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Use of Whole-Blood Samples in In-House Bulk and Single-Cell Antigen-Specific Gamma Interferon Assays for Surveillance of Mycobacterium tuberculosis Infections

Raffaella Palazzo,^1, Fabiana Spensieri,^1, Marco Massari,² Giorgio Fedele,¹ Loredana Frasca,¹ Stefania Carrara,³ Delia Goletti,³ and Clara M. Ausiello^1*

Department of Infectious, Parasitic and Immune-Mediated Diseases,¹ Centre of Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome 00161, Italy,² Second Division of Health Department, Translational Research Unit, National Institute for Infectious Diseases Lazzaro Spallanzani, Rome, Italy³

Received 21 August 2007/ Returned for modification 14 September 2007/ Accepted 11 November 2007

Tests based on the gamma interferon (IFN-) assay (IGA) are used as adjunctive tools for the diagnosis of Mycobacterium tuberculosis infection. Here we compared in-house and commercial whole-blood IGAs to identify a suitable assay for the surveillance of tuberculosis in population studies. The IGAs were selected on the basis of the ease with which they are performed and because they require a small amount of a biological sample and do not require cell purification. Since a "gold standard" for latently M. tuberculosis-infected individuals is not available, the sensitivities and the specificities of the IGAs were determined with samples from patients with clinically diagnosed active tuberculosis and in Mycobacterium bovis BCG-unvaccinated healthy controls. The in-house tests consisted of a bulk assay based on diluted whole blood and a single-cell assay based on IFN- intracellular staining. The commercial assays used were the QuantiFERON-TB-Gold (Q-TB) and the Q-TB in-tube tests. When the purified protein derivative was used as the antigen, in-house whole-blood intracellular staining was found to be highly discriminatory between active tuberculosis patients and BCG-vaccinated healthy controls, whereas the other IGAs did not discriminate between the two categories of patients. When M. tuberculosis-specific antigens were used, a very strong agreement between the results of the Q-TB in-tube assay and the clinical diagnosis was observed, while the Q-TB assay, performed according to the manufacturer's instructions, showed a significantly lower performance. Intriguingly, when the test was performed with RD1 proteins instead of peptides, its sensitivity was significantly increased. The in-house assay with diluted whole blood showed an elevated sensitivity and an elevated specificity, and the results agreed with the clinical diagnosis. Considering that the in-house assay uses 1/20 of the sample compared with the amount of sample used in the commercial IGA, it appears to be particularly promising for use in pediatric studies. Overall, the different assays showed different performance characteristics that need to be considered for surveillance of tuberculosis in population studies.

Published ahead of print on 21 November 2007.

R.P. and F.S. contributed equally to this study.