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Review
. 2022 Mar 9;31(163):210218.
doi: 10.1183/16000617.0218-2021. Print 2022 Mar 31.

The role of antibodies in tuberculosis diagnosis, prophylaxis and therapy: a review from the ESGMYC study group

Solomon Tibebu Melkie  1   2 , Lilibeth Arias  1   3 , Chiara Farroni  4 , Mateja Jankovic Makek  5   6 , Delia Goletti  4   6 , Cristina Vilaplana  7   3   6
Affiliations
Review

The role of antibodies in tuberculosis diagnosis, prophylaxis and therapy: a review from the ESGMYC study group

Solomon Tibebu Melkie et al. Eur Respir Rev. .

Abstract

Tuberculosis (TB) is still responsible for the deaths of >1 million people yearly worldwide, and therefore its correct diagnosis is one of the key components of any TB eradication programme. However, current TB diagnostic tests have many limitations, and improved diagnostic accuracy is urgently needed. To improve the diagnostic performance of traditional serology, a combination of different Mycobacterium tuberculosis (MTB) antigens and different antibody isotypes has been suggested, with some showing promising performance for the diagnosis of active TB. Given the incomplete protection conferred by bacille Calmette-Guérin (BCG) vaccination against adult pulmonary TB, efforts to discover novel TB vaccines are ongoing. Efficacy studies from advanced TB vaccines designed to stimulate cell-mediated immunity failed to show protection, suggesting that they may not be sufficient and warranting the need for other types of immunity. The role of antibodies as tools for TB therapy, TB diagnosis and TB vaccine design is discussed. Finally, we propose that the inclusion of antibody-based TB vaccines in current clinical trials may be advisable to improve protection.

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Conflict of interest statement

Conflict of interest: S.T. Melkie reports support for the present manuscript: co-funded by the EACEA (Education, Audiovisual and Culture Executive Agency, award 2015–2323) of the European Commission, receives a scholarship from the EACEA. Registered in the EMJMD LIVE (Erasmus+ Mundus Joint Master Degree Leading International Vaccinology Education). Conflict of interest: L. Arias has nothing to disclose. Conflict of interest: C. Farroni has nothing to disclose. Conflict of interest: M. Jankovic Makek reports receiving consulting fees from Insmed incorporated and Biomerieux outside the submitted work. Conflict of interest: D. Goletti has nothing to disclose. Conflict of interest: C. Vilaplana reports support for the present manuscript received from CIBER Enfermedades Respiratorias (CB06/06/0031), payment made to the institution. Grants or contracts received from Spanish Government-FEDER Funds through CPII18/00031, outside the submitted work. Other non-financial interests reported as follows: C. Vilaplana's lab hosts secondments from the EMJMD LIVE MsC students (Erasmus+ Mundus Joint Master Degree Leading International Vaccinology Education), co-funded by the EACEA (Education, Audiovisual and Culture Executive Agency, award 2015–2323).

Figures

FIGURE 1
FIGURE 1
Potential mechanisms of action of antibodies in tuberculosis: a) antibodies enhance phagocytosis of Mycobacterium tuberculosis (MTB) by neutrophils and macrophage via FcR binding; b) antibodies also enhance the fusion of phagosome and lysosome; c) antibodies activate CD4+ T-cells; d) antibodies enhance killing of infected macrophages by activating natural killer (NK) cells; e) antibodies facilitate direct neutralisation of the bacilli; f) antibodies block the binding of MTB to epithelial cells and prevent extrapulmonary dissemination of the bacteria. ADCP: antibody-dependent cellular phagocytosis; CMI: cell-mediated immunity; ADCC: antibody-dependant cellular cytotoxicity; Ag: antigen; Ab: antibody; TCR: T-cell receptor; MHC: major histocompatibility complex.
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