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. 2019 Nov 29;9:18012. doi: 10.1038/s41598-019-54537-9

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© The Author(s) 2019

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.

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(A) Structure of mannose-capped lipoarabinomannan (ManLAM) present in all M.tb complex strains. ManLAM (depicted here as LAM) is a heterogeneous molecule comprised of a GPI-anchor, which can contain from 1–4 fatty acids, an α-(1 → 6) mannan core with multiple branches of a single mannose, an α-(1 → 5) arabinan core with multiple branches of different length at the C3 position of some arabinoses. The non-reducing end of some of these arabinan branches are decorated with 2-α-mono-, di- and tri-mannosaccharide caps. A 5-methyl-thio-xylose (MTX) is present per LAM molecule, being the epitope recognized by the new FujiLAM test. LAM also contains succinate motifs, which biological function is still unclear but participate in determining the spatial conformation of LAM. (B) Alere Determine LAM Ag test (LAM-test) performed in M.tb H₃₇R_v LAM spiked urine determining that the lowest amount that this test can detect LAM in urine is 0.0005 μg/ml of urine (500 pg). (C) A quick delipidation step for LAM spiked urine using chloroform (CHCl₃) improves the detection of LAM by the LAM-test. Student’s t test, treatment vs. non-treatment, n = 3–8, using LAM spiked urine from different human donors; ***p < 0.0005.