Developing biomarkers assays to accelerate tuberculosis drug development : defining target product profiles

Funding: This study is supported by the UNITE4TB consortium (www.unite4tb.org). UNITE4TB has received funding from the Innovative Medicines Initiative 2 Joint Undertaking (JU) under grant agreement No 101007873. The JU receives support from the European Union’s Horizon 2020 research and innovation programme and EFPIA, Deutsches Zentrum für Infektionsforschung e. V. (DZIF), and Ludwig-Maximilians-Universität München (LMU; Munich, Germany). EFPIA/AP contribute to 50% of funding, whereas the contribution of DZIF and the LMU Hospital Munich has been granted by the German Federal Ministry of Education and Research. CL is supported by DZIF under grant TTU-TB 02.709.Drug development for tuberculosis is hindered by the methodological limitations in the definitions of patient outcomes, particularly the slow organism growth and difficulty in obtaining suitable and representative samples throughout the treatment. We developed target product profiles for biomarker assays suitable for early-phase and late-phase clinical drug trials by consulting subject-matter experts on the desirable performance and operational characteristics of such assays for monitoring of tuberculosis treatment in drug trials. Minimal and optimal criteria were defined for scope, intended use, pricing, performance, and operational characteristics of the biomarkers. Early-stage trial assays should accurately quantify the number of viable bacilli, whereas late-stage trial assays should match the number, predict relapse-free cure, and replace culture conversion endpoints. The operational criteria reflect the infrastructure and resources available for drug trials. The effective tools should define the sterilising activity of the drug and lower the probability of treatment failure or relapse in people with tuberculosis. The target product profiles outlined in this Review should guide and de-risk the development of biomarker-based assays suitable for phase 2 and 3 clinical drug trials.Peer reviewe

Antibodies against complement-regulatory proteins on platelets in immune thrombocytopenia

In immune thrombocytopenia (ITP), antibodies reacting with platelet membrane glycoproteins (GP) mediate premature platelet cleavage, resulting in thrombocytopenia and therefore a risk of bleeding. These antibodies may induce complement activation, thus mediating complement-induced platelet destruction. In this study, we investigated the possibility of an additional complement-related pathogenic mechanism, where antibodies against the complement-regulatory factors CD55 and CD59 may directly interfere with normal complement function. CD55 downregulates both the classic and the alternative activation pathways, while CD59 blocks the formation of the membrane attack complex; both proteins are present on platelets and may therefore be targets of autoantibodies. Using the simultaneous analysis of specific platelet antibodies (SASPA) assay, we found that in some cases of immune-mediated thrombocytopenia, anti-CD55 and -CD59 antibodies are detectable in patients’ sera and/or on their autologous platelets in combination with antibodies against platelet-specific GP. Although antibodies against CD55 and CD59 seem to be a rare phenomenon, this finding may have clinical relevance due to the availability of highly effective therapeutics targeting the complement system

BCA-1/CXCL13 expression is associated with CXCR5-positive B-cell cluster formation in acute renal transplant rejection

BCA-1/CXCL13 expression is associated with CXCR5-positive B-cell cluster formation in acute renal transplant rejection.BackgroundRecent studies showed a crucial role for B cells in acute renal allograft rejection. It remains largely unknown, however, which mechanisms lead to the B-cell recruitment into the allograft. The chemokine CXCL13 and its corresponding receptor CXCR5 play a central role in B-cell trafficking to secondary lymphatic tissue and ectopic B-cell clusters in rheumatoid arthritis. We therefore investigated the potential role of CXCL13 and CXCR5 in formation of B-cell clusters in renal transplant rejection.MethodsSerial immunohistochemical staining for CXCL13, CXCR5, and CD20 was carried out in protocol biopsies of 23 patients obtained between day 4 and day 9 after renal transplantation. Intragraft mRNA expression of CXCL13 was assessed by real-time polymerase chain reaction (PCR) analysis.ResultsOf 23 kidney biopsies obtained between days 4 and 9 after renal transplantation, 13 revealed an acute rejection. Four of these patients showed a substantial infiltration of the transplant with cluster-forming B cells. By immunohistochemistry CXCL13 and the corresponding receptor CXCR5 were exclusively detected in areas of B-cell clusters. Intrarenal CXCL13 mRNA expression was 27-fold higher in transplants with B-cell clusters compared to rejecting allografts without B-cell accumulation (P = 0.011).ConclusionWe describe a striking colocalization of CXCL13 expression with CXCR5- and CD20-positive B cells in renal transplants undergoing rejection. This is the first study demonstrating a potential role of CXCL13 and its specific receptor CXCR5 in recruitment of B cells in renal allograft rejection