The meta-analysis for ideal cytokines to distinguish the latent and active TB infection
Tóm tắt
One forth whole-world population is infected with Mycobacterium tuberculosis (Mtb), but 90% of them are asymptotic latent infection without any symptoms but positive result in IFN-γ release assay. There is lack of ideal strategy to distinguish active tuberculosis (TB) and latent tuberculosis infection (LTBI). Some scientist had focused on a set of cytokines as biomarkers besides interferon- gamma (IFN-γ) to distinguish active TB and LTBI, but with considerable variance of results. This meta-analysis aimed to evaluate the overall discriminative ability of potential immune molecules to distinguish active TB and LTBI. PubMed, the Cochrane Library, and Web of Science databases were searched to identify studies assessing diagnostic roles of cytokines for distinguishing active TB and LTBI published up to August 2018. The quality of enrolled studies was assessed using Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2). The pooled diagnostic sensitivity and specificity of each cytokine was calculated by using Meta-DiSc software. Area under the summary receiver operating characteristic curve (AUC) was used to summarize the overall diagnostic performance of each biomarker. Fourteen studies with 982 subjects met the inclusion criteria, including 526 active TB and 456 LTBI patients. Pooled sensitivity, specificity and AUC for discriminating between active TB and LTBI were analyzed for IL-2 (0.87, 0.61 and 0.9093), IP-10 (0.77, 0.73 and 0.8609), IL-5 (0.64, 0.75 and 0.8533), IL-13 (0.75, 0.71 and 0.8491), IFN-γ (0.67, 0.75 and 0.8031), IL-10 (0.68, 0.74 and 0.7957) and TNF-α (0.67, 0.64 and 0.7783). The heterogeneous subgroup analysis showed that cytokine detection assays, TB incidence, and stimulator with Mtb antigens are main influence factors for their diagnostic performance. The meta-analysis showed cytokine production could assist the distinction between active TB and LTBI, IL-2 with the highest overall accuracy. No single biomarker is likely to show sufficiently diagnostic performance due to limited sensitivity and specificity. Further prospective studies are needed to identify the optimal combination of biomarkers to enhanced diagnostic capacity in clinical practice.
Tài liệu tham khảo
Organization WH. Global tuberculosis report 2018. Geneva: World Health Organization; 2018.
Barry CE 3rd, Boshoff HI, Dartois V, Dick T, Ehrt S, Flynn J, Schnappinger D, Wilkinson RJ, Young D. The spectrum of latent tuberculosis: rethinking the biology and intervention strategies. Nat Rev Microbiol. 2009;7(12):845–55.
Milburn H. Key issues in the diagnosis and management of tuberculosis. J R Soc Med. 2007;100(3):134–41.
Agarwal SP. The revised National Tuberculosis Control Programme: the gains and the future road map. Natl Med J India. 2005;18(5):225–9.
O'Garra A, Redford PS, McNab FW, Bloom CI, Wilkinson RJ, Berry MP. The immune response in tuberculosis. Annu Rev Immunol. 2013;31:475–527.
Alsdurf H, Hill PC, Matteelli A, Getahun H, Menzies D. The cascade of care in diagnosis and treatment of latent tuberculosis infection: a systematic review and meta-analysis. Lancet Infect Dis. 2016;16(11):1269–78.
Latorre I, De Souza-Galvao M, Ruiz-Manzano J, Lacoma A, Prat C, Altet N, Ausina V, Dominguez J. Evaluating the non-tuberculous mycobacteria effect in the tuberculosis infection diagnosis. Eur Respir J. 2010;35(2):338–42.
Farhat M, Greenaway C, Pai M, Menzies D. False-positive tuberculin skin tests: what is the absolute effect of BCG and non-tuberculous mycobacteria? Int J Tuberc Lung Dis. 2006;10(11):1192–204.
Brock I, Weldingh K, Lillebaek T, Follmann F, Andersen P. Comparison of tuberculin skin test and new specific blood test in tuberculosis contacts. Am J Respir Crit Care Med. 2004;170(1):65–9.
Matulis G, Juni P, Villiger PM, Gadola SD. Detection of latent tuberculosis in immunosuppressed patients with autoimmune diseases: performance of a mycobacterium tuberculosis antigen-specific interferon gamma assay. Ann Rheum Dis. 2008;67(1):84–90.
Lange C, Pai M, Drobniewski F, Migliori GB. Interferon-gamma release assays for the diagnosis of active tuberculosis: sensible or silly? Eur Respir J. 2009;33(6):1250–3.
Okamoto M, Kawabe T, Iwasaki Y, Hara T, Hashimoto N, Imaizumi K, Hasegawa Y, Shimokata K. Evaluation of interferon-gamma, interferon-gamma-inducing cytokines, and interferon-gamma-inducible chemokines in tuberculous pleural effusions. J Lab Clin Med. 2005;145(2):88–93.
Supriya P, Chandrasekaran P, Das SD. Diagnostic utility of interferon-gamma-induced protein of 10 kDa (IP-10) in tuberculous pleurisy. Diagn Microbiol Infect Dis. 2008;62(2):186–92.
Pokkali S, Das SD, Logamurthy R. Expression of CXC and CC type of chemokines and its receptors in tuberculous and non-tuberculous effusions. Cytokine. 2008;41(3):307–14.
Lalvani A. Millington KA. T cells and tuberculosis: beyond interferon-gamma. J Infect Dis. 2008;197(7):941–3.
Won EJ, Choi JH, Cho YN, Jin HM, Kee HJ, Park YW, Kwon YS, Kee SJ. Biomarkers for discrimination between latent tuberculosis infection and active tuberculosis disease. J Inf Secur. 2016;74(3):281–93.
Wang S, Diao N, Lu C, Wu J, Gao Y, Chen J, Zhou Z, Huang H, Shao L, Jin J, et al. Evaluation of the diagnostic potential of IP-10 and IL-2 as biomarkers for the diagnosis of active and latent tuberculosis in a BCG-vaccinated population. PLoS One. 2012;7(12):e51338.
Chegou NN, Black GF, Kidd M, van Helden PD, Walzl G. Host markers in QuantiFERON supernatants differentiate active TB from latent TB infection: preliminary report. BMC Pulm Med. 2009;9:21.
Frahm M, Goswami ND, Owzar K, Hecker E, Mosher A, Cadogan E, Nahid P, Ferrari G, Stout JE. Discriminating between latent and active tuberculosis with multiple biomarker responses. Tuberculosis (Edinburgh, Scotland). 2011;91(3):250–6.
Walzl G, Haks MC, Joosten SA, Kleynhans L, Ronacher K, Ottenhoff TH. Clinical immunology and multiplex biomarkers of human tuberculosis. Cold Spring Harb Perspect Med. 2014;5(4):a018515.
Nemeth J, Winkler HM, Karlhofer F, Selenko-Gebauer N, Graninger W, Winkler S. T cells co-producing mycobacterium tuberculosis-specific type 1 cytokines for the diagnosis of latent tuberculosis. Eur Cytokine Netw. 2010;21(1):34–9.
Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M, Shekelle P, Stewart LA. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev. 2015;4:1.
Whiting P, Rutjes AW, Reitsma JB, Bossuyt PM, Kleijnen J. The development of QUADAS: a tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews. BMC Med Res Methodol. 2003;3:25.
Leeflang MM. Systematic reviews and meta-analyses of diagnostic test accuracy. Clin Microbiol Infect. 2014;20(2):105–13.
Jones CM, Athanasiou T. Summary receiver operating characteristic curve analysis techniques in the evaluation of diagnostic tests. Ann Thorac Surg. 2005;79(1):16–20.
Lijmer JG, Bossuyt PM, Heisterkamp SH. Exploring sources of heterogeneity in systematic reviews of diagnostic tests. Stat Med. 2002;21(11):1525–37.
Deeks JJ, Macaskill P, Irwig L. The performance of tests of publication bias and other sample size effects in systematic reviews of diagnostic test accuracy was assessed. J Clin Epidemiol. 2005;58(9):882–93.
Jeong YH, Hur YG, Lee H, Kim S, Cho JE, Chang J, Shin SJ, Lee H, Kang YA, Cho SN, et al. Discrimination between active and latent tuberculosis based on ratio of antigen-specific to mitogen-induced IP-10 production. J Clin Microbiol. 2014;53(2):504–10.
Kamakia R, Kiazyk S, Waruk J, Meyers A, Ochanda J, Ball TB, Oyugi J. Potential biomarkers associated with discrimination between latent and active pulmonary tuberculosis. Int J Tuberc Lung Dis. 2017;21(3):278–85.
Amanatidou V, Critselis E, Trochoutsou A, Soldatou A, Benetatou K, Spyridis N, Papadopoulos NG, Tsolia MN. Interferon gamma inducible protein-10 in the diagnosis of paediatric tuberculosis infection in a low TB incidence country. Int J Tuberc Lung Dis. 2015;19(12):1463–9.
Biselli R, Mariotti S, Sargentini V, Sauzullo I, Lastilla M, Mengoni F, Vanini V, Girardi E, Goletti D, D’Amelio R, et al. Detection of interleukin-2 in addition to interferon-gamma discriminates active tuberculosis patients, latently infected individuals, and controls. Clin Microbiol Infect. 2010;16(8):1282–4.
Chiappini E, Della Bella C, Bonsignori F, Sollai S, Amedei A, Galli L, Niccolai E, Del Prete G, Singh M, D’Elios MM, et al. Potential role of M. tuberculosis specific IFN-gamma and IL-2 ELISPOT assays in discriminating children with active or latent tuberculosis. PLoS One. 2012;7(9):e46041.
Movahedi B, Mokarram P, Hemmati M, Mosavari N, Zare R, Ardekani LS, Mostafavi-Pour Z. IFN-gamma and IL-2 responses to recombinant AlaDH against ESAT-6/CFP-10 fusion antigens in the diagnosis of latent versus active tuberculosis infection. Iran J Med Sci. 2017;42(3):275–83.
Della Bella C, Spinicci M, Grassi A, Bartalesi F, Benagiano M, Truthmann K, Tapinassi S, Troilo A, D’Elios S, Alnwaisri H, et al. Novel M. tuberculosis specific IL-2 ELISpot assay discriminates adult patients with active or latent tuberculosis. PLoS One. 2018;13(6):e0197825.
Petrone L, Vanini V, Chiacchio T, Petruccioli E, Cuzzi G, Schinina V, Palmieri F, Ippolito G, Goletti D. Evaluation of IP-10 in Quantiferon-Plus as biomarker for the diagnosis of latent tuberculosis infection. Tuberculosis (Edinburgh, Scotland). 2018;111:147–53.
Wergeland I, Pullar N, Assmus J, Ueland T, Tonby K, Feruglio S, Kvale D, Damas JK, Aukrust P, Mollnes TE, et al. IP-10 differentiates between active and latent tuberculosis irrespective of HIV status and declines during therapy. J Inf Secur. 2015;70(4):381–91.
Nonghanphithak D, Reechaipichitkul W, Namwat W, Naranbhai V, Faksri K. Chemokines additional to IFN-gamma can be used to differentiate among Mycobacterium tuberculosis infection possibilities and provide evidence of an early clearance phenotype. Tuberculosis (Edinburgh, Scotland). 2017;105:28–34.
Suzukawa M, Akashi S, Nagai H, Nagase H, Nakamura H, Matsui H, Hebisawa A, Ohta K. Combined analysis of IFN-gamma, IL-2, IL-5, IL-10, IL-1RA and MCP-1 in QFT supernatant is useful for distinguishing active tuberculosis from latent infection. PLoS One. 2016;11(4):e0152483.
Wu J, Wang S, Lu C, Shao L, Gao Y, Zhou Z, Huang H, Zhang Y, Zhang W. Multiple cytokine responses in discriminating between active tuberculosis and latent tuberculosis infection. Tuberculosis (Edinburgh, Scotland). 2016;102:68–75.
Kim S, Lee H, Kim H, Kim Y, Cho JE, Jin H, Kim DY, Ha SJ, Kang YA, Cho SN, et al. Diagnostic performance of a cytokine and IFN-gamma-induced chemokine mRNA assay after mycobacterium tuberculosis-specific antigen stimulation in whole blood from infected individuals. J Mol Diagn. 2015;17(1):90–9.
Flynn JL, Chan J. Immunology of tuberculosis. Annu Rev Immunol. 2001;19:93–129.
Kaufmann SH. How can immunology contribute to the control of tuberculosis? Nat Rev Immunol. 2001;1(1):20–30.
Chegou NN, Detjen AK, Thiart L, Walters E, Mandalakas AM, Hesseling AC, Walzl G. Utility of host markers detected in Quantiferon supernatants for the diagnosis of tuberculosis in children in a high-burden setting. PLoS One. 2013;8(5):e64226.
Suter-Riniker F, Berger A, Mayor D, Bittel P, Iseli P, Bodmer T. Clinical significance of interleukin-2/gamma interferon ratios in mycobacterium tuberculosis-specific T-cell signatures. Clin Vaccine Immunol. 2011;18(8):1395–6.
Gerosa F, Nisii C, Righetti S, Micciolo R, Marchesini M, Cazzadori A, Trinchieri G. CD4(+) T cell clones producing both interferon-gamma and interleukin-10 predominate in bronchoalveolar lavages of active pulmonary tuberculosis patients. Clin Immunol (Orlando, Fla). 1999;92(3):224–34.
Farber JM. Mig and IP-10: CXC chemokines that target lymphocytes. J Leukoc Biol. 1997;61(3):246–57.
Petrone L, Cannas A, Aloi F, Nsubuga M, Sserumkuma J, Nazziwa RA, Jugheli L, Lukindo T, Girardi E, Reither K, et al. Blood or urine IP-10 cannot discriminate between active tuberculosis and respiratory diseases different from tuberculosis in children. Biomed Res Int. 2015;2015:589471.
Tong X, Lu H, Yu M, Wang G, Han C, Cao Y. Diagnostic value of interferon-gamma-induced protein of 10kDa for tuberculous pleurisy: a meta-analysis. Clin Chim Acta. 2017;471:143–9.
Mihret A, Bekele Y, Bobosha K, Kidd M, Aseffa A, Howe R, Walzl G. Plasma cytokines and chemokines differentiate between active disease and non-active tuberculosis infection. J Inf Secur. 2013;66(4):357–65.
Agren D, Stehr M, Berthold CL, Kapoor S, Oehlmann W, Singh M, Schneider G. Three-dimensional structures of apo- and holo-L-alanine dehydrogenase from mycobacterium tuberculosis reveal conformational changes upon coenzyme binding. J Mol Biol. 2008;377(4):1161–73.