A novel indirect ELISA for serodiagnosis of mucormycosis using antigens from Rhizopus arrhizus.


Journal

Mycoses
ISSN: 1439-0507
Titre abrégé: Mycoses
Pays: Germany
ID NLM: 8805008

Informations de publication

Date de publication:
May 2024
Historique:
revised: 22 04 2024
received: 26 02 2024
accepted: 24 04 2024
medline: 7 5 2024
pubmed: 7 5 2024
entrez: 7 5 2024
Statut: ppublish

Résumé

Due to a delay in diagnosis by conventional techniques and high mortality, the development of a standardised and rapid non-culture-based technique is an unmet need in pulmonary, gastrointestinal, and disseminated forms of mucormycosis. Though limited studies have been conducted for molecular diagnosis, there are no established serologic tests for this highly fatal infection. To develop and evaluate an indirect in-house enzyme-linked immunosorbent assay (ELISA) utilising antigens of Rhizopus arrhizus for detecting anti-Rhizopus antibodies (IgG and IgM) in sera of patients with mucormycosis. We extracted both secretory and mycelial Rhizopus antigens using standardised protocols. Bradford assay was used for protein quantification. We then standardised an indirect ELISA using R. arrhizus mycelial and secretory antigens (10.0 μg/mL in bicarbonate buffer pH 9.2) for detecting anti-Rhizopus IgG and IgM antibodies in patient sera. We included patients with mucormycosis, other fungal infections, and healthy controls. Antibody index value (E-value) was calculated for each patient sample. Asparagine broth culture filtrate utilising 85% ammonium sulphate salt fractionation and mycelial homogenate grown in yeast extract peptone dextrose (YPD) broth precipitated with trichloroacetic acid (TCA) yielded a large amount of good-quality protein for the assay. We included 55 patients with mucormycosis (rhino-orbito-cerebral mucormycosis [ROCM, n = 39], pulmonary [n = 15], gastrointestinal [n = 1]), 24 with other fungal infections (probable aspergillosis [n = 14], candidiasis [n = 10]), and healthy controls (n = 16). The sensitivity of the antibody test for diagnosing mucormycosis ranged from 83.6-92.7% for IgG and 72.7-87.3% for IgM, with a specificity of 91.7-92.5% for IgG and 80-82.5% for IgM. The sera from patients with other fungal infections and healthy individuals did not show significant cross-reactivity. The detection of anti-Rhizopus IgG antibody performed significantly better in comparison to IgM-based ELISA for diagnosing both ROCM (sensitivity of 84.6% vs. 69.2%) and pulmonary cases (86.6% vs. 80.0%). More extensive studies are required to confirm our findings.

Sections du résumé

BACKGROUND BACKGROUND
Due to a delay in diagnosis by conventional techniques and high mortality, the development of a standardised and rapid non-culture-based technique is an unmet need in pulmonary, gastrointestinal, and disseminated forms of mucormycosis. Though limited studies have been conducted for molecular diagnosis, there are no established serologic tests for this highly fatal infection.
OBJECTIVE OBJECTIVE
To develop and evaluate an indirect in-house enzyme-linked immunosorbent assay (ELISA) utilising antigens of Rhizopus arrhizus for detecting anti-Rhizopus antibodies (IgG and IgM) in sera of patients with mucormycosis.
METHODS METHODS
We extracted both secretory and mycelial Rhizopus antigens using standardised protocols. Bradford assay was used for protein quantification. We then standardised an indirect ELISA using R. arrhizus mycelial and secretory antigens (10.0 μg/mL in bicarbonate buffer pH 9.2) for detecting anti-Rhizopus IgG and IgM antibodies in patient sera. We included patients with mucormycosis, other fungal infections, and healthy controls. Antibody index value (E-value) was calculated for each patient sample.
RESULTS RESULTS
Asparagine broth culture filtrate utilising 85% ammonium sulphate salt fractionation and mycelial homogenate grown in yeast extract peptone dextrose (YPD) broth precipitated with trichloroacetic acid (TCA) yielded a large amount of good-quality protein for the assay. We included 55 patients with mucormycosis (rhino-orbito-cerebral mucormycosis [ROCM, n = 39], pulmonary [n = 15], gastrointestinal [n = 1]), 24 with other fungal infections (probable aspergillosis [n = 14], candidiasis [n = 10]), and healthy controls (n = 16). The sensitivity of the antibody test for diagnosing mucormycosis ranged from 83.6-92.7% for IgG and 72.7-87.3% for IgM, with a specificity of 91.7-92.5% for IgG and 80-82.5% for IgM. The sera from patients with other fungal infections and healthy individuals did not show significant cross-reactivity.
CONCLUSION CONCLUSIONS
The detection of anti-Rhizopus IgG antibody performed significantly better in comparison to IgM-based ELISA for diagnosing both ROCM (sensitivity of 84.6% vs. 69.2%) and pulmonary cases (86.6% vs. 80.0%). More extensive studies are required to confirm our findings.

Identifiants

pubmed: 38712824
doi: 10.1111/myc.13730
doi:

Substances chimiques

Antigens, Fungal 0
Antibodies, Fungal 0
Immunoglobulin M 0
Immunoglobulin G 0

Types de publication

Journal Article Evaluation Study

Langues

eng

Sous-ensembles de citation

IM

Pagination

e13730

Subventions

Organisme : Indian Council of Medical Research

Informations de copyright

© 2024 Wiley‐VCH GmbH. Published by John Wiley & Sons Ltd.

Références

Chakrabarti A, Chatterjee SS, Das A, et al. Invasive zygomycosis in India: experience in a tertiary care hospital. Postgrad Med J. 2009;85(1009):573‐581.
Prakash H, Chakrabarti A. Global epidemiology of Mucormycosis. J Fungi (Basel, Switzerland). 2019;5(1):26.
Patel A, Kaur H, Xess I, et al. A multicentre observational study on the epidemiology, risk factors, management and outcomes of mucormycosis in India. Clin Microbiol Infect. 2020;26(7):944.e9‐944.e15.
Jeong W, Keighley C, Wolfe R, et al. The epidemiology and clinical manifestations of mucormycosis: a systematic review and meta‐analysis of case reports. Clin Microbiol Infect. 2019;25(1):26‐34.
Muthu V, Agarwal R, Dhooria S, et al. Has the mortality from pulmonary mucormycosis changed over time? A systematic review and meta‐analysis. Clin Microbiol Infect. 2021;27(4):538‐549.
Lackner N, Posch W, Lass‐Flörl C. Microbiological and molecular diagnosis of mucormycosis: from old to new. Microorg. 2021;9(7):1518.
Millon L, Caillot D, Berceanu A, et al. Evaluation of serum Mucorales polymerase chain reaction (PCR) for the diagnosis of Mucormycoses: the MODIMUCOR prospective trial. Clin Infect Dis. 2022;75(5):777‐785.
Rocchi S, Scherer E, Mengoli C, et al. Interlaboratory evaluation of Mucorales PCR assays for testing serum specimens: a study by the fungal PCR initiative and the Modimucor study group. Med Mycol. 2021;59(2):126‐138.
Lackner M, Caramalho R, Lass‐Flörl C. Laboratory diagnosis of mucormycosis: current status and future perspectives. Future Microbiol. 2014;9(5):683‐695. doi:10.2217/fmb.14.23
Skiada A, Lass‐Floerl C, Klimko N, Ibrahim A, Roilides E, Petrikkos G. Challenges in the diagnosis and treatment of mucormycosis. Med Mycol. 2018;56(suppl_1):S93‐S101.
Wheat LJ. Rapid diagnosis of invasive aspergillosis by antigen detection. Transpl Infect Dis. 2003;5(4):158‐166.
Lamoth F, Calandra T. Early diagnosis of invasive mould infections and disease. J Antimicrob Chemother. 2017;72(suppl_1):i19‐i28.
Kȩdzierska A. (1→3)‐β‐D‐glucan—a new marker for the early serodiagnosis of deep‐seated fungal infections in humans. Pol J Microbiol. 2007;56(1):3‐9.
Mercier T, Guldentops E, Lagrou K, Maertens J. Galactomannan, a surrogate marker for outcome in invasive Aspergillosis: finally coming of age. Front Microbiol. 2018;9:661.
Lehrnbecher T, Robinson PD, Fisher BT, et al. Galactomannan, β‐D‐Glucan, and polymerase chain reaction–based assays for the diagnosis of invasive fungal disease in pediatric cancer and hematopoietic stem cell transplantation: a systematic review and meta‐analysis. Clin Infect Dis. 2016;63(10):1340‐1348.
Leeflang MM, Debets‐Ossenkopp YJ, Wang J, et al. Galactomannan detection for invasive aspergillosis in immunocompromised patients. Cochrane Database Syst Rev. 2015;2015(9):CD007394.
White TJ, Bruns T, Lee S, Taylor J. Amplification and Direct Sequencing Of Fungal Ribosomal Rna Genes For Phylogenetics. PCR Protocols. Elsevier; 1990:315‐322.
Bhadauria V, Peng YL. Optimization of a protein extraction technique for fungal proteomics. Indian J Microbiol. 2010;50(Suppl 1):127‐131.
Duong‐Ly KC, Gabelli SB. Salting out of proteins using ammonium sulfate precipitation. Methods Enzymol. 2014;541:85‐94.
Ammonium Sulfate Calculator from EnCor Biotechnology Inc. Accessed April 17, 2023. https://www.encorbio.com/protocols/AM‐SO4.htm
Kielkopf CL, Bauer W, Urbatsch IL. Bradford assay for determining protein concentration. Cold Spring Harb Protoc. 2020;2020(4):102269.
Cornely OA, Alastruey‐Izquierdo A, Arenz D, et al. Global guideline for the diagnosis and management of mucormycosis: an initiative of the European Confederation of Medical Mycology in cooperation with the Mycoses Study Group Education and Research Consortium. Lancet Infect Dis. 2019;19(12):e405‐e421.
Peter Donnelly J, Chen SC, Kauffman CA, et al. Revision and update of the consensus definitions of invasive fungal disease from the European Organization for Research and Treatment of cancer and the Mycoses Study Group Education and Research Consortium. Clin Infect Dis. 2020;71(6):1367‐1376.
Muthu V, Agarwal R, Patel A, et al. Definition, diagnosis, and management of COVID‐19‐associated pulmonary mucormycosis: Delphi consensus statement from the Fungal Infection Study Forum and Academy of Pulmonary Sciences, India. Lancet Infect Dis. 2022;22(9):e240‐e253.
Muthu V, Rudramurthy SM, Chakrabarti A, Agarwal R. Epidemiology and pathophysiology of COVID‐19‐associated Mucormycosis: India versus the rest of the world. Mycopathologia. 2021;186(6):739‐754.
Patel A, Agarwal R, Rudramurthy SM, et al. Multicenter epidemiologic study of coronavirus disease‐associated Mucormycosis, India. Emerg Infect Dis. 2021;27(9):2349‐2359.
Wysong DR, Waldorf AR. Electrophoretic and immunoblot analyses of Rhizopus arrhizus antigens. J Clin Microbiol. 1987;25(2):358‐363.
Jones KW, Kaufman L. Development and evaluation of an immunodiffusion test for diagnosis of systemic Zygomycosis (Mucormycosis): preliminary report. J Clin Microbiol. 1978;7(1):97‐101.
Kaufman L, Turner LF, McLaughlin DW. Indirect enzyme‐linked immunosorbent assay for zygomycosis. J Clin Microbiol. 1989;27(9):1979‐1982.
Kaufman L, Mendoza L, Standard PG. Immunodiffusion test for serodiagnosing subcutaneous zygomycosis. J Clin Microbiol. 1990;28(9):1887‐1890.
Krishnaswamy A, Barnes N, Lotlikar NP, Damare SR. An improved method for protein extraction from minuscule quantities of fungal biomass. Indian J Microbiol. 2019;59(1):100‐104.
Falahati M, Ghanbari S, Ebrahimi M, et al. Fractionation and identification of the allergic proteins in Aspergillus species. Curr Med Mycol. 2016;2(4):37‐45.
Li Z, Luo R, Zhang Y, Yana X, Pang Q. Effective protein extraction from mycelium and fruiting body of Auricularia auricula for proteomics studies. Int J Food Prop. 2018;21(1):2156‐2166.
Sato K, Oinuma KII, Niki M, et al. Identification of a novel Rhizopus‐specific antigen by screening with a signal sequence trap and evaluation as a possible diagnostic marker of mucormycosis. Med Mycol. 2017;55(7):713‐719.
Shibata W, Niki M, Sato K, et al. Detection of Rhizopus‐specific antigen in human and murine serum and bronchoalveolar lavage. Med Mycol. 2020;58(7):958‐964.
Davies GE, Thornton CR. Development of a monoclonal antibody and a Serodiagnostic lateral‐flow device specific to Rhizopus arrhizus (Syn. R. oryzae), the principal global agent of mucormycosis in humans. J Fungi. 2022;8(7):756.
Thornton CR, Davies GE, Dougherty L, Thornton CR. Development of a monoclonal antibody and a lateral‐flow device for the rapid detection of a Mucorales‐specific biomarker. J Fungi (Basel). 2023;8(7):1‐14.
de Heer K, Gerritsen MG, Visser CE, Leeflang MM. Galactomannan detection in broncho‐alveolar lavage fluid for invasive aspergillosis in immunocompromised patients. Cochrane Database Syst Rev. 2019;5(5):CD012399.
Sehgal IS, Choudhary H, Dhooria S, et al. Diagnostic cut‐off of Aspergillus fumigatus‐specific IgG in the diagnosis of chronic pulmonary aspergillosis. Mycoses. 2018;61(10):770‐776.
Sehgal IS, Dhooria S, Choudhary H, et al. Utility of serum and bronchoalveolar lavage fluid galactomannan in diagnosis of chronic pulmonary aspergillosis. J Clin Microbiol. 2019;57(3):e01821‐18.
Agarwal R, Singh Sehgal I, Muthu V, et al. Revised clinical practice guidelines for diagnosing, classifying, and treating allergic bronchopulmonary aspergillosis/mycoses: a Delphi statement from the ISHAM‐ABPA working group. Eur Respir J. 2024;63(4):2400061.
Weig M, Frosch M, Tintelnot K, et al. Use of recombinant mitogillin for improved serodiagnosis of Aspergillus fumigatus‐associated diseases. J Clin Microbiol. 2001;39(5):1721‐1730.
Kappe R, Rimek D. Antikörper‐Nachweis bei invasiver aspergillose. Mycoses. 2004;47(Suppl 1):55‐59.
Richardson M, Page I. Role of serological tests in the diagnosis of mold infections. Curr Fungal Infect Rep. 2018;12(3):127‐136.
Lass‐Flörl C, Samardzic E, Knoll M. Serology anno 2021—fungal infections: from invasive to chronic. Clin Microbiol Infect. 2021;27(9):1230‐1241.
White PL. Developments in fungal serology. Curr Fungal Infect Rep. 2023;17(2):132‐143.
Gebremariam T, Alkhazraji S, Soliman SSM, et al. Anti‐CotH3 antibodies protect mice from mucormycosis by prevention of invasion and augmenting opsonophagocytosis. Sci Adv. 2019;5(6):1‐15.

Auteurs

Hansraj Choudhary (H)

Indian Council of Medical Research (ICMR), New Delhi, India.

Harsimran Kaur (H)

Department of Medical Microbiology, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India.

Shreya Singh (S)

Department of Medical Microbiology, Dr. B. R. Ambedkar Institute of Medical Sciences, Mohali, Punjab, India.

Rachna Singh (R)

Department of Microbial Biotechnology, Panjab University, Chandigarh, India.

Valliappan Muthu (V)

Department of Pulmonary Medicine, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India.

Roshan Verma (R)

Department of Otolaryngology (ENT), Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India.

Shivaprakash M Rudramurthy (SM)

Department of Medical Microbiology, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India.

Ritesh Agarwal (R)

Department of Pulmonary Medicine, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India.

Sanjay Jain (S)

Department of Internal Medicine, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India.

Amanjit Bal (A)

Department of Histopathology, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India.

Anup K Ghosh (AK)

Department of Medical Microbiology, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India.

Arunaloke Chakrabarti (A)

Doodhdhari Burfani Hospital, Bhupatwala, Haridwar, Uttarakhand, India.

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