The Influence of Malnutrition, Diabetes Mellitus, and Helminth Infections on Biosignatures in Latent Tuberculosis in a South Indian Population
The Influence of Malnutrition, Diabetes Mellitus, and Helminth Infections on Biosignatures in Latent Tuberculosis in a South Indian Population
About 2 billion people worldwide are infected with tuberculosis (TB). Ninety percent of those
 people have latent TB infection (LTBI). Risk factors like malnutrition, diabetes mellitus
 (DM), and helminth infection can affect the development of active TB. Researchers want to
 study LTBI individuals with these issues to see how they may contribute to a person s higher
 risk for developing active TB. This study will take place in Chennai, India.

 Objective:

 To estimate the prevalence of malnutrition, DM, and helminth infections in people with LTBI.

 Eligibility:

 People age 14 65 with or without LTBI.

 Design:

 Participants will be screened with a medical history and physical exam focused on symptoms of
 active TB. Those who have TB symptoms will not take part in the study. Those who do not have
 TB symptoms will have a physical exam with vital signs, height, and weight. They will give
 blood and stool samples.

 Participants will be assigned to 1 of 6 groups. They will repeat some of the screening tests.
 They will give urine samples. Some groups will have a chest X-ray. Some groups will have an
 ultrasound of the abdomen.

 Participants will complete a survey about their history of smoking and drug and alcohol use.

 Participants will have data collected about their nutritional status and body composition.
 Their skinfold thickness, ratio of waist/hip circumference, and grip strength will be
 measured.

 Participants with DM, malnutrition, or helminth infection will be given standard of care or
 referred for follow-up treatment.

 Participation will last up to 6 months.
Approximately 2 billion people worldwide are infected with Mycobacterium tuberculosis (TB),
 with 90% of individuals having latent infection (LTBI). The control of TB requires clearly
 delineated helper T cell (Th) 1 responses and, to a lesser extent, Th17 responses, which both
 play important roles in the induction and maintenance of protective immune responses in mouse
 models of TB infection and in the prevention of active disease, as seen in LTBI. During
 latency, M. tuberculosis is contained in localized granulomas. Mycobacteria-specific T cells
 mediate delayed-type hypersensitivity reactions to purified protein derivative (PPD), and
 this reaction is generally considered to indicate an LTBI status in the absence of
 demonstrable active infection.

 Among the various risk factors that are known to play a role in promoting active TB, HIV is
 the most well studied and described. However, in low-HIV-endemic countries like India, other
 risk factors might play a more prominent role in active TB pathogenesis. These include
 malnutrition, diabetes mellitus (DM), and helminth infections. LTBI individuals with these
 comorbidities or coinfections could be at a higher risk for developing active TB than their
 healthy LTBI counterparts without these comorbidities. Thus, it is imperative to study the
 pathogenesis of TB infection and disease in these at-risk populations.

 In this study, we will estimate the prevalence of severe to moderate malnutrition,
 uncontrolled DM, and helminth infections in LTBI-positive individuals. We will collect
 samples from a cohort of individuals with LTBI, those with LTBI and coexistent malnutrition,
 DM, or helminth coinfection, and those without any of these conditions. Individual
 participation may last up to 6 months. The main objective of the study is to estimate the
 prevalence of malnutrition, DM, and helminth infections in LTBI individuals.

 Simultaneously, we will perform transcriptomic, proteomic, and metabolomic assays, including
 profiles in serum and urine, to determine the biosignature portfolio of these individuals. In
 addition, immunological assays examining cytokine/chemokine signatures as well as other
 immune parameters related to innate and adaptive responses will be performed to enhance the
 understanding of the immunological cross-talk between LTBI and malnutrition, DM, and helminth
 infections.
-  PARTICIPANT INCLUSION CRITERIA (Screening Phase)

 Individuals who meet the following criteria are eligible to participate in the screening
 phase:

 -  Aged 14 to 65 years.

 -  Willingness to provide blood, urine, and stool samples for examination.

 -  Willingness to have samples and data stored.

 -  Able to provide informed consent.

 PARTICIPANT EXCLUSION CRITERIA (Screening Phase)

 -  Pulmonary symptoms suggestive of TB (cough >2 weeks in duration and/or intermittent
 fever >1 week in duration and/or hemoptysis).

 -  Two IGRA tests with indeterminate results (mitogen values <10 IU).

 PARTICIPANT INCLUSION CRITERIA (Study Phase)

 Individuals are eligible for the study phase if they meet the requirements for one of the
 study groups, as follows:

 1. LTBI+ and severe to moderate malnutrition (BMI <17 kg/m2);

 2. LTBI+ and uncontrolled DM (HbA1c >8%);

 3. LTBI+ and helminth infection (positive stool qPCR and/or serology);

 4. LTBI+ with more than one of the conditions defined in groups 1 3;

 5. healthy LTBI+ controls who are negative for all of the above conditions; and

 6. healthy LTBI-negative controls with none of the above conditions.

 PARTICIPANT EXCLUSION CRITERIA (Study Phase)

 -  Pulmonary symptoms suggestive of TB (cough >2 weeks in duration and/or intermittent
 fever >1 week in duration and/or hemoptysis).

 -  Pregnant or lactating women.

 -  Previous treatment for LTBI.

 -  Anemia with hemoglobin <8 g/dl (evaluated at the screening phase visit).

 -  For LTBI+ participants, clinically indicated chest X-ray positive for pulmonary TB.

 -  For malnourished participants, clinically indicated abdominal ultrasound positive for
 abdominal TB.

 -  Known documented cases of cancer, acquired immune deficiency syndrome, or other
 immunosuppressive illness.

 -  History of any other illness or condition which, in the investigator s judgment, may
 substantially increase the risk associated with the participant s participation in the
 protocol, or compromise the scientific objectives.