Mass Spectrometric Identification of Urinary Biomarkers of Pulmonary Tuberculosis
Flonza Isa,
Sean Collins,
Myung Hee Lee,
Diessy Decome,
Nancy Dorvil,
Patrice Joseph,
Lauren Smith,
Stephen Salerno,
Martin T. Wells,
Steven Fischer,
James M. Bean,
Jean W. Pape,
Warren D. Johnson,
Daniel W. Fitzgerald,
Kyu Y. Rhee
Affiliations
Flonza Isa
Department of Medicine, Weill Cornell Medicine, New York, NY, United States; Center for Global Health, Weill Cornell Medicine, New York, NY, United States
Sean Collins
Department of Medicine, Stanford Medicine, Stanford, CA, United States
Myung Hee Lee
Center for Global Health, Weill Cornell Medicine, New York, NY, United States
Diessy Decome
Groupe Haitien d'Etude du Sarcome de Kaposi et des Infections Opportunistes (GHESKIO), Port au Prince, Haiti
Nancy Dorvil
Groupe Haitien d'Etude du Sarcome de Kaposi et des Infections Opportunistes (GHESKIO), Port au Prince, Haiti
Patrice Joseph
Groupe Haitien d'Etude du Sarcome de Kaposi et des Infections Opportunistes (GHESKIO), Port au Prince, Haiti
Lauren Smith
Mayo Clinic, Rochester, MN, United States
Stephen Salerno
Department of Statistical Science, Cornell University, Ithaca, NY, United States
Martin T. Wells
Department of Statistical Science, Cornell University, Ithaca, NY, United States
Steven Fischer
Agilent Technologies, Santa Clara, CA, United States
James M. Bean
Memorial Sloan Kettering Cancer Center, New York, NY, United States
Jean W. Pape
Center for Global Health, Weill Cornell Medicine, New York, NY, United States; Groupe Haitien d'Etude du Sarcome de Kaposi et des Infections Opportunistes (GHESKIO), Port au Prince, Haiti
Warren D. Johnson
Department of Medicine, Weill Cornell Medicine, New York, NY, United States; Center for Global Health, Weill Cornell Medicine, New York, NY, United States; Groupe Haitien d'Etude du Sarcome de Kaposi et des Infections Opportunistes (GHESKIO), Port au Prince, Haiti
Daniel W. Fitzgerald
Department of Medicine, Weill Cornell Medicine, New York, NY, United States; Center for Global Health, Weill Cornell Medicine, New York, NY, United States; Groupe Haitien d'Etude du Sarcome de Kaposi et des Infections Opportunistes (GHESKIO), Port au Prince, Haiti; Corresponding authors at: Department of Medicine, Weill Cornell Medicine, New York, NY, United States.
Kyu Y. Rhee
Department of Medicine, Weill Cornell Medicine, New York, NY, United States; Center for Global Health, Weill Cornell Medicine, New York, NY, United States; Corresponding authors at: Department of Medicine, Weill Cornell Medicine, New York, NY, United States.
Background: Tuberculosis (TB) is the leading infectious cause of death worldwide. A major barrier to control of the pandemic is a lack of clinical biomarkers with the ability to distinguish active TB from healthy and sick controls and potential for development into point-of-care diagnostics. Methods: We conducted a prospective case control study to identify candidate urine-based diagnostic biomarkers of active pulmonary TB (discovery cohort) and obtained a separate blinded “validation” cohort of confirmed cases of active pulmonary TB and controls with non-tuberculous pulmonary disease for validation. Clean-catch urine samples were collected and analyzed using high performance liquid chromatography-coupled time-of-flight mass spectrometry. Results: We discovered ten molecules from the discovery cohort with receiver-operator characteristic (ROC) area-under-the-curve (AUC) values >85%. These 10 molecules also significantly decreased after 60 days of treatment in a subset of 20 participants followed over time. Of these, a specific combination of diacetylspermine, neopterin, sialic acid, and N-acetylhexosamine exhibited ROC AUCs >80% in a blinded validation cohort of participants with active TB and non-tuberculous pulmonary disease. Conclusion: Urinary levels of diacetylspermine, neopterin, sialic acid, and N-acetylhexosamine distinguished patients with tuberculosis from healthy controls and patients with non-tuberculous pulmonary diseases, providing a potential noninvasive biosignature of active TB. Funding: This study was funded by Weill Cornell Medicine, the National Institute of Allergy and Infectious Diseases, the Clinical and Translational Science Center at Weill Cornell, the NIH Fogarty International Center grants, and the NIH Tuberculosis Research Unit (Tri-I TBRU). Keywords: Tuberculosis, Biomarker, Metabolomics, Urine