A proposed methodology for conducting a remote rigid gas permeable contact lens consultation

PURPOSE

COVID-19 spread to numerous countries, overwhelming healthcare systems and economies worldwide. COVID-19 restrictions have prevented patients from attending consultations in person and led to the further development of telemedicine to provide health care. The situation also applies to contact lens (CL) practitioners and their patients; telemedicine enables practitioners to provide patients with regular and continuing care. This study aimed to investigate available tools to enable continuing care for rigid gas permeable (RGP) CL wearers who are unable to attend face-to-face consultations.

METHODS

The study consists of three components. Firstly, an approach to enable the assessment of a patient's CL fitting and cornea remotely. Secondly, to find an affordable and reliable method to obtain a patient's visual acuity (VA), and thirdly, to develop a questionnaire to provide practitioners with information to deliver optimal patient care.

RESULTS

The use of a macro lens, smartphone, and auxiliary materials enables high-quality images of the anterior eye and RGP CL to be obtained. Two free and validated smartphone applications (apps) for VA measurements were identified which are available on Android and iOS systems. Two questionnaires were also developed to enable practitioners to obtain additional patient information to facilitate optimal patient care.

CONCLUSION

This study has developed the components of a remote CL consultation to enable patients who cannot attend scheduled appointments to receive care and advice to ensure the safety of their RGP CL wear. The tools involved in this study are low-cost, affordable, and an adjunct, not a substitute, for face-to-face consultations.

A Systematic Literature Review of the Career Choice of Helping Professionals Who Have Experienced Cumulative Harm as a Result of Adverse Childhood Experiences

The pervasive effects of cumulative harm resulting from adverse childhood experiences influence all aspects of an individual's life course. Research highlights a relationship between early trauma and career choice; however, there is a dearth of research pertaining specifically to cumulative harm and the influence on career choice in the helping professions. A systematic literature review was conducted to explore the associations of cumulative harm and childhood trauma on career decision making in people in the helping professions. A search was conducted across databases between February 1990 and February 2019 relevant to searches combining three areas of interest: (a) "childhood trauma," (b) "career choice," and (c) "helping professionals." Database searches and further manual searches yielded a total of 208 articles, and 28 studies satisfied all inclusion criteria. Only studies that were peer-reviewed and published between February 1990 and February 2019 were included. The evidence from the review indicated that family of origin dysfunction, parentification, individual characteristics, and traits developed through adversity, and experiential motivations were associated with the career choice in the helping professions. Further research is required to explore different professional cohorts and the utility of life themes as both a source of data for research and reflexive practice in helping professionals.

Was Dürer 500 years ahead of science?

Brewster's dark patch is a simple optical effect in the environment. It is easily seen, but apparently it has not been formally noticed or explained until quite recently. Nevertheless, some artists appear to have represented it in paintings without, of course, knowing its optical origins. A case can be made that a watercolor by Albrecht Dürer from around 1497 illustrates the phenomenon.

Polarization optics of the Brewster's dark patch visible on water surfaces versus solar height and sky conditions: theory, computer modeling, photography, and painting

When the sun is near the horizon, a circular band with approximately vertically polarized skylight is formed at 90° from the sun, and this skylight is only weakly reflected from the region of the water surface around the Brewster's angle (53° from the nadir). Thus, at low solar heights under a clear sky, an extended dark patch is visible on the water surface when one looks toward the north or south quarter perpendicular to the solar vertical. In this work, we study the radiance distribution of this so-called Brewster's dark patch (BDP) in still water as functions of the solar height and sky conditions. We calculate the pattern of reflectivity R of a water surface for a clear sky and obtain from this idealized situation the shape of the BDP. From three full-sky polarimetric pictures taken about a clear, a partly cloudy, and an overcast sky, we determine the R pattern and compose from that synthetic color pictures showing how the radiance distribution of skylight reflected at the water surface and the BDPs would look under these sky conditions. We also present photographs taken without a linearly polarizing filter about the BDP. Finally, we show a 19th century painting on which a river is seen with a dark region of the water surface, which can be interpreted as an artistic illustration of the BDP.

Dual Energy X-Ray Absorptiometry (DXA): Can it Detect Acute Scaphoid Fractures?

This prospective study investigated whether dual energy X-ray absorptiometry (DXA) could detect acute scaphoid fractures. We blindly compared 10 normal and 10 fractured scaphoid images produced with a new technique of DXA scan analysis. This measured and plotted the density of the scaphoid throughout its length, producing a linear graph of the scaphoids’ density instead of a single area (g/cm2) measurement of bone density.

These new plots only detected six of the 10 fractures and suggested that four of the normal controls were fractured. Thus, this technique of DXA scan analysis is neither sensitive nor specific for the detection of acute scaphoid fractures.

Changes in corneal biomechanics and applanation tonometry with induced corneal swelling

PURPOSE

To investigate the changes in Goldmann applanation tonometry (GAT) and Ocular Response Analyzer (ORA) measurements with corneal edema induced by contact lenses.

METHODS

Twenty-five healthy, normal subjects (age, 23 ± 2 years) had central corneal radius (CCR), ORA, GAT, and central corneal thickness (CCT) measurements performed in both eyes before a thick, soft hydrogel contact lens was worn with eye closure for 2 hours in one eye. Measurements were repeated immediately after lens removal and every 20 minutes thereafter for the following hour.

RESULTS

The experimental and control eyes behaved asymmetrically over time (repeated measures analysis of variance [RMANOVA]; P < 0.05) for all variables except CCR. GAT, ORA Goldmann-correlated intraocular pressure (ORAg), and ORA corneal-compensated intraocular pressure (ORAcc) showed comparable overestimations, whereas corneal hysteresis (CH) and corneal resistance factor (CRF) responded to corneal swelling in dissimilar ways (RMANOVA; α = 0.05). The variation in GAT in experimental eyes could be predicted by changes in CRF (0.85 [0.23] mm Hg ΔGAT/mm Hg ΔCRF; P < 0.001), but not by CCT or CH. The covariation of both CH and CRF with CCT was influenced by the presence of corneal swelling (Eye×ΔCCT interaction, P < 0.001 and P = 0.003, respectively).

CONCLUSIONS

The GAT overestimation caused by small amounts of corneal swelling represents an overall increase in corneal rigidity, which is partially characterized by CRF. In contrast, CH does not appear to usefully quantify biomechanical changes induced by corneal swelling. The accuracy of ORAcc is affected by corneal swelling.

A clinical description of Ocular Response Analyzer measurements

PURPOSE

To examine the interrelationships among the Ocular Response Analyzer (ORA; Reichert Ophthalmic Instruments, Buffalo, NY), Goldmann applanation tonometer (GAT), and corneal geometry measurements in a young, healthy sample.

METHODS

Central corneal radius, ORA, GAT, and central corneal thickness (CCT) measurements were taken in 99 subjects (age, 21 ± 2 years) who were free of ocular and systemic disease.

RESULTS

The mean ± SD corneal hysteresis (CH) and corneal resistance factor (CRF) were 10.4 ± 1.2 and 10.1 ± 1.5 mm Hg, respectively. The Bland-Altman 95% limits of agreement of ORA Goldmann-correlated IOP (ORAg) and ORA corneal-compensated (ORAcc) IOP with reference to GAT were -4.5 to +6.0 and -4.1 to +6.8 mm Hg, respectively. The full equations used by the ORA to calculate ORAcc and CRF were reconstructed. The statistically significant effect of CCT on GAT became redundant if CRF was included in a multivariate regression analysis. Both CH and CRF were associated with CCT (R(2) = 0.252 and 0.290, respectively).

CONCLUSIONS

Sample CH and CRF were consistent with those reported in the literature. ORAg and ORAcc agreed poorly with GAT. CRF appears to be at least a partial description of corneal rigidity. The ocular determinants of CH are unclear.

Goldmann Tonometry Correction Factors Based on Numerical Analysis

With the world’s aging population, it is expected that the number of people affected by glaucoma, the second most common cause of irreversible blindness, will increase considerably. Current knowledge on glaucoma progression relates elevation of the intraocular pressure (IOP) to optic nerve damage and hence visual impairment. For this reason, IOP measurement in tonometry has become an essential part of routine eye examinations needed for the diagnosis and management of the disease. The accuracy of the current reference standard in tonometry, the Goldmann applanation tonometer, is known to be affected by the natural variations in corneal thickness, curvature, and material properties. Earlier studies attempted to quantify these effects and produced correction factors that considered the variations in each one of these parameters separately, and no guidance was given as to how to combine the effects of variations in more than one parameter. The present research attempted to address this gap by conducting a multidimensional numerical study that considered variations in thickness, curvature, material properties, and IOP, and used the results to develop a single correction equation that considered these parameters simultaneously. The results of the analysis and the correction equation were validated successfully against the outcome of earlier clinical and mathematical studies on the effect of individual parameters, and the correction equation was presented in a simple form suitable for clinical application.

Assessment of Corneal Biomechanical Properties and Their Variation with Age

PURPOSE

The aim of this study was to determine the stress-strain behavior of corneal tissue and how the behavior was affected by age.

METHODS

Human corneal specimens ranging in age between 50 and 95 years were tested under inflation conditions to determine their stress-strain behavior. The corneas were subjected to two load rates that represent dynamic and static loading conditions. The pressure-deformation results were analyzed using shell theory to derive the stress-strain behavior.

RESULTS

The corneas demonstrated clear nonlinear behavior with an initial low stiffness stage and a final high stiffness stage. The transition between the two stages coincided with intraocular pressures between 12 and 20 mmHg. There was a considerable increase in stiffness associated with both age and load rate. Equations were derived to describe the nonlinear stress-strain relationship of corneal tissue for any age between 50 and 95 years, and these equations are presented in a form suitable for use in numerical simulations.

CONCLUSIONS

The cornea demonstrates considerable stiffening with age with the behavior closely fitting an exponential power function typical of collagenous tissue. The increase in stiffness could be related to the additional age-related nonenzymatic cross-linking affecting the stromal collagen fibrils.

Modulatory effects of heparin and short-length oligosaccharides of heparin on the metastasis and growth of LMD MDA-MB 231 breast cancer cells in vivo

Expression of the chemokine receptor CXCR4 allows breast cancer cells to migrate towards specific metastatic target sites which constitutively express CXCL12. In this study, we determined whether this interaction could be disrupted using short-chain length heparin oligosaccharides. Radioligand competition binding assays were performed using a range of heparin oligosaccharides to compete with polymeric heparin or heparan sulphate binding to I(125) CXCL12. Heparin dodecasaccharides were found to be the minimal chain length required to efficiently bind CXCL12 (71% inhibition; P<0.001). These oligosaccharides also significantly inhibited CXCL12-induced migration of CXCR4-expressing LMD MDA-MB 231 breast cancer cells. In addition, heparin dodecasaccharides were found to have less anticoagulant activity than either a smaller quantity of polymeric heparin or a similar amount of the low molecular weight heparin pharmaceutical product, Tinzaparin. When given subcutaneously in a SCID mouse model of human breast cancer, heparin dodecasaccharides had no effect on the number of lung metastases, but did however inhibit (P<0.05) tumour growth (lesion area) compared to control groups. In contrast, polymeric heparin significantly inhibited both the number (P<0.001) and area of metastases, suggesting a differing mechanism for the action of polymeric and heparin-derived oligosaccharides in the inhibition of tumour growth and metastases.

The effect of contact lens induced oedema on the accuracy of Goldmann tonometry in a mature population

AIM

To determine the effect of contact lens induced oedema on the accuracy of Goldmann tonometry measurements of intraocular pressure (IOP) in mature subjects.

METHODS

22 healthy subjects aged between 50 and 60 years were recruited. Corneal curvature, IOP, and central corneal thickness (CCT) were measured before and after two hours of monocular closed eye wear of a thick hydroxyethyl methacrylate (HEMA) contact lens. Measurements were then repeated at 20 minute intervals for one hour after lens removal.

RESULTS

Both CCT (+54.1 mum) and IOP (+2.7 mm Hg) increased significantly after lens wear (p<0.001, paired t test with Bonferroni correction). For the hour following lens removal, the measured IOP was correlated to the increase in CCT (r = 0.84, p<0.001), at a rate of 1.0 mm Hg/10 mum (95% confidence interval, 0.8 to 1.2 mm Hg/10 mum, linear mixed model analysis).

CONCLUSIONS

A relatively small increase in CCT from contact lens induced corneal oedema caused an overestimation error in Goldmann tonometry measurements of IOP in healthy mature subjects.

Genetic modification of the manganese superoxide dismutase/glutathione peroxidase 1 pathway influences intracellular ROS generation in quiescent, but not contracting, skeletal muscle cells

Increased amounts of reactive oxygen species (ROS) are generated by skeletal muscle during contractile activity, but their intracellular source is unclear. The oxidation of 2',7'-dichlorodihydrofluorescein (DCFH) was examined as an intracellular probe for reactive oxygen species in skeletal muscle myotubes derived from muscles of wild-type mice and mice that were heterozygous knockout for manganese superoxide dismutase (Sod2(+/-)), homozygous knockout for glutathione peroxidase 1 (GPx1(-/-)), or MnSOD transgenic overexpressors (Sod2-Tg). Myoblasts were stimulated to fuse and loaded with DCFH 5-7 days later. Intracellular DCF epifluorescence was measured and myotubes were electrically stimulated to contract for 15 min. Quiescent myotubes with decreased MnSOD or GPx1 showed a significant increase in the rate of DCFH oxidation whereas those with increased MnSOD did not differ from wild type. Following contractions, myotubes from all groups showed an equivalent increase in DCF fluorescence. Thus the oxidation of DCFH in quiescent skeletal muscle myotubes is influenced by the content of enzymes that regulate mitochondrial superoxide and hydrogen peroxide content. In contrast, the increase in DCFH oxidation following contractions was unaffected by reduced or enhanced MnSOD or absent GPx1, indicating that reactive oxygen species produced by contractions were predominantly generated by nonmitochondrial sources.

A human phase 1 vaccine clinical trial of the Plasmodium falciparum malaria vaccine candidate apical membrane antigen 1 in Montanide ISA720 adjuvant

A dose escalating, placebo-controlled phase 1 trial was conducted to test the safety and immunogenicity of a vaccine containing recombinant Plasmodium falciparum apical membrane antigen 1 (AMA1) formulated in Montanide ISA720. Three groups of volunteers were vaccinated intramuscularly with 5 microg, 20 microg or 80 microg of AMA1, respectively, in 0.5 mL of formulation at 0, 3 and 6 months. Anti-AMA1 antibody levels and T cell stimulation indices were measured before and after each vaccination. No vaccine-related serious adverse events were recorded. Most subjects generated a mild to moderate, transient local reaction after the first vaccination. Three subjects developed a local reaction approximately 10 days following vaccination. Six of the 29 subjects seroconverted. Only one of these developed a high antibody titre. However, the interpretation of this trial was compromised by a loss of potency of the formulated vaccine during the course of the study.

Safety and immunogenicity of a three-component blood-stage malaria vaccine (MSP1, MSP2, RESA) against Plasmodium falciparum in Papua New Guinean children

Combination B is a malaria vaccine that comprises recombinant Plasmodium falciparum (P. falciparum) blood-stage proteins MSP1, MSP2 and RESA, formulated with the adjuvant Montanide ISA 720. A phase I-IIb double-blind randomised placebo-controlled trial was undertaken in 120 children aged 5-9 years. Subjects were randomised in four groups: (i) No sulphadoxine-pyrimethamine (SP)+vaccine, (ii) No SP+placebo, (iii) SP+vaccine, (iv) SP+placebo. 15 microg of each protein were given in the thigh, at both first and second injection (4 weeks apart). The placebo was adjuvant emulsified with saline. No serious or severe AEs occurred. Moderate AEs were seen in 3% of the vaccine and 3% of the placebo recipients after first injection and in 12 and 10% after second injection. The vaccine induced significant antibody responses to all three antigens but triggered an IFN-gamma response to MSP1 only. At Week 12, the IFN-gamma response to MSP1 was substantially higher in the vaccine group where No SP had been given. Combination B proved to be safe and immunogenic in children aged 5-9 years. Vaccine immunogenicity was neither impaired by circulating parasites nor increased after pre-treatment with SP and pre-treatment is not advisable in future trials of malaria vaccines, at least for those including blood-stage antigens.

Oesophageal cancer and cachexia: the effect of short-term treatment with thalidomide on weight loss and lean body mass

BACKGROUND

Cachexia is common in patients with advanced cancer and has a direct impact on well-being and mortality.

AIM

To test the hypothesis that thalidomide can promote weight gain and lean body mass in patients with advanced oesophageal cancer.

METHODS

In an open-label study, 11 patients with non-obstructing and inoperable oesophageal cancer were established on an isocaloric diet for 2 weeks, followed by 2 weeks on thalidomide, 200 mg daily. The primary end-points were weight change and lean body mass. Secondary end-points were quality of life and changes in resting energy expenditure.

RESULTS

Ten patients completed the study protocol. The average caloric intake remained the same throughout the study period in all patients. Nine of 10 patients (95% confidence interval, 0.60, 0.98) lost weight on diet alone. The mean weight gain on thalidomide in the following 2 weeks was 1.29 kg (median, 1.25 kg). A similar trend was shown in the lean body mass. Eight of nine patients (95% confidence interval, 0.57, 0.98) initially lost lean body mass on diet alone (missing data in one patient). The mean gain in lean body mass on thalidomide in the following 2 weeks was 1.75 kg (median, 1.33 kg).

CONCLUSIONS

Thalidomide treatment appeared to reverse the loss of weight and lean body mass over the 2-week trial period.

A recombinant blood-stage malaria vaccine reduces Plasmodium falciparum density and exerts selective pressure on parasite populations in a phase 1-2b trial in Papua New Guinea

The malaria vaccine Combination B comprises recombinant Plasmodium falciparum ring-infected erythrocyte surface antigen and 2 merozoite surface proteins (MSP1 and MSP2) formulated in oil-based adjuvant. A phase 1-2b double-blind, randomized, placebo-controlled trial in 120 children (5-9 years old) in Papua New Guinea demonstrated a 62% (95% confidence limits: 13%, 84%) reduction in parasite density in children not pretreated with sulfadoxine-pyrimethamine. Vaccinees had a lower prevalence of parasites carrying the MSP2-3D7 allelic form (corresponding to that in the vaccine) and a higher incidence of morbid episodes associated with FC27-type parasites. These results demonstrate functional activity of Combination B against P. falciparum in individuals with previous malaria exposure. The specific effects on parasites with particular msp2 genotypes suggest that the MSP2 component, at least in part, accounted for the activity. The vaccine-induced selection pressure exerted on the parasites and its consequences for morbidity strongly argue for developing vaccines comprising conserved antigens and/or multiple components covering all important allelic types.

Different affinities of glycosaminoglycan oligosaccharides for monomeric and dimeric interleukin-8: a model for chemokine regulation at inflammatory sites

The binding of interleukin-8 (IL-8) to heparan sulfate (HS) proteoglycans on the surface of endothelial cells is crucial for the recruitment of neutrophils to an inflammatory site. Fluorescence anisotropy measurements yielded an IL-8 dimerization constant of 120 nM. The binding affinities, obtained by isothermal fluorescence titration, of size-defined heparin and HS oligosaccharides to the chemokine were found to depend on the oligomerization state of IL-8: high affinity was detected for monomeric and low affinity was detected for dimeric IL-8, referring to a self-regulatory mechanism for its chemoattractant effect. The highest affinity for monomeric IL-8 was detected for the HS octamer with a K(d) < 5 nM whereas the dissociation constants of dimeric IL-8 were found in the medium micromolar range. No indication for increasing affinities for monomeric IL-8 with increasing oligosaccharide chain length was found. Instead, a periodic pattern was obtained for the dissociation constants of the GAG oligosaccharides with respect to chain length, referring to optimum and least optimum chain lengths for IL-8 binding. GAG disaccharides were identified to be the minimum length for chemokine binding. Conformational changes of the dimeric chemokine, determined using CD spectroscopy, were detected only for the IL-8/HS complexes and not for heparin, pointing to an HS-induced activation of the chemokine with respect to receptor binding. Thermal unfolding of IL-8 yielded a single transition at 56 degrees C which was completely prevented by the presence of undigested HS or heparin, indicating structural stabilization, thereby prolonging the biological effect of the chemokine.

Safety and immunogenicity of a three-component blood-stage malaria vaccine in adults living in an endemic area of Papua New Guinea

A Phase I safety and immunogenicity study with a three-component blood-stage malaria vaccine was conducted in adult male subjects living in an endemic area of Papua New Guinea. The preparations were recombinant proteins which corresponded to parts of the two merozoite surface proteins of Plasmodium falciparum (MSP1 and 2), and of the ring-infected erythrocyte surface antigen (RESA). The three proteins were emulsified with the adjuvant Montanide ISA720. Ten subjects were injected twice (four weeks apart) with the vaccine formulation and two with the adjuvant alone. Mild pain at the site of injection was reported by about half of the subjects but no systemic reaction related to the formulation occurred. There was a sharp rise in geometric mean stimulation index after the second dose compared to baseline for MSP1 and RESA, while the rise was small for MSP2. Geometric mean antibody titres increased for MSP1 during the study, whereas they hardly changed for MSP2 and RESA. The vaccine formulation was safe when used in an already immune population. The vaccine induced good cellular responses, especially for MSP1 and RESA. Boosting of humoral responses was weak, probably because of high baseline antibody levels.

Human phase I vaccine trials of 3 recombinant asexual stage malaria antigens with Montanide ISA720 adjuvant

Two phase I vaccine trials were conducted to test the immunogenicity and safety of a vaccine containing three recombinant malaria antigens from the asexual stage of Plasmodium falciparum. The three antigens are a fragment of MSP1 (190LCS.T3); MSP2 and a portion of RESA and were formulated in Montanide ISA720 adjuvant. These trials investigated the dose response of each antigen for eliciting both antibody and T-cell responses and the immunogenicity of a mixture of the antigens compared with the antigens injected separately. All three antigens elicited both antibody and T-cell responses. Strong T-cell responses were observed with 190LCS.T3 and RESA with stimulation indices exceeding 100 for peripheral blood leucocytes in some individuals. The antibody responses were generally weak. The human antibody responses observed with MSP2 in Montanide ISA720 were not significantly different from those obtained in an earlier trial which used MSP2 with alum as the adjuvant. No antigenic competition was observed: volunteers receiving a mixture of antigens had similar responses to those receiving the three antigens at separate sites. Tenderness and pain at the injection site were common over the first few days following immunization. In some volunteers, especially those receiving the highest doses tested, there was a delayed reaction at the injection site with pain and swelling occurring approximately 10 days after injection.

Conversion factor for comparison of data from Humphrey and Medmont automated perimeters

Background: Clinical experience has shown that the sensitivity indices reported by the Humphrey Field Analyser (HFA) are generally higher than those given by the Medmont Automated Perimeter (M600). It is the purpose of this paper to determine a conversion factor for the two perimeters and to confirm this prediction using clinical data. Theory predicted that HFA(sensitivity) - 5 dB = M600(sensitivity). Methods: Sensitivity versus eccentricity profiles were measured over the central visual field on 10 young subjects using both perimeters. Results: Both the HFA and the M600 operate within the realms of the Weber law and measure similar Weber fractions. The sensitivity profiles had similar slopes (about -0.2 dB/degree) and were separated by about six decibels with the HFA reporting higher sensitivity values. This result confirmed the theoretical prediction. Conclusion: The difference in threshold sensitivities between the two perimeters is a result of differences in scaling factors and instrument luminances. A suggested clinical conversion factor is to subtract 5 dB from the HFA data to approximate those of the M600.

Fractionated high dose rate brachytherapy moulds--a precise treatment for carcinoma of the pinna

BACKGROUND AND PURPOSE

The aim of this paper is to describe a fractionated high dose rate brachytherapy procedure for the treatment of small superficial cancers of the pinna and to report the outcome in a small series of patients.

MATERIALS AND METHODS

Thirteen patients with superficial cancers of the pinna, not invading cartilage, have been treated and in the majority of cases the tumour thickness was determined by a transdermal ultrasound measurement. For the single-plane moulds the prescribed surface dose was 45 Gy in eight fractions over 5 days and the moulds were constructed such that the full thickness of the disease, as determined by the ultrasound measurement, would lie within the 80% isodose surface. One case was treated with a sandwich mould and in this case the dose was reduced to 42.5 Gy. The treatment machine was a high dose rate microselectron, which contains a single stepping iridium source.

RESULTS

The radiation reactions were of moderate severity, but were limited to the high dose volume. In all cases there was complete tumour resolution and rapid healing occurred leaving a barely perceptible scar. There were no recurrences over a minimum follow-up time of 18 months and there were no late radiation complications in this period.

CONCLUSIONS

The treatment of superficial carcinoma of the pinna by means of HDR moulds is a safe and reliable technique. In this small series of patients there was total tumour control with excellent cosmesis.

Immunisation with recombinant AMA-1 protects mice against infection with Plasmodium chabaudi

The Plasmodium merozoite surface antigen apical membrane antigen-1 (AMA-1) has previously been shown to provide partial protection to Saimiri and rhesus monkeys immunised with recombinant Plasmodium fragile or parasite-derived Plasmodium knowlesi AMA-1, respectively. In the study reported here we have used the Plasmodium chabaudi/mouse model system to extend our pre-clinical assessment of an AMA-1 vaccine. We describe here the expression of the full-length Plasmodium chabaudi adami AMA-1 and the P. chabaudi adami AMA-1 ectodomain using both baculovirus and Escherichia coli. The ectodomain expressed in E. coli, which contained an N-terminal hexa-his tag, was purified by Ni-chelate chromatography and refolded in vitro in the presence of oxidised and reduced glutathione to generate intramolecular disulphide bonds. In a series of vaccine trials, in both inbred and outbred mice, highly significant protection was obtained by immunising with the refolded AMA-1 ectodomain. Protection was shown to correlate with antibody response and was dependent on intact disulphide bonds. Passive transfer of antibodies raised in rabbits against the refolded AMA-1 ectodomain was also protective. In view of this demonstration that E. coli expression of a soluble P. chabaudi AMA-1 domain can generate a vaccine that is effective in mice, we are pursuing a similar approach to generating a vaccine against P. falciparum for testing in human volunteers.

Selection of an adjuvant for vaccination with the malaria antigen, MSA-2

Various formulations of the Plasmodium falciparum merozoite surface antigen, MSA-2, were made and tested in animals in order to select one for use in human vaccine trials. Recombinant constructs representing both major allelic forms of MSA-2 were formulated with a range of adjuvants and used to immunize rabbits, mice and sheep. After immunization, antibody responses obtained with the most potent adjuvants were at least tenfold greater than responses obtained with the least potent adjuvant Alhydrogel, which was used as the reference standard, although its lower potency indicated against its further use in clinical trials. Based on broadly similar results obtained with the three animal species, several adjuvants, including the water-in-oil adjuvant Montanide ISA 720, the oil-in-water adjuvant SAF-1, and liposomes containing lipid A formulated with Alhydrogel were demonstrated to be potent and potentially suitable for the clinical evaluation of MSA-2 as a candidate malaria vaccine antigen. Of these, ISA 720 was selected for further trial.

Phase I trial in humans of an oil-based adjuvant SEPPIC MONTANIDE ISA 720

Seppic MONTANIDE ISA 720 is a metabolizable oil adjuvant that has given good results in animals with recombinant malarial antigens. Twelve human volunteers were given increasing intramuscular doses of MONTANIDE ISA 720, ranging from 0.6 to 1.8 ml. The adjuvant was well tolerated with only minor local effects, including tenderness, local swelling and discomfort on use. MONTANIDE ISA 720 may prove to be an acceptable and effective adjuvant for use in people.

Chimeric potyvirus-like particles as vaccine carriers

Presentation of subunit vaccines in a highly ordered aggregate form can result in enhanced immune responses. Coat protein (CP) monomers of a potyvirus (Johnsongrass mosaic virus) when produced in heterologous host expression systems (Escherichia coli, yeast and insect cells) self-polymerized to produce potyvirus-like particles (PVLPs). The N- and C-terminal regions of potyvirus CP are surface-exposed and are not required for assembly. Hybrid CP monomers containing short peptides fused to their N- and/or C-termini, or large target antigens fused to the N-terminus or replacing most of the N- or C-terminal exposed regions retained the ability to assemble into hybrid PVLPs. Such chimeric PVLPs were highly immunogenic in mice and rabbits even in the absence of any adjuvant. Potyvirus CP is highly versatile in accommodating peptides or large antigens and is able to present antigens exposed on the surface of virus-like particles. This, combined with the efficiency of high level bacterial and insect cell expression systems, makes PVLPs an attractive non-pathogenic and non-replicative vaccine carrier.

Irradiation induces up-regulation of E9 protein (CD105) in human vascular endothelial cells

The use of MAb E-9 raised against tissue-cultured endothelial cells (EC) has shown marked heterogeneity in vascular EC lining the blood vessels of normal and tumour tissues. MAb E-9 is human EC-specific and the protein recognized by it is a homodimer with a molecular mass of 97 kDa. The E-9 protein is resistant to treatment by 3 mM sodium periodate, but is sensitive to 10% trichloroacetic acid and 70% ethanol. E-9 protein has been assigned to a new cluster, CD105, and mapped to human chromosome 9q3. It has approximately 70% homology with type-III cell-surface receptor for transforming growth factor beta (TGF-beta). Recently CD105 has been reported to be the gene in patients with hereditary haemorrhagic telangiectasia. We have examined the effects of radiation on its expression in normal human umbilical-vein endothelial cells (HUVEC) and brain-tumour-derived endothelial cells (BTEC). Irradiation induced dose- and time-dependent up-regulation in the expression of the E-9 protein on the plasma membranes of EC, and also resulted in greater increase in the expression of the E-9 protein in semi-confluent (proliferating) as compared with confluent (non-proliferating) EC. It may well be that, following radiotherapy in cancer patients, E-9 protein is also up-regulated. The presence of increased amounts of E-9 protein in EC makes it an attractive target in the control of angiogenesis, especially after radiotherapy in cancer patients. The time scale involved in the up-regulation of E-9 protein following irradiation has led us to suggest that it may be a secondary event, the primary being the production and release of mitogenic factors (such as basic fibroblast growth factor) from irradiated EC.

Protective immunity induced in squirrel monkeys with recombinant apical membrane antigen-1 of Plasmodium fragile

Saimiri sciureus boliviensis monkeys were immunized with the Plasmodium fragile form of the merozoite apical membrane antigen-1 produced using the baculovirus expression system and combined with Montanide ISA 720 adjuvant. Following three immunizations, monkeys were challenged with 10,000 P. fragile trophozoite parasites. Antibody titers determined by fluorescence microscopy indicated an enhanced response following the second immunization. Four of five control animals had parasite counts > 5% 18-26 days following challenge. Four of five immunized monkeys had reduced levels of maximum parasitemia or delays in accumulated parasite counts, suggestive of protection. Rechallenge of the animals with P. falciparum resulted in three of four adjuvant control animals developing patent parasitemia whereas none of five immunized animals were infected, suggesting some level of heterologous protection.

Application of angiogenic oligosaccharides of hyaluronan increases blood vessel numbers in rat skin

Angiogenic oligosaccharides of hyaluronan were applied to the backs of young, adult male rats and the number of blood vessels, within a depth of 136 microns beneath the base of the epidermis, were evaluated. Application of hyaluronan oligosaccharides significantly increased the mean number of blood vessels/mm skin length in six of 11 treated rats when compared with controls. Application of radiolabeled hyaluronan oligosaccharides to skin of one rat demonstrated a penetration to a depth of approximately 800 microns, suggesting that the blood vessels beneath the epidermis would be exposed to the hyaluronan. Hyaluronan has previously been shown to stimulate endothelial cell proliferation; we demonstrate here that these hyaluronan oligosaccharides also specifically stimulate endothelial cell migration. This action of hyaluronan oligosaccharides may prove useful in retarding blood vessel paucity and degeneration observed during the ageing process and following radiotherapy.

Expression and characterisation of equine herpesvirus 1 glycoprotein H using a recombinant baculovirus

A recombinant baculovirus capable of expressing the glycoprotein H (gH) gene of equine herpesvirus 1 (EHV-1) was constructed. EHV-1 gH gene products in recombinant baculovirus infected insect cells were identified as 105 kDa and 110 kDa species compared with a 115 kDa product detected in EHV-1 infected mammalian cells. The extent of N-glycosylation of EHV-1 gH in both insect and mammalian cells was indicated by a shift in apparent molecular weights after PNGase F treatment to 90 kDa and 95 kDa forms, which compared with the predicted value of 90 kDa for the unglycosylated polypeptide. The recombinant EHV-1 gH was recognised by equine sera demonstrating that EHV-1 gH is a target for the immune system of the natural host. However, while the recombinant EHV-1 gH product from infected insect cells was immunogenic in mice, it did not induce a neutralizing antibody response against EHV-1.

Plasmodium falciparum infection of splenectomized and intact Guyanan Saimiri monkeys

Spleen-intact and splenectomized Saimiri monkeys of Guyanan origin were examined for their potential suitability for Plasmodium falciparum protection studies. The animals could be readily infected with adapted strains of P. falciparum (Indochina 1/CDC and Uganda Palo Alto FUP strains), but spontaneously recovered without drug treatment and without development of severe clinical disease. In intact animals, peak parasitemia prior to recovery generally ranged from 0.1% to 10%, whereas in splenectomized animals the peak parasitemia was generally higher so that some animals were given drug treatment to assist in recovery from infection. In reinfection studies, previously infected spleen-intact monkeys demonstrated sterile immunity to the homologous parasite strain but not to a heterologous strain. However, in monkeys infected with the heterologous strain, the peak parasitemia was less than in the first infection and of shorter duration. Splenectomized animals did not demonstrate sterile immunity although the peak parasitemia achieved was less than in the previous infection of each of these monkeys. While the lack of major clinical disease indicated that these monkeys did not provide a good animal model for human malaria, the development of protective immunity was consistent with a useful role in evaluating candidate vaccine antigens.

Quantitation of endothelial cell specific protein E-9 employing a single monoclonal antibody in an indirect sandwich ELISA

An indirect enzyme-linked immunosorbent assay is described for the quantitation of protein E-9 which is specifically expressed on human vascular endothelial cells. The assay capitalizes on the dimeric structure of the E-9 protein by utilizing a single monoclonal antibody as both the capture and detection reagent. Detection is achieved by conjugating the Mab with biotin and is followed by the addition of streptavidin peroxidase to provide high sensitivity. Bound activity is measured by enhanced chemiluminescence utilizing standard Amerlite chemistry. The optimised assay is reproducible and is highly sensitive. Using this assay it was possible to detect the presence of E-9 protein in tissue culture media of endothelial cells and in serum samples--in one case even at 1/100 dilution. In vitro, X irradiation resulted in a greater than two-fold increase (P < or = 0.005) in the level of E-9 protein in culture supernatants of human umbilical vein endothelial cells (HUVEC). There are potential applications for measurements of E-9 protein in body fluids and tissue extracts from patients with a vast variety of diseases characterised by vascular endothelial damage and/or activation.

Expression of equine herpesvirus 1 glycoprotein D by using a recombinant baculovirus

Glycoprotein D (gD) of equine herpesvirus 1 (EHV-1) was expressed at the surface of insect cells infected by a recombinant baculovirus. EHV-1 gD was detected as multiple forms (56, 52, and 48 kDa) from 18 to 96 h postinfection. Laboratory animals inoculated with the recombinant EHV-1 gD developed neutralizing antibody responses against both EHV-1 and EHV-4.

A monoclonal antibody detects heterogeneity in vascular endothelium of tumours and normal tissues

A new murine monoclonal antibody (MAb), E-9, has been raised using tissue-cultured human umbilical vein endothelial cells. The antigen recognized by this MAb is a peptide of 170 kDa under non-reducing conditions and 96 kDa under reducing conditions. MAb E-9 showed marked heterogeneity in its distribution in various tissues. The antigen recognized by it was present in vascular endothelial cells of all tumours, foetal organs and in regenerating and inflamed tissues. It stained a few normal tissues. However, with the exception of tonsils, staining tended to be weak and limited to a few blood vessels, as revealed by double staining using pan-endothelial antibody (CD31) and antibody to von Willebrand factor, another marker of vascular endothelium. Surprisingly, blood vessels within the placental villi were completely negative. The function of the antigen recognized by MAb E-9 is not known, but its evaluation and use should increase our understanding of angiogenesis.

Prognostic relevance of serum hyaluronan levels in patients with breast cancer

The serum hyaluronan (HA) level of 238 women with breast cancer was measured by means of a specific radiometric assay. The results show no significant increase in serum HA when compared to levels in 120 control sera. A number of prognostic factors were evaluated including stage of disease, lymph-node involvement, tumour size, histology and presence of oestrogen and progesterone receptors in the tumour. No correlation was found with serum HA concentration and we conclude that serum HA level is of no prognostic significance in breast cancer.

The development of a malaria vaccine

This paper is a progress report and summarises R & D by the consortium to develop a malaria vaccine. The research strategies and research progress are discussed. The business arrangements and the roles of each partner are given.

Failure of recombinant vaccinia viruses expressing Plasmodium falciparum antigens to protect Saimiri monkeys against malaria

Saimiri sciurus monkeys were immunized at multiple sites with recombinant vaccinia viruses expressing Plasmodium falciparum antigen genes and boosted 4 weeks later. Control monkeys were immunized with a thymidine kinase-negative vaccinia virus mutant. Two weeks later, all of the monkeys were challenged by intravenous inoculation of P. falciparum (Indochina strain) parasites. A group of unimmunized monkeys was challenged in parallel. All of the monkeys that received vaccinia virus recombinants or the control virus produced good anti-vaccinia virus antibody responses. However, those that received a single construct containing ring-infected erythrocyte surface antigen (RESA) given at eight sites did not produce significant antibody to any of the three major RESA repeat epitopes after immunization but were primed for an enhanced antibody response after challenge infection with P. falciparum. Most of the monkeys produced detectable antibodies to the RESA epitopes after challenge infection. One group of monkeys was immunized with four constructs (expressing RESA, two merozoite surface antigens [MSA-1 and MSA-2], and a rhoptry protein [AMA-1]), each given at two sites. While these monkeys failed to produce significant antibody against MSA-2 or AMA-1 after immunization, they produced enhanced responses against these antigens after challenge infection. Immunization involved an allelic form of MSA-2 different from that present in the parasite challenge strain, so that the enhanced responses seen after challenge infection indicated the presence of T-cell epitopes common to both allelic forms. No groups of monkeys showed any evidence of protection against challenge, as determined by examination of the resulting parasitemias.

Peptide vaccines derived from a malarial surface antigen: effects of dose and adjuvants on immunogenicity

Peptides P2122 (CKNNNSTNSGI) and P513 (CSQRSTNSAST) containing an epitope of a malarial surface antigen (MSA2) recognised by inhibitory monoclonal antibodies were conjugated to diphtheria toxoid (DT) protein and formulated with various gel-based and water in oil emulsion adjuvants in vaccine trials in mice and rabbits. The P2122-DT construct was effective in raising antibodies reactive with both the immunising peptide and the native antigen. Effective adjuvanticity as measured by the titre of the anti-peptide or anti-protein response in mice varied in the order: Algammulin, Montanide ISA 50 greater than or equal to Freund's adjuvant, Montanide ISA 708, 721, 70 much greater than alum, Squalene Arlacel greater than SAF-1. A similar order of adjuvant efficacy: Freund's greater than alum greater than Squalene Arlacel greater than SAF-1, was observed in rabbits.

Vaccination of sheep with cell culture grown orf virus

Orf virus, derived from contagious pustular dermatitis (scabby mouth) lesions in sheep, was adapted to cell culture and subsequently evaluated as a potential vaccine for sheep. The traditional vaccine virus, prepared from the infected scabs of orf virus lesions in sheep, was used to vaccinate sheep by scratching with an applicator (mounted pins) dipped in virus. Less than 10 TCID50 (50% tissue culture infectious doses) of virus was required to produce large lesions (greater than 5 mm diameter) which developed during a period of 10 to 14 d prior to onset of healing which was complete by 28 to 30 d. A serum neutralising antibody response was also detected and protection against challenge by application of virulent virus to abraded skin was demonstrated in that challenge lesions developed and healed more quickly (14 d against 30 d). However, cell culture-adapted virus required more than 10(5) TCID50 to induce even small lesions (less than 2 mm diameter). An antibody response could not be detected and no evidence of protection against challenge with virulent virus was demonstrated. In contrast, a recent field isolate has yielded a cell culture-adapted virus preparation that readily infects sheep, produces large lesions, detectable antibody and protects against challenge. This isolate is distinct from the traditional vaccine strain on the basis of restriction enzyme analysis but provides cross-protection in sheep inmmunisation and challenge studies. These results demonstrate that a cell culture produced scabby mouth vaccine is feasible.

Development of a vaccine preventing parvovirus-induced reproductive failure in pigs

An inactivated porcine parvovirus (PPV) vaccine for the prevention of PPV-induced reproductive failure in pigs was developed, using virus grown in cell culture, inactivated with beta-propiolactone and adjuvanted with aluminum hydroxide. The vaccine was tested for safety by subcutaneous injection into pregnant gilts. There were no signs of abnormal reactions nor evidence of PPV infection in the gilts or their foetuses when they were sacrificed 6 weeks after vaccination. To demonstrate that the vaccine was immunogenic, pigs were immunised either once or twice with 4 weeks between doses. Resulting antibody titres (haemagglutination inhibition - HAI) ranged from less than 8 to 64 (geometric mean of 30) after one dose of vaccine, and from 128 to 512 (geometric mean 256) after two doses. To demonstrate that the vaccine was protective, antibody-negative gilts were vaccinated twice, with 4 weeks between doses, joined after the second dose, and were then infected with virulent PPV 40 to 50 days after joining. In litters from 10 vaccinated gilts, none of 93 foetuses showed evidence of PPV infection. In contrast, in litters from two unvaccinated gilts, all 13 foetuses showed evidence of PPV infection and 10 of these were mummified. The average number of live piglets per litter was 9.2 from vaccinated gilts and 1.5 from unvaccinated gilts. The vaccine was therefore considered to be effective in preventing PPV reproductive failure in susceptible gilts.

Immune response to a synthetic peptide corresponding to an epitope of a parasitophorous vacuole membrane antigen from Plasmodium falciparum

The parasitophorous vacuole membrane antigen QF 116 from Plasmodium falciparum contains a defined epitope, DNNLVSGP, proximal to the carboxyl-terminus which binds to the inhibitory monoclonal antibody 8E7/55. A synthetic peptide containing this epitope was constructed and coupled to diphtheria toxoid as carrier. Mice and rabbits were inoculated with this conjugate using CFA, SAF-1, or aluminum phosphate as adjuvants. The peptide conjugate was highly immunogenic in both animal species, giving rise to polyclonal antibodies with a similar epitope specificity as the original mAb. Antibody titers were dependent on the route of immunization. Rabbit antibodies produced in sufficient quantity for biologic assays inhibited parasite growth in vitro. This synthetic peptide thus shows promise as an immunogen for use in synthetic vaccine design.

Immune response to a synthetic peptide corresponding to an epitope of a parasitophorous vacuole membrane antigen from Plasmodium falciparum

The parasitophorous vacuole membrane antigen QF 116 from Plasmodium falciparum contains a defined epitope, DNNLVSGP, proximal to the carboxyl-terminus which binds to the inhibitory monoclonal antibody 8E7/55. A synthetic peptide containing this epitope was constructed and coupled to diphtheria toxoid as carrier. Mice and rabbits were inoculated with this conjugate using CFA, SAF-1, or aluminum phosphate as adjuvants. The peptide conjugate was highly immunogenic in both animal species, giving rise to polyclonal antibodies with a similar epitope specificity as the original mAb. Antibody titers were dependent on the route of immunization. Rabbit antibodies produced in sufficient quantity for biologic assays inhibited parasite growth in vitro. This synthetic peptide thus shows promise as an immunogen for use in synthetic vaccine design.