Detection of anti-leishmania (Leishmania) chagasi immunoglobulin G by flow cytometry for cure assessment following chemotherapeutic treatment of American visceral leishmaniasis

Clin Vaccine Immunol. 2007 May;14(5):569-76. doi: 10.1128/CVI.00354-06. Epub 2007 Mar 14.

Abstract

The residual serological reactivity observed in patients cured of visceral leishmaniasis (VL) represents the major factor underlying the low efficiency of most anti-Leishmania serological approaches to assess posttherapeutic cure in VL. Herein, we have described a detuned flow cytometry-based methodology to detect anti-live (FC-ALPA-immunoglobulin G [IgG]) and anti-fixed (FC-AFPA-IgG) L. chagasi promastigote IgG, along the titration curve (1:2,000 to 1:128,000), as a tool to assess late (12 months after treatment [12 mAT]) and early (2 and 6 mAT) posttherapeutic cure of pediatric American visceral leishmaniasis. Reactivities were reported as the percentage of positive fluorescent parasite (PPFP), using a PPFP of 50% as a cutoff to segregate positive and negative results. Our data demonstrated that both FC-ALPA-IgG at 1:4,000 and FC-ALPA-IgG at 1:32,000 are useful for late cure assessment in VL, with 100% specificity and outstanding likelihood ratio indices. Cure assessment at 6 mAT also showed promising performance indices, identifying 81% and 71.4% of the treated patients with negative results. However, new interpretation parameters were necessary to monitor cure at 2 mAT. We then introduced the differential PPFP (DeltaPPFP) of 25% as a new cutoff for early cure assessment at specific serum dilutions to analyze IgG reactivity by FC-ALPA-IgG and FC-AFPA-IgG. Our data demonstrated that at 2 mAT, DeltaPPFP was >25% in 60% and 57.1% of treated patients, whereas at 6 mAT, a DeltaPPFP of >25% was observed in 100% and 95.2% of samples assayed by FC-ALPA-IgG and FC-AFPA-IgG, respectively. Together, our findings showed the potential of both FC-ALPA-IgG and FC-AFPA-IgG regarding their applicability to detect differential serological reactivity and further contribution to posttherapeutic cure assessment in VL.

Publication types

  • Clinical Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Amphotericin B / therapeutic use
  • Animals
  • Antibodies, Protozoan / blood*
  • Antigens, Protozoan / immunology
  • Antiprotozoal Agents / therapeutic use
  • Child
  • Child, Preschool
  • Female
  • Flow Cytometry / methods
  • Follow-Up Studies
  • Humans
  • Immunoglobulin G / blood*
  • Infant
  • Leishmania / immunology*
  • Leishmaniasis, Visceral / blood*
  • Leishmaniasis, Visceral / diagnosis
  • Leishmaniasis, Visceral / drug therapy*
  • Male
  • Treatment Outcome

Substances

  • Antibodies, Protozoan
  • Antigens, Protozoan
  • Antiprotozoal Agents
  • Immunoglobulin G
  • Amphotericin B