Tuberculosis (TB), caused by the bacterium Mycobacterium tuberculosis, remains one of the world’s deadliest and most widespread infectious diseases. Early detection is critical to stop its spread. Sputum-based tests—which detect Mtb itself or Mtb DNA—are the gold standard for early, accurate TB detection; but sputum (mucus from the lungs) must be cough up and can be difficult to collect—especially from children and people with HIV. The only commercially available test is a urine test that detects a molecule known as lipoarabinomannan (LAM), which is released by Mtb and can be found in body fluids; but the test works poorly in most patients, limiting its usefulness.

Jacqueline Achkar, M.D., M.S., has received a five-year, $4 million National Institutes of Health grant to develop new, simple, and highly sensitive tests to detect Mtb without the need for sputum. Her team has developed human monoclonal antibodies that can detect LAM at very low levels. They will test those antibodies in urine and in “exhaled breath concentrate”—a fluid containing LAM concentrations up to 1,000 times higher than in urine.

By studying samples from patients with TB in the U.S., South Africa, and the Democratic Republic of the Congo, the team hopes to find antibody combinations that can detect Mtb LAM much better than current urine tests and investigate LAM in exhaled breath condensate. The goal is a highly sensitive, affordable, and easy-to-use test that works for both HIV-positive and HIV-negative patients. Such a tool could improve TB control efforts worldwide by enabling early diagnosis and treatment.

Dr. Achkar is professor of medicine, and of microbiology & immunology, director of global health research at the Global Health Center, associate director for translational research at the Clinical Research Training Program at Einstein, and an attending physician at Montefiore Medical Center. (1R01AI185330-01A1)