Vanessa da Silva Ribeiro

IgG avidity in differential serodiagnosis of human strongyloidiasis active infection

IgG avidity assays have been developed for several parasitic diseases although there are no researches focused in strongyloidiasis diagnosis. Definitive diagnosis of strongyloidiasis is based on the presence of Strongyloides larvae in stool, but majority of cases involve low and irregular larval output. While limitations of serological assays for strongyloidiasis are well known, characteristics of persons who are misdiagnosed based on negative coproparasitological tests have been little explored. The aim of the present study was to evaluate the use of IgG avidity to detect patients with active strongyloidiasis and to characterize sources of disagreement between serology and coproparasitology. A total of 80 serum samples was analyzed, 40 from patients with Strongyloides larvae in stool (G1) and 40 from individuals with negative coproparasitology, but positive serology (G2). Serum samples were analyzed in an indirect IgG avidity ELISA using urea 6M in serial double dilutions from 1:80 to 1:2560. Avidity index (AI) was calculated to each serum dilution and analyzed as screening AI (serum dilution of 1:160) or mean AI of different serum dilutions that had a positive result. Statistical analyzes were performed by Mann-Whitneys (U) and Fishers exact tests. At screening dilution, median of AI was 68% in G1 and 88% in G2 (P<0.0001), whereas median of mean AI in G1 was 72% and in G2 94% (P<0.0001), but there was no significant differences between both AI in each patient group. A cut off value established at AI of 75% demonstrated a significant difference between groups, with G1 sera showing AI<75% and G2 sera with AI>75% (P<0.0001). In conclusion, IgG avidity assays may distinguish active infection with Strongyloides stercoralis from suspect or serologically false positive cases.

Usefulness of concanavalin-A non-binding fraction of Strongyloides venezuelensis larvae to detect IgG and IgA in human strongyloidiasis.

Glycosylated components from Strongyloides have an important role in parasite establishment and host recognition of these substances. Considering the sugar-binding capacity of lectins, such as concanavalin-A (Con-A), IgG and IgA detection in serum samples from strongyloidiasis patients was tested using different antigenic preparations. The total saline extract (SE) of Strongyloides venezuelensis filariform larvae was fractionated in Con-A column to obtain Con-A unbound (Con-A UF) and Con-A bound (Con-A BF) fractions. Sensitivity (Se), specificity (Sp), area under the ROC curve (AUC), likelihood ratio (LR), and correlation coefficients were calculated. Con-A UF showed the highest diagnostic parameters for IgG detection (Se 95.0%, Sp 92.5%, AUC 0.99, LR 12.7) and high correlation (r = 0.700) with SE. Con-A fractions did not clearly demonstrate any usefulness for IgA detection. In conclusion, the results obtained demonstrate that Con-A UF is an important source of specific peptides efficient to detect IgG in strongyloidiasis immunodiagnosis.

Specific phage-displayed peptides discriminate different forms of neurocysticercosis by antibody detection in the serum samples

Neurocysticercosis (NC), caused by Taenia solium metacestode, infects the central nervous system and is a devastating parasitic infection. Diagnosis is based on symptoms, imaging, serology and epidemiology. Current markers present variable sensitivity and specificity, frequent cross‐reactions and are not able to discriminate NC clinical forms. The aim of this study was to select mimotopes of T. solium metacestode antigens that may be used in NC immunodiagnosis, specifically to discriminate between active and inactive forms. A random peptide phage display library was screened against IgY from chickens immunized with total saline extract from T. solium metacestodes and validated against 110 serum samples, classified into active NC (18), inactive NC (22), cross‐reactive parasitic diseases (40) and healthy controls (30). We have successfully selected seven peptides with significant immunoreactivity to IgG of NC patients, with sensitivity ranging from 95·5% to 100% to detect the inactive form and specificity varied from 85·7% to 94·3%. One phage‐displayed peptide (Cc48) can be directly used as biomarker to distinguish inactive from active forms with an accuracy of 95·7%, and this novel mimotope may also be used as an auxiliary tool to neuroimaging tests and treatment follow‐up.

Detergent fraction of heterologous antigen to detect IgA and IgG in strongyloidiasis using saliva and serum paired samples.

Strongyloides stercoralis causes chronic asymptomatic infections in immunocompetent human hosts and systemic invasion in immunocompromised patients, developing into a fatal hyperinfection syndrome. IgA and IgG detection in saliva and serum paired samples were tested using total saline extract from Strongyloides venezuelensis (SE(*)) and its detergent phase (D) extracted with Triton X-114. Saliva and serum paired samples were obtained from: 25 patients with confirmed strongyloidiasis; 25 patients with other parasitoses and 20 from apparently healthy individuals. Sensitivity, specificity, diagnostic efficiency, positive and negative predictive values and likelihood ratio were calculated at the optimum point of reaction. Using D phase sensitivity and specificity to detect IgA in saliva were 76.0% and 88.9% and in serum 80.0% and 86.7%, respectively. To detect IgG, D phase showed sensitivity and specificity of 88.0% and 88.9% in saliva and 88.0% and 84.4% in serum, respectively. D phase proved to be specific and efficient and could be utilized as an alternative antigen for IgA and IgG detection in saliva and serum samples for strongyloidiasis diagnosis.

Ion-exchange protocol to obtain antigenic fractions with potential for serodiagnosis of strongyloidiasis.

The aim of this study was to fractionate and partially characterize the antigenic extract of filariform larvae of Strongyloides venezuelensis in ion-exchange resin diethylaminoethyl sepharose (DEAE), to obtain antigenic fractions potentially applicable in immunoassays. Somatic antigen (SA) and its fractions DEAE S1 and DEAE S2 - which interacted with the resin - were evaluated by 1-dimensional electrophoresis to obtain protein profiles. SA and its fractions were tested in serum samples for IgG detection by ELISA. Serum samples (n = 155) were analysed: 50 from strongyloidiasis patients (G1), 55 from patients with other parasitic infections (G2) and 50 from healthy volunteers. Sensitivity (Se), specificity (Sp), area under curve (AUC) and likelihood ratios (LR) were calculated. The DEAE S2 fraction provided a high diagnostic value for IgG detection (Se 92·0%, Sp 91·4%, AUC 0·981, LR+ 10·75, LR - 0·09). In conclusion, the DEAE S2 fraction would probably be a source of immunodominant polypeptides for IgG detection in human strongyloidiasis serodiagnosis.

IgA detection in human neurocysticercosis using different preparations of heterologous antigen

Neurocysticercosis (NC) is the most important neurological disease of parasitic origin in humans. IgA and IgG detection in serum from neurocysticercosis patients was tested using some antigenic preparations of total saline extract from Taenia saginata: detergent (D) and aqueous (A) phases extracted with Triton X-114 and the jacalin bound (JBF) and unbound fractions (JUF) obtained by affinity chromatography using jacalin column. Samples were obtained from 45 patients with definitive NC, who were subdivided into active-NC group and inactive-NC group; 35 patients with other parasitoses; and 30 apparently healthy individuals. Sensitivity and specificity were calculated. Specificity to detect IgA and IgG for D phase, respectively, were 89.8% and 86.9% and for IgG detection 91.3% and 76.8% when using D phase and JUF, respectively. D phase and JBF proved to be specific and efficient and could be efficiently utilized as an alternative antigen for IgA detection in NC, with comparable results with IgG.

Specific IgG avidity in active and inactive human neurocysticercosis.

IgG avidity determination in serum samples was investigated to distinguish active and inactive human neurocysticercosis (NC). High avidity index (>70%) was found in 23.5% of cases in active group and 67.9% in inactive group (P = 0.0058). We reported for the first time that IgG avidity assay may distinguish active from inactive NC.

Jacalin-unbound fraction of Taenia saginata in immunodiagnosis of neurocysticercosis in human cerebrospinal fluid

The aim of this study was to evaluate jacalin-bound fraction (JBF) and jacalin-unbound fraction (JUF) of the total saline extract from Taenia saginata metacestodes for human neurocysticercosis (NC) immunodiagnosis in cerebrospinal fluid. Total extract, JBF, and JUF were separated by affinity chromatography using Sepharose(®)-jacalin and were tested in enzyme-linked immunosorbent assay (ELISA) and Western blotting (WB) to detect immunoglobulin G. In ELISA test, JUF showed the higher diagnostic efficiency and specificity indexes, 92% and 100%, respectively. In WB, 5 immunodominant proteins (39-42, 47-52, 64-68, 70, and 75 kDa) were detected when using JUF. In conclusion, the results achieved demonstrate that JUF, obtained from T. saginata metacestodes, are an important source of specific peptides and are efficient in the diagnosis of NC.

Taenia saginata metacestode antigenic fractions obtained by ion-exchange chromatography: Potential source of immunodominant markers applicable in the immunodiagnosis of human neurocysticercosis ☆ ☆☆

The aim of this study was to fractionate and partially characterize fractions obtained from the total saline extract (SE) of Taenia saginata metacestodes after ion-exchange procedure in carboxymethyl sepharose (CM) and diethylaminoethyl sepharose (DEAE) resins, as a source of antigenic markers applicable in the immunodiagnosis of neurocysticercosis (NCC). For IgG detection by enzyme-linked immunosorbent assay (ELISA) and immunoblotting, 140 serum samples were analyzed: 45 from patients with NCC (G1), 50 from patients with other parasitic infections (G2), and 45 from healthy individuals. Sensitivity (Se), specificity (Sp), area under curve (AUC), and likelihood ratios (LR) were calculated. CM S2 and DEAE S2 fractions provided high diagnostic values (Se 88.8% and 93.4%; Sp 93.7% and 92.6%; AUC 0.965 and 0.987; LR+ 14.07 and 12.67; LR- 0.11 and 0.07, respectively). In conclusion, CM S2 and DEAE S2 fractions are important sources of specific peptides, with high efficiency to diagnose NCC.

Usefulness of gel filtration fraction as potential biomarker for neurocysticercosis in serum: towards a new diagnostic tool.

There is an increasing interest in improving neurocysticercosis (NCC) diagnosis through the search of new and alternative antigenic sources, as those obtained from heterologous antigens. The aim of this study was to obtain potential biomarkers for NCC diagnosis after gel filtration chromatography [gel filtration fraction (GFF)] from the total saline extract (SE) from Taenia saginata metacestodes, followed by protein identification and application in immunodiagnostic. SE and GFF proteic profiles were characterized in gel electrophoresis, and diagnostic performance was verified by testing 160 serum samples through enzyme-linked immunosorbent assay and immunoblotting. Sensitivity (Se), specificity (Sp) and other diagnostic parameters were calculated. Polypeptides of interest in the diagnosis of human NCC present at GFF were analysed by mass spectrometry (MS) and B-cell epitopes were predicted. GFF had the best diagnostic parameters: Se 93·3%; Sp 93%; AUC 0·990; LR+ = 13·42 and LR- = 0·07, and proved to be useful reacting with serum samples in immunoblotting. Proteic profile ranged from 64 to 68 kDa and enolase and calcium binding protein calreticulin precursor were identified after MS. The enolase and calcium-binding protein calreticulin precursor showed 18 and 10 predicted B-cell epitopes, respectively. In conclusion we identified important markers in the GFF with high efficiency to diagnose NCC.