Detection of Immunoglobulin G1 Against rK39 Improves Monitoring of Treatment Outcomes in Visceral Leishmaniasis

Abstract

Background: Visceral leishmaniasis (VL), caused by the Leishmania donovani complex, is a fatal, neglected tropical disease that is targeted for elimination in India, Nepal, and Bangladesh. Improved diagnostic tests are required for early case detection and for monitoring the outcomes of treatments. Previous investigations using Leishmania lysate antigen demonstrated that the immunoglobulin (Ig) G1 response is a potential indicator of a patient's clinical status after chemotherapy.

Methods: IgG1 or IgG enzyme-linked immunosorbent assays (ELISAs) with rK39 or lysate antigens and novel IgG1 rK39 rapid diagnostic tests (RDTs) were assessed with Indian VL serum samples from the following clinical groups: paired pre- and postchemotherapy (deemed cured); relapsed; other infectious diseases; and endemic, healthy controls.

Results: With paired pre- and post-treatment samples (n = 37 pairs), ELISAs with rK39- and IgG1-specific conjugates gave a far more discriminative decrease in post-treatment antibody responses when compared to IgG (P < .0001). Novel IgG1 rK39 RDTs provided strong evidence for decreased IgG1 responses in patients who had successful treatment (P < .0001). Furthermore, both IgG1 rK39 RDTs (n = 38) and ELISAs showed a highly significant difference in test outcomes between cured patients and those who relapsed (n = 23; P < .0001). RDTs were more sensitive than corresponding ELISAs.

Conclusions: We present strong evidence for the use of IgG1 in monitoring treatment outcomes in VL, and the first use of an IgG1-based RDT using the rK39 antigen for the discrimination of post-treatment cure versus relapse in VL. Such an RDT may have a significant role in monitoring patients and in targeted control and elimination of this devastating disease.

Keywords: IgG1; cure; rapid diagnostic test; relapse; visceral leishmaniasis.

Figure 1.

Decrease in IgG1 levels of cured patients was more evident and consistent than the decline in total IgG, by enzyme-linked immunosorbent assay (ELISA). The ELISA results for the rK39 antigen with cured visceral leishmaniasis paired samples (n = 37 pairs) and relapse samples (n = 20). Abbreviation: IgG, immunoglobulin G. *Indicates very strong evidence for a difference (paired t-test P < .0001). Strong evidence was also seen between IgG1 and IgG in 6-month cured samples (P < .0001, not depicted).

Figure 2.

Example of enzyme-linked immunosorbent assay plate quadrants. Cured paired serum samples at day 0 (pre-treatment) and at 6 months after treatment (patients deemed cured). Abbreviations: EHC, endemic, healthy control; IgG, immunoglobulin G; R, patient deemed relapsed.