e Alveolar echinococcosis (AE), caused by the Echinococcus multilocularis metacestode, represents one of the most frequently fatal zoonoses. Early diagnosis significantly reduces morbidity and mortality associated with AE. Diagnosis of AE largely depends on a combination of imaging and serological tests due to its minimal clinical manifestations. Several antigens derived from the whole worm and protoscolex have been targeted for AE serodiagnosis, while the antigenic properties of E. multilocularis hydatid fluid (EmHF) are unclear. We observed two AE-specific 6-and 8-kDa antigen proteoforms through an immunoproteome array of the EmHF. We identified these proteins as representing an E. multilocularis antigen B3 (EmAgB3) isoform, and the proteins were shown to be encoded by the same gene. We cloned the gene and expressed the recombinant EmAgB3 protein (rEmAgB3) in Escherichia coli. rEmAgB3 exhibited sensitivity of 90.9% (80/88 cases) and specificity of 98.5% (597/606 samples) by immunoblotting. The positive and negative predictive values were 89.9% and 98.6%, respectively. The protein did not show antibody responses to 33 AE sera collected during posttreatment follow-up monitoring. Mouse sera experimentally infected with AE protoscoleces began to demonstrate specific antibody responses to native and recombinant EmAgB3 6 months after infection. At that stage, fully mature metacestode vesicles that harbored the brood capsule, primary cell, and protoscolex were observed within an AE mass(es). The response declined along with worm degeneration. Our results demonstrate that the immune responses to this EmAgB3 isoform were highly correlated with worm viability accompanied with AE progression. rEmAgB3 is a promising biomarker for serological assessment of AE patients.A lveolar echinococcosis (AE), an infection caused by Echinococcus multilocularis metacestodes, is one of the most frequently chronic and fatal zoonoses (1-3). Epidemiological evidence has demonstrated that 0.5 to 6 of 100,000 inhabitants are infected in areas of endemicity of Europe and Central Asia (4, 5). In the Tibetan and Qinghai plateaus in China, the population at risk of infection is estimated to encompass 60 million (6).Two kinds of hosts are intimately involved in the life cycle of E. multilocularis. Domestic and wild canids (definitive hosts) harbor the adult tapeworm in their intestines. The worms produce numerous eggs, which pass out of the host with gravid segments. When wild rodents and humans (intermediate hosts) take in the eggs, oncospheres are activated in the small intestine; they then penetrate the intestinal wall and enter the circulation. They primarily lodge in the liver and grow slowly into multivesiculated metacestode vesicles, in which brood capsules, primary cells, and protoscoleces develop, resulting in AE (1, 7). AE usually presents with a complex of nonspecific liver manifestations that mimic cystadenoma, hepatocellular carcinoma, and liver cirrhosis (8, 9).Diagnosis of AE largely depends on a combination of imaging and serologi...