Research Article: Sensitive electrochemiluminescence (ECL) immunoassays for detecting lipoarabinomannan (LAM) and ESAT-6 in urine and serum from tuberculosis patients

Date Published: April 18, 2019

Publisher: Public Library of Science

Author(s): Tobias Broger, Michael Tsionksy, Anu Mathew, Todd L. Lowary, Abraham Pinter, Tatiana Plisova, Daniel Bartlett, Simone Barbero, Claudia M. Denkinger, Emmanuel Moreau, Kiyonori Katsuragi, Masanori Kawasaki, Payam Nahid, George B. Sigal, Katalin Andrea Wilkinson.


Tuberculosis (TB) infection was responsible for an estimated 1.3 million deaths in 2017. Better diagnostic tools are urgently needed. We sought to determine whether accurate TB antigen detection in blood or urine has the potential to meet the WHO target product profiles for detection of active TB.

We developed Electrochemiluminescence (ECL) immunoassays for Lipoarabinomannan (LAM) and ESAT-6 detection with detection limits in the pg/ml range and used them to compare the concentrations of the two antigens in the urine and serum of 81 HIV-negative and -positive individuals with presumptive TB enrolled across diverse geographic sites.

LAM and ESAT-6 overall sensitivities in urine were 93% and 65% respectively. LAM and ESAT-6 overall sensitivities in serum were 55% and 46% respectively. Overall specificity was ≥97% in all assays. Sensitivities were higher in HIV-positive compared to HIV-negative patients for both antigens and both sample types, with signals roughly 10-fold higher on average in urine than in serum. The two antigens showed similar concentration ranges within the same sample type and correlated.

LAM and ESAT-6 can be detected in the urine and serum of TB patients, regardless of the HIV status and further gains in clinical sensitivity may be achievable through assay and reagent optimization. Accuracy in urine was higher with current methods and has the potential to meet the WHO accuracy target if the findings can be transferred to a point-of-care TB test.

Partial Text

Tuberculosis (TB), an infection caused by Mycobacterium tuberculosis (Mtb), was responsible for an estimated 1.3 million deaths in 2017 [1]. As most cases of TB can be safely and effectively treated after early diagnosis, the high observed mortality rate is associated with poor efficiency in identifying affected individuals and delays in treatment initiation [2]. Traditional methods like smear microscopy and nucleic acid tests like Xpert MTB/RIF (Xpert) rely on sputum as the sample matrix, which leads to poorer test sensitivity in certain populations, like people living with HIV and children, who are more likely to have disease that is extra-pulmonary or paucibacillary in nature and less likely to be able to produce sputum [3,4]. Data show that 20–60% of HIV-positive patients presenting for TB diagnosis are unable to produce a sputum sample [5,6].

In this study, we have shown that LAM and ESAT-6 can be detected in both urine and serum samples of TB patients, using newly developed sensitive ECL immunoassays. The two antigens assayed showed similar concentration ranges within the same sample type. The concentrations were on average roughly 10-fold higher in urine than in serum, but correlated. The measured concentrations of LAM in urine for HIV- patients (from undetectable to about 1,000 pg/mL using the S4-20 capture antibody) were consistent with values reported for this population using a technique involving pre-concentration of LAM from urine using nanocages followed by quantitation by Western blot [24]. It is further known that the Alere LF-LAM threshold is in the range of 1,000 pg/ml which is also consistent with our results.