Phosphorothioate backbone modification modulates macrophage activation by CpG DNA

Macrophages respond to unmethylated CpG motifs present in nonmammalian DNA. Stabilized phosphorothioate-modified oligodeoxynucleotides (PS-ODN) containing CpG motifs form the basis of immunotherapeutic agents. In this study, we show that PS-ODN do not perfectly mimic native DNA in activation of macrophages. CpG-containing PS-ODN were active at 10- to 100-fold lower concentrations than corresponding phosphodiester ODN in maintenance of cell viability in the absence of CSF-1, in induction of NO production, and in activation of the IL-12 promoter. These enhancing effects are attributable to both increased stability and rate of uptake of the PS-ODN. By contrast, PS-ODN were almost inactive in down-modulation of the CSF-1R from primary macrophages and activation of the HIV-1 LTR. Delayed or poor activation of signaling components may contribute to this, as PS-ODN were slower and less effective at inducing phosphorylation of the extracellular signal-related kinases 1 and 2. In addition, at high concentrations, non-CpG PS-ODN specifically inhibited responses to CpG DNA, whereas nonstimulatory phosphodiester ODN had no such effect. Although nonstimulatory PS-ODN caused some inhibition of ODN uptake, this did not adequately explain the levels of inhibition of activity. The results demonstrate that the phosphorothioate backbone has both enhancing and inhibitory effects on macrophage responses to CpG DNA.

Metastatic extragonadal seminoma associated with cardiac transplantation

A 37-year-old man who had successfully undergone cardiac transplantation for dilated cardiomyopathy presented with a history of severe pain over his left shoulder, rib cage and thoracic spine. Clinical examination revealed the presence of bony tenderness over these sites, but there was no other clinical evidence of malignancy. Further investigations suggested the presence of multiple bony metastases. Bone biopsy revealed extensive bone marrow infiltration by large undifferentiated cells showing pronounced cytoplasmic vacuolation with a striking granulomatous reaction. Immunocytochemistry revealed these anaplastic cells to be cytokeratin and placenta-like alkaline phosphatase positive but S100, CD30 and lymphoid marker negative. Analyses by in situ hybridisation of these cells revealed no evidence of Epstein-Barr virus infection. Overall the pathology suggested a diagnosis of metastatic seminoma. Confirmation of this diagnosis was obtained by the analysis of serum human chorionic gonadotrophin which was elevated at 90 IU/l. In the absence of testicular or retroperitoneal disease, it is very likely that this unusual case of metastatic seminoma was related to the patient's immunosuppressive therapy, which at diagnosis included cyclosporin and prednisolone. The patient was successfully treated with cisplatin based chemotherapy and decreased immunosuppression and remains in complete remission one year after completion of chemotherapy. Seminoma is an uncommon complication of prolonged immunosuppression with very few cases being described in the literature post-organ transplantation. This case shows that the clinical presentation of this treatable tumour in this patient population can be unusual and difficult to diagnose.

Complement degradation product C3d in urine: marker of lupus nephritis

OBJECTIVE

To examine whether serum and urine C3d, a degradation product of C3, correlate with renal and extrarenal lupus activity.

METHODS

Serum and urinary C3d levels were measured by ELISA in 15 healthy individuals and 24 patients with systemic lupus erythematosus (SLE) (8 with inactive disease, 7 with active but nonrenal disease, 9 with active lupus nephritis). Disease activity variables like serum C3, C4, and anti-dsDNA antibodies were also measured.

RESULTS

The median serum C3d levels were significantly higher (p < 0.01) in patients with active (26 arbitrary units/ml; AU/ml) and inactive SLE (27 AU/ml) compared to healthy controls (11.25 AU/ml); levels were comparable in patients with active renal and extrarenal SLE. On the other hand, urine C3d was elevated only in patients with active SLE; its level was highest in patients with active lupus nephritis (0.87 AU/ml) compared to patients with active extrarenal diseases (0.31 AU/ml; p < 0.05), to patients with inactive lupus nephritis (0.06 AU/ml; p < 0.001), or to levels in healthy individuals (0.06; p < 0.001). Urine C3d showed stronger correlation with disease activity score (SLE Disease Activity Index) than serum C3, C4, anti-dsDNA antibodies, and serum C3d.

CONCLUSION

Urine C3d is a good index of active lupus, particularly lupus nephritis.

Leishmania donovani: cellular and humoral immune responses in Indian langur monkeys, Presbytis entellus

We have previously reported that disease mimicking human visceral leishmaniasis can be established in Presbytis entellus, the Indian langur monkey, following a single intravenous challenge of 10(8) Leishmania donovani amastigotes. In the present report, infection was assessed in monkeys infected intravenously with a single dose of 10(8) amastigotes (HDA group), three weekly doses of 10(7) amastigotes (LDA group) and three weekly doses of 5 x 10(7) promastigotes (HDP group). Typical clinical infection was established in all three groups with significant parasite load. There was a gradual and sustained rise in anti-leishmania specific immunoglobulin G response, and a severe fall in the lymphoproliferative response to the T cell mitogens PHA and Con A by day 80 post infection (p.i.). The antibody level remained elevated until death in monkeys of the HDA and HDP groups; the T-cell responses showed a recovery prior to death. T-cell responses to leishmania antigen, however, could not be demonstrated in any of these monkeys prior to death. One monkey of the LDA group survived for 155 days and two monkeys spontaneously eradicated the infection. Surprisingly, one monkey of the HDA group also achieved spontaneous cure. In the three monkeys which eradicated infection spontaneously, the antibody level declined to baseline levels on day 180 p.i. with a well demonstrable antigen specific lymphoproliferative response; no parasites could be demonstrated in splenic aspirates by direct examination of culture. These data demonstrate that disease severity may be the function of the total inoculum dose rather than the stage of the parasite and that the immunological responses in the Indian langur model parallel the reported changes in human visceral leishmaniasis. This makes the langur a potentially useful model for the evaluation of candidate anti-leishmanial drugs and vaccines.

Characterization and evaluation of detoxification functions of a nontumorigenic immortalized porcine hepatocyte cell line (HepLiu)

Primary porcine hepatocytes (PPH) are currently used in research and therapeutic applications as the biological component of extracorporeal liver assist devices to overcome the shortage of human hepatocytes. However, their finite life span and typically rapid loss of functions limit their utility. An immortalized, nontumorigenic, highly differentiated porcine hepatocyte cell line was developed in our laboratory to resolve these disadvantages. PPH were transfected with simian virus 40 (SV40) T antigen under the control of the SV40 early promoter. From the established 69 clones, 23 clones displaying hepatocyte-like morphology were screened for diazepam metabolism. One clone, HepLiu D63, has been maintained in culture for > 2 years, through more than 60 passages and 240 divisions. Albumin protein, present in early passages, was lost at later passages, but albumin transcript still was detectable in later passages. Carbamoyl phosphate synthetase, a gateway enzyme of the urea cycle, was consistently detectable in HepLiu cells. Cytokeratin 18, a characteristic marker of primary hepatocytes, was detected by both immunofluorescent staining and Western blot in HepLiu cells. Furthermore, maintenance of P450 functions in HepLiu cells was evidenced by diazepam and 7-ethoxycoumarin metabolites measured by HPLC. Phase II conjugative function was measured as acetaminophen glucuronidation. P450 dealkylase was demonstrated microscopically by the conversion of a nonfluorescent substrate to a fluorescent product. Both Northern blot analysis and immunofluorescent staining showed SV40 T antigen expression in the nuclei of HepLiu cells. No tumor formation occurred when HepLiu cells were injected into severe combined immunodeficient (SCID) mice nor was the TAI (a tumor marker) mRNA expressed, even in later passages. This immortalized, nontumorigenic, highly functional cell line may provide a valuable tool for drug/toxicological studies, liver biologic regulation studies, and artificial liver support systems.

Prediction of prolonged ventilator dependence in children by respiratory function measurements

Complications of ventilatory support are more common if this assistance is prolonged. Our aim was to determine if results of respiratory function measurement on the first day of ventilation identified children who would develop prolonged ventilatory dependence (> or = 4 days) and whether such results were a more accurate predictor than readily available clinical data. Thirty three children, median age 2 years (range 0.1-13.6), who were supported by a constant flow ventilator and hence had measurements of compliance of the respiratory system (CRS) and resistance of the respiratory system (RRS) on the first day of ventilatory support, were retrospectively identified. Those who needed prolonged ventilatory support had a lower CRS on day one (p < 0.01) and required at any time during their ventilatory career both a higher maximum inspired oxygen concentration (p < 0.01) and peak inspiratory pressure (PIP) (p < 0.01). Logistic regression analysis demonstrated that only a low CRS and high maximum PIP were significantly correlated with prolonged ventilator dependence. A low CRS (<0.4 (ml/cmH2O) kg(-1)) and a high maximum PIP (>27 cmH2O) had similar sensitivities (83%) and specificities (71% and 67% respectively) in predicting prolonged ventilatory dependence. The CRS results, unlike the maximum PIP results, however, were always available on the first day of ventilatory support. We therefore conclude that respiratory function measurements have a role in identifying children who would benefit from strategies to prevent prolonged ventilator dependence.

Vaccine potential of 56-66 kDa protease secreted by Entamoeba histolytica

Excretory/secretory (ES) antigens and sub-cellular fractions of E. histolytica (HM1:IMSS strain) were tested for the presence of common proteases using substrate gel electrophoresis. We obtained two E. histolytica proteases (56-66 kDa and 29 kDa) from ES material, soluble components and plasma membrane. Protease 56-66 kDa from ES antigen was selected for immunizing hamsters because it gave a consistent broad band. We observed 62.5 per cent protection in immunized animals, compared to 0 per cent in unimmunized controls. Although all vaccinated golden hamsters showed high antibody response, there was no correlation between antibody titres and protection. 56-66 kDa ES protease could thus prevent disease and could be a candidate molecular vaccine against amoebiasis.

Pigmented nails and Strongyloides stercoralis infestation causing clinical worsening in a patient treated for immunoproliferative small intestinal disease: two unusual observations

Immunoproliferative small intestinal disease (IPSID) is commonly reported from developing countries with poor socioeconomic conditions, hygiene, and high frequency of gastrointestinal infections and infestations. The disease requires anti-malignant chemotherapy in lymphomatous stage. Reported here is a 20-year old man with IPSID lymphoma who responded to anti-malignant chemotherapy initially, but later deteriorated due to Strongyloides stercoralis infestation, which was treated successfully with mebendazole. Importance of an early recognition and adequate treatment for gastrointestinal infections and infestations before anti-malignant chemotherapy for this disease is highlighted considering the occurrence of this disease in the developing world. The patient developed alternate brown black and white lines in the finger nails after combination chemotherapy, which has not been reported earlier in this disease; the nail changes disappeared 6 months after the withdrawal of doxorubicin suggesting this drug as the cause for such nail changes during anti-malignant combination chemotherapy.

Effect of passively transferred anti-poliovirus antibodies on seroconversion

A prospective study enrolling 50 mother-infant pairs was undertaken to determine the effect of maternal antibodies on poliovirus antibody titres and seroconversion rates in infants and to determine the difference in titres and seroconversion rates following three and five doses of oral poliovaccine (OPV). Cord blood samples and samples collected 4 weeks after 3rd and 5th doses of trivalent oral poliovaccine were processed for estimation of anti-poliovirus antibody titres. These were expressed as geometric mean titres (GMT). Significance was analyzed using unpaired 't' test. The relationship between maternal antibody titres and seroconversion was determined by correlation coefficient test. Post OPV5 titres were significantly higher than post OPV3 titres for type 1 and type 2 polioviruses. Seroconversion rates against type 1, 2 and 3 polioviruses were 92.9%, 100.0% and 92.9% following OPV3 and 100.0%, 100.0% and 93.2% following OPV5. The cord blood titres did not have any relation to post-OPV3 or post-OPV5 titres. Although there is significant passive transfer of poliovirus antibodies across the placenta, this does not affect titres achieved after immunization. Post-OPV5 titres against type 1 and type 2 viruses are significantly higher than post-OPV3 titres. The seroconversion rates following OPV5 are higher than those obtained post-OPV3 but this difference is not statistically significant.

Isoenzyme and molecular characterization of Entamoeba histolytica and Entamoeba dispar isolates from symptomatic and asymptomatic subjects

AIM

To correlate the clinical features of amebic infections with the characteristics of Entamoeba culture isolates of stools.

METHODS

Isolates from seven irritable bowel syndrome (IBS) patients, four asymptomatic cyst passers (ACP) and five patients with invasive amebic disease were subjected to hexokinase polyacrylamide electrophoresis (HK-PAGE) and their DNA subjected to restriction fragment (RF) analysis of amplified polymerase chain reaction (PCR) products. These findings were correlated with anti-amebic serology. Two axenic pathogenic strains (HM1:IMSS, NIH:200) and one xenic nonpathogenic strain (SAW1734) were used as standards.

RESULTS

All isolates from IBS patients as well as ACP had slow-moving (nonpathogenic) band pattern, whereas those from patients with invasive disease had fast-moving (pathogenic) band pattern on HK-PAGE. Serological data using EIA and RF patterns of PCR-amplified genome corroborated these results.

CONCLUSIONS

Our results support the view that there are two species of Entamoeba infecting humans--E. histolytica(pathogenic) and E. dispar (nonpathogenic), and HK-PAGE of culture isolates can differentiate between them.

Sparfloxacin in the treatment of purulent sinusitis-a multicentric study in Indian patients

Sparfloxacin, a new quinolone antibacterial was used to treat one hundred and thirty two patients with acute purulent sinusitis, at a dosage of 400 mg on the first day followed by 200 mg once daily for a further four days. A clinically successful outcome (defined as disappearance of nasal discharge, fever, pain, tenderness over the sinuses and headache) was recorded in 122 ( 95.3%) patients. Sparfloxacin was well tolerated. Fourteen adverse experiences were reported in 7 patients ( 5.3%); they were mainly gastrointestinal and mild. No phototoxic or cardiological adverse events occurred. An unusual feature was that Staphylococcus aureus and Pseudomonas spp. were the most common bacterial species isolated from middle meatal was of patients in this study.

Effect of bacterial association on virulence of Entamoeba histolytica to baby hamster kidney cell monolayers

Axenic E. histolytica trophozoite strain NIH:200 and HMI:IMSS when co-associated with aerobic bacteria Escherichia coli strain K12 and serotype 056 showed marked increase in virulence as observed by destruction of baby hamster kidney (BHK) monolayers. However, when incubated with anaerobic bacterial strains Clostridium perfringens and Bacteroides fragilis virulence remained unaltered. Further, adherence of E. histolytica to BHK monolayer was found to be mediated by N-acetyl-D-galactosamine.

Lack of in vitro lymphoproliferative response to hepatitis B surface antigen in healthy vaccine recipients

A majority of HBsAg vaccine recipients show good anti-HBs antibody responses but poor antigen specific lymphoproliferative responses. We investigated the basis for this poor in vitro antigen specific proliferative responsiveness in vaccinees who had received the standard three dose schedule (0, 1 and 6 months) of plasma derived HBsAg vaccine. Peripheral blood mononuclear cells (PBMC) from 26 of 29 (89.7%) vaccinees failed to show lymphoproliferative responses to HBsAg in spite of having a very good anti-HBs antibody response (geometric mean titre 3154 IU/1). The mitogen (phytohaemagglutinin, PHA) and antigen (purified protein derivative, PPD) driven lymphoproliferative responses in these individuals were normal. Addition of exogenous recombinant interleukin-2 (rIL-2) along with HBsAg had no effect in the response to HBsAg in six of nine vaccinees, who were tested six months after the third vaccine dose or in four unvaccinated controls. However, in three vaccinees who did not have lymphoproliferative response to HBsAg alone, addition of exogenous rIL-2 resulted in a synergistic response. These data suggest that HBsAg reactive cells are few in the peripheral circulation of a majority of individuals following the standard three dose schedule of vaccination and addition of exogenous rIL-2 induces a response only in a subgroup of individuals. The inability of HBsAg to induce a T cell proliferative response may have implications for the maintenance of protective immunity and immunological memory following vaccination.

Perinatal lung function measurements and prediction of respiratory problems in infancy

The aim of this study was to determine which lung function test employed in the perinatal period gave the results most significantly associated with respiratory problems in infancy. The ratio of the proportion of time to reach peak tidal expiratory flow to total expiratory time (tPTEF:tE), thoracic gas volume (TGV) and airway resistance (R(aw)) (from which specific conductance (SG(aw)) was calculated) measurements were examined from 85 infants born at or near term. The infants were followed until at least one year of age and described as symptomatic if they wheezed for at least 24 hours. Twenty-three infants were symptomatic in the first year. The symptomatic group, compared to the asymptomatic, had a higher median FRC (p < 0.01) and R(aw) (p < 0.001); their median SG(aw) was lower (p < 0.001). It was possible to obtain tPTEF:tE results from only 61 infants; the median tPTEF:tE did not differ significantly between symptomatic and asymptomatic infants. Logistic regression analysis demonstrated a high R(aw) and FRC, but not a low tPTEF:tE, independently related to positive symptom status. A high R(aw) (>26 cm H2O (1 s(-1))(-1)) was the most sensitive (83%) predictor of subsequent respiratory problems, but all the tests examined had low positive predictive values.

Chronic hepatitis B virus carriers have low lymphoproliferative responses to HBsAg and reduced interleukin-2 synthesis

BACKGROUND

Chronic carriers of hepatitis B virus (HBV) have impairment of lymphoproliferative responses. Recently HBV infection of peripheral blood mononuclear cells (PBMC) has been reported. The defect in the proliferative capacity of carrier PBMC has not been correlated to the presence of HBV in these cells.

METHODS

PBMC of fourteen HBV carriers and 14 healthy individuals were stimulated with phytohemagglutinin (PHA), pokeweed mitogen (PWM) or anti-CD3 for 3 days and with HBsAg and purified protein derivative (PPD) for 6 days. The supernatants of unstimulated and PHA-stimulated PBMC cultures were bioassayed for interleukin-2 (IL-2); the supernatants of unstimulated and lipopolysaccharide (LPS)-stimulated cultures were bioassayed for IL-1. DNA extracted from PBMC was hybridized with a 32P-labeled HBV probe to look for HBV DNA.

RESULTS

HBV carriers' PBMC showed impaired responses to PHA, PWM and anti-CD3. No carrier demonstrated lymphoproliferative response to hepatitis B surface antigen (HBsAg). Seven of eight carriers with impaired HBsAg-specific proliferative responses who were tested for their response to an unrelated antigen showed a positive response to PPD. PBMC from HBV carriers produced similar amounts of IL-1 as normal PBMC on LPS stimulation; however, they produced significantly lower amounts of IL-2 as compared to normal PBMC under both spontaneous and PHA-stimulated conditions. HBV DNA was demonstrable in the PBMC of all fourteen carriers.

CONCLUSIONS

The abnormal immune function found in chronic HBV carriers may be a consequence of replicative viral infection of the mononuclear cells.

Proteinase activity & virulence of Entamoeba histolytica on passage through hamster liver

This study was undertaken to determine the enzymatic differences in the process of increasing the degree of virulence in E. histolytica successively passaged in hamster liver. Substrate gel electrophoresis was used to compare proteinase banding patterns under reducing conditions from whole cell lysates of one axenic E. histolytica (strain HM1:IMSS) and five xenic isolates of the same strain of E. histolytica passaged five times through hamster liver. Trophozoites successively passaged in hamster liver showed in supernatants, major bands in the 56-97 kDa region whereas only the axenic strain produced additional band at 34 KDa. Inoculation of amoebic trophozoites into hamster led to progressive increase in proteinase activity of supernatants as well as increased virulence of amoebae; proteinase activity of amoebae showed an excellent correlation with their virulence. All the infected animals died when activity of proteinase was 0.152 mg of protein.

Manoeuvres to elevate mean airway pressure, effects on blood gases and lung function in children with and without pulmonary pathology

During mechanical ventilation, mean airway pressure (MAP) can be increased by a variety of manoeuvres, for example increasing inspiratory time or elevating the positive end expiratory pressure (PEEP). It seemed likely that the effect on blood gases and lung function of a particular manoeuvre to increase MAP would be influenced by the presence of respiratory pathology and thus the manoeuvre best at improving respiratory status in children with an abnormal chest radiograph appearance would differ from that most efficacious in children without such a problem. The aim of this study was to test that hypothesis. Twenty-two children, median age 15 months (range 2.5 weeks-10 years) were examined. Group 1 (n = 10) had no chest radiograph abnormalities and group 2 (n = 12) lobar collapse and/or consolidation. The patients were studied at baseline settings and at an elevated MAP resulting from (in random order) an increase in inspiratory time (T1), pressure PEEP or peak inspiratory pressure (PIP). In group 1, elevating PIP improved oxygenation and carbon dioxide elimination (P < 0.01) and prolonging T1 improved oxygenation (P < 0.05). In group 2, only raising PEEP significantly improved oxygenation (P < 0.01), but this was associated with carbon dioxide retention (P < 0.01).

CONCLUSION

The presence of lung pathology does influence which manoeuvre should be used to elevate MAP to improve blood gases in the paediatric population.

RNase L dimerization in a mammalian two-hybrid system in response to 2',5'-oligoadenylates

RNase L, a key enzyme in the anti-viral activity of interferons, requires activation by 2',5'-linked oligoadenylates (2-5A) to cleave viral and cellular single-stranded RNA. Here we demonstrate that 2-5A causes formation of stable dimers of RNase L in intact human cells as measured with a mammalian two-hybrid system. Hybrid proteins consisting of the GAL4 DNA binding domain fused to RNase L and the VP16 transactivation domain fused to RNase L were able to associate and drive transcription of a reporter gene, but only after cells were transfected with 2-5A. Several functional forms of 2-5A, such as p3A2'p5'A2'p5'A, were capable of activating transcription in human HeLa cells. In contrast, p3A2'p5'A, which can neither activate nor dimerize RNase L, did not induce gene expression. Evidence for the involvement of the C-terminal region of RNase L in dimerization was obtained by expressing truncated forms of RNase L. These findings describe a convenient, high-throughput screening method for RNase L activators which could lead to the discovery of novel anti-viral and anti-cancer agents.

Vaccination of langur monkeys (Presbytis entellus) against Leishmania donovani with autoclaved L. major plus BCG

The protective potential of killed Leishmania major (ALM) along with BCG was evaluated against L. donovani in Indian langur monkeys in single and triple dose schedules. A delayed protection was observed in monkeys after a single dose schedule of ALM (3 mg)+BCG (3 mg) given intradermally 2 months before intravenous challenge with L. donovani. Triple dose schedule each of 1 mg ALM + 1 mg BCG was more effective. The status remained unchanged until the end of the experiment (approximately 8 months). The study indicates that a combination of ALM + BCG may be a good candidate vaccine for exploiting against human Kala-azar.