Use of tetanus toxoid for testing cell-mediated immunity

Validation of a Candida albicans delayed-type hypersensitivity (DTH) model in female juvenile rats for use in immunotoxicity assessments

Establishing an in vivo cell-mediated immunity (CMI) assay, such as the delayed-type hypersensitivity (DTH) assay, has been identified as an important gap and recommended to receive highest priority for new model development in several workshops on developmental immunotoxicity. A Candida albicans DTH model has recently been developed that has the advantage over other DTH models, which use alternative sensitizing antigens, in that antigen-specific antibodies, which may interfere with the assay, are not produced. In addition, the in vivo C. albicans DTH model was demonstrated to be more sensitive in detecting immunosuppression than DTH models using keyhole limpet hemocyanin (KLH) or sheep red blood cells as antigens, as well as some ex vivo CMI assays. While KLH and sheep red blood cells are non-physiological immunogens, C. albicans is an important human pathogen. The present studies were conducted in order to optimize and validate the C. albicans DTH model for use in developmental immunotoxicity studies using juvenile rats. Three known immunosuppressive compounds with different mechanisms of action were tested in this model, cyclosprorin A (CsA), cyclophosphamide (CPS), and dexamethasone (DEX). Animals were sensitized with formalin-fixed C. albicans on postnatal day (PND) 28 and challenged with chitosan on PND 38. Drug was administered beginning on PND 23 and continued until PND 37. Exposure to each of the three immunotoxicants resulted in statistically significant decreases in the DTH response to C. albicans-derived chitosan. Decreases in footpad swelling were observed at ≥10 mg CsA/kg/day, ≥5 mg CPS/kg/day, and ≥0.03 mg DEX/kg/day. These results demonstrate that the C. albicans DTH model, optimized for use in juvenile rats, can be used to identify immunotoxic compounds, and fills the need for a sensitive in vivo CMI model for assessments of developmental immunotoxicity. Abbreviations Ab, antibody APC, antigen presenting cell BSA, bovine serum albumin C. albicans, Candida albicans CI, challenge interval CMI, cell-mediated immunity CO, challenge only CPS, cyclophosphamide CsA, cyclosporin A CTL, cytotoxic T lymphocyte DEX, dexamethasone DIT, developmental immunotoxicity DTH, delayed-type hypersensitivity ip, intraperitoneal KLH, keyhole limpet hemocyanin MLR, mixed lymphocyte reaction OVA, ovalbumin PBS, phosphate-buffered saline PND, postnatal day sc, subcutaneous SEM, standard error of the mean SRBC, sheep red blood cells.

Quantifying monocyte infiltration in response to intradermal tetanus toxoid injection

Aims: To characterize monocyte response in a delayed-type hypersensitivity reaction to intradermal tetanus toxoid (TT) injection. Materials & methods: Men with positive serum anti-tetanus titers were stratified by last TT vaccination. Subjects were administered three intradermal injections of TT and one saline control on the same side of the back. Skin biopsies were taken post-injection. After 2 weeks, the procedure was repeated on the contralateral side. Results: Men who received TT booster vaccination 1 month before the study showed greater reproducibility and lower variability in monocyte responses than those who were not revaccinated. Monocyte concentration in subjects re-vaccinated within 1 month of study start appeared maximal at 48 h post-injection. Conclusion: This assay represents a novel approach that allows for quantification of dermal monocyte/macrophage influx. This clinical methodology has potential utility in the pharmacodynamic evaluation of therapies targeting inflammatory disorders, which involve monocyte tissue recruitment, like the delayed-type hypersensitivity response.

Validation of the Candida albicans delayed-type hypersensitivity (DTH) model in the female B₆C₃F₁ mouse for use in immunotoxicological investigations

Although numerous models are used to evaluate the immunotoxic effects of xenobiotics on cell-mediated immunity (CMI), no holistic model for evaluating such effects on the delayed-type hypersensitivity (DTH) response has gained widespread acceptance. Due to a lack of interference from antigen-specific antibody production, the Candida albicans DTH model has recently been demonstrated to be a more appropriate model for assessing effects on CMI than other DTH models that utilize different sensitizing antigens, such as sheep erythrocytes (SRBC) or keyhole limpet hemocyanin (KLH). The present studies were conducted to validate the C. albicans DTH model for its ability to detect suppression (or the lack thereof) of CMI following exposure for 28 days to well-characterized immunosuppressive drugs, each having a different mechanism of action. The compounds evaluated included azathioprine (AZA), cyclophosphamide (CPS), cyclosporin A (CSA), dexamethasone (DEX), and the non-immunotoxic compound, benzo[e]pyrene (B[e]P). Exposure to each of the four known immunotoxicants resulted in statistically significant decreases in the DTH response to C. albicans. Footpad swelling was decreased following exposure to AZA at ≥ 20 mg/kg but not at 10 mg/kg, CPS at ≥ 10 mg/kg but not at 5 mg/kg, CSA at ≥ 3 mg/kg but not at 1 mg/kg, or DEX at ≥ 0.3 mg/kg (intermittently at 0.1 mg/kg) but not at 0.03 mg/kg. As expected, exposure to B[e]P for 28 days at doses up to 40 mg/kg had no effect on the DTH response. These results demonstrated that the C. albicans DTH assay in the B₆C₃F₁ mouse was capable of appropriately classifying each test article as to its immunotoxic effects on CMI. Furthermore, comparisons of these results with previous reports of effects on ex vivo CMI end points suggest that this DTH assay may be more sensitive than standard ex vivo assays at detecting immunosuppressive effects.

Ingested (Oral) IFN-α Represses TNF-α mRNA in Relapsing-Remitting Multiple Sclerosis

In a phase II trial in relapsing-remitting multiple sclerosis (RRMS), patients ingesting 10,000 IU, but not 30,000 IU, interferon-alpha (IFN-alpha) showed fewer gadolinium enhancements at months 5 and 6, along with decreased proinflammatory tumor necrosis factor-alpha (TNF-alpha) protein secretion. Therefore, we examined MxA mRNA induction and TNF-alpha mRNA repression after 100, 300, 1,000, 3,000, and 10,000 IU doses of ingested IFN-alpha in 24 RRMS patients to determine the optimal dose for future clinical trials in MS. Maximal TNF-alpha repression occurs at 100, 1,000, and 3,000 IU. These data provide new optimal doses for additional clinical studies using ingested IFN-alpha in MS.

Anergy during pregnancy

OBJECTIVE

This study was undertaken to determine whether the prevalence of anergy is higher among pregnant women than among nonpregnant women.

STUDY DESIGN

Sixty human immunodeficiency virus-seronegative women (n = 30 pregnant, n = 30 nonpregnant) from the Duke University Medical Center (Durham, North Carolina) clinic were enrolled. Skin tests were performed with purified protein derivative of tuberculin, Candida antigen, mumps antigen, and tetanus toxoid. A power calculation was done to determine adequate sample size, and data were analyzed with the Fisher exact test and the t test.

RESULTS

Three women in each group did not have a response to any of the antigens tested, for an anergy prevalence of 10%. Pregnant women were less likely to have a reaction to skin testing with tetanus toxoid than were nonpregnant women (10% vs 40%; P <.02).

CONCLUSION

Human immunodeficiency virus-seronegative pregnant women did not appear to have a higher prevalence of anergy than that seen among comparable nonpregnant women. Human immunodeficiency virus-seronegative pregnant women who are being evaluated with the purified protein derivative of tuberculin skin test are therefore unlikely to need anergy skin testing just because they are pregnant.

Effects of diets with graded levels of naturally deoxynivalenol-contaminated oats on immune response in growing pigs

A trial was conducted to evaluate the effect of including different levels of deoxynivalenol (DON)-contaminated oats in the complete diets of growing pigs on immune response and performance. The diets contained 0.6, 1.8 and 4.7 mg DON/kg, and both restricted and ad libitum feeding were used. Performance was recorded as weight gain, feed intake, efficiency of feed utilization and carcass quality. Immune response parameters recorded included primary and secondary antibody titres after injections of five different antigens: Human serum albumin (HSA), sheep red blood cells (SRBC), paratuberculosis vaccine (MPT), tetanus toxoid (TT) and diphteria toxoid (DT). A johnin test was also performed. Lymphocyte stimulation response was measured with three different mitogens (PWM, ConA and PHA). A significant, DON dose-dependent reduction in secondary antibody response to tetanus toxoid was observed. A slightly higher mitogen response after PHA stimulation in lymphocytes from the medium and high DON groups compared to the low DON group after 9 weeks was considered inconclusive. No other indication of dose-dependent immune response inhibition or stimulation was found. Significantly reduced feed intake with increased levels of DON was observed in groups fed restricted rations according to weight, but not in animals fed ad libitum.

Assessment of delayed-type hypersensitivity in man: a comparison of the "Multitest" and conventional intradermal injection of six antigens

Recall of delayed type hypersensitivity (DTH) as a test for cell-mediated immune competence was assessed in 254 subjects using the Multitest device which delivers seven skin-test antigens intradermally; 77 subjects were tested concurrently by Multitest and a conventional panel of six antigens. Similar results were obtained with Multitest and the conventional panel (R = 0.65). Reproducibility of Multitest between three observers, who independently assessed the aggregate size of reactions (the reaction score) in 45 subjects, was high (R = 0.89). Twenty-four subjects were tested twice 3 months apart; the correlation for the reaction score was high (R = 0.88), demonstrating the suitability of Multitest for serial studies of immune function. Anergy was infrequent (1%) among 110 healthy male controls but was more frequent (8%) among a group of 101 healthy male homosexuals (P less than 0.05). The response rate to particular test antigens differed for the three Australian groups tested and a previously studied French group. Hence there is a need to establish normal profiles of DTH responsiveness for different geographic areas, as well as among subjects of known age and sex, when assessing cell-mediated immunity by the level of DTH responsiveness to multiple skin test antigens.

Delayed hypersensitivity to tetanus toxoid in man: in vivo and in vitro studies

The frequency of positive delayed hypersensitivity skin test reactions to tetanus toxoid in 47 healthy volunteers was 80%. The frequency of immediate hypersensitivity was low (8%) and there was less discomfort than with streptokinase or PPD. There was good correlation between leukocyte migration inhibition and delayed hypersensitivity skin testing, and a quantitative relationship was demonstrated between diameter of cutaneous reaction and degree of leukocyte migration inhibition. No relationship was demonstrated between any measures of immune responsiveness and the interval from the last booster immunization. It was concluded that tetanus toxoid is a valuable antigen for assessment of delayed hypersensitivity in man.