从实验室到临床实践:神经囊虫病诊断免疫学和分子工具的最新进展

L. Toribio, J. Bustos, Hector H. Garcia
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摘要

神经囊尾蚴病(NCC)是由疟原虫幼虫侵入中枢神经系统(CNS)引起的,是许多发展中国家癫痫和其他神经系统疾病的主要病因。NCC 的诊断具有挑战性,因为它依赖于脑成像检查(CT 或 MRI),而这些检查在流行的农村地区或资源有限的地区很难获得。此外,有些 NCC 病例不易通过影像学检查发现,导致诊断结果不确定。目前已开发出多种实验室检测方法(主要是免疫学检测方法)来支持诊断和/或监测治疗效果,但由于这些方法依赖于寄生虫材料,因此成本高昂、费时费力,而且无法在全球范围内使用。因此,最近的进展集中在重组或合成抗原以及单克隆抗体的应用上,以达到 NCC 免疫诊断的目的。同样,分子诊断也得到了探索,并取得了可喜的成果。在此,我们介绍了过去 13 年中用于 NCC 诊断的免疫学和分子诊断工具的最新进展,讨论了这些工具在应对重要挑战方面的潜在应用,以及如何聚焦未来方向以改善 NCC 诊断,重点是提高可及性和测试验证的重要性,从而为临床决策提供充分支持。
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From laboratory to clinical practice: an update of the immunological and molecular tools for neurocysticercosis diagnosis
Neurocysticercosis (NCC) is caused by the invasion of Taenia solium larvae in the central nervous system (CNS) and stands as the predominant cause of epilepsy and other neurological disorders in many developing nations. NCC diagnosis is challenging because it relies on brain imaging exams (CT or MRI), which are poorly available in endemic rural or resource-limited areas. Moreover, some NCC cases cannot be easily detected by imaging, leading to inconclusive results. Multiple laboratory assays, principally immunological, have been developed to support the diagnosis and/or monitor the treatment efficacy, but its production can be costly, laborious, and non-globally accessible because they depend on parasite material. Therefore, recent advances have been focused on the implementation of recombinant or synthetic antigens as well as monoclonal antibodies for NCC immunodiagnosis purposes. Similarly, molecular diagnosis has been explored, obtaining promising results. Here we described the recent progress in the development of immunological and molecular diagnostic tools for NCC diagnosis over the past 13 years, discussing their potential application to address important challenges and how to focus future directions to improve NCC diagnosis with emphasis on enhance accessibility and the importance of test validation to provide an adequate support for clinical decisions.
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