Abstract
BACKGROUNDTuberculosis (TB) kills more people than any other infection, and new diagnostic tests to identify active cases are required. We aimed to discover and verify novel markers for TB in nondepleted plasma.METHODSWe applied an optimized quantitative proteomics discovery methodology based on multidimensional and orthogonal liquid chromatographic separation combined with high-resolution mass spectrometry to study nondepleted plasma of 11 patients with active TB compared with 10 healthy controls. Prioritized candidates were verified in independent UK (n = 118) and South African cohorts (n = 203).RESULTSWe generated the most comprehensive TB plasma proteome to date, profiling 5022 proteins spanning 11 orders-of-magnitude concentration range with diverse biochemical and molecular properties. We analyzed the predominantly low–molecular weight subproteome, identifying 46 proteins with significantly increased and 90 with decreased abundance (peptide FDR ≤ 1%, q ≤ 0.05). Verification was performed for novel candidate biomarkers (CFHR5, ILF2) in 2 independent cohorts. Receiver operating characteristics analyses using a 5-protein panel (CFHR5, LRG1, CRP, LBP, and SAA1) exhibited discriminatory power in distinguishing TB from other respiratory diseases (AUC = 0.81).CONCLUSIONWe report the most comprehensive TB plasma proteome to date, identifying novel markers with verification in 2 independent cohorts, leading to a 5-protein biosignature with potential to improve TB diagnosis. With further development, these biomarkers have potential as a diagnostic triage test.FUNDINGColciencias, Medical Research Council, Innovate UK, NIHR, Academy of Medical Sciences, Program for Advanced Research Capacities for AIDS, Wellcome Centre for Infectious Diseases Research.
Highlights
The tuberculosis (TB) pandemic continues relentlessly, killing more humans than any other infectious disease, and progress in its containment is lagging behind other major diseases, such as HIV and malaria [1]
A fundamental issue with controlling the global pandemic is the inadequacy of current diagnostic tests for TB, which have multiple limitations, such as insufficient sensitivity, high cost, and reliance on laboratory infrastructure [2, 3]
Proteins have been proposed as viable diagnostic candidates given their phenotypic relevance and stability under specified conditions
Summary
The tuberculosis (TB) pandemic continues relentlessly, killing more humans than any other infectious disease, and progress in its containment is lagging behind other major diseases, such as HIV and malaria [1]. Extensive proteomic discovery research has been conducted in TB This has identified novel diagnostic markers for the active disease [10,11,12,13,14,15,16] and progression from latent disease [17], an optimal diagnostic panel has yet to be defined [18]. Other analytes, such as matrix degradation products, have been found by a hypothesis-driven approach [7, 19] but have not been identified by mass spectrometry–based strategies. We aimed to discover and verify novel markers for TB in nondepleted plasma
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