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Efficacy and safety of recombinant Mycobacterium tuberculosis ESAT-6 protein for diagnosis of pulmonary tuberculosis: A phase II trial

Qing-Feng Sun, Miao Xu, Jin-Guo Wu, Bao-Wen Chen, Wei-Xin Du, Ji-Guang Ding, Xiao-Bing Shen, Cheng Su, Jin-Sheng Wen, Guo-Zhi Wang

Department of Infectious Diseases, Third Affiliated Hospital to Wenzhou Medical College, Zhejiang, China (mainland)

Med Sci Monit 2013; 19:969-977

DOI: 10.12659/MSM.889425

Available online:

Published: 2013-11-12


Background: This study aimed to determine the efficacy and safety of recombinant Mycobacterium tuberculosis ESAT-6 protein for diagnosis of pulmonary tuberculosis (TB).
Material and Methods: A phase II trial was performed in 158 patients with pulmonary TB (145 initially-treated and 13 re-treated) and 133 healthy subjects. Skin testing was carried out by injecting purified protein derivative (PPD) (on left forearm) or recombinant ESAT-6 protein at a dosage of 2, 5, or 10 μg/mL (on the right forearm) in each subject. Reaction activity and adverse events were monitored at 24, 48, and 72 h following the injection. Receiver operating characteristic curves were plotted to determine the areas under the curves (AUCs) and the cut-off induration diameters for the optimal diagnostic performance.
Results: The reaction activity was significantly increased upon recombinant ESAT-6 injection in pulmonary TB patients compared with healthy subjects. In pulmonary TB patients, the reaction was dose-dependent, and at 48 h, 10 μg/mL recombinant ESAT-6 produced a reaction similar to that produced by PPD. The AUCs for a 10 μg/mL dosage were 0.9823, 0.9552, and 0.9266 for 24 h, 48 h, and 72 h, respectively, and the induration diameters of 4.5–5.5 mm were the optimal trade-off values between true positive rates and false positive rates. No serious adverse events occurred in any subjects.
Conclusions: Recombinant ESAT-6 protein is efficacious and safe for diagnosing pulmonary TB. Based on the reaction, performance, safety, and practicability, we recommend that 10 μg/mL at 48 h with an induration cut-off value of 5.0 mm be used.

Keywords: Antigens, Bacterial - genetics, Analysis of Variance, Adult, Area Under Curve, Bacterial Proteins - genetics, China, Dose-Response Relationship, Drug, ROC Curve, Recombinant Proteins - genetics, Skin Tests, Tuberculosis, Pulmonary - diagnosis



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