Biomarkers to predict FDG PET/CT activity after the standard duration of treatment for spinal tuberculosis: An exploratory study

• Published in: Tuberculosis (Edinburgh, Scotland) Scotland), 2021-07, Vol.129, p.102107-102107, Article 102107
• Main Authors: Mann, Theresa N., Warwick, James, Chegou, Novel N., Davis, Johan H., Beltran, Caroline G.G., Griffith-Richards, Stephanie, Kidd, Martin, du Toit, Jacques, Lamberts, Robert P., Walzl, Gerhard
• Format: Article
• Language: English
• Subjects: Adult; Biomarkers; Biomarkers - blood; Computed tomography; Cross-Sectional Studies; CXCL10 protein; Cytokines; Cytokines - blood; Duration of Therapy; Emission analysis; Erythrocyte sedimentation rate; Erythrocytes; Female; Fluorodeoxyglucose F18; Humans; Investigations; IP-10 protein; Male; Middle Aged; Multiple regression models; Patients; Positron emission; Positron emission tomography; Positron Emission Tomography Computed Tomography; South Africa; Spinal; Tertiary Care Centers; Tomography; Treatment response; Tuberculosis; Tuberculosis, Spinal - diagnostic imaging; Tuberculosis, Spinal - drug therapy; γ-Interferon
• ISSN: 1472-9792; 1873-281X
• DOI: 10.1016/j.tube.2021.102107

18F-Fluorodeoxyglucose (FDG) Positron Emission Tomography- Computed Tomography (PET/CT) scans can be used to assess healing following treatment for spinal tuberculosis (TB) but have limited accessibility and high cost. This study investigated the association between immune biomarkers and FDG-PET/CT activity after ≥9 months of treatment for spinal TB. Patients who had completed ≥9 months of treatment for spinal TB were recruited from a major hospital in the Western Cape, South Africa. Participants underwent a FDG-PET/CT scan and FDG- PET/CT activity was quantified for all spinal and extra-spinal sites. Participants also provided a blood sample, which was evaluated for 19 cytokines along with erythrocyte sedimentation rate (ESR). Correlations and multiple regression analyses were used to investigate the association between biomarkers and PET/CT measures. Twenty-eight patients were recruited, of whom 24 (86%) had spinal and/or extra-spinal FDG-PET/CT activity. In the strongest multiple regression model, CXCL10/IP-10, VEGFA, IFN-γ, CRP and Factor D/Adipsin explained 52% of the variation in overall maximal FDG uptake. Conventional monitoring marker ESR showed no significant association with PET/CT measures. The current findings offered encouragement that biomarkers to predict FDG-PET/CT activity may show some promise and identified candidate biomarkers for further investigation in this regard. •Most individuals still had FDG-PET/CT activity at the spine lesion after ≥9 months of TB treatment.•Conventional monitoring marker ESR showed no association with FDG-PET/CT activity.•A novel five-biomarker signature explained 52% of maximal FDG-PET/CT activity.•Biomarker/PET/CT associations varied with HIV status and/or previous TB.