Exploring the Serologic Immunodominance to Chitinase 1 in Coccidioidomycosis

Coccidioidomycosis, or valley fever (VF), is a fungal infection caused by Coccidioides that is highly endemic in southern Arizona and central California. The antibody response to infection in combination with clinical presentation and radiographic findings are often used to diagnose disease, as a highly sensitive and specific antigen-based assay has yet to be developed and commercialized. In this dissertation, a panel of monoclonal antibodies (mAbs) was generated in an attempt to identify circulating antigen in VF-positive patients. Despite utilizing a mixture of antigens, almost all mAbs obtained were against chitinase 1 (CTS1), a protein previously identified as a main component in serodiagnostic reagents. While CTS1 was undoubtedly a dominant seroreactive antigen, it was not successfully detected in circulation in patient samples prompting a shift toward further understanding the importance of CTS1 in antibody-based diagnostic assays. Interestingly, depletion of this antigen from diagnostic antigen preparations resulted in complete loss of patient IgG reactivity by immunodiffusion. This finding encouraged the development of a rapid, 10-minute point-of-care test in lateral flow assay (LFA) format to exclusively detect anti-CTS1 antibodies from human and non-human animal patients with coccidioidal infection. A CTS1 LFA was developed that demonstrated 92.9% sensitivity and 97.7% specificity when compared to current quantitative serologic assays (complement fixation and immunodiffusion). A commercially available LFA that utilizes a proprietary mixture of antigens was shown to be less sensitive (64.3%) and less specific (79.1%). This result provides evidence that a single antigen can be used to detect antibodies consistently and accurately from patients with VF. The LFA presented here shows promise as a helpful tool to rule-in or rule-out a diagnosis of VF such that patients may avoid unnecessary antibacterial treatments, improving healthcare efficiency.