concluded that immunoprecipitation methods with BCG derived antigens are not useful for the detection of a specific antibody response in tuberculosis or for discrimination between tuberculosis and leprosy.

The use of murine monoclonal antibodies without purification of antigen in the serodiagnosis of tuberculosis

A serum diagnostic test for tuberculosis has been devised on the basis of competitive inhibition by human sera of the binding of 125I-labelled murine monoclonal antibodies (Mabs) to a solid-phase bound pressate of M. tuberculosis. Five monoclonal antibodies binding to distinct antigenic determinants of the organism were used as structural probes which conferred their stringent combining site specificities to the polyclonal mixture of human antibodies. Sera from patients but not from healthy controls competed effectively with the binding of 125I-labelled Mabs to M. tuberculosis-coated polyvinyl plates. This inhibition technique eliminated the need for elaborate purification of antigen used in previous serological methods. Some Mabs gave considerably more positive results than others. The best combination of tests used 2 Mabs and yielded a positive result in 71% of 41 patients with smear-positive pulmonary tuberculosis. This approach is applicable in principle to the serodiagnosis of other human bacterial diseases.

Detection of immunoglobulin G antibody to purified protein derivative in patients with tuberculosis by radioimmunoassay and enzyme-linked immunosorbent assay

Sera from patients with active tuberculosis and sera from appropriate control individuals were assayed for immunoglobulin G antibody activity to purified protein derivative by a polystyrene tube radioimmunoassay and an enzyme-linked immunosorbent assay. Both assays showed a marked increase in immunoglobulin G antibody activity in patients with active tuberculosis. There was no overlap between the values for the patient group and the values for the purified protein derivative skin test-positive control individuals. The replication of these assays was excellent, and both could provide quantitative measurements of immunoglobulin G antibody activity to purified protein derivative antigen within 24 h. These techniques have potential as rapid diagnostic aids in evaluating patients with suspected active tuberculosis.

Comparison of enzyme-linked immunosorbent assay and hemagglutination test using mycobacterial glycolipids

Enzyme-linked immunosorbent assay and hemagglutination methods were compared using mycobacterial glycolipids as antigens. Both methods were found to have equivalent specificity and sensitivity in detecting mycobacterial diseases. Both tests had 96% specificity; the sensitivity of the enzyme-linked immunosorbent assay was 86%, and that of the hemagglutination test was 88.6%.

ELISA tests for antibodies against mycobacterial glycolipids

ELISA tests with purified mycobacterial glycolipids and bovine heart cardiolipin are described. The possible clinical use of ELISA tests with mycobacterial glycolipids for the diagnosis of tuberculosis and other mycobacterioses is discussed.

Granulomagenic activity of serologically active glycolipids from Mycobacterium bovis BCG

The granulomagenic properties of serologically active glycolipids A1, B2, B3, and C isolated from Mycobacterium bovis BCG were studied. Glycolipid A1, dissolved in olive and injected intradermally in guinea pigs, was able to elicit a granulomatous response that seemed to be of the nonallergic type. This granulomagenic activity was quite striking since only 2 mug was necessary to elicit the reaction. The B and C glycolipids were milder granulomagenic agents. Glycolipid A1, dissolved in olive oil and injected intraperitoneally, was toxic for mice. Mice lost weight after the injection of as little as 10 mug of A1, although not even a dose of 100 mug was lethal. Glycolipid A1 failed to immunize mice against aerogenic infection with virulent tubercle bacilli.