8 research outputs found

    RISK6, a 6-gene transcriptomic signature of TB disease risk, diagnosis and treatment response

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    Improved tuberculosis diagnostics and tools for monitoring treatment response are urgently needed. We developed a robust and simple, PCR-based host-blood transcriptomic signature, RISK6, for multiple applications: identifying individuals at risk of incident disease, as a screening test for subclinical or clinical tuberculosis, and for monitoring tuberculosis treatment. RISK6 utility was validated by blind prediction using quantitative real-time (qRT) PCR in seven independent cohorts. Prognostic performance significantly exceeded that of previous signatures discovered in the same cohort. Performance for diagnosing subclinical and clinical disease in HIV-uninfected and HIV-infected persons, assessed by area under the receiver-operating characteristic curve, exceeded 85%. As a screening test for tuberculosis, the sensitivity at 90% specificity met or approached the benchmarks set out in World Health Organization target product profiles for non-sputum-based tests. RISK6 scores correlated with lung immunopathology activity, measured by positron emission tomography, and tracked treatment response, demonstrating utility as treatment response biomarker, while predicting treatment failure prior to treatment initiation. Performance of the test in capillary blood samples collected by finger-prick was noninferior to venous blood collected in PAXgene tubes. These results support incorporation of RISK6 into rapid, capillary blood-based point-of-care PCR devices for prospective assessment in field studies

    Resource managers' and users’ perspectives on factors contributing to unauthorised hunting in western Tanzania

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    Unauthorized use of natural resources is one of the challenges facing protected areas in Africa. Understanding factors influencing this behavior can help improve the efficiency of conservation efforts. We conducted focus group discussions with authorized resource users and managers in the Ugalla ecosystem of western Tanzania to determine factors facilitating and motivating unauthorized hunting. The two groups of study participants had different perspectives on the subject. Resource managers dwelt on factors facilitating hunting, for example, inadequate patrol resources and impassable patrol roads. On the other hand, resource users discussed both motivating factors, for example, limited income-generating opportunities; and facilitating factors, some of which were also mentioned by resource managers (eg, poorly managed hunting cases). There was also variability in how study participants perceived the importance of different factors. Some factors were perceived as highly important but mentioned less frequently and others were mentioned often but ranked low. Some were mentioned by both resource managers and users with the same frequency but ranked differently (eg, the management of unauthorized hunting cases). Overall, we suggest considering the views of people with different interests in natural resources to comprehensively understand the factors that influence unauthorized hunting for improved conservation outcomes. Some were mentioned by both resource managers and users with the same frequency but ranked differently (eg, the management of unauthorized hunting cases). Overall, we suggest considering the views of people with different interests in natural resources to comprehensively understand the factors that influence unauthorized hunting for improved conservation outcomes. Some were mentioned by both resource managers and users with the same frequency but ranked differently (eg, the management of unauthorized hunting cases). Overall, we suggest considering the views of people with different interests in natural resources to comprehensively understand the factors that influence unauthorized hunting for improved conservation outcomes

    A Serum Circulating miRNA Signature for Short-Term Risk of Progression to Active Tuberculosis Among Household Contacts

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    Biomarkers that predict who among recently Mycobacterium tuberculosis (MTB)-exposed individuals will progress to active tuberculosis are urgently needed. Intracellular microRNAs (miRNAs) regulate the host response to MTB and circulating miRNAs (c-miRNAs) have been developed as biomarkers for other diseases. We performed machine-learning analysis of c-miRNA measurements in the serum of adult household contacts (HHCs) of TB index cases from South Africa and Uganda and developed a c-miRNA-based signature of risk for progression to active TB. This c-miRNA-based signature significantly discriminated HHCs within 6 months of progression to active disease from HHCs that remained healthy in an independent test set [ROC area under the ROC curve (AUC) 0.74, progressors < 6 Mo to active TB and ROC AUC 0.66, up to 24 Mo to active TB], and complements the predictions of a previous cellular mRNA-based signature of TB risk

    Immunometabolic Signatures Predict Risk of Progression to Active Tuberculosis and Disease Outcome

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    Immunogenetics and cellular immunology of bacterial infectious disease

    Four-gene pan-African blood signature predicts progression to tuberculosis

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    Rationale: Contacts of patients with tuberculosis (TB) constitute an important target population for preventive measures because they are at high risk of infection with Mycobacterium tuberculosis and progression to disease. Objectives: We investigated biosignatures with predictive ability for incident TB. Methods: In a case–control study nested within the Grand Challenges 6-74 longitudinal HIV-negative African cohort of exposed household contacts, we employed RNA sequencing, PCR, and the pair ratio algorithm in a training/test set approach. Overall, 79 progressors who developed TB between 3 and 24 months after diagnosis of index case and 328 matched nonprogressors who remained healthy during 24 months of follow-up were investigated. Measurements and Main Results: A four-transcript signature derived from samples in a South African and Gambian training set predicted progression up to two years before onset of disease in blinded test set samples from South Africa, the Gambia, and Ethiopia with little population-associated variability, and it was also validated in an external cohort of South African adolescents with latent M. tuberculosis infection. By contrast, published diagnostic or prognostic TB signatures were predicted in samples from some but not all three countries, indicating site-specific variability. Post hoc meta-analysis identified a single gene pair, C1QC/TRAV27 (complement C1q C-chain / T-cell receptor-α variable gene 27) that would consistently predict TB progression in household contacts from multiple African sites but not in infected adolescents without known recent exposure events. Conclusions: Collectively, we developed a simple whole blood–based PCR test to predict TB in recently exposed household contacts from diverse African populations. This test has potential for implementation in national TB contact investigation programs
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