The presence of antibodies to lymphotoxin and tumor necrosis factor in normal serum

Monoclonal antibody therapy for Kawasaki disease: a protocol for systematic reviews and meta-analysis

BACKGROUND

Kawasaki disease (KD) is a form of self-limiting vasculitis that causes coronary artery abnormality in children. Based on reports of elevated plasma level of cytokines such as tumor necrosis factor-α in KD patients, clinical trials of monoclonal antibodies that block cytokine cascades have been conducted. However, the studies have revealed contradictory results. The objective of this study is to examine the effectiveness of treatment with monoclonal antibodies for KD patients.

METHODS

Relevant randomized controlled trials (RCTs), cluster RCTs, quasi-RCTs, cross-over trials, and any observational studies (e.g., cohort studies, case-control studies, case series, and case reports) will be included to summarize available evidence both qualitatively and quantitatively. Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and ICUSHI will be searched. We will assess coronary artery and treatment outcomes of the interventions. Two authors will independently screen studies for inclusion and consulting with a third author where necessary to resolve discrepancies. The risk of bias of included studies will be assessed using the Cochrane Collaboration risk of bias tool and quality of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Meta-analysis of the included studies will be conducted using fixed effects or random effects models depending on the degree of between-study heterogeneity. Results will be presented using risk ratios with 95 % confidence interval (CI) for dichotomous outcomes and standardized mean differences with 95 % CI for continuous outcomes.

DISCUSSION

This systematic review and meta-analysis protocol does not require ethical approval. We will disseminate the findings of this systematic review and meta-analysis via publications in peer-reviewed journals.

TRIAL REGISTRATION

PROSPERO CRD42016033079 .

Measurement of cytokines in clinical samples using immunoassays: problems and pitfalls

With the explosion in interest in cytokines and an increasing understanding of their possible involvement in the pathogenesis of many diseases, the number of studies measuring cytokines in body fluids has increased markedly over the last 5 to 10 years. However, it is readily apparent from the literature that the level of awareness of the many factors that can potentially influence the results obtained is very low. Such factors are likely to contribute considerably to the disparities seen among similar types of study. These include assay properties such as standardization and specificity, type of sample and sample handling, and many biological influences such as age, sex, ethnic background, and diurnal rhythmicity. Clearly, it is not possible to control for all these factors, but a minimum evaluation of assays should be carried out as described, including recovery and parallelity studies using relevant samples and the establishment of reproducibility and normal healthy population levels. An awareness of these factors, which is the purpose of this review, may hopefully lead to an improvement in the quality of studies incorporating the measurement of cytokines in clinical samples and should aid in the interpretation of the data.

A comparative study of different enzyme immunosorbent assays for human tumor necrosis factor-alpha

Enzyme immunosorbent assays (ELISA) for human tumor necrosis factor-alpha (TNF-alpha) are available from many companies. Although this cytokine is meanwhile well established in scientific work its detection in human blood still leads often to conflicting results. We studied the analytical performance of three different commercial ELISA (Amersham, Immunotech and Medgenix Diagnostics) in plasma samples of 30 human immunodeficiency virus (HIV) infected individuals. All kits showed significantly different mean concentrations of TNF-alpha in the study population (p < 0.05). Kit A: 30.9 pg/ml +/- 46.6 vs. kit B: 46.9 pg/ml +/- 24.8 vs kit C: 11.8 pg/ml +/- 11.6. Results of assays A and B (r = 0.34) as well as A and C (r = 0.31) were not significantly correlated. A good statistical relation between values was only found for assay B and assay C (r = 0.80. p < 0.001). Three plasma samples were spiked with TNF-alpha standard of the corresponding kit to a final concentration of 200 pg/ml. The detection results of these samples were compared with the variation conceded by the manufacturer. Assay A detected two samples above the corresponding coefficient of intra-assay variation (recovery: 81.8% and 89.2%). All three values obtained with assay B were markedly out of its variation range (recovery: 88.7%, 84.6% and 89.0%) while assay C showed again two results above the intra-assay variation (recovery: 92.1% and 89.6%). In our observations we found relevant differences between commercial ELISA kits of different manufacturers, which made interpretation of TNF-alpha in human plasma samples difficult. Additionally, it should be taken into consideration that plasma specimen may contain cytokine-binding proteins or autoantibodies which are capable of blocking epitopes of TNF-alpha. This may lead to the loss of the necessary immunoreactivity which prevents detection antibodies from recognizing these molecules.

Characterization of naturally occurring autoantibodies against tumour necrosis factor-alpha (TNF-alpha): in vitro function and precise epitope mapping by phage epitope library

Naturally occurring autoantibodies against cytokines exist in the sera of patients with autoimmune diseases as well as in the sera of normal individuals. We report here that affinity-purified autoantibodies against human TNF-alpha from one rheumatoid arthritis (RA) patient inhibited the cytotoxic effect of TNF-alpha on the mouse fibrosarcoma cell line WEHI 164, by 50%. In an attempt to predict the autoantibodies' recognition site on TNF-alpha protein we screened a random nanopeptide phage library with the affinity-purified TNF-alpha autoantibodies. Among 63 random selected clones, 46 clones carried the sequence ASSLLASSP, NSSPYLNTK or PQSPGSSFP. Frequency analysis of the relative occurrence of the 20 amino acids in the nanopeptides displayed by 50 random bacteriophages picked before selection and 63 after selection to bind to TNF-alpha autoantibodies indicated that proline (P < 0.0003) and serine (P < 0.04) are involved in the binding of the autoantibodies to the phages. Furthermore, we demonstrated that three synthetic peptides (ASSLLASSP, NSSPYLNTK and PPLKPVIDE) displayed by the selected phages reduced the binding of the autoantibodies to TNF-alpha protein by 50%. Interestingly, the sera of mice (BALB/c) immunized with phages displaying ASSLLASSP and NSSPYLNTK peptide showed an anti-TNF-alpha response as detected by ELISA. This response was not found in mice immunized with the wild type phage. Thus, the recombinant phages selected from the phage libraries could be used as carrier for immunization, and therefore as a tool for vaccine development. This work sets the stage for experiments designed to isolate ligands for protective antibodies.

Binding of cytokines to pharmaceutically prepared human immunoglobulin

Pharmaceutically prepared IgG, pooled from sera of over 2,000 normal individuals, contained both monomeric and dimeric IgG. Each type of IgG bound 125I-labeled interleukin (IL)-1 alpha, IL-1 beta, IL-6, and tumor necrosis factor (TNF)-alpha. Increased binding to IgG was observed if 125I-IL-1 beta was denatured by heating to 39 degrees C. However, the binding of both nondenatured and denatured 125I-IL-1 beta was not inhibited by unlabeled IL-1 beta. In contrast, binding of 125I-IL-1 alpha, 125I-IL-6, and 125I-TNF alpha was inhibited by the corresponding unlabeled cytokine. Papain-digestion of IgG abolished binding of 125I-TNF alpha but failed to influence the displaceable binding of 125I-IL-1 alpha and 125I-IL-6. 125I-TNF alpha was a mixture of trimeric and monomeric forms, the latter being the predominant form at lower concentrations. The apparent saturability of 125I-TNF alpha was explained by a higher nonspecific binding of monomeric than of trimeric 125I-TNF alpha to IgG. The amounts of cytokine antibodies in IgG preparations would contribute approximately 2 micrograms anti-IL-1 alpha IgG and 1 microgram anti-IL-6 IgG per kg body wt during high dose immune globulin therapy. In conclusion, pharmaceutical preparations of human IgG contain specific and neutralizing, high affinity antibodies against IL-1 alpha and IL-6, but not against TNF alpha or IL-1 beta. There are significant methodological pitfalls that hamper detection of IgG autoantibodies against cytokines.

Capture immunoassay for ruminant tumor necrosis factor-alpha: comparison with bioassay

Monoclonal antibodies and IgG purified from rabbit polyclonal antiserum, raised against recombinant bovine tumor necrosis factor-alpha (TNF-alpha), have been employed in ELISA procedures to quantitate bovine TNF-alpha. These antibodies were potent in neutralizing the biological activity of recombinant as well as natural bovine TNF-alpha. The monoclonal antibodies were used as capture antibodies and were either passively adsorbed or covalently linked to ELISA plates. Polyclonal rabbit anti-TNF IgG was used as the detecting antibody in combination with a biotinylated anti-rabbit serum and a streptavidin-horseradish peroxidase conjugate. The detection limit for recombinant TNF-alpha medium was 10 pg ml-1 and in bovine or ovine serum was 35 pg ml-1. A good correlation was found between the ELISA and the WEHI-164 Clone 13 biologic assay when TNF-alpha was measured in medium containing serum or in serum. This capture ELISA was also capable of detecting ovine, but not porcine. TNF in supernatants from cultures of lipopolysaccharide-stimulated pulmonary alveolar macrophages.

Serum-induced suppression of interferon (IFN) activity. Lack of evidence for the presence of specific autoantibodies to IFN-alpha in normal human sera

IgG antibodies binding to different IFN species have been described in sera of healthy and diseased individuals. Human serum immunoglobulins have also been shown to interfere with IFN bioactivity. To characterize these antibodies, human recombinant IFN-alpha 2A (rIFN-alpha) was radioiodinated, and ligand binding studies were performed in human sera as well as on the human cell line A-549 in the presence of human serum. 125I-rIFN-alpha bound to serum factors of healthy individuals. However, less than 3% of the binding was to IgG and the binding was non-saturable and therefore most likely non-specific. 125I-rIFN-alpha bound to receptors on A-549 cells, and the ligand-receptor complexes appeared to internalize. However, both cell binding and internalization of 125I-rIFN-alpha were independent of the presence of human serum. We conclude that normal human sera do not contain detectable autoantibodies to rIFN-alpha.

Tumor necrosis factor-alpha and interleukin 6 synergistically induce T cell growth

T cells stimulated with phytohemagglutinin are dependent on monocyte-derived helper signals (e.g. interleukin (IL) 6 and IL 1) for their proliferation. In the present study the effect of recombinant tumor necrosis factor alpha (rTNF-alpha) as a helper signal for growth of highly purified peripheral blood human T cells stimulated with phytohemagglutinin was examined. TNF-alpha alone had a weak co-stimulatory effect, while a combination of TNF-alpha and IL 6 provided highly effective synergistic helper signals for T cell proliferation. The effect of TNF-alpha could not be ascribed to secondary induction of IL 1 production. The effect of TNF-alpha on T cell proliferation was also found to be independent of the autocrine T cell growth factors IL 2 and IL 4. This latter points to dissimilarity between IL 1 and TNF-alpha in the mechanism by which each of these two cytokines in combination with IL 6 promotes T cell proliferation. TNF-alpha, IL 6 and IL 1 thus seem to follow different pathways in their function as helper signals in T cell activation.