Clinical Efficacy of Serum Antiglycopeptidolipid Core IgA Antibody Test for Screening Nontuberculous Mycobacterial Pulmonary Disease in Bronchiectasis: A European Multicenter Cohort Study

Hayoung Choi; Chloe Hughes; Zsofia Eke; Morven Shuttleworth; Michal Shteinberg; Eva Polverino; Pieter C Goeminne; Tobias Welte; Francesco Blasi; Amelia Shoemark; Merete B Long; Stefano Aliberti; Charles S Haworth; Felix C Ringshausen; Michael R Loebinger; Natalie Lorent; James D Chalmers

doi:10.1016/j.chest.2024.10.029

Clinical Efficacy of Serum Antiglycopeptidolipid Core IgA Antibody Test for Screening Nontuberculous Mycobacterial Pulmonary Disease in Bronchiectasis: A European Multicenter Cohort Study

Chest. 2024 Oct 28:S0012-3692(24)05418-7. doi: 10.1016/j.chest.2024.10.029. Online ahead of print.

Authors

Hayoung Choi¹, Chloe Hughes², Zsofia Eke², Morven Shuttleworth², Michal Shteinberg³, Eva Polverino⁴, Pieter C Goeminne⁵, Tobias Welte⁶, Francesco Blasi⁷, Amelia Shoemark², Merete B Long², Stefano Aliberti⁸, Charles S Haworth⁹, Felix C Ringshausen¹⁰, Michael R Loebinger¹¹, Natalie Lorent¹², James D Chalmers¹³

Affiliations

¹ Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea.
² Division of Molecular and Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, Scotland.
³ Pulmonology Institute and CF Center, Carmel Medical Center and the Technion - Israel Institute of Technology, B. Rappaport Faculty of Medicine, Haifa, Israel.
⁴ Hospital Clinic of Barcelona, University of Barcelona, CIBERES, IDIBAPS, Barcelona, Spain.
⁵ Department of Respiratory Disease, AZ Nikolaas, Sint-Niklaas, Belgium.
⁶ Department of Respiratory Medicine and Infectious Diseases, Hannover Medical School, Frankfurt, Germany.
⁷ Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Italy; Respiratory Unit and Cystic Fibrosis Center, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico Milano, Italy.
⁸ Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; Respiratory Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.
⁹ Cambridge Centre for Lung Infection, Royal Papworth Hospital and University of Cambridge, Cambridge.
¹⁰ Department of Respiratory Medicine and Infectious Diseases, Hannover Medical School, Frankfurt, Germany; Biomedical Research in End-Stage and Obstructive Lung Disease Hannover, German Center for Lung Research, Hannover, Germany; European Reference Network on Rare and Complex Respiratory Diseases, Frankfurt, Germany.
¹¹ Host Defence Unit, Department of Respiratory Medicine, Royal Brompton Hospital and Harefield NHS Foundation Trust, Imperial College London, London, England; National Heart and Lung Institute, Imperial College London, London, England.
¹² Department of Respiratory Diseases, University Hospitals Leuven, Belgium; Department of Chronic Diseases, Metabolism and Aging, BREATHE Laboratory, KU Leuven, Leuven, Belgium.
¹³ Division of Molecular and Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, Scotland. Electronic address: jchalmers@dundee.ac.uk.

PMID: 39490969
DOI: 10.1016/j.chest.2024.10.029

Abstract

Background: The serum antiglycopeptidolipid core IgA antibody test has been proposed as a diagnostic tool for Mycobacterium avium complex pulmonary diseases. Cross-reactivity with other nontuberculous mycobacteria (NTM), including Mycobacterium abscessus, indicates that it may have a role as a broader screening test for nontuberculous mycobacterial pulmonary disease (NTM-PD). NTM-PD is believed to be underdiagnosed in patients with bronchiectasis.

Research question: Can the serum antiglycopeptidolipid core IgA antibody test be used to screen for NTM-PD in bronchiectasis?

Study design and methods: Patients from the prospective European Bronchiectasis Registry (European Multicentre Bronchiectasis Audit and Research Collaboration-Bronchiectasis Research Involving Databases, Genomics and Endotyping; ClinicalTrails.gov Identifier: NCT03791086) were enrolled. Patients from the United Kingdom, Italy, Spain, Belgium, The Netherlands, and Germany were included. A control cohort of patients without any underlying lung disease also was recruited. The levels of serum IgA antibodies against the glycopeptidolipid core were measured using an enzyme immunoassay kit, and receiver operating characteristics curve analysis was conducted to evaluate the accuracy of the antibody level in screening for NTM-PD.

Results: Two hundred eighty-two patients were enrolled (151 female patients [53.6%]; median age, 68 years). Median antiglycopeptidolipid core IgA antibody levels were 0.2 U/mL (interquartile range [IQR], 0.1-0.3 U/mL) in patients without NTM isolation and NTM-PD (n = 238), 0.3 U/mL (IQR, 0.2-0.4 U/mL) in patients with NTM isolation that was incompatible with the diagnosis of NTM-PD (n = 18), and 1.5 U/mL (IQR, 0.4-6.2 U/mL) in patients with NTM-PD (n = 26; P = .0001). Antibody levels showed excellent accuracy in identifying patients with NTM-PD (area under the receiver operating characteristic curve, 0.886; 95% CI, 0.800-0.973) in the bronchiectasis cohort and also showed excellent discrimination of patients with NTM-PD from those with NTM isolation who did not meet the diagnostic criteria for NTM-PD (0.816; 95% CI, 0.687-0.945).

Interpretation: The antiglycopeptidolipid core IgA antibody demonstrated excellent efficacy in screening for NTM-PD in a large cohort of patients with bronchiectasis.

Clinical trial registry: ClinicalTrials.gov; No.: NCT03791086; URL: www.

Clinicaltrials: gov.

Keywords: antiglycopeptidolipid core IgA test; bronchiectasis; nontuberculous mycobacteria; serodiagnosis.

Associated data

ClinicalTrials.gov/NCT03791086