Keller, M. D. | bioRxiv Science

bioRxiv2026

Automated detection of Loa loa: a field trial in Cameroon

Onchocerciasis (river blindness) is targeted for elimination through mass administration (MDA) of ivermectin (IVM) to endemic populations. In areas where loiasis, caused by the blood-borne filarial parasite Loa loa, is co-endemic, IVM MDA faced significant challenges because individuals harboring more than 30,000 L. loa microfilaria (mf)/mL of blood are at high risk of developing serious adverse events (SAEs) that can sometimes be fatal. An alternative strategy was developed for safe IVM distribution: the so-called 'Test and Not Treat' (TaNT), which identifies and excludes individuals with high mf density from IVM MDA and treats only those with minimal risk. TaNT requires a point-of-care diagnostic device to rapidly quantify L. loa parasites in field conditions. The NTDscope is a handheld device which captures bright-field videos of whole blood in capillaries. An onboard algorithm detects and counts the live microfilaria of L. loa via movement of red blood cells. This paper describes (i) a new detection algorithm; and (ii) a May 2025 field trial in Cameroon using the NTDscope with new algorithm (550 patients). Results for the TaNT use case (i.e. flagging cases with L. loa mf densities > 30,000 mf/mL): 94% to 97% sensitivity, and 94% to 97% specificity. The results indicate that the NTDscope and new algorithm provide a greater margin of safety than the predecessor device, and can potentially offer rapid, effective field detection of high mf infections to enable scalability of the TaNT strategy.

pathology↗

bioRxiv2024

Altered Purinergic Signaling and CD8+ T Cell Dysregulation in STAT3 GOF Syndrome

Signal transduction downstream of activating stimuli controls CD8+ T cell biology, however these external inputs can become uncoupled from transcriptional regulation in Primary Immune Regulatory Disorders (PIRD). Gain-of-function (GOF) variants in STAT3 amplify cytokine signaling and cause a severe PIRD characterized by early onset autoimmunity, lymphoproliferation, recurrent infections, and immune dysregulation. In both primary human and mouse models of STAT3 GOF, CD8+ T cells have been implicated as pathogenic drivers of autoimmunity. The molecular mechanisms by which STAT3 GOF variants drive this pathology remain unclear. We found that naive CD8+ T cells have an increased capacity for IFN-{gamma} and TNF- secretion. Given this dysregulation of CD8+ T cell function, we evaluated changes in immunoregulatory pathways and found evidence of dysregulated purinergic signaling via high dimensional immune profiling, single-cell RNA sequencing, and functional assessment. Specifically, while expression of CD39, which transforms ATP to AMP, was increased on CD8+ T cells from patients with STAT3 GOF, downstream purinergic family members, CD73 and the adenosine receptor, A2AR, were downregulated, impairing the potential to produce or sense inhibitory adenosine. Patients with STAT3 GOF can be clinically treated with JAK inhibitors and this partially normalized naive CD8+ T cell dysregulation, including aberrant cytokine production. The extent of normalization of cytokine secretion scaled with normalization of CD73 and A2AR. This suggests that a dysregulated purinergic signaling axis plays an important role in CD8+ T cell dysregulation in STAT3 GOF, which may have implications for other inflammatory disorders with amplified STAT signaling. One Sentence SummaryAmplified STAT3 signaling in CD8+ T cells from STAT3 GOF patients alters purinergic signaling and dysregulates CD8+ T cell function.

immunology↗