Prospective Analysis of urINe LAM to Eliminate NTM Sputum Screening (PAINLESS) study: Rationale and trial design for testing urine lipoarabinomannan as a marker of NTM lung infection in cystic fibrosis.
<h4>Background</h4>Routine screening for nontuberculous mycobacterial (NTM) lung disease is dependent on sputum cultures. This is particularly challenging in the cystic fibrosis (CF) population due to reduced sputum production and low culture sensitivity. Biomarkers of infection that do...
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Public Library of Science (PLoS)
2025-01-01
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| Online Access: | https://doi.org/10.1371/journal.pone.0309191 |
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| author | Kara M Calhoun Emily Armantrout Katie Poch Silvia Caceres Valerie K Lovell Marion Jones Kenneth C Malcolm Brian Vestal Emily Wheeler Noel Rysavy Jordan Manzer Ibrahim Aboellail Delphi Chatterjee Jerry A Nick |
| author_facet | Kara M Calhoun Emily Armantrout Katie Poch Silvia Caceres Valerie K Lovell Marion Jones Kenneth C Malcolm Brian Vestal Emily Wheeler Noel Rysavy Jordan Manzer Ibrahim Aboellail Delphi Chatterjee Jerry A Nick |
| author_sort | Kara M Calhoun |
| collection | DOAJ |
| description | <h4>Background</h4>Routine screening for nontuberculous mycobacterial (NTM) lung disease is dependent on sputum cultures. This is particularly challenging in the cystic fibrosis (CF) population due to reduced sputum production and low culture sensitivity. Biomarkers of infection that do not rely on sputum may lead to earlier diagnosis, but validation trials require a unique prospective design.<h4>Purpose</h4>The rationale of this trial is to investigate the utility of urine lipoarabinomannan (LAM) as a test to identify people with CF with a new positive NTM culture. We hypothesize that urine LAM is a sensitive, non-invasive screening test with a high negative predictive value to identify individuals with a relatively low risk of having positive NTM sputum culture.<h4>Study design</h4>This is a prospective, single-center, non-randomized observational study in adults with CF, 3 years of negative NTM cultures, and no known history of NTM positive cultures. Patients are followed for two year-long observational periods with the primary endpoint being a positive NTM sputum culture within a year of a positive urine LAM result and a secondary endpoint of a positive NTM sputum culture within 3 years of a positive urine LAM result. Study implementation includes remote consent and sample collection to accommodate changes from the COVID-19 pandemic.<h4>Conclusions</h4>This report describes the study design of an observational study aimed at using a urine biomarker to assist in the diagnosis of NTM lung infection in pwCF. If successful, urine LAM could be used as an adjunct to traditional sputum cultures for routine NTM screening, and replace cultures in low-risk individuals unable to produce sputum. |
| format | Article |
| id | doaj-art-eb8d4162f6ec407db13803cade59d76f |
| institution | DOAJ |
| issn | 1932-6203 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj-art-eb8d4162f6ec407db13803cade59d76f2025-08-20T03:21:47ZengPublic Library of Science (PLoS)PLoS ONE1932-62032025-01-01203e030919110.1371/journal.pone.0309191Prospective Analysis of urINe LAM to Eliminate NTM Sputum Screening (PAINLESS) study: Rationale and trial design for testing urine lipoarabinomannan as a marker of NTM lung infection in cystic fibrosis.Kara M CalhounEmily ArmantroutKatie PochSilvia CaceresValerie K LovellMarion JonesKenneth C MalcolmBrian VestalEmily WheelerNoel RysavyJordan ManzerIbrahim AboellailDelphi ChatterjeeJerry A Nick<h4>Background</h4>Routine screening for nontuberculous mycobacterial (NTM) lung disease is dependent on sputum cultures. This is particularly challenging in the cystic fibrosis (CF) population due to reduced sputum production and low culture sensitivity. Biomarkers of infection that do not rely on sputum may lead to earlier diagnosis, but validation trials require a unique prospective design.<h4>Purpose</h4>The rationale of this trial is to investigate the utility of urine lipoarabinomannan (LAM) as a test to identify people with CF with a new positive NTM culture. We hypothesize that urine LAM is a sensitive, non-invasive screening test with a high negative predictive value to identify individuals with a relatively low risk of having positive NTM sputum culture.<h4>Study design</h4>This is a prospective, single-center, non-randomized observational study in adults with CF, 3 years of negative NTM cultures, and no known history of NTM positive cultures. Patients are followed for two year-long observational periods with the primary endpoint being a positive NTM sputum culture within a year of a positive urine LAM result and a secondary endpoint of a positive NTM sputum culture within 3 years of a positive urine LAM result. Study implementation includes remote consent and sample collection to accommodate changes from the COVID-19 pandemic.<h4>Conclusions</h4>This report describes the study design of an observational study aimed at using a urine biomarker to assist in the diagnosis of NTM lung infection in pwCF. If successful, urine LAM could be used as an adjunct to traditional sputum cultures for routine NTM screening, and replace cultures in low-risk individuals unable to produce sputum.https://doi.org/10.1371/journal.pone.0309191 |
| spellingShingle | Kara M Calhoun Emily Armantrout Katie Poch Silvia Caceres Valerie K Lovell Marion Jones Kenneth C Malcolm Brian Vestal Emily Wheeler Noel Rysavy Jordan Manzer Ibrahim Aboellail Delphi Chatterjee Jerry A Nick Prospective Analysis of urINe LAM to Eliminate NTM Sputum Screening (PAINLESS) study: Rationale and trial design for testing urine lipoarabinomannan as a marker of NTM lung infection in cystic fibrosis. PLoS ONE |
| title | Prospective Analysis of urINe LAM to Eliminate NTM Sputum Screening (PAINLESS) study: Rationale and trial design for testing urine lipoarabinomannan as a marker of NTM lung infection in cystic fibrosis. |
| title_full | Prospective Analysis of urINe LAM to Eliminate NTM Sputum Screening (PAINLESS) study: Rationale and trial design for testing urine lipoarabinomannan as a marker of NTM lung infection in cystic fibrosis. |
| title_fullStr | Prospective Analysis of urINe LAM to Eliminate NTM Sputum Screening (PAINLESS) study: Rationale and trial design for testing urine lipoarabinomannan as a marker of NTM lung infection in cystic fibrosis. |
| title_full_unstemmed | Prospective Analysis of urINe LAM to Eliminate NTM Sputum Screening (PAINLESS) study: Rationale and trial design for testing urine lipoarabinomannan as a marker of NTM lung infection in cystic fibrosis. |
| title_short | Prospective Analysis of urINe LAM to Eliminate NTM Sputum Screening (PAINLESS) study: Rationale and trial design for testing urine lipoarabinomannan as a marker of NTM lung infection in cystic fibrosis. |
| title_sort | prospective analysis of urine lam to eliminate ntm sputum screening painless study rationale and trial design for testing urine lipoarabinomannan as a marker of ntm lung infection in cystic fibrosis |
| url | https://doi.org/10.1371/journal.pone.0309191 |
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