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Mullane MJ, Thomas HM, Carapetis JR, Lizama C, Billingham W, Cooper MN, Everest C, Sampson CR, Newall N, Pearce S, Lannigan F, McNulty E, Cresp R, Mace AO, Barrow T, Bowen AC. Tonsils at Telethon: developing a standardised collection of tonsil photographs for group A streptococcal (GAS) research. Front Pediatr 2024; 12:1367060. [PMID: 38725980 PMCID: PMC11079290 DOI: 10.3389/fped.2024.1367060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 04/09/2024] [Indexed: 05/12/2024] Open
Abstract
Introduction Group A streptococcus (GAS) infections, such as pharyngitis and impetigo, can lead to rheumatic fever and rheumatic heart disease (RHD). Australian Aboriginal and Torres Strait Islander populations experience high rates of RHD and GAS skin infection, yet rates of GAS pharyngitis are unclear. Anecdotally, clinical presentations of pharyngitis, including tonsillar hypertrophy and sore throat, are uncommon. This study aimed to develop a standardised set of tonsil photographs and determine tonsil size distribution from an urban paediatric population. Methods A prospective cohort of children aged 3-15 years were recruited at the public events "Discover Day" and "Telethon Weekend" (October 2017) in Perth, Western Australia, Australia. Tonsil photographs, symptomatology, and GAS rapid antigen detection tests (RADT) were collected. Tonsil size was graded from the photographs using the Brodsky Grading Scale of tonsillar hypertrophy (Brodsky) by two independent clinicians, and inter-rater reliability calculated. Pharyngitis symptoms and GAS RADT were correlated, and immediate results provided. Results Four hundred and twenty-six healthy children participated in the study over three days. The median age was seven years [interquartile range (IQR) 5.9-9.7 years]. Tonsil photographs were collected for 92% of participants, of which 62% were rated as good-quality photographs and 79% were deemed of adequate quality for assessment by both clinicians. When scored by two independent clinicians, 57% received the same grade. Average Brodsky grades (between clinicians) were 11%, 35%, 28%, 22% and 5% of grades 0,1,2,3 and 4, respectively. There was moderate agreement in grading using photographs, and minimal to weak agreement for signs of infection. Of 394 participants, 8% reported a sore throat. Of 334 GAS RADT performed, <1% were positive. Discussion We report the first standardised use of paediatric tonsil photographs to assess tonsil size in urban-living Australian children. This provides a proof of concept from an urban-living cohort that could be compared with children in other settings with high risk of GAS pharyngitis or rheumatic fever such as remote-living Australian Indigenous populations.
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Affiliation(s)
- Marianne J. Mullane
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
| | - Hannah M. Thomas
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
| | - Jonathan R. Carapetis
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
- Department of Infectious Diseases, Perth Children’s Hospital, Perth, WA, Australia
| | - Catalina Lizama
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
| | - Wesley Billingham
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
| | - Matthew N. Cooper
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
| | - Christine Everest
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
| | - Claudia R. Sampson
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
- Department of Infectious Diseases, Perth Children’s Hospital, Perth, WA, Australia
| | - Nelly Newall
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
| | - Sarah Pearce
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
| | - Francis Lannigan
- Department of Infectious Diseases, Perth Children’s Hospital, Perth, WA, Australia
| | - Eamonn McNulty
- Department of Infectious Diseases, Perth Children’s Hospital, Perth, WA, Australia
| | - Rebecca Cresp
- Department of Infectious Diseases, Perth Children’s Hospital, Perth, WA, Australia
| | - Ariel O. Mace
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
- Department of Infectious Diseases, Perth Children’s Hospital, Perth, WA, Australia
| | - Tina Barrow
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
- School of Medicine, The University of Notre Dame Australia, Fremantle, WA, Australia
| | - Asha C. Bowen
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
- Department of Infectious Diseases, Perth Children’s Hospital, Perth, WA, Australia
- School of Medicine, The University of Notre Dame Australia, Fremantle, WA, Australia
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2
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Pickering J, Sampson C, Mullane M, Sheel M, Barth DD, Lane M, Walker R, Atkinson D, Carapetis JR, Bowen AC. A pilot study to develop assessment tools for Group A Streptococcus surveillance studies. PeerJ 2023; 11:e14945. [PMID: 36935916 PMCID: PMC10022509 DOI: 10.7717/peerj.14945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 02/02/2023] [Indexed: 03/15/2023] Open
Abstract
Introduction Group A Streptococcus (GAS) causes pharyngitis (sore throat) and impetigo (skin sores) GAS pharyngitis triggers rheumatic fever (RF) with epidemiological evidence supporting that GAS impetigo may also trigger RF in Australian Aboriginal children. Understanding the concurrent burden of these superficial GAS infections is critical to RF prevention. This pilot study aimed to trial tools for concurrent surveillance of sore throats and skins sore for contemporary studies of RF pathogenesis including development of a sore throat checklist for Aboriginal families and pharynx photography. Methods Yarning circle conversations and semi-structured interviews were performed with Aboriginal caregivers and used to develop the language and composition of a sore throat checklist. The sore throat story checklist was combined with established methods of GAS pharyngitis and impetigo surveillance (examination, bacteriological culture, rapid antigen detection and serological tests) and new technologies (photography) and used for a pilot cross-sectional surveillance study of Aboriginal children attending their health clinic for a routine appointment. Feasibility, acceptability, and study costs were compiled. Results Ten Aboriginal caregivers participated in the sore-throat yarning circles; a checklist was derived from predominant symptoms and their common descriptors. Over two days, 21 Aboriginal children were approached for the pilot surveillance study, of whom 17 were recruited; median age was 9 years [IQR 5.5-13.5], 65% were female. One child declined throat swabbing and three declined finger pricks; all other surveillance elements were completed by each child indicating high acceptability of surveillance assessments. Mean time for screening assessment was 19 minutes per child. Transport of clinical specimens enabled gold standard microbiological and serological testing for GAS. Retrospective examination of sore throat photography concorded with assessments performed on the day. Conclusion Yarning circle conversations were effective in deriving culturally appropriate sore throat questionnaires for GAS pharyngitis surveillance. New and established tools were feasible, practical and acceptable to participants and enable surveillance to determine the burden of superficial GAS infections in communities at high risk of RF. Surveillance of GAS pharyngitis and impetgio in remote Australia informs primary RF prevention with potential global translation.
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Affiliation(s)
- Janessa Pickering
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, Australia., Perth, Australia
| | - Claudia Sampson
- School of Medicine, University of Western Australia, Crawley, Perth, Australia
| | - Marianne Mullane
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, Australia., Perth, Australia
| | - Meru Sheel
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- National Centre for Epidemiology and Population Health, ANU College of Health and Medicine, The Australian National University, Acton, ACT, Canberra, Australia
| | - Dylan D. Barth
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, Australia., Perth, Australia
- Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Perth, Western Australia
| | - Mary Lane
- Broome Regional Aboriginal Medical Service, Broome, Australia
| | - Roz Walker
- School of Population and Global Health, University of Western Australia, Perth, Australia
- Ngank Yira Institute for Change, Murdoch University, Perth, Australia
| | - David Atkinson
- School of Medicine, University of Western Australia, Crawley, Perth, Australia
| | - Jonathan R. Carapetis
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, Australia., Perth, Australia
- School of Medicine, University of Western Australia, Crawley, Perth, Australia
- Department of Infectious Diseases, Perth Children’s Hospital, Nedlands, Perth, Australia
| | - Asha C. Bowen
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, Australia., Perth, Australia
- School of Medicine, University of Western Australia, Crawley, Perth, Australia
- Department of Infectious Diseases, Perth Children’s Hospital, Nedlands, Perth, Australia
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
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3
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Arshad V, Talha KM, Baddour LM. Epidemiology of infective endocarditis: novel aspects in the twenty-first century. Expert Rev Cardiovasc Ther 2022; 20:45-54. [PMID: 35081845 DOI: 10.1080/14779072.2022.2031980] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
INTRODUCTION The epidemiology of infective endocarditis (IE) in this millennium has changed with emergence of new risk factors and reemergence of others. This, coupled with modifications in national guidelines in the setting of a pandemic, prompted an address of the topic. AREAS COVERED Our goal is to provide a contemporary review of IE epidemiology considering changing incidence of rheumatic heart disease (RHD), cardiac device implantation, and injection drug use (IDU), with SARS-CoV-2 pandemic as the backdrop. METHODS PubMed and Google Scholar were used to identify studies of interest. EXPERT OPINION Our experience over the past two decades verifies the notion that there is not one 'textbook' profile of IE. Multiple factors have dramatically impacted IE epidemiology, and these factors differ, based, in part on geography. RHD has declined in many areas of the world, whereas implanted cardiovascular devices-related IE has grown exponentially. Perhaps the most influential, at least in areas of the United States, is injection drug use complicating the opioid epidemic. Healthy younger individuals contracting a potentially life-threatening infection has been tragic. In the past year, epidemiological changes due to the COVID-19 pandemic have also occurred. No doubt, changes will characterize IE in the future and serial review of the topic is warranted.
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Affiliation(s)
- Verda Arshad
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Khawaja M Talha
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Larry M Baddour
- Department of Cardiovascular Disease, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA.,Division of Infectious Diseases, Department of Medicine, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA
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Edwards JG, Barry M, Essam D, Elsayed M, Abdulkarim M, Elhossein BMA, Mohammed ZHA, Elnogomi A, Elfaki ASE, Elsayed A, Chang AY. Health system and patient-level factors serving as facilitators and barriers to rheumatic heart disease care in Sudan. Glob Health Res Policy 2021; 6:35. [PMID: 34598719 PMCID: PMC8486630 DOI: 10.1186/s41256-021-00222-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 09/15/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Rheumatic heart disease (RHD) remains a leading cause of morbidity and mortality in Sub-Saharan Africa despite widely available preventive therapies such as prophylactic benzathine penicillin G (BPG). In this study, we sought to characterize facilitators and barriers to optimal RHD treatment with BPG in Sudan. METHODS We conducted a mixed-methods study, collecting survey data from 397 patients who were enrolled in a national RHD registry between July and November 2017. The cross-sectional surveys included information on demographics, healthcare access, and patient perspectives on treatment barriers and facilitators. Factors associated with increased likelihood of RHD treatment adherence to prophylactic BPG were assessed by using adjusted logistic regression. These data were enhanced by focus group discussions with 20 participants, to further explore health system factors impacting RHD care. RESULTS Our quantitative analysis revealed that only 32% of the study cohort reported optimal prophylaxis adherence. Younger age, reduced primary RHD healthcare facility wait time, perception of adequate health facility staffing, increased treatment costs, and high patient knowledge about RHD were significantly associated with increased odds of treatment adherence. Qualitative data revealed significant barriers to RHD treatment arising from health services factors at the health system level, including lack of access due to inadequate healthcare staffing, lack of faith in local healthcare systems, poor ancillary services, and patient lack of understanding of disease. Facilitators of RHD treatment included strong interpersonal support. CONCLUSIONS Multiple patient and system-level barriers to RHD prophylaxis adherence were identified in Khartoum, Sudan. These included patient self-efficacy and participant perception of healthcare facility quality. Strengthening local health system infrastructure, while enhancing RHD patient education, may help to improve treatment adherence in this vulnerable population.
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Affiliation(s)
- Jeffrey G. Edwards
- Stanford University School of Medicine, Stanford, CA USA
- Present Address: Boston Medical Center, Department of Pediatrics, Boston University School of Medicine, Residency Program Coordinator, c/o Jeffrey Edwards, 801 Albany, St Boston, MA 02119-2598 USA
- Boston Children’s Hospital, Harvard Medical School, Boston, MA USA
| | - Michele Barry
- Department of Medicine, Stanford University, Stanford, CA USA
- Center for Innovation in Global Health, Stanford University, Stanford, CA USA
| | - Dary Essam
- Alazhari Health Research Center, Alzaeim Alazhari University, Khartoum, Sudan
| | - Mohammed Elsayed
- Alazhari Health Research Center, Alzaeim Alazhari University, Khartoum, Sudan
| | | | | | - Zahia H. A. Mohammed
- Faculty of Medicine, Alzaeim Alazhari University, Khartoum, Sudan
- Department of Psychiatry, Alzaeim Alazhari University Khartoum, Khartoum, Sudan
| | | | - Amna S. E. Elfaki
- Alazhari Health Research Center, Alzaeim Alazhari University, Khartoum, Sudan
| | - Ahmed Elsayed
- Alazhari Health Research Center, Alzaeim Alazhari University, Khartoum, Sudan
| | - Andrew Y. Chang
- Department of Medicine, Stanford University, Stanford, CA USA
- Center for Innovation in Global Health, Stanford University, Stanford, CA USA
- Cardiovascular Institute, Stanford University, Stanford, CA USA
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5
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Nevagi RJ, Dai W, Khalil ZG, Hussein WM, Capon RJ, Skwarczynski M, Toth I. Self-assembly of trimethyl chitosan and poly(anionic amino acid)-peptide antigen conjugate to produce a potent self-adjuvanting nanovaccine delivery system. Bioorg Med Chem 2019; 27:3082-3088. [PMID: 31176567 DOI: 10.1016/j.bmc.2019.05.033] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 05/15/2019] [Accepted: 05/20/2019] [Indexed: 12/13/2022]
Abstract
Short peptides derived from virulent pathogen proteins are promising antigens for the development of vaccines against infectious diseases. However, in order to mimic the danger signals associated with natural infection and stimulate an adaptive immune response, peptide antigens must be co-delivered with immune adjuvants. In this study, a group A streptococcus (GAS) M-protein derived B-cell epitope: J8, and universal T-helper epitope P25 containing peptides, were chemically coupled with different anionic amino acid-based polymers. The poly(anionic amino acid)-peptide antigen conjugates were mixed with trimethyl chitosan (TMC) to produce self-adjuvanting nanoparticulate vaccine candidates. TMC from two different sources were used to analyse their effect on immunogenicity. The nanoparticles produced from a peptide modified with 10 residues of polyglutamic acid and fungal TMC (NP5) stimulated production of the highest levels of serum antibodies in outbred mice. These antibodies were opsonic against all clinical GAS isolates tested.
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Affiliation(s)
- Reshma J Nevagi
- School of Chemistry and Molecular Biosciences, The University of Queensland, St. Lucia, QLD 4072, Australia
| | - Wei Dai
- School of Chemistry and Molecular Biosciences, The University of Queensland, St. Lucia, QLD 4072, Australia
| | - Zeinab G Khalil
- Institute of Molecular Biosciences, The University of Queensland, St. Lucia, QLD 4072, Australia
| | - Waleed M Hussein
- School of Chemistry and Molecular Biosciences, The University of Queensland, St. Lucia, QLD 4072, Australia; Helwan University, Pharmaceutical Organic Chemistry Department, Faculty of Pharmacy, Ein Helwan, Helwan 11795, Egypt
| | - Robert J Capon
- Institute of Molecular Biosciences, The University of Queensland, St. Lucia, QLD 4072, Australia
| | - Mariusz Skwarczynski
- School of Chemistry and Molecular Biosciences, The University of Queensland, St. Lucia, QLD 4072, Australia
| | - Istvan Toth
- School of Chemistry and Molecular Biosciences, The University of Queensland, St. Lucia, QLD 4072, Australia; Institute of Molecular Biosciences, The University of Queensland, St. Lucia, QLD 4072, Australia; School of Pharmacy, The University of Queensland, Woolloongabba, QLD 4102, Australia.
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6
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Abstract
The clinico-epidemiological features of diseases caused by group A streptococci (GAS) is presented through the lens of the ecology, population genetics, and evolution of the organism. The serological targets of three typing schemes (M, T, SOF) are themselves GAS cell surface proteins that have a myriad of virulence functions and a diverse array of structural forms. Horizontal gene transfer expands the GAS antigenic cell surface repertoire by generating numerous combinations of M, T, and SOF antigens. However, horizontal gene transfer of the serotype determinant genes is not unconstrained, and therein lies a genetic organization that may signify adaptations to a narrow ecological niche, such as the primary tissue reservoirs of the human host. Adaptations may be further shaped by selection pressures such as herd immunity. Understanding the molecular evolution of GAS on multiple levels-short, intermediate, and long term-sheds insight on mechanisms of host-pathogen interactions, the emergence and spread of new clones, rational vaccine design, and public health interventions.
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7
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Gandhi GD, Krishnamoorthy N, Motal UMA, Yacoub M. Towards developing a vaccine for rheumatic heart disease. Glob Cardiol Sci Pract 2017; 2017:e201704. [PMID: 28971103 PMCID: PMC5621712 DOI: 10.21542/gcsp.2017.4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Rheumatic heart disease (RHD) is the most serious manifestations of rheumatic fever, which is caused by group A Streptococcus (GAS or Streptococcus pyogenes) infection. RHD is an auto immune sequelae of GAS pharyngitis, rather than the direct bacterial infection of the heart, which leads to chronic heart valve damage. Although antibiotics like penicillin are effective against GAS infection, improper medical care such as poor patient compliance, overcrowding, poverty, and repeated exposure to GAS, leads to acute rheumatic fever and RHD. Thus, efforts have been put forth towards developing a vaccine. However, a potential global vaccine is yet to be identified due to the widespread diversity of S. pyogenes strains and cross reactivity of streptococcal proteins with host tissues. In this review, we discuss the available vaccine targets of S. pyogenes and the significance of in silico approaches in designing a vaccine for RHD.
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Affiliation(s)
- Geethanjali Devadoss Gandhi
- Division of Cardiovascular Research, Sidra Medical and Research Center, Qatar Foundation, Doha, Qatar.,Division of Experimental Genetics, Sidra Medical and Research Center, Doha, Qatar
| | - Navaneethakrishnan Krishnamoorthy
- Division of Cardiovascular Research, Sidra Medical and Research Center, Qatar Foundation, Doha, Qatar.,Division of Experimental Genetics, Sidra Medical and Research Center, Doha, Qatar.,Heart Science Centre, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Ussama M Abdel Motal
- Division of Cardiovascular Research, Sidra Medical and Research Center, Qatar Foundation, Doha, Qatar
| | - Magdi Yacoub
- Division of Cardiovascular Research, Sidra Medical and Research Center, Qatar Foundation, Doha, Qatar.,Heart Science Centre, National Heart and Lung Institute, Imperial College London, London, United Kingdom
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8
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Differing Efficacies of Lead Group A Streptococcal Vaccine Candidates and Full-Length M Protein in Cutaneous and Invasive Disease Models. mBio 2016; 7:mBio.00618-16. [PMID: 27302756 PMCID: PMC4916377 DOI: 10.1128/mbio.00618-16] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Group A Streptococcus (GAS) is an important human pathogen responsible for both superficial infections and invasive diseases. Autoimmune sequelae may occur upon repeated infection. For this reason, development of a vaccine against GAS represents a major challenge, since certain GAS components may trigger autoimmunity. We formulated three combination vaccines containing the following: (i) streptolysin O (SLO), interleukin 8 (IL-8) protease (Streptococcus pyogenes cell envelope proteinase [SpyCEP]), group A streptococcal C5a peptidase (SCPA), arginine deiminase (ADI), and trigger factor (TF); (ii) the conserved M-protein-derived J8 peptide conjugated to ADI; and (iii) group A carbohydrate lacking the N-acetylglucosamine side chain conjugated to ADI. We compared these combination vaccines to a “gold standard” for immunogenicity, full-length M1 protein. Vaccines were adjuvanted with alum, and mice were immunized on days 0, 21, and 28. On day 42, mice were challenged via cutaneous or subcutaneous routes. High-titer antigen-specific antibody responses with bactericidal activity were detected in mouse serum samples for all vaccine candidates. In comparison with sham-immunized mice, all vaccines afforded protection against cutaneous challenge. However, only full-length M1 protein provided protection in the subcutaneous invasive disease model. This set of experiments demonstrates the inherent variability of mouse models for the characterization of GAS vaccine candidate protective efficacy. Such variability poses an important challenge for GAS vaccine development, as advancement of candidates to human clinical trials requires strong evidence of efficacy. This study highlights the need for an open discussion within the field regarding standardization of animal models for GAS vaccine development.
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9
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Pandey M, Mortensen R, Calcutt A, Powell J, Batzloff MR, Dietrich J, Good MF. Combinatorial Synthetic Peptide Vaccine Strategy Protects against Hypervirulent CovR/S Mutant Streptococci. THE JOURNAL OF IMMUNOLOGY 2016; 196:3364-74. [PMID: 26969753 DOI: 10.4049/jimmunol.1501994] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 02/16/2016] [Indexed: 11/19/2022]
Abstract
Cluster of virulence responder/sensor (CovR/S) mutant group A streptococci (GAS) are serious human pathogens of multiple M protein strains that upregulate expression of virulence factors, including the IL-8 proteaseStreptococcus pyogenescell envelope proteinase (SpyCEP), thus blunting neutrophil-mediated killing and enabling ingress of bacteria from a superficial wound to deep tissue. We previously showed that a combination vaccine incorporating J8-DT (conserved peptide vaccine from the M protein) and a recombinant SpyCEP fragment protects against CovR/S mutants. To enhance the vaccine's safety profile, we identified a minimal epitope (S2) that was the target for anti-SpyCEP Abs that could protect IL-8 from SpyCEP-mediated proteolysis. Abs from healthy humans and from mice experimentally infected with GAS also recognized S2, albeit at low titers. Native SpyCEP may be poorly immunogenic (cryptic or subdominant), and it would be to the organism's advantage if the host did not induce a strong Ab response against it. However, S2 conjugated to diphtheria toxoid is highly immunogenic and induces Abs that recognize and neutralize SpyCEP. Hence, we describe a two-component peptide vaccine that induces Abs (anti-S2) that protect IL-8 from proteolysis and other Abs (anti-J8) that cause strain-independent killing in the presence of neutrophils. We show that either component alone is ineffectual in preventing skin infection and bacteremia due to CovR/S mutants but that the combination induces complete protection. This protection correlated with a significant influx of neutrophils to the infection site. The data strongly suggest that the lack of natural immunity to hypervirulent GAS strains in humans could be rectified by this combination vaccine.
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Affiliation(s)
- Manisha Pandey
- Institute for Glycomics, Griffith University, Gold Coast Campus, Southport, Queensland 4222, Australia;
| | - Rasmus Mortensen
- Department of Infectious Disease Immunology, Statens Serum Institut, 2300 Copenhagen, Denmark; and Department of Immunology and Microbiology, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Ainslie Calcutt
- Institute for Glycomics, Griffith University, Gold Coast Campus, Southport, Queensland 4222, Australia
| | - Jessica Powell
- Institute for Glycomics, Griffith University, Gold Coast Campus, Southport, Queensland 4222, Australia
| | - Michael R Batzloff
- Institute for Glycomics, Griffith University, Gold Coast Campus, Southport, Queensland 4222, Australia
| | - Jes Dietrich
- Department of Infectious Disease Immunology, Statens Serum Institut, 2300 Copenhagen, Denmark; and
| | - Michael F Good
- Institute for Glycomics, Griffith University, Gold Coast Campus, Southport, Queensland 4222, Australia;
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10
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van Sorge NM, Cole JN, Kuipers K, Henningham A, Aziz RK, Kasirer-Friede A, Lin L, Berends ETM, Davies MR, Dougan G, Zhang F, Dahesh S, Shaw L, Gin J, Cunningham M, Merriman JA, Hütter J, Lepenies B, Rooijakkers SHM, Malley R, Walker MJ, Shattil SJ, Schlievert PM, Choudhury B, Nizet V. The classical lancefield antigen of group a Streptococcus is a virulence determinant with implications for vaccine design. Cell Host Microbe 2015; 15:729-740. [PMID: 24922575 DOI: 10.1016/j.chom.2014.05.009] [Citation(s) in RCA: 96] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Revised: 04/15/2014] [Accepted: 04/29/2014] [Indexed: 12/19/2022]
Abstract
Group A Streptococcus (GAS) is a leading cause of infection-related mortality in humans. All GAS serotypes express the Lancefield group A carbohydrate (GAC), comprising a polyrhamnose backbone with an immunodominant N-acetylglucosamine (GlcNAc) side chain, which is the basis of rapid diagnostic tests. No biological function has been attributed to this conserved antigen. Here we identify and characterize the GAC biosynthesis genes, gacA through gacL. An isogenic mutant of the glycosyltransferase gacI, which is defective for GlcNAc side-chain addition, is attenuated for virulence in two infection models, in association with increased sensitivity to neutrophil killing, platelet-derived antimicrobials in serum, and the cathelicidin antimicrobial peptide LL-37. Antibodies to GAC lacking the GlcNAc side chain and containing only polyrhamnose promoted opsonophagocytic killing of multiple GAS serotypes and protected against systemic GAS challenge after passive immunization. Thus, the Lancefield antigen plays a functional role in GAS pathogenesis, and a deeper understanding of this unique polysaccharide has implications for vaccine development.
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Affiliation(s)
- Nina M van Sorge
- Department of Pediatrics, University of California San Diego, La Jolla, CA 92093, USA.,Medical Microbiology, University Medical Center Utrecht,3584 CX Utrecht, The Netherlands
| | - Jason N Cole
- Department of Pediatrics, University of California San Diego, La Jolla, CA 92093, USA.,Australian Infectious Diseases Research Centre, School of Chemistry and Molecular Biosciences, The University of Queensland, St. Lucia, Queensland,QLD 4072, Australia
| | - Kirsten Kuipers
- Department of Pediatrics, University of California San Diego, La Jolla, CA 92093, USA
| | - Anna Henningham
- Department of Pediatrics, University of California San Diego, La Jolla, CA 92093, USA
| | - Ramy K Aziz
- Department of Bioengineering, University of California San Diego, La Jolla, CA 92093, USA.,Department of Microbiology and Immunology, Faculty of Pharmacy, Cairo University,11562 Cairo, Egypt
| | - Ana Kasirer-Friede
- Department of Medicine, University of California San Diego, La Jolla, CA 92093, USA
| | - Leo Lin
- Department of Pediatrics, University of California San Diego, La Jolla, CA 92093, USA
| | - Evelien T M Berends
- Medical Microbiology, University Medical Center Utrecht,3584 CX Utrecht, The Netherlands
| | - Mark R Davies
- Australian Infectious Diseases Research Centre, School of Chemistry and Molecular Biosciences, The University of Queensland, St. Lucia, Queensland,QLD 4072, Australia.,The Wellcome Trust Sanger Institute, The Wellcome Trust Genome Campus, Hinxton, CB10 1SA,United Kingdom
| | - Gordon Dougan
- The Wellcome Trust Sanger Institute, The Wellcome Trust Genome Campus, Hinxton, CB10 1SA,United Kingdom
| | - Fan Zhang
- Division of Infectious Diseases, Boston Children's Hospital, Boston, MA 02115, USA
| | - Samira Dahesh
- Department of Pediatrics, University of California San Diego, La Jolla, CA 92093, USA
| | - Laura Shaw
- Department of Pediatrics, University of California San Diego, La Jolla, CA 92093, USA
| | - Jennifer Gin
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, CA 92093, USA
| | - Madeleine Cunningham
- Department of Microbiology and Immunology, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | - Joseph A Merriman
- Department of Microbiology, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA
| | - Julia Hütter
- Max Planck Institute of Colloids and Interfaces, Department of Biomolecular Systems, 14476 Potsdam, Germany.,Freie Universität Berlin, Institute of Chemistry and Biochemistry, Department of Biology, Chemistry and Pharmacy, 14195 Berlin, Germany
| | - Bernd Lepenies
- Max Planck Institute of Colloids and Interfaces, Department of Biomolecular Systems, 14476 Potsdam, Germany.,Freie Universität Berlin, Institute of Chemistry and Biochemistry, Department of Biology, Chemistry and Pharmacy, 14195 Berlin, Germany
| | - Suzan H M Rooijakkers
- Medical Microbiology, University Medical Center Utrecht,3584 CX Utrecht, The Netherlands
| | - Richard Malley
- Division of Infectious Diseases, Boston Children's Hospital, Boston, MA 02115, USA
| | - Mark J Walker
- Australian Infectious Diseases Research Centre, School of Chemistry and Molecular Biosciences, The University of Queensland, St. Lucia, Queensland,QLD 4072, Australia
| | - Sanford J Shattil
- Department of Medicine, University of California San Diego, La Jolla, CA 92093, USA
| | - Patrick M Schlievert
- Department of Microbiology, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA
| | - Biswa Choudhury
- Glycobiology Research and Training Center, University of California San Diego, La Jolla, CA 92093, USA
| | - Victor Nizet
- Department of Pediatrics, University of California San Diego, La Jolla, CA 92093, USA.,Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, CA 92093, USA.,Glycobiology Research and Training Center, University of California San Diego, La Jolla, CA 92093, USA
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11
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Pandey M, Langshaw E, Hartas J, Lam A, Batzloff MR, Good MF. A Synthetic M Protein Peptide Synergizes with a CXC Chemokine Protease To Induce Vaccine-Mediated Protection against Virulent Streptococcal Pyoderma and Bacteremia. THE JOURNAL OF IMMUNOLOGY 2015; 194:5915-25. [DOI: 10.4049/jimmunol.1500157] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Accepted: 04/19/2015] [Indexed: 12/22/2022]
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12
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Zaman M, Chandrudu S, Giddam AK, Reiman J, Skwarczynski M, McPhun V, Moyle PM, Batzloff MR, Good MF, Toth I. Group A Streptococcal vaccine candidate: contribution of epitope to size, antigen presenting cell interaction and immunogenicity. Nanomedicine (Lond) 2014; 9:2613-24. [DOI: 10.2217/nnm.14.190] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Aim: Utilize lipopeptide vaccine delivery system to develop a vaccine candidate against Group A Streptococcus. Materials & methods: Lipopeptides synthesized by solid-phase peptide synthesis-bearing carboxyl (C)-terminal and amino (N)-terminal Group A Streptococcus peptide epitopes. Nanoparticles formed were evaluated in vivo. Results: Immune responses were induced in mice without additional adjuvant. We demonstrated for the first time that incorporation of the C-terminal epitope significantly enhanced the N-terminal epitope-specific antibody response and correlated with forming smaller nanoparticles. Antigen-presenting cells had increased uptake and maturation by smaller, more immunogenic nanoparticles. Antibodies raised by vaccination recognized isolates. Conclusion: Demonstrated the lipopeptidic nanoparticles to induce an immune response which can be influenced by the combined effect of epitope choice and size.
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Affiliation(s)
- Mehfuz Zaman
- School of Chemistry & Molecular Biosciences, The University of Queensland, St. Lucia, Australia
- Institute for Glycomics, Griffith University, Gold Coast, Australia
| | - Saranya Chandrudu
- School of Chemistry & Molecular Biosciences, The University of Queensland, St. Lucia, Australia
| | - Ashwini K Giddam
- School of Chemistry & Molecular Biosciences, The University of Queensland, St. Lucia, Australia
| | - Jennifer Reiman
- Institute for Glycomics, Griffith University, Gold Coast, Australia
| | - Mariusz Skwarczynski
- School of Chemistry & Molecular Biosciences, The University of Queensland, St. Lucia, Australia
| | - Virginia McPhun
- Institute for Glycomics, Griffith University, Gold Coast, Australia
| | - Peter M Moyle
- School of Chemistry & Molecular Biosciences, The University of Queensland, St. Lucia, Australia
- School of Pharmacy, The University of Queensland, Woolloongabba, Australia
| | | | - Michael F Good
- Institute for Glycomics, Griffith University, Gold Coast, Australia
| | - Istvan Toth
- School of Chemistry & Molecular Biosciences, The University of Queensland, St. Lucia, Australia
- School of Pharmacy, The University of Queensland, Woolloongabba, Australia
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13
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Guilherme L, Postol E, Ferreira FM, DeMarchi LMF, Kalil J. StreptInCor: a model of anti-Streptococcus pyogenes vaccine reviewed. AUTO- IMMUNITY HIGHLIGHTS 2013; 4:81-5. [PMID: 26000146 PMCID: PMC4389027 DOI: 10.1007/s13317-013-0053-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Accepted: 07/13/2013] [Indexed: 11/25/2022]
Abstract
Streptococcus pyogenes infections remain a health problem in multiple countries because of poststreptococcal sequelae, such as rheumatic fever and rheumatic heart disease. The epidemiological growth of streptococcal diseases in undeveloped and developing countries has encouraged many groups to study vaccine candidates for preventing group A streptococcus infections. We developed a vaccine epitope (StreptInCor) composed of 55 amino acid residues of the C-terminal portion of the M protein that encompasses both T and B cell protective epitopes. Using human blood samples, we showed that the StreptInCor epitope is recognized by individuals bearing different HLA class II molecules and could be considered a universal vaccine epitope. In addition, the StreptInCor molecular structure was solved by nuclear magnetic resonance spectroscopy, and a series of structural stability experiments was performed to elucidate its folding/unfolding mechanism. Using BALB-c and HLA class II transgenic mice, we evaluated the immune response over an extended period and found that StreptInCor was able to induce a robust immune response in both models. No cross-reaction was observed against cardiac proteins. The safety of the vaccine epitope was evaluated by analyzing histopathology, and no autoimmune or pathological reactions were observed in the heart or other organs. Vaccinated BALB/c mice challenged with a virulent strain of S. pyogenes had 100 % survival over 30 days. Taking all results into account, StreptInCor could be a safe and effective vaccine against streptococcus-induced disease.
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Affiliation(s)
- Luiza Guilherme
- Heart Institute (InCor), School of Medicine, University of São Paulo, São Paulo, Brazil
- Institute for Immunology Investigation, National Institute of Science and Technology, University of São Paulo, São Paulo, Brazil
- Laboratório de Imunologia, Instituto do Coração (HC-FMUSP), Av. Dr. Eneas de Carvalho Aguiar, 44, São Paulo, SP 05403–903 Brazil
| | - Edilberto Postol
- Heart Institute (InCor), School of Medicine, University of São Paulo, São Paulo, Brazil
- Institute for Immunology Investigation, National Institute of Science and Technology, University of São Paulo, São Paulo, Brazil
| | - Frederico Moraes Ferreira
- Heart Institute (InCor), School of Medicine, University of São Paulo, São Paulo, Brazil
- Institute for Immunology Investigation, National Institute of Science and Technology, University of São Paulo, São Paulo, Brazil
| | - Lea M. F. DeMarchi
- Heart Institute (InCor), School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Jorge Kalil
- Heart Institute (InCor), School of Medicine, University of São Paulo, São Paulo, Brazil
- Institute for Immunology Investigation, National Institute of Science and Technology, University of São Paulo, São Paulo, Brazil
- Clinical Immunology and Allergy Division, School of Medicine, University of São Paulo, São Paulo, Brazil
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14
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Position statement of the World Heart Federation on the prevention and control of rheumatic heart disease. Nat Rev Cardiol 2013; 10:284-92. [DOI: 10.1038/nrcardio.2013.34] [Citation(s) in RCA: 172] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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