Circulating parasite antigen(s) in lymphatic filariasis: use of monoclonal antibodies to phosphocholine for immunodiagnosis

Hybridoma cell lines producing monoclonal antibodies (MAb) against a 200 kD antigen found circulating in the sera of microfilaremic patients infected with Wuchereria bancrofti were obtained by immunizing mice with a partially purified antigen preparation. A sensitive MAb (CA101)-based ELISA for measuring circulating parasite antigen was capable of detecting antigen in the sera of 93% of patients with microfilaremia, 46% of those with lymphatic obstruction, and 56% of patients with tropical pulmonary eosinophilia syndrome. Circulating antigen was absent from sera of normal controls, and "false positives" were recorded in only two of 17 patients with nonfilarial helminth infections. By ELISA and immunoblot analysis, it was shown that three of the monoclonals raised to this 200 kD antigen were directed to epitopes of phosphocholine (PC). Two MAb (CA86, CA101) were identified as having the T15 idiotype previously associated with antibodies to the PC of pneumococcal teichoic acid; one was untypeable. All three of these anti-PC MAb reacted with adult, microfilaria, and larval antigen preparations, and by immunoblotting showed multiple banding patterns that indicated the presence of PC determinants on many different antigenic molecules. On the other hand, target antigens of CA101 which were found in the circulation of infected patients were limited to three species with apparent m.w. of 200, 160, and 78 kD. The 200 kD antigen was seen more frequently than the other two antigens. Other T15 anti-PC MAb derived from mice not immunized with filarial antigen showed similar patterns of reactivity with circulating filarial antigen.

Circulating parasite antigen(s) in lymphatic filariasis: use of monoclonal antibodies to phosphocholine for immunodiagnosis

Hybridoma cell lines producing monoclonal antibodies (MAb) against a 200 kD antigen found circulating in the sera of microfilaremic patients infected with Wuchereria bancrofti were obtained by immunizing mice with a partially purified antigen preparation. A sensitive MAb (CA101)-based ELISA for measuring circulating parasite antigen was capable of detecting antigen in the sera of 93% of patients with microfilaremia, 46% of those with lymphatic obstruction, and 56% of patients with tropical pulmonary eosinophilia syndrome. Circulating antigen was absent from sera of normal controls, and "false positives" were recorded in only two of 17 patients with nonfilarial helminth infections. By ELISA and immunoblot analysis, it was shown that three of the monoclonals raised to this 200 kD antigen were directed to epitopes of phosphocholine (PC). Two MAb (CA86, CA101) were identified as having the T15 idiotype previously associated with antibodies to the PC of pneumococcal teichoic acid; one was untypeable. All three of these anti-PC MAb reacted with adult, microfilaria, and larval antigen preparations, and by immunoblotting showed multiple banding patterns that indicated the presence of PC determinants on many different antigenic molecules. On the other hand, target antigens of CA101 which were found in the circulation of infected patients were limited to three species with apparent m.w. of 200, 160, and 78 kD. The 200 kD antigen was seen more frequently than the other two antigens. Other T15 anti-PC MAb derived from mice not immunized with filarial antigen showed similar patterns of reactivity with circulating filarial antigen.

Parasite-specific anergy in human filariasis. Insights after analysis of parasite antigen-driven lymphokine production

The antigen-specific immune unresponsiveness seen in bancroftian filariasis was studied by examining lymphokine production in peripheral blood mononuclear cells (PBMC) or PBMC subpopulations from 10 patients with asymptomatic microfilaremia, 13 patients with elephantiasis and 6 normal North Americans. In each group of patients, the kinetics of the lymphokine response and the response to mitogens and nonparasite antigens did not differ significantly. In marked contrast, when antigen-induced lymphokine production was examined, most patients with microfilaremia were unable to produce either interleukin 2 (IL-2) or gamma-interferon (i.e., were nonresponders), and the few who could (hyporesponders, generally with quite low microfilaremia levels) did so at levels significantly less than those of patients with elephantiasis, all of whom showed strong responses to parasite antigen. Removal of neither adherent cells or T8+ cells affected the parasite-specific anergy seen in those with microfilaremia, suggesting a state of T cell tolerance to the parasite in patients with this most common clinical manifestation of bancroftian filariasis.

Immunopathology of ocular onchocerciasis. 2. Anti-retinal autoantibodies in serum and ocular fluids

Ocular fluids and sera from 12 onchocerciasis patients and nine age-matched controls living in Tamale, Ghana, were examined for the presence of anti-retinal autoantibodies by the indirect immunoperoxidase technique. Antibodies directed against autoantigens of the inner retina (nerve fiber, ganglion cell, and Müller cell) were found in the sera of 10 of 12 patients, but in only three of nine controls (P less than 0.003). Autoimmune antibodies against the outer segment of the photoreceptor were noted in 7 of 12 patients, in contrast to only one of nine controls (P less than 0.02). Findings with the ocular fluids generally mirrored those with the sera. These autoantibodies could not be absorbed by conventional techniques using either retinal S-antigen (S-Ag) or the interphotoreceptor retinoid binding protein, an observation suggesting that other ocular antigens are involved. Such anti-retinal antibodies, especially those directed against the inner retina, may play a significant role in the pathogenesis of the retinal degeneration and optic atrophy that occur as a consequence of onchocerciasis.

Eosinophilia in Southeast Asian refugees: evaluation at a referral center

We determined the cause of persistent eosinophilia in 128 Indochinese refugees for whom initial comprehensive routine screening had failed to yield an explanation. Intestinal parasitism with one or multiple organisms was the cause of eosinophilia in all but six of these patients. Hookworm and Strongyloides stercoralis were among the potentially pathogenic organisms most frequently implicated (55% and 38%, respectively). There was no correlation between the age or sex of the patients and the type of infecting organism. We also confirmed the usefulness of a previously described serological test for diagnosing infection with Strongyloides stercoralis and examined the test's ability to distinguish between infected and noninfected individuals and to determine parasitological cure.

Use of monoclonal antibodies to quantify subclasses of human IgG. II. Enzyme immunoassay to define antigen specific (anti-filarial) IgG subclass antibodies

Because of their single epitope specificity, monoclonal antibodies (Mcabs) may perform with different levels of efficiency in immunoassays depending on the accessibility of the particular epitope recognized. In order to develop assays capable of detecting specific antibodies of each of the four human IgG subclasses, we have evaluated by ELISA the performance characteristics of a panel of Mcabs raised to the subclass proteins. At least one Mcab to each of the four subclasses was identified that was specific in its ability to capture its own relevant IgG subclass without any associated light chain, allotype or isoallotype activity and that was able to function effectively as a probe in an optimized, quantitative ELISA. When IgG subclass antibodies were measured in sera from patients with filariasis using specific filarial antigen, the sensitivities of each subclass antibody assay varied; for IgG1 and IgG4 antibodies the sensitivity of detection was 50 ng/ml and for IgG2 and IgG3, 10 ng/ml. The potency of the Mcab, determined by its titration for use as a probe, did not correlate with the sensitivity of the assay. These Mcabs were also capable of defining IgG subclass antibody responses qualitatively in immunoblot analyses with little or no non-specific binding. The availability of such highly characterized Mcabs for use in quantitative and qualitative definition of specific IgG subclass antibody responses should greatly improve our detection and subsequent understanding of the role of these IgG subclasses in various disease states.

Loa loa infection in temporary residents of endemic regions: recognition of a hyperresponsive syndrome with characteristic clinical manifestations

Loiasis in residents of endemic areas is generally manifested by microfilaremia, episodic angioedema, periocular migration of adult worms, modest eosinophilia, and variable antibody levels. In 20 temporary residents who acquired loiasis in West Africa, however, the clinical presentations were markedly different. Only three of the 20 had detectable microfilaremia. Furthermore, these patients often showed a state of marked immunological hyperresponsiveness manifested by very high titers of antibody to filariae, increased levels of serum IgE, and profound hypereosinophilia--to levels greater than 3,000/mm3 in 18 of the 20. These patients were also notable for the increased severity, frequency, and pruritic nature of their angioedema. Also, significant complications occurred in seven of the 20; one patient developed endomyocardial fibrosis and six, renal disease after treatment with diethylcarbamazine. Thirteen of the 20 developed subcutaneous nodules; adult parasites were recovered from three of five of these patients who underwent biopsy. All of the patients responded to therapy with diminution of their clinical symptoms and decreases in levels of eosinophils, IgE, and antibody to filariae.

IgE responses in human filariasis. IV. Parallel antigen recognition by IgE and IgG4 subclass antibodies

Immediate hypersensitivity responses are highly modulated in filariasis, and with few exceptions, the majority of infected individuals do not develop allergic manifestations. One possible mechanism for this modulated responsiveness could involve the high levels of IgG "blocking antibodies" shown to be present in filariasis and other chronic helminth infections. When immunoblot analyses were done to analyze the immunoglobulin (Ig) E and IgG antibody responses of patients simultaneously, remarkable similarity in the patterns of antigen binding was observed. In this study, the four IgG subclasses were analyzed in a similar manner in relation to IgE. The results clearly demonstrate that IgG4 was primarily responsible for this "parallel" recognition that was seen previously between IgG and IgE antibodies. These results lend additional support to the possibility that IgG4 may play an important role in modulating IgE-mediated allergic responses in vivo.

IgE responses in human filariasis. IV. Parallel antigen recognition by IgE and IgG4 subclass antibodies

Immediate hypersensitivity responses are highly modulated in filariasis, and with few exceptions, the majority of infected individuals do not develop allergic manifestations. One possible mechanism for this modulated responsiveness could involve the high levels of IgG "blocking antibodies" shown to be present in filariasis and other chronic helminth infections. When immunoblot analyses were done to analyze the immunoglobulin (Ig) E and IgG antibody responses of patients simultaneously, remarkable similarity in the patterns of antigen binding was observed. In this study, the four IgG subclasses were analyzed in a similar manner in relation to IgE. The results clearly demonstrate that IgG4 was primarily responsible for this "parallel" recognition that was seen previously between IgG and IgE antibodies. These results lend additional support to the possibility that IgG4 may play an important role in modulating IgE-mediated allergic responses in vivo.

Comparison of immunoblot and immunoprecipitation methods for analyzing cross-reactive antibodies to filarial antigens

Qualitative analysis of antibody responses in helminth infections is essential not only for developing better immunodiagnostic antigens but also for understanding immune recognition and its relevance to immunopathogenesis and protective immunity. In this study 2 qualitative analytic methods (immunoprecipitation and immunoblotting) were compared for the ability to define the extent of cross-reactivity in the serum antibodies from patients with various forms of filariasis (caused by Brugia malayi, Wuchereria bancrofti, Loa loa and Tetrapetalonema perstans) or other non filarial helminth infections (ascariasis, strongyloidiasis, trichinosis, echinococcosis and schistosomiasis). Our results demonstrated that the spectrum of cross-reactive antibodies identified by immunoprecipitation was limited because of the selective radiolabeling of particular filarial antigens, while immunoblotting was able to detect a much wider range of cross-reactive antibodies in both filarial and non-filarial serum pools. In addition, this latter procedure was easily adapted for simultaneous analysis of different antibody isotopes (e.g., IgE and IgG) to the same antigens in individual sera. Immunoblotting thus provides an excellent tool for studying the spectrum of antibodies of different isotypes evoked during helminth infections and for discriminating between those responses that are species-specific and those that are cross-reactive.

Immediate hypersensitivity responses in the immunopathogenesis of human onchocerciasis

It is not clear what role immediate hypersensitivity immune responses have in the pathogenesis of human onchocerciasis, but it is certain that these responses are prominent both in the course of natural infection and during the Mazzotti reactions that follow treatment with diethylcarbamazine. In humans, the levels of total serum IgE associated with onchocerciasis are as high or higher than those associated with almost any helminth infection, although specific IgE antibodies to Onchocerca volvulus appear to be a small and still poorly characterized fraction of the total serum IgE. Evidence about the relationship of these prominent IgE responses in patients with onchocerciasis to the onchocercal skin disease that manifests as pruritus and papular eruptions is conflicting, but in a guinea pig model of ocular pathology induced by onchocerca microfilariae evidence for the pathogenetic importance of IgE and immediate hypersensitivity is much less equivocal. The suggestive findings from this model make it imperative to carry out similar studies of Onchocerca-affected human eyes to determine whether immediate hypersensitivity responses play a similar critical role in the pathogenesis of the ocular lesions in humans.

In vitro parasite antigen-induced antibody responses in human helminth infections

Helminth parasites characteristically induce vigorous antibody responses in human infections, but the immunoregulatory mechanisms determining the level of these responses are not at all understood. To investigate these mechanisms, peripheral blood mononuclear cells were obtained from 10 patients with parasitic helminth infections (three with schistosomiasis, three with onchocerciasis, and four with loiasis), along with six normal controls. These cells were then cultured in vitro and the capacity of the cells to respond to a specific parasite antigenic stimulus was examined by measuring the amount of parasite-specific antibody produced. Parasite antigen alone, without exogenous mitogen, induced an IgG anti-parasite antibody response in vitro. Optimal responses were obtained at extremely low antigen concentrations--concentrations at which little if any polyclonal immunoglobulin production occurred. Additionally, the in vitro induction of parasite-specific antibody was antigen dose-dependent, requiring much lower antigen concentrations than those necessary to induce lymphocyte blastogenesis. Antibody production was shown to require the cooperative interaction of B and T cells. These studies demonstrate that in vitro responses to antigens from naturally acquired parasitic infections, like those in individuals postimmunization, can be utilized to dissect the cellular and humoral factors that regulate antibody production to naturally acquired human pathogens.

In vitro parasite antigen-induced antibody responses in human helminth infections

Helminth parasites characteristically induce vigorous antibody responses in human infections, but the immunoregulatory mechanisms determining the level of these responses are not at all understood. To investigate these mechanisms, peripheral blood mononuclear cells were obtained from 10 patients with parasitic helminth infections (three with schistosomiasis, three with onchocerciasis, and four with loiasis), along with six normal controls. These cells were then cultured in vitro and the capacity of the cells to respond to a specific parasite antigenic stimulus was examined by measuring the amount of parasite-specific antibody produced. Parasite antigen alone, without exogenous mitogen, induced an IgG anti-parasite antibody response in vitro. Optimal responses were obtained at extremely low antigen concentrations--concentrations at which little if any polyclonal immunoglobulin production occurred. Additionally, the in vitro induction of parasite-specific antibody was antigen dose-dependent, requiring much lower antigen concentrations than those necessary to induce lymphocyte blastogenesis. Antibody production was shown to require the cooperative interaction of B and T cells. These studies demonstrate that in vitro responses to antigens from naturally acquired parasitic infections, like those in individuals postimmunization, can be utilized to dissect the cellular and humoral factors that regulate antibody production to naturally acquired human pathogens.

IgE responses in human filariasis. III. Specificities of IgE and IgG antibodies compared by immunoblot analysis

IgE and IgG immune responses were qualitatively characterized in three well-defined groups of patients with different clinical manifestations of lymphatic filariasis caused by infection with Wuchereria bancrofti; viz. tropical pulmonary eosinophilia (TPE), chronic lymphatic obstruction with elephantiasis (CP), and asymptomatic microfilaremia (MF). A complex filarial antigen preparation extracted from adult filarial parasites was separated on SDS-polyacrylamide gels, and was electrophoretically transferred to nitrocellulose paper before being incubated with individual sera and being probed with radiolabeled anti-IgE or protein A. Three clinical groups of patients showed distinct patterns of antigen recognition by both IgE and IgG antibodies, with TPE patients showing the most diverse patterns and microfilaremic individuals the most restricted responses for both antibody isotypes. "Dual recognition" of antigens by IgE and IgG antibodies seemed to be the rule rather than the exception for each individual's immune response to the parasite antigens, but the relative magnitudes of IgG and IgE responses differed among the three groups. The ratio of IgG to IgE antibody was generally greater in patients with MF and CP than in those with TPE. These findings of the comparative specificities and relative abundance of IgE and IgG antibodies in infected patients may have fundamental importance in explaining the clinical expression (especially allergic reactivity) and disease pathogenesis of human filarial infections.

IgE responses in human filariasis. III. Specificities of IgE and IgG antibodies compared by immunoblot analysis

IgE and IgG immune responses were qualitatively characterized in three well-defined groups of patients with different clinical manifestations of lymphatic filariasis caused by infection with Wuchereria bancrofti; viz. tropical pulmonary eosinophilia (TPE), chronic lymphatic obstruction with elephantiasis (CP), and asymptomatic microfilaremia (MF). A complex filarial antigen preparation extracted from adult filarial parasites was separated on SDS-polyacrylamide gels, and was electrophoretically transferred to nitrocellulose paper before being incubated with individual sera and being probed with radiolabeled anti-IgE or protein A. Three clinical groups of patients showed distinct patterns of antigen recognition by both IgE and IgG antibodies, with TPE patients showing the most diverse patterns and microfilaremic individuals the most restricted responses for both antibody isotypes. "Dual recognition" of antigens by IgE and IgG antibodies seemed to be the rule rather than the exception for each individual's immune response to the parasite antigens, but the relative magnitudes of IgG and IgE responses differed among the three groups. The ratio of IgG to IgE antibody was generally greater in patients with MF and CP than in those with TPE. These findings of the comparative specificities and relative abundance of IgE and IgG antibodies in infected patients may have fundamental importance in explaining the clinical expression (especially allergic reactivity) and disease pathogenesis of human filarial infections.

The Mazzotti reaction following treatment of onchocerciasis with diethylcarbamazine: clinical severity as a function of infection intensity

To determine definitively whether or not the severity of the Mazzotti reaction was correlated with infection intensity, as determined by skin snip quantification, 21 infected Ghanian patients were evaluated during 7 days of treatment with 200 mg/day of diethylcarbamazine. Serial blood, urine and skin biopsy samples were collected during the progression of the Mazzotti reaction. Hypotension, fever, adenitis and pruritus were all correlated with infection intensity in these patients while arthralgia and tachycardia were not. Peripheral blood eosinopenia and neutrophilia also correlated with intensity of infection and appeared to reflect the accumulation of degranulating eosinophils around "mobilized" microfilariae that migrated from the dermis to the epidermis after diethylcarbamazine (DEC). Other mobilized microfilariae apparently were cleared by the liver and resulted in abnormal liver enzyme levels in the serum which, again, were directly correlated with the patients' microfilarial density. Though the severity of the Mazzotti reaction clearly correlated with intensity of infection, the different times of onset of symptoms, and cellular and serum chemistry changes indicate that there are probably multiple infection intensity-dependent mechanisms responsible for mediating this complex reaction.

Efficacy of diethylcarbamazine in eradicating infection with lymphatic-dwelling filariae in humans

Diethylcarbamazine (DEC) is an effective microfilaricidal drug against Wuchereria bancrofti, Brugia malayi, and Brugia timori--the three lymphatic-dwelling filariae infecting humans. However, effectiveness in killing the adult stage of these parasites has been more difficult to establish. The present review of available evidence from the literature suggests that: (1) in addition to being a microfilaricidal agent, DEC in conventional dosages effectively kills adult worms of these three parasites in many patients; (2) relatively high total dosages of DEC (including dosages considerably in excess of those currently recommended) generally give better long-term therapeutic results than lower dosages; (3) spaced doses of DEC (weekly or monthly) are more effective than the same total dosage given in consecutive daily doses; (4) chronic administration of low-dose DEC, as in medicated salt, can effectively control filariasis caused by W. bancrofti or B. malayi; and (5) rational determination of the DEC regimen ideal for the killing of adult filarial parasites awaits the development of assays capable of sensitively detecting the presence of living adult parasites.

Prominence of IgG4 in the IgG antibody response to human filariasis

The four subclasses of IgG are distinct in structure, function, and degree of participation in the response to complex antigens. Because these differences could have important pathogenetic significance, we analyzed total and filaria antigen-specific IgG of each subclass in 31 patients with different clinical manifestations of Bancroftian filariasis. Subclass-specific, affinity-purified polyclonal antibodies were prepared from antisera raised in sheep immunized with purified myeloma IgG subclass proteins. These were radiolabeled (125I) and used to detect IgG1, IgG2, IgG3, and IgG4 in solid phase radioimmunoassays (SPRIA). The antigen-specific SPRIA was used with Brugia malayi adult antigen (BmA) bound to Sepharose 4B, whereas measurement of total IgG subclass levels in each serum was with goat anti-human IgG bound to the solid matrix. Quantification of total subclass levels was by reference to the WHO 67/97 standard, and of specific subclass antibody by development of standards from high titered sera. Although there were modest increases of total IgG1 and IgG2 in patients with filariasis compared with normals, the most striking finding was the extreme elevation of both total, and particularly, filaria antigen-specific IgG4. These elevations were seen for essentially all patients, but the relative proportion of the total IgG antibody response accounted for by IgG4 antibody was particularly marked (up to 95%) in patients with either microfilaremia or the tropical pulmonary eosinophilia syndrome. The meaning of this special prominence of the IgG4 antibody response to filarial infection is not yet clear, but the question of whether these antibodies play a role in immediate hypersensitivity reactions as either reagins or blocking antibodies is being investigated for its potential pathogenetic significance.

Prominence of IgG4 in the IgG antibody response to human filariasis

The four subclasses of IgG are distinct in structure, function, and degree of participation in the response to complex antigens. Because these differences could have important pathogenetic significance, we analyzed total and filaria antigen-specific IgG of each subclass in 31 patients with different clinical manifestations of Bancroftian filariasis. Subclass-specific, affinity-purified polyclonal antibodies were prepared from antisera raised in sheep immunized with purified myeloma IgG subclass proteins. These were radiolabeled (125I) and used to detect IgG1, IgG2, IgG3, and IgG4 in solid phase radioimmunoassays (SPRIA). The antigen-specific SPRIA was used with Brugia malayi adult antigen (BmA) bound to Sepharose 4B, whereas measurement of total IgG subclass levels in each serum was with goat anti-human IgG bound to the solid matrix. Quantification of total subclass levels was by reference to the WHO 67/97 standard, and of specific subclass antibody by development of standards from high titered sera. Although there were modest increases of total IgG1 and IgG2 in patients with filariasis compared with normals, the most striking finding was the extreme elevation of both total, and particularly, filaria antigen-specific IgG4. These elevations were seen for essentially all patients, but the relative proportion of the total IgG antibody response accounted for by IgG4 antibody was particularly marked (up to 95%) in patients with either microfilaremia or the tropical pulmonary eosinophilia syndrome. The meaning of this special prominence of the IgG4 antibody response to filarial infection is not yet clear, but the question of whether these antibodies play a role in immediate hypersensitivity reactions as either reagins or blocking antibodies is being investigated for its potential pathogenetic significance.

Filarial parasite-specific T cell lines: induction of IgE synthesis

The development of T lymphocyte lines and clones of defined specificity has provided an important method for investigating T cell recognition of foreign antigens as well as T cell influence on B cell activity. We described previously a parasite-specific T cell line (TCL) derived from a patient with a naturally acquired filarial infection and elevated levels of serum IgE. The TCL is composed of Leu-3+ helper cells and is maintained independent of exogenous growth factors. In the present study, we used these T cells to investigate their immunoregulatory function on the in vitro IgE response. These parasite-specific T cells can provide isotype-specific help for antigen-induced IgE production by B cells in vitro. Autologous T cells profoundly suppress IgE production in a concentration-dependent manner. Furthermore, soluble factors generated from these filarial-specific TCL after antigen stimulation are able to induce the production of IgE in normal human cells not already synthesizing measurable amounts of IgE in vitro. Partial physicochemical characterization of this factor has shown that it is heat labile, has an m.w. between 10,000 and 30,000 M(r), and is a mannose-rich glycoprotein.

Filarial parasite-specific T cell lines: induction of IgE synthesis

The development of T lymphocyte lines and clones of defined specificity has provided an important method for investigating T cell recognition of foreign antigens as well as T cell influence on B cell activity. We described previously a parasite-specific T cell line (TCL) derived from a patient with a naturally acquired filarial infection and elevated levels of serum IgE. The TCL is composed of Leu-3+ helper cells and is maintained independent of exogenous growth factors. In the present study, we used these T cells to investigate their immunoregulatory function on the in vitro IgE response. These parasite-specific T cells can provide isotype-specific help for antigen-induced IgE production by B cells in vitro. Autologous T cells profoundly suppress IgE production in a concentration-dependent manner. Furthermore, soluble factors generated from these filarial-specific TCL after antigen stimulation are able to induce the production of IgE in normal human cells not already synthesizing measurable amounts of IgE in vitro. Partial physicochemical characterization of this factor has shown that it is heat labile, has an m.w. between 10,000 and 30,000 M(r), and is a mannose-rich glycoprotein.

Immunoradiometric assay for detection of filarial antigens in human serum

The immunoradiometric assay (IRMA) for detection of filarial antigens in the serum of patients infected with Brugia malayi (Bm) or the closely related filarial parasite Wuchereria bancrofti (Wb) was investigated, and its performance and clinical utility were examined. Reference sera prepared by the addition of crude Bm antigen (BmA) to negative control human sera provided a reproducible reference curve. The IRMA displayed acceptable precision and reproducibility. Agreement between dilutions (parallelism) was good in sera without specific antibody, but the presence of even modest levels of antibody resulted in nonparallelism in about one-half of the tested sera from endemic areas. Significant reduction in detectable BmA occurred when low levels of specific antibody (less than 1 microgram/ml) were added to BmA containing sera. Thus, antibody interference limited absolute quantitation of antigen in the IRMA. Results were therefore expressed in a semi-quantitative manner by using the mean + 3 SD of the binding of nonexposed human sera as the positive threshold. The frequency of reliable filarial antigen detection in individuals from the Wb endemic areas of India and the South Pacific was the following: microfilaremia, 15 out of 15; elephantiasis, 2 out of 18; tropical pulmonary eosinophilia, 2 out 8. These findings show clearly that a two-site IRMA can effectively detect circulating antigen (and thus be diagnostic of infection) in a great many patients with filariasis, but to enhance the sensitivity of the assay to the point where all patients can be diagnosed, a number of suggested modifications will be necessary.

IgE production in vitro by peripheral blood mononuclear cells of patients with parasitic helminth infections

Helminth parasites induce production of high levels of IgE antibodies but the immunoregulatory mechanisms determining this IgE biosynthesis are poorly understood. To investigate these mechanisms, peripheral blood mononuclear cells were obtained from six normal controls, six atopic patients and eight patients with parasitic helminth infections (three with schistosomiasis, two with loiasis, three with onchocerciasis). Cells were cultured at 1 X 10(6) cells/ml for 8 days in the presence of media alone or media supplemented with pokeweed mitogen (PWM) or cycloheximide; the supernatant fluids from these cultures were then assayed quantitatively for total and parasite specific IgE and IgG using an avidin-biotin amplified (for IgE) or standard (for IgG) microelisa assay. The geometric mean spontaneous IgE production was markedly elevated in peripheral blood mononuclear cells from parasitized individuals (2,487 pg/ml) when compared to those from atopics (358 pg/ml) or normals (152 pg/ml). Spontaneous IgG synthesis was equivalent in all three groups (range 140-420 ng/ml). PWM did not induce IgE production in any group and in the parasitized group even caused significant suppression of total IgE synthesis. Antigen specific antibody production (both IgE and IgG) paralleled total immunoglobulin synthesis. These findings demonstrate for the first time spontaneously enhanced IgE production in vitro in patients with helminth infections and provide a model system for studying the suppressive and regulatory mechanisms controlling IgE secretion.

Immunoradiometric assay for detection of filarial antigens in human serum

The immunoradiometric assay (IRMA) for detection of filarial antigens in the serum of patients infected with Brugia malayi (Bm) or the closely related filarial parasite Wuchereria bancrofti (Wb) was investigated, and its performance and clinical utility were examined. Reference sera prepared by the addition of crude Bm antigen (BmA) to negative control human sera provided a reproducible reference curve. The IRMA displayed acceptable precision and reproducibility. Agreement between dilutions (parallelism) was good in sera without specific antibody, but the presence of even modest levels of antibody resulted in nonparallelism in about one-half of the tested sera from endemic areas. Significant reduction in detectable BmA occurred when low levels of specific antibody (less than 1 microgram/ml) were added to BmA containing sera. Thus, antibody interference limited absolute quantitation of antigen in the IRMA. Results were therefore expressed in a semi-quantitative manner by using the mean + 3 SD of the binding of nonexposed human sera as the positive threshold. The frequency of reliable filarial antigen detection in individuals from the Wb endemic areas of India and the South Pacific was the following: microfilaremia, 15 out of 15; elephantiasis, 2 out of 18; tropical pulmonary eosinophilia, 2 out 8. These findings show clearly that a two-site IRMA can effectively detect circulating antigen (and thus be diagnostic of infection) in a great many patients with filariasis, but to enhance the sensitivity of the assay to the point where all patients can be diagnosed, a number of suggested modifications will be necessary.