Plasma multiomics distinguishes pulmonary tuberculosis from other respiratory infections

Plasma multiomics distinguishes pulmonary tuberculosis from other respiratory infections | medRxiv Skip to main content Home About Submit ALERTS / RSS Search for this keyword Advanced Search Plasma multiomics distinguishes pulmonary tuberculosis from other respiratory infections View ORCID Profile Zaynab Mousavian , Firdaus Nabeemeeah , Mary M. Nellis , Neel R. Gandhi , Russell R. Kempker , Dean P. Jones , Hadiya Johnson , Mojahidul Islam , Matthew J. Magee , Neil Martinson , Ashish A. Sharma , Jeffrey M. Collins doi: https://doi.org/10.64898/2026.03.18.26348671 Zaynab Mousavian 1 Hubert Department of Global Health, Emory University Rollins School of Public Health , Atlanta, GA, USA Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Zaynab Mousavian For correspondence: zmousa2{at}emory.edu Jeffrey.michael.collins{at}emory.edu Firdaus Nabeemeeah 2 Perinatal HIV Research Unit (PHRU), University of the Witwatersrand , Johannesburg, South Africa Find this author on Google Scholar Find this author on PubMed Search for this author on this site Mary M. Nellis 3 Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine , Atlanta, GA, USA Find this author on Google Scholar Find this author on PubMed Search for this author on this site Neel R. Gandhi 1 Hubert Department of Global Health, Emory University Rollins School of Public Health , Atlanta, GA, USA 4 Department of Epidemiology, Emory University Rollins School of Public Health , Atlanta, GA, USA Find this author on Google Scholar Find this author on PubMed Search for this author on this site Russell R. Kempker 3 Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine , Atlanta, GA, USA Find this author on Google Scholar Find this author on PubMed Search for this author on this site Dean P. Jones 5 Division of Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, Emory University School of Medicine , Atlanta, GA, USA Find this author on Google Scholar Find this author on PubMed Search for this author on this site Hadiya Johnson 6 Department of Pathology, Emory University School of Medicine , Atlanta, GA, USA Find this author on Google Scholar Find this author on PubMed Search for this author on this site Mojahidul Islam 6 Department of Pathology, Emory University School of Medicine , Atlanta, GA, USA Find this author on Google Scholar Find this author on PubMed Search for this author on this site Matthew J. Magee 1 Hubert Department of Global Health, Emory University Rollins School of Public Health , Atlanta, GA, USA Find this author on Google Scholar Find this author on PubMed Search for this author on this site Neil Martinson 2 Perinatal HIV Research Unit (PHRU), University of the Witwatersrand , Johannesburg, South Africa 7 Johns Hopkins University Center for TB Research , Baltimore, MD Find this author on Google Scholar Find this author on PubMed Search for this author on this site Ashish A. Sharma 6 Department of Pathology, Emory University School of Medicine , Atlanta, GA, USA Find this author on Google Scholar Find this author on PubMed Search for this author on this site Jeffrey M. Collins 3 Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine , Atlanta, GA, USA Find this author on Google Scholar Find this author on PubMed Search for this author on this site For correspondence: zmousa2{at}emory.edu Jeffrey.michael.collins{at}emory.edu Abstract Full Text Info/History Metrics Supplementary material Data/Code Preview PDF Abstract Novel blood-based biomarkers for tuberculosis (TB) are needed to develop rapid, point-of-care diagnostics. We sought to use combined plasma metabolomics and high-density cytokine profiling to identify a biomarker signature that can differentiate pulmonary TB (PTB) from patients hospitalized with other respiratory diseases and ambulatory household contacts with TB symptoms. We analyzed plasma concentrations of 28 cytokines and 118 metabolites from 391 adults (≥18 years) presenting with respiratory symptoms suggestive of TB, of which 187 had PTB confirmed by Xpert MTB and/or M. tuberculosis sputum culture and 204 were controls in whom PTB was excluded. Our study identified a 5-marker signature (IFN.gamma, IL.22, IL.10, methionine and oxoproline) with an AUC of 0.97 (95% CI: 0.95–1.00) in the test set. The signature had 98% and 84% sensitivity at 70% and 98% specificity respectively, which meet WHO target product profiles for both non-sputum triage and diagnostic TB tests. Competing Interest Statement The authors have declared no competing interest. Funding Statement This work was supported by grants from the U.S. National Institute of Allergy and Infectious Diseases (NIAID) [R01 AI182244, R21 AI178324, K23 AI144040, P30 AI168386, P30 AI050409, K24 AI114444]; and the National Center for Advancing Translational Sciences [UL1 TR002378], Bethesda, MD, USA. Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Written informed consent was obtained from all study participants, and study approval was obtained from the institutional review boards (IRBs) of Emory University (Atlanta, Georgia, USA, IRB # 00006763) and the Human Research Ethics Committee (Medical) of the University of the Witwatersrand(Wits HREC:171009), South Africa. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data Availability Data is provided within the supplementary information files. Copyright The copyright holder for this preprint is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. All rights reserved. No reuse allowed without permission. Back to top Previous Next Posted March 19, 2026. 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Magee , Neil Martinson , Ashish A. Sharma , Jeffrey M. Collins medRxiv 2026.03.18.26348671; doi: https://doi.org/10.64898/2026.03.18.26348671 Share This Article: Copy Citation Tools Plasma multiomics distinguishes pulmonary tuberculosis from other respiratory infections Zaynab Mousavian , Firdaus Nabeemeeah , Mary M. Nellis , Neel R. Gandhi , Russell R. Kempker , Dean P. Jones , Hadiya Johnson , Mojahidul Islam , Matthew J. Magee , Neil Martinson , Ashish A. Sharma , Jeffrey M. Collins medRxiv 2026.03.18.26348671; doi: https://doi.org/10.64898/2026.03.18.26348671 Citation Manager Formats BibTeX Bookends EasyBib EndNote (tagged) EndNote 8 (xml) Medlars Mendeley Papers RefWorks Tagged Ref Manager RIS Zotero Tweet Widget Facebook Like Google Plus One Subject Area Infectious Diseases (except HIV/AIDS) Subject Areas All Articles Addiction Medicine (638) Allergy and Immunology (918) Anesthesia (351) Cardiovascular Medicine (5007) Dentistry and Oral Medicine (496) Dermatology (428) Emergency Medicine (676) Endocrinology (including Diabetes Mellitus and Metabolic Disease) (1693) Epidemiology (16267) Forensic Medicine (36) Gastroenterology (1241) Genetic and Genomic Medicine (7280) Geriatric Medicine (751) Health Economics (1093) Health Informatics (5291) Health Policy (1467) Health Systems and Quality Improvement (1832) Hematology (599) HIV/AIDS (1382) Infectious Diseases (except HIV/AIDS) (16492) Intensive Care and Critical Care Medicine (1203) Medical Education (700) Medical Ethics (156) Nephrology (752) Neurology (7598) Nursing (378) Nutrition (1130) Obstetrics and Gynecology (1296) Occupational and Environmental Health (1040) Oncology (3746) Ophthalmology (1093) Orthopedics (409) Otolaryngology (465) Pain Medicine (501) Palliative Medicine (143) Pathology (721) Pediatrics (1858) Pharmacology and Therapeutics (756) Primary Care Research (786) Psychiatry and Clinical Psychology (6133) Public and Global Health (9994) Radiology and Imaging (2532) Rehabilitation Medicine and Physical Therapy (1520) Respiratory Medicine (1270) Rheumatology (661) Sexual and Reproductive Health (804) Sports Medicine (597) Surgery (803) Toxicology (109) Transplantation (319) Urology (308)

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