ESAT-6蛋白在结核病诊断和潜伏感染中的研究进展

结核分枝杆菌（Mycobacterium tuberculosis,MTB）感染所引起的结核病,是威胁人类健康的重要传染性疾病之一。近年来,由于器官移植、艾滋病的流行、全球移民速度的增加等原因,结核病的疫情呈明显的上升趋势。全球每年因结核病死亡的人数约有300万,目前我国属全球22个结核病高负担国家之一,结核病人数在世界排名第二,仅次于印度,约有5．5亿人感染过MTB,约450万人患有结核病,其中200万人是开放性结核病,每年因结核病死亡的人数约有13万。     

应用PPD或特异性抗原ESAT-6和CFP-10诊断结核病的全血IFN-γ试验

目的:为了评价QuantiFERON-TB试验在已接种BCG疫苗、未接种BCG疫苗及结核病患者人群中的作用,并且应用结核分支杆菌特异性抗原ESAT-6和CFP-10的全血试验,比较它的诊断性能。 设计:用PPD,ESAT-6或CFP-10刺激已接种BCG疫苗、未接种BCG疫苗及结核病患者的全血,分析其IFN-τ应答水平,评价该试验的敏感性及特异性。 结果:没有一个未接种BCG疫苗者对M.tb-PPD,ESAT-6或CFP-10产生阳性应答。在已接种BCG疫苗的19人中,有9人(9/19,47％)对M.tb-PPD产生应答,而只有2人(2/19,10.5％)对ESAT-6或CFP-10产生应答。在QuantiFERON-TB试验中,利用不同抗原,所得到的敏感性水平相似,其中对M.tb-PPD的敏感性为79％,对ESAT-6或CFP-10的敏感性为72％。 结论:结果表明,利用M.tb-PPD的全血试验不能有效的区分BCG疫苗接种者和结核病患者。M.tb特异性的新的重组抗原ESAT-6或CFP-10.能够提高全血试验的特异性,并且能够区分TB感染,非典型分支杆菌反应性及BCG疫苗接种。这个试验,将为控制和消灭结核病提供一个优于目前所采用的结核菌素皮肤试验的量化的方法。     

结核分枝杆菌毒力因子ESAT-6和CFP-10的研究进展

ESAT-6和CFP-10是结核分枝杆菌中含量丰富的毒力因子,分别由RD1区相邻的基因esxA和esxB编码,二者可以协同转录形成紧密二聚体。此二聚体在破坏宿主的免疫应答、发挥毒性、参与吞噬溶酶体到宿主细胞质的易位、激活嗜中性粒细胞发挥趋化作用等生物学作用中扮演着重要角色。ESAT-6和CFP-10有良好的免疫原性,可应用于结核病的诊断和疫苗研究。进一步探索它们的分子结构和致病机制可为结核病的预防、诊断和治疗提供新思路。     

结核分枝杆菌CFP10-ESAT6融合蛋白的克隆表达及效价测定

目的 在大肠杆菌中表达结核分枝杆菌RD1区CFP10-ESAT6融合蛋白,测定融合蛋白对结核分枝杆菌致敏豚鼠的效价.方法 以结核分枝杆菌标准株H37Rv为模板,采用Overlap PCR方法扩增CFP10-ESAT6融合基因,并克隆入pET-30a质粒,IPTG诱导工程菌表达融合蛋白,离子层析柱分离纯化融合蛋白.以结核分枝杆菌致敏豚鼠进行皮肤变态反应(DTH)测定. 结果 结核分枝杆菌融合蛋白在大肠杆菌中以可溶形式表达,融合蛋白占总菌体蛋白的30%以上,经离子层析柱纯化纯度达95%以上.重组蛋白可诱导结核分枝杆菌致敏豚鼠产生迟发型超敏反应,2.5 μg/ml 重组蛋白诱导豚鼠皮试反应与TB-PPD(50 IU/ml) 等效.结论 重组融合蛋白有望成为结核感染皮试诊断用新试剂.     

CFP10/ESAT6融合蛋白-ELISPOT方法的建立及其在结核分枝杆菌感染诊断中的应用价值

目的建立应用酶联免疫斑点试验(Enzyme Linked-Immunospot Assay,ELISPOT)检测结核分枝杆菌感染的方法 ,评价CFP10/ESAT6融合蛋白抗原在检测结核分枝杆菌感染中的应用价值。方法通过比较不同的实验条件确定ELIS-POT检测结核分枝杆菌感染方法的最佳细胞浓度、孵育时间、蛋白抗原浓度等,建立ELISPOT方法。以PPD皮肤试验作对照。结果 ELISPOT方法的最佳实验条件为:每孔细胞浓度2×105,CFP10/ESAT6融合蛋白抗原浓度20~40μg/mL,细胞孵育时间20h。应用PPD皮试检测30例健康体检者、38例非结核疾病患者和40例结核病患者的阳性率分别为40.0%、0%、72.5%,而ELISPOT检测的阳性率分别为20.0%、10.5%、92.5%。应用ELISPOT检测40例结核病痰菌阳性组和阴性组的灵敏度分别为94.4%、90.9%。结论应用CFP10/ESAT6融合蛋白作为抗原建立的ELISPOT方法可初步应用于诊断结核分枝杆菌感染、辅助结核病诊断。     

牛分枝杆菌特异性四联融合蛋白在牛结核病诊断中的临床应用

目的以原核表达的MPB70-MPB83-CFP10-ESAT-6融合蛋白作为诊断抗原,建立牛结核病抗体检测间接ELISA(iELISA)。方法用iELISA检测90份健康牛血清,确定样本阴阳性临界值(S/P)为0.17。iELISA与商品化胶体金试剂条(ICG)平行检测150份临床奶牛血清样本;以结核菌素皮内试验(TST)为参考方法,检测了华中地区四个奶牛场的560头中国黑白花奶牛和90份进口奶牛结核阴性血清;对其中22头奶牛进行鼻拭子分菌检验,4头分菌阳性奶牛的血清抗体检测也为阳性。结果iELISA与ICG的符合率为93.33%(140/150),与TST的总符合率为87.32%(489/560),与细菌培养的总符合率为77.27%(17/22)。以TST为参考方法,iELISA的敏感性和特异性分别为72.37%和89.67%。结论该方法具有较高的灵敏度与特异性,与其它方法有较高的符合率。     

结核分枝杆菌CFP10-ESAT6融合蛋白的克隆表达及效价测定

目的在大肠杆菌中表达结核分枝杆菌RD1区CFP10-ESAT6融合蛋白,测定融合蛋白对结核分枝杆菌致敏豚鼠的效价。方法以结核分枝杆菌标准株H₃₇R_v为模板,采用Overlap PCR方法扩增CFP10-ESAT6融合基因,并克隆入pET-30a质粒,IPTG诱导工程菌表达融合蛋白,离子层析柱分离纯化融合蛋白。以结核分枝杆菌致敏豚鼠进行皮肤变态反应(DTH)测定。结果结核分枝杆菌融合蛋白在大肠杆菌中以可溶形式表达,融合蛋白占总菌体蛋白的30%以上,经离子层析柱纯化纯度达95%以上。重组蛋白可诱导结核分枝杆菌致敏豚鼠产生迟发型超敏反应,2.5μg/ml重组蛋白诱导豚鼠皮试反应与TB-PPD(50 IU/ml)等效。结论重组融合蛋白有望成为结核感染皮试诊断用新试剂。     

结核分枝杆菌lhp-esat6融合基因穿梭表达载体的构建及在BCG中的表达

目的　构建能表达结核分枝杆菌早期分泌蛋白CFP10 -ESAT6融合蛋白的重组卡介苗 (recombinantBCG ,rBCG)。方法　以 pQE30 -CFP10 -ESAT6质粒为模板 ,通过PCR扩增 6 33bplhp -esat6基因 ,将该基因定向克隆到穿梭表达载体pJCH0 2中构建重组 pJCH0 2 -CFP10 -ESAT6质粒。用电穿孔法将重组质粒导入BCG菌构建rBCG ,将rBCG培养 2 3天 ,于收菌前 3天每天 4 5℃热诱导 4 5min ,对表达产物作SDS -PAGE及免疫印迹分析。结果　重组质粒 pJCH0 2 -CFP10 -ESAT6经酶切及测序证实构建成功 ,并在BCG中经热诱导成功表达出了具有CFP10及ESAT6抗原性的CFP10 -ESAT6融合蛋白。结论　成功构建能表达CFP10 -ESAT6融合蛋白的重组BCG ,为发展新型结核病疫苗奠定了基础。     

结核分枝杆菌ESAT-6蛋白的表达与纯化

目的构建结核分枝杆菌esat-6基因原核表达载体,使其在大肠杆菌中表达融合重组蛋白,并纯化。方法用PCR方法从结核分枝杆菌H37Rv基因组中扩增出esat-6基因片段,克隆至pMD18-T载体,PCR筛选阳性克隆并测序;用限制性内切酶消化后,目的片段亚克隆至表达载体pGEX-4T-2,构建pGEX-esat-6重组质粒,将其转化入大肠杆菌JM109;PCR和双酶切鉴定转化菌落;将阳性菌株经IPTG诱导,SDS-PAGE和免疫印迹分析靶蛋白的表达;用谷胱甘肽-琼脂糖亲合层析法纯化融合蛋白。结果PCR扩增出esat-6 288bp的基因,克隆到pMD18-T载体中,经测序与GenBank中序列一致;随后亚克隆到表达载体pGEX-4T-2构建重组表达质粒,在JM109中表达了ESAT-6融合蛋白,表达的蛋白能被GST免疫血清识别;通过亲和层析纯化获得的蛋白能被结核病人血清识别。结论成功构建esat-6重组表达质粒,该质粒在JM109中表达ESAT-6融合蛋白,并获得较纯的蛋白。     

结核分枝杆菌CFP10-ESAT6融合蛋白在大肠杆菌中的高效表达

目的　在大肠杆菌中高效融合表达结核分枝杆菌分泌蛋白ESAT 6和CFP 10 ,获得纯化的重组ESAT6 CFP10 (rCFP10 ESAT6 )融合蛋白抗原。方法 通过聚合酶链反应 (polymerasechainreaction ,PCR)扩增CFP10 ESAT6融合基因 ;以质粒pET 2 8a为表达载体 ,构建重组质粒 ,转化大肠杆菌BL2 1(DE3) ;以异丙基硫代半乳糖苷 (IPTG)诱导表达目的蛋白 ,通过SDS PAGE电泳和蛋白免疫印迹法 (Westernblotting)鉴定rCFP10 ESAT6在大肠杆菌中的表达 ,确定rCFP10 ESAT6蛋白抗原在大肠杆菌中的表达形式 ;采用ChelatingSepharoseFastFlow蛋白纯化试剂纯化重组蛋白。West ernblotting及酶联免疫吸附试验 (ELISA)分析重组蛋白的免疫原性。结果 重组质粒pET2 8a CFP10 ESAT6中目的基因测序结果与报道序列相同 ;在大肠杆菌中以可溶性形式表达 ;分子量约2 8kDa ,表达量约占菌体总蛋白的 4 6 % ,纯化后的rCFP10 ESAT6样品经SDS PAGE和激光密度扫描分析表明其纯度为 90 %左右 ,每 10 0ml培养菌可获得 16mg左右的重组蛋白 ;Western印迹结果证实重组蛋白与His·tag单克隆抗体及确诊的肺结核病患者血清发生特异免疫反应。ELISA结果分析表明 ,该重组抗原能区分肺结核患者血清及正常人血清。结论 成功地表达和纯化了结核分枝杆菌CFP10-ESAT6融合蛋白。该重组蛋白具有特异的免疫原性。     

Characteristic profile of antibody responses to PPD,ESAT-6, and CFP-10 of Mycobacterium tuberculosis in pulmonary tuberculosis suspected cases in Surabaya,Indonesia

Accurate and rapid diagnostic tools are important aspects of managing tuberculosis (TB) cases appropriately. However, the sensitivity and specificity of diagnostic kits based on immune response such as the tuberculin skin test (TST) and interferon gamma release assay (IGRA) are still debated. Thus, the exploration and assessment of specific biomarker-targeted antibodies are needed for the development of an accurate and rapid diagnostic tool. The present study was conducted in patients with a respiratory problem suspected to be TB at Dr. Soetomo Hospital, Surabaya, Indonesia. Among 102 patients tested by GeneXpert and AFB, 59 serum samples were from cases retrospectively determined to have active TB. A total of 102 serum of healthy controls (HC) was also collected. The PPD antigen and the recombinant CFP-10 and ESAT-6 proteins were prepared. Antibody responses against these proteins were evaluated by ELISA. All samples were also screened for the possibility of Mycobacterium avium-intracellulare complex (MAC) infection using Capilla MaC kit. The results showed that TB patients had a significantly higher concentration of IgG antibody in response to PPD than the HC. In addition, the receiver operating characteristic (ROC) curve analysis showed that PPD was acceptable for diagnostic purposes with an AUC value of 0.835 (95% CI 0.770-0.900, p < 0.0001). However, ESAT-6 and CFP-10 had low AUCs, and 32 samples from both groups showed a low concentration of IgA antibody against all antigens. The MAC detection results also showed that the concentration of IgA in the HC group was the highest. The current results indicate that PPD is a better antigen for antibody-based detection of TB than ESAT-6 and CFP-10. Based on the MAC detection assay, 53 people in the HC group were probably infected with rapidly growing nontuberculous mycobacteria (NTM), although antibody response to PPD was low.     

Performance of whole blood IFN-gamma test for tuberculosis diagnosis based on PPD or the specific antigens ESAT-6 and CFP-10.

OBJECTIVE: To evaluate the QuantiFERON-TB test in BCG-vaccinated, non-BCG-vaccinated and tuberculosis (TB) patient donor groups, and to compare its diagnostic performance with that of a blood test based on the Mycobacterium tuberculosis specific antigens ESAT-6 and CFP-10. DESIGN: Analysis of the IFN-gamma responses of whole blood cells from BCG-vaccinated or non-BCG-vaccinated donors or patients with tuberculosis, stimulated with PPD, ESAT-6 or CFP-10 antigens, and evaluation of the specificity and sensitivity of the test. RESULTS: None of the non-vaccinated donors showed positive responses to M. tuberculosis-PPD, ESAT-6 or CFP-10. In BCG-vaccinated donors, 9/19 (47%) donors responded to the QuantiFERON-TB test based on M. tuberculosis-PPD, whereas 2/19 (10.5%) responded to either ESAT-6 or CFP-10. Comparable levels of sensitivity were obtained with the QuantiFERON-TB test based on M. tuberculosis-PPD (79%) and ESAT-6 or CFP-10 antigens (72%). CONCLUSION: Our results demonstrate that the whole blood test based on M. tuberculosis-PPD did not efficiently distinguish BCG-vaccinated donors from individuals with disease due to M. tuberculosis. The introduction of new recombinant antigens specific for M. tuberculosis, such as ESAT-6 or CFP-10, should increase the specificity of the whole blood test and enable discrimination between TB infection, atypical mycobacterial reactivity and reactivity due to BCG vaccination. Such a test would provide a quantum improvement over the current practice of using the tuberculin skin test for TB control and elimination.     

结核分枝杆菌早期分泌抗原靶6家族其他蛋白抗原的研究进展

目前结核分枝杆菌的致病机制和宿主的防御机制尚不十分清楚,结核分枝杆菌蛋白抗原生物学特性的研究有助于该问题的阐明,将为结核病疫苗、免疫诊断试剂和新药的开发奠定基础.早期分泌抗原靶6（ESAT-6）家族蛋白是一类小分子蛋白,呈螺旋状结构,它们通过ESAT-6分泌系统（ESAT-6 secretion system,ESX）分泌到细胞外.该家族共有23个成员（EsxA～W）,其在基因组上相邻排列的2个蛋白编码基因形成11个类操纵子结构的基因对.该家族蛋白参与宿主与致病菌之间的相互作用,是人免疫系统识别的优势抗原,大多数是T细胞优势抗原,在结核分枝杆菌致病机制和机体的免疫保护机制方面起关键作用.鉴于EsxA和EsxB的研究概况国内外报道较多,而其他ESAT-6家族成员研究报道较少.因此,笔者着重概要地介绍ESAT-6家族其他成员的国内外研究进展情况,为进一步的深入研究和应用奠定基础.     

结核分枝杆菌分泌蛋白ESAT-6-CFP10的融合表达及纯化

目的在原核表达系统融合表达结核分枝杆菌早期分泌性抗原靶ESAT-6和培养滤液蛋白CFP10的融合蛋白(rE6C)并纯化,测定抗原性和特异性。方法用将一个柔性的氨基酸“接头”插入原核表达载体pET32c(﹢)中,构建pET32c(﹢)-linker。PCR法扩增ESAT-6、CFP10基因。将ESAT-6克隆入改建的载体pET32c(﹢)的linker前,CFP10克隆入linker后,构建E6C融合基因,转化大肠杆菌XL1-blue,抽提质粒,酶切鉴定;在大肠杆菌BL21中表达,纯化rE6C蛋白,通过酶联免疫吸附测定(ELISA)法检测其抗原性和特异性。结果重组质粒pET32c(﹢)-ESAT-6-CFP10靶基因的测序结果与预计序列完全一致。携带重组质粒的菌株经诱导产生高水平的表达产物,纯化的表达产物具备较高的纯度、抗原性和特异性。结论pET32c(﹢)-ESAT-6-CFP10质粒在BL21菌中能高效表达,rE6C融合蛋白具有良好的抗原性和特异性,有望用于结核分枝杆菌感染的临床诊断。     

ESAT-6 and CFP-10 in clinical versus environmental isolates of Mycobacterium kansasii

Mycobacterium kansasii consists of 5 genetically distinct groups, of which 2 are associated with human disease. Determinants of the differences in virulence are unknown. Potential genes of interest are esat-6 and cfp-10, which are associated with virulence of Mycobacterium tuberculosis and Mycobacterium bovis but are lacking in bacille Calmette-Guérin and in most environmental mycobacteria (M. kansasii is an exception). We investigated esat-6 and cfp-10 genes in 22 clinical and 14 environmental isolates of M. kansasii. Both were present in all isolates; each genetic group had its own characteristic Southern-blot pattern corresponding to a highly conserved fingerprint pattern. Nucleotide sequences of the genes differed 12.6% and 10.1%, respectively, from the M. tuberculosis homologues, but the deduced amino acid sequences were <5% different. In vitro, clinical and environmental genotypes of M. kansasii expressed CFP-10 and ESAT-6. Thus, virulence of M. kansasii is not directly related to esat-6 and cfp-10 genes or gene expression.     

Factors associated with differential T cell responses to antigens ESAT-6 and CFP-10 in pulmonary tuberculosis patients

The T-SPOT.TB assay detects cellular immune responses to 2 core Mycobacterium tuberculosis antigens, early secreted antigenic target of 6-kDa protein (ESAT-6) and culture filtrate protein-10 (CFP-10). T-SPOT.TB has been recently used for auxiliary diagnosis of active pulmonary tuberculosis (PTB). However, testing can produce inconsistent results due to differential PTB patient immune responses to these antigens, prompting us to identify factors underlying inconsistent results.Data were retrospectively analyzed from 1225 confirmed PTB patients who underwent T-SPOT.TB testing at 5 specialized tuberculosis hospitals in China between December 2012 and November 2015. Numbers of spot-forming cells (SFCs) reflecting T cell responses to ESAT-6 and CFP-10 antigens were recorded then analyzed via multivariable logistic regression to reveal factors underlying discordant T cell responses to these antigens.The agreement rate of 84.98% (82.85%–86.94%) between PTB patient ESAT-6 and CFP-10 responses demonstrated high concordance. Additionally, positivity rates were higher for ESAT-6 than for CFP-10 (84.8% vs 80.7%, P < .001), with ESAT-6 and CFP-10 microwell SFC numbers for each single positive group not differing significantly (P > .99), while spot numbers of the single positive group were lower than numbers for the double positive group (P < .001). Elderly patients (aged ≥66 years) and patients receiving retreatment were most likely to have discordance results.ESAT-6 promoted significantly more positive T-SPOT.TB results than did CFP-10 in PTB patients. Advanced age and retreatment status were correlated with discordant ESAT-6 and CFP-10 results. Assessment of factors underlying discordance may lead to improved PTB diagnosis using T-SPOT.TB.