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Morrison AL, Sarfas C, Sibley L, Williams J, Mabbutt A, Dennis MJ, Lawrence S, White AD, Bodman-Smith M, Sharpe SA. IV BCG Vaccination and Aerosol BCG Revaccination Induce Mycobacteria-Responsive γδ T Cells Associated with Protective Efficacy against M. tb Challenge. Vaccines (Basel) 2023; 11:1604. [PMID: 37897006 PMCID: PMC10611416 DOI: 10.3390/vaccines11101604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/05/2023] [Accepted: 10/10/2023] [Indexed: 10/29/2023] Open
Abstract
Intravenously (IV) delivered BCG provides superior tuberculosis (TB) protection compared with the intradermal (ID) route in non-human primates (NHPs). We examined how γδ T cell responses changed in vivo after IV BCG vaccination of NHPs, and whether these correlated with protection against aerosol M. tuberculosis challenge. In the circulation, Vδ2 T cell populations expanded after IV BCG vaccination, from a median of 1.5% (range: 0.8-2.3) of the CD3+ population at baseline, to 5.3% (range: 1.4-29.5) 4 weeks after M. tb, and were associated with TB protection. This protection was related to effector and central memory profiles; homing markers; and production of IFN-γ, TNF-α and granulysin. In comparison, Vδ2 cells did not expand after ID BCG, but underwent phenotypic and functional changes. When Vδ2 responses in bronchoalveolar lavage (BAL) samples were compared between routes, IV BCG vaccination resulted in highly functional mucosal Vδ2 cells, whereas ID BCG did not. We sought to explore whether an aerosol BCG boost following ID BCG vaccination could induce a γδ profile comparable to that induced with IV BCG. We found evidence that the aerosol BCG boost induced significant changes in the Vδ2 phenotype and function in cells isolated from the BAL. These results indicate that Vδ2 population frequency, activation and function are characteristic features of responses induced with IV BCG, and the translation of responses from the circulation to the site of infection could be a limiting factor in the response induced following ID BCG. An aerosol boost was able to localise activated Vδ2 populations at the mucosal surfaces of the lung. This vaccine strategy warrants further investigation to boost the waning human ID BCG response.
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Affiliation(s)
- Alexandra L. Morrison
- Vaccine Development and Evaluation Centre, UK Health Security Agency, Porton Down, Salisbury SP4 0JG, UK
| | - Charlotte Sarfas
- Vaccine Development and Evaluation Centre, UK Health Security Agency, Porton Down, Salisbury SP4 0JG, UK
| | - Laura Sibley
- Vaccine Development and Evaluation Centre, UK Health Security Agency, Porton Down, Salisbury SP4 0JG, UK
| | - Jessica Williams
- Vaccine Development and Evaluation Centre, UK Health Security Agency, Porton Down, Salisbury SP4 0JG, UK
| | - Adam Mabbutt
- Vaccine Development and Evaluation Centre, UK Health Security Agency, Porton Down, Salisbury SP4 0JG, UK
| | - Mike J. Dennis
- Vaccine Development and Evaluation Centre, UK Health Security Agency, Porton Down, Salisbury SP4 0JG, UK
| | - Steve Lawrence
- Vaccine Development and Evaluation Centre, UK Health Security Agency, Porton Down, Salisbury SP4 0JG, UK
| | - Andrew D. White
- Vaccine Development and Evaluation Centre, UK Health Security Agency, Porton Down, Salisbury SP4 0JG, UK
| | - Mark Bodman-Smith
- Infection and Immunity Research Institute, St. George’s University of London, London SW17 0BD, UK
| | - Sally A. Sharpe
- Vaccine Development and Evaluation Centre, UK Health Security Agency, Porton Down, Salisbury SP4 0JG, UK
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White AD, Tran AC, Sibley L, Sarfas C, Morrison AL, Lawrence S, Dennis M, Clark S, Zadi S, Lanni F, Rayner E, Copland A, Hart P, Diogo GR, Paul MJ, Kim M, Gleeson F, Salguero FJ, Singh M, Stehr M, Cutting SM, Basile JI, Rottenberg ME, Williams A, Sharpe SA, Reljic R. Spore-FP1 tuberculosis mucosal vaccine candidate is highly protective in guinea pigs but fails to improve on BCG-conferred protection in non-human primates. Front Immunol 2023; 14:1246826. [PMID: 37881438 PMCID: PMC10594996 DOI: 10.3389/fimmu.2023.1246826] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 09/19/2023] [Indexed: 10/27/2023] Open
Abstract
Tuberculosis remains a major health threat globally and a more effective vaccine than the current Bacillus Calmette Guerin (BCG) is required, either to replace or boost it. The Spore-FP1 mucosal vaccine candidate is based on the fusion protein of Ag85B-Acr-HBHA/heparin-binding domain, adsorbed on the surface of inactivated Bacillus subtilis spores. The candidate conferred significant protection against Mycobacterium. tuberculosis challenge in naïve guinea pigs and markedly improved protection in the lungs and spleens of animals primed with BCG. We then immunized rhesus macaques with BCG intradermally, and subsequently boosted with one intradermal and one aerosol dose of Spore-FP1, prior to challenge with low dose aerosolized M. tuberculosis Erdman strain. Following vaccination, animals did not show any adverse reactions and displayed higher antigen specific cellular and antibody immune responses compared to BCG alone but this did not translate into significant improvement in disease pathology or bacterial burden in the organs.
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Affiliation(s)
- Andrew D. White
- United Kingdom Health Security Agency (UKHSA), Porton Down, Salisbury, United Kingdom
| | - Andy C. Tran
- Institute for Infection and Immunity, St George’s University of London, London, United Kingdom
| | - Laura Sibley
- United Kingdom Health Security Agency (UKHSA), Porton Down, Salisbury, United Kingdom
| | - Charlotte Sarfas
- United Kingdom Health Security Agency (UKHSA), Porton Down, Salisbury, United Kingdom
| | - Alexandra L. Morrison
- United Kingdom Health Security Agency (UKHSA), Porton Down, Salisbury, United Kingdom
| | - Steve Lawrence
- United Kingdom Health Security Agency (UKHSA), Porton Down, Salisbury, United Kingdom
| | - Mike Dennis
- United Kingdom Health Security Agency (UKHSA), Porton Down, Salisbury, United Kingdom
| | - Simon Clark
- United Kingdom Health Security Agency (UKHSA), Porton Down, Salisbury, United Kingdom
| | - Sirine Zadi
- United Kingdom Health Security Agency (UKHSA), Porton Down, Salisbury, United Kingdom
| | - Faye Lanni
- United Kingdom Health Security Agency (UKHSA), Porton Down, Salisbury, United Kingdom
| | - Emma Rayner
- United Kingdom Health Security Agency (UKHSA), Porton Down, Salisbury, United Kingdom
| | - Alastair Copland
- Institute for Infection and Immunity, St George’s University of London, London, United Kingdom
| | - Peter Hart
- Institute for Infection and Immunity, St George’s University of London, London, United Kingdom
| | - Gil Reynolds Diogo
- Institute for Infection and Immunity, St George’s University of London, London, United Kingdom
| | - Matthew J. Paul
- Institute for Infection and Immunity, St George’s University of London, London, United Kingdom
| | - Miyoung Kim
- Institute for Infection and Immunity, St George’s University of London, London, United Kingdom
| | - Fergus Gleeson
- Department of Oncology, The Churchill Hospital, Oxford, United Kingdom
| | - Francisco J. Salguero
- United Kingdom Health Security Agency (UKHSA), Porton Down, Salisbury, United Kingdom
| | | | | | - Simon M. Cutting
- School of Biological Sciences, Royal Holloway University of London, Surrey, United Kingdom
- Sporegen Ltd , London Bioscience Innovation Centre, London, United Kingdom
| | - Juan I. Basile
- Department of Microbiology, Tumour and Cell Biology and Centre for Tuberculosis Research, Karolinska Institute, Stockholm, Sweden
| | - Martin E. Rottenberg
- Department of Microbiology, Tumour and Cell Biology and Centre for Tuberculosis Research, Karolinska Institute, Stockholm, Sweden
| | - Ann Williams
- United Kingdom Health Security Agency (UKHSA), Porton Down, Salisbury, United Kingdom
| | - Sally A. Sharpe
- United Kingdom Health Security Agency (UKHSA), Porton Down, Salisbury, United Kingdom
| | - Rajko Reljic
- Institute for Infection and Immunity, St George’s University of London, London, United Kingdom
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3
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White AD, Sibley L, Sarfas C, Morrison AL, Bewley K, Churchward C, Fotheringham S, Gkolfinos K, Gooch K, Handley A, Humphries HE, Hunter L, Kennard C, Longet S, Mabbutt A, Moffatt M, Rayner E, Tipton T, Watson R, Hall Y, Bodman-Smith M, Gleeson F, Dennis M, Salguero FJ, Carroll M, McShane H, Cookson W, Hopkin J, Sharpe S. Influence of Aerosol Delivered BCG Vaccination on Immunological and Disease Parameters Following SARS-CoV-2 Challenge in Rhesus Macaques. Front Immunol 2022; 12:801799. [PMID: 35222355 PMCID: PMC8863871 DOI: 10.3389/fimmu.2021.801799] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 12/24/2021] [Indexed: 12/19/2022] Open
Abstract
The tuberculosis vaccine, Bacille Calmette-Guerin (BCG), also affords protection against non-tuberculous diseases attributable to heterologous immune mechanisms such as trained innate immunity, activation of non-conventional T-cells, and cross-reactive adaptive immunity. Aerosol vaccine delivery can target immune responses toward the primary site of infection for a respiratory pathogen. Therefore, we hypothesised that aerosol delivery of BCG would enhance cross-protective action against severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection and be a deployable intervention against coronavirus disease 2019 (COVID-19). Immune parameters were monitored in vaccinated and unvaccinated rhesus macaques for 28 days following aerosol BCG vaccination. High-dose SARS-CoV-2 challenge was applied by intranasal and intrabronchial instillation and animals culled 6–8 days later for assessment of viral, disease, and immunological parameters. Mycobacteria-specific cell-mediated immune responses were detected following aerosol BCG vaccination, but SARS-CoV-2-specific cellular- and antibody-mediated immunity was only measured following challenge. Early secretion of cytokine and chemokine markers associated with the innate cellular and adaptive antiviral immune response was detected following SARS-CoV-2 challenge in vaccinated animals, at concentrations that exceeded titres measured in unvaccinated macaques. Classical CD14+ monocytes and Vδ2 γδ T-cells quantified by whole-blood immunophenotyping increased rapidly in vaccinated animals following SARS-CoV-2 challenge, indicating a priming of innate immune cells and non-conventional T-cell populations. However, viral RNA quantified in nasal and pharyngeal swabs, bronchoalveolar lavage (BAL), and tissue samples collected at necropsy was equivalent in vaccinated and unvaccinated animals, and in-life CT imaging and histopathology scoring applied to pulmonary tissue sections indicated that the disease induced by SARS-CoV-2 challenge was comparable between vaccinated and unvaccinated groups. Hence, aerosol BCG vaccination did not induce, or enhance the induction of, SARS-CoV-2 cross-reactive adaptive cellular or humoral immunity, although an influence of BCG vaccination on the subsequent immune response to SARS-CoV-2 challenge was apparent in immune signatures indicative of trained innate immune mechanisms and primed unconventional T-cell populations. Nevertheless, aerosol BCG vaccination did not enhance the initial clearance of virus, nor reduce the occurrence of early disease pathology after high dose SARS-CoV-2 challenge. However, the heterologous immune mechanisms primed by BCG vaccination could contribute to the moderation of COVID-19 disease severity in more susceptible species following natural infection.
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Affiliation(s)
- Andrew D White
- Research and Evaluation, United Kingdom Health Security Agency, Salisbury, United Kingdom
| | - Laura Sibley
- Research and Evaluation, United Kingdom Health Security Agency, Salisbury, United Kingdom
| | - Charlotte Sarfas
- Research and Evaluation, United Kingdom Health Security Agency, Salisbury, United Kingdom
| | - Alexandra L Morrison
- Research and Evaluation, United Kingdom Health Security Agency, Salisbury, United Kingdom
| | - Kevin Bewley
- Research and Evaluation, United Kingdom Health Security Agency, Salisbury, United Kingdom
| | - Colin Churchward
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Susan Fotheringham
- Research and Evaluation, United Kingdom Health Security Agency, Salisbury, United Kingdom
| | - Konstantinos Gkolfinos
- Research and Evaluation, United Kingdom Health Security Agency, Salisbury, United Kingdom
| | - Karen Gooch
- Research and Evaluation, United Kingdom Health Security Agency, Salisbury, United Kingdom
| | - Alastair Handley
- Research and Evaluation, United Kingdom Health Security Agency, Salisbury, United Kingdom
| | - Holly E Humphries
- Research and Evaluation, United Kingdom Health Security Agency, Salisbury, United Kingdom
| | - Laura Hunter
- Research and Evaluation, United Kingdom Health Security Agency, Salisbury, United Kingdom
| | - Chelsea Kennard
- Research and Evaluation, United Kingdom Health Security Agency, Salisbury, United Kingdom
| | - Stephanie Longet
- Research and Evaluation, United Kingdom Health Security Agency, Salisbury, United Kingdom
| | - Adam Mabbutt
- Research and Evaluation, United Kingdom Health Security Agency, Salisbury, United Kingdom
| | - Miriam Moffatt
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Emma Rayner
- Research and Evaluation, United Kingdom Health Security Agency, Salisbury, United Kingdom
| | - Tom Tipton
- Research and Evaluation, United Kingdom Health Security Agency, Salisbury, United Kingdom
| | - Robert Watson
- Research and Evaluation, United Kingdom Health Security Agency, Salisbury, United Kingdom
| | - Yper Hall
- Research and Evaluation, United Kingdom Health Security Agency, Salisbury, United Kingdom
| | - Mark Bodman-Smith
- Infection and Immunity Research Institute, St George's University of London, London, United Kingdom
| | - Fergus Gleeson
- Department of Oncology, Churchill Hospital, Oxford, United Kingdom
| | - Mike Dennis
- Research and Evaluation, United Kingdom Health Security Agency, Salisbury, United Kingdom
| | - Francisco J Salguero
- Research and Evaluation, United Kingdom Health Security Agency, Salisbury, United Kingdom
| | - Miles Carroll
- Research and Evaluation, United Kingdom Health Security Agency, Salisbury, United Kingdom
| | - Helen McShane
- The Jenner Institute, University of Oxford, Oxford, United Kingdom
| | - William Cookson
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Julian Hopkin
- College of Medicine, Institute of Life Science, Swansea University, Swansea, United Kingdom
| | - Sally Sharpe
- Research and Evaluation, United Kingdom Health Security Agency, Salisbury, United Kingdom
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4
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Sarfas C, White AD, Sibley L, Morrison AL, Gullick J, Lawrence S, Dennis MJ, Marsh PD, Fletcher HA, Sharpe SA. Characterization of the Infant Immune System and the Influence and Immunogenicity of BCG Vaccination in Infant and Adult Rhesus Macaques. Front Immunol 2021; 12:754589. [PMID: 34707617 PMCID: PMC8542880 DOI: 10.3389/fimmu.2021.754589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 09/27/2021] [Indexed: 11/13/2022] Open
Abstract
In many countries where tuberculosis (TB) is endemic, the Bacillus Calmette–Guérin (BCG) vaccine is given as close to birth as possible to protect infants and children from severe forms of TB. However, BCG has variable efficacy and is not as effective against adult pulmonary TB. At present, most animal models used to study novel TB vaccine candidates rely on the use of adult animals. Human studies show that the infant immune system is different to that of an adult. Understanding how the phenotypic profile and functional ability of the immature host immune system compares to that of a mature adult, together with the subsequent BCG immune response, is critical to ensuring that new TB vaccines are tested in the most appropriate models. BCG-specific immune responses were detected in macaques vaccinated within a week of birth from six weeks after immunization indicating that neonatal macaques are able to generate a functional cellular response to the vaccine. However, the responses measured were significantly lower than those typically observed following BCG vaccination in adult rhesus macaques and infant profiles were skewed towards the activation and attraction of macrophages and monocytes and the synthesis in addition to release of pro-inflammatory cytokines such as IL-1, IL-6 and TNF-α. The frequency of specific immune cell populations changed significantly through the first three years of life as the infants developed into young adult macaques. Notably, the CD4:CD8 ratio significantly declined as the macaques aged due to a significant decrease in the proportion of CD4+ T-cells relative to a significant increase in CD8+ T-cells. Also, the frequency of both CD4+ and CD8+ T-cells expressing the memory marker CD95, and memory subset populations including effector memory, central memory and stem cell memory, increased significantly as animals matured. Infant macaques, vaccinated with BCG within a week of birth, possessed a significantly higher frequency of CD14+ classical monocytes and granulocytes which remained different throughout the first three years of life compared to unvaccinated age matched animals. These findings, along with the increase in monokines following vaccination in infants, may provide an insight into the mechanism by which vaccination with BCG is able to provide non-specific immunity against non-mycobacterial organisms.
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Affiliation(s)
- Charlotte Sarfas
- National Infection Service, UK Health Security Agency, Salisbury, United Kingdom
| | - Andrew D White
- National Infection Service, UK Health Security Agency, Salisbury, United Kingdom
| | - Laura Sibley
- National Infection Service, UK Health Security Agency, Salisbury, United Kingdom
| | - Alexandra L Morrison
- National Infection Service, UK Health Security Agency, Salisbury, United Kingdom
| | - Jennie Gullick
- National Infection Service, UK Health Security Agency, Salisbury, United Kingdom
| | - Steve Lawrence
- National Infection Service, UK Health Security Agency, Salisbury, United Kingdom
| | - Mike J Dennis
- National Infection Service, UK Health Security Agency, Salisbury, United Kingdom
| | - Philip D Marsh
- National Infection Service, UK Health Security Agency, Salisbury, United Kingdom
| | - Helen A Fletcher
- Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sally A Sharpe
- National Infection Service, UK Health Security Agency, Salisbury, United Kingdom
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Bewley KR, Gooch K, Thomas KM, Longet S, Wiblin N, Hunter L, Chan K, Brown P, Russell RA, Ho C, Slack G, Humphries HE, Alden L, Allen L, Aram M, Baker N, Brunt E, Cobb R, Fotheringham S, Harris D, Kennard C, Leung S, Ryan K, Tolley H, Wand N, White A, Sibley L, Sarfas C, Pearson G, Rayner E, Xue X, Lambe T, Charlton S, Gilbert S, Sattentau QJ, Gleeson F, Hall Y, Funnell S, Sharpe S, Salguero FJ, Gorringe A, Carroll M. Immunological and pathological outcomes of SARS-CoV-2 challenge following formalin-inactivated vaccine in ferrets and rhesus macaques. Sci Adv 2021; 7:eabg7996. [PMID: 34516768 PMCID: PMC8442907 DOI: 10.1126/sciadv.abg7996] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 07/21/2021] [Indexed: 05/16/2023]
Abstract
There is an urgent requirement for safe and effective vaccines to prevent COVID-19. A concern for the development of new viral vaccines is the potential to induce vaccine-enhanced disease (VED). This was reported in several preclinical studies with both SARS-CoV-1 and MERS vaccines but has not been reported with SARS-CoV-2 vaccines. We have used ferrets and rhesus macaques challenged with SARS-CoV-2 to assess the potential for VED in animals vaccinated with formaldehyde-inactivated SARS-CoV-2 (FIV) formulated with Alhydrogel, compared to a negative control vaccine. We showed no evidence of enhanced disease in ferrets or rhesus macaques given FIV except for mild transient enhanced disease seen 7 days after infection in ferrets. This increased lung pathology was observed at day 7 but was resolved by day 15. We also demonstrate that formaldehyde treatment of SARS-CoV-2 reduces exposure of the spike receptor binding domain providing a mechanistic explanation for suboptimal immunity.
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Affiliation(s)
| | - Karen Gooch
- Public Health England, Porton Down, Salisbury SP4 0JG, UK
| | | | | | - Nathan Wiblin
- Public Health England, Porton Down, Salisbury SP4 0JG, UK
| | - Laura Hunter
- Public Health England, Porton Down, Salisbury SP4 0JG, UK
| | - Kin Chan
- Public Health England, Porton Down, Salisbury SP4 0JG, UK
| | - Phillip Brown
- Public Health England, Porton Down, Salisbury SP4 0JG, UK
| | - Rebecca A. Russell
- The Sir William Dunn School of Pathology, University of Oxford, Oxford OX1 3RE, UK
| | - Catherine Ho
- Public Health England, Porton Down, Salisbury SP4 0JG, UK
| | - Gillian Slack
- Public Health England, Porton Down, Salisbury SP4 0JG, UK
| | | | - Leonie Alden
- Public Health England, Porton Down, Salisbury SP4 0JG, UK
| | - Lauren Allen
- Public Health England, Porton Down, Salisbury SP4 0JG, UK
| | - Marilyn Aram
- Public Health England, Porton Down, Salisbury SP4 0JG, UK
| | - Natalie Baker
- Public Health England, Porton Down, Salisbury SP4 0JG, UK
| | - Emily Brunt
- Public Health England, Porton Down, Salisbury SP4 0JG, UK
| | - Rebecca Cobb
- Public Health England, Porton Down, Salisbury SP4 0JG, UK
| | | | - Debbie Harris
- Public Health England, Porton Down, Salisbury SP4 0JG, UK
| | | | | | - Kathryn Ryan
- Public Health England, Porton Down, Salisbury SP4 0JG, UK
| | - Howard Tolley
- Public Health England, Porton Down, Salisbury SP4 0JG, UK
| | - Nadina Wand
- Public Health England, Porton Down, Salisbury SP4 0JG, UK
| | - Andrew White
- Public Health England, Porton Down, Salisbury SP4 0JG, UK
| | - Laura Sibley
- Public Health England, Porton Down, Salisbury SP4 0JG, UK
| | | | - Geoff Pearson
- Public Health England, Porton Down, Salisbury SP4 0JG, UK
| | - Emma Rayner
- Public Health England, Porton Down, Salisbury SP4 0JG, UK
| | - Xiaochao Xue
- The Sir William Dunn School of Pathology, University of Oxford, Oxford OX1 3RE, UK
| | - Teresa Lambe
- The Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford OX3 7DQ, UK
| | - Sue Charlton
- Public Health England, Porton Down, Salisbury SP4 0JG, UK
| | - Sarah Gilbert
- The Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford OX3 7DQ, UK
| | - Quentin J. Sattentau
- The Sir William Dunn School of Pathology, University of Oxford, Oxford OX1 3RE, UK
| | - Fergus Gleeson
- Oxford Departments of Radiology and Nuclear Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 7LE, UK
| | - Yper Hall
- Public Health England, Porton Down, Salisbury SP4 0JG, UK
| | - Simon Funnell
- Public Health England, Porton Down, Salisbury SP4 0JG, UK
- Quadram Institute Bioscience, Norwich Research Park, Norfolk, UK
| | - Sally Sharpe
- Public Health England, Porton Down, Salisbury SP4 0JG, UK
| | | | | | - Miles Carroll
- Public Health England, Porton Down, Salisbury SP4 0JG, UK
- Pandemic Preparedness Centre, Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7LG, UK
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White AD, Sibley L, Gullick J, Sarfas C, Clark S, Fagrouch Z, Verschoor E, Salguero FJ, Dennis M, Sharpe S. TB and SIV Coinfection; a Model for Evaluating Vaccine Strategies against TB Reactivation in Asian Origin Cynomolgus Macaques: A Pilot Study Using BCG Vaccination. Vaccines (Basel) 2021; 9:945. [PMID: 34579182 PMCID: PMC8473354 DOI: 10.3390/vaccines9090945] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 08/12/2021] [Accepted: 08/16/2021] [Indexed: 11/17/2022] Open
Abstract
This pilot study aimed to determine the utility of a cynomolgus macaque model of coinfection with simian immunodeficiency virus (SIV) for the assessment of vaccines designed to prevent reactivation of TB. Following infection caused by aerosol exposure to an ultralow dose of Mycobacterium tuberculosis (M. tb), data trends indicated that subsequent coinfection with SIVmac32H perturbed control of M. tb infection as evidenced by the increased occurrence of progressive disease in this group, higher levels of pathology and increased frequency of progressive tuberculous granulomas in the lung. BCG vaccination led to improved control of TB-induced disease and lower viral load in comparison to unvaccinated coinfected animals. The M. tb-specific IFNγ response after exposure to M. tb, previously shown to be associated with bacterial burden, was lower in the BCG-vaccinated group than in the unvaccinated groups. Levels of CD4+ and CD8+ T cells decreased in coinfected animals, with counts recovering more quickly in the BCG-vaccinated group. This pilot study provides proof of concept to support the use of the model for evaluation of interventions against reactivated/exacerbated TB caused by human immunodeficiency virus (HIV) infection.
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Affiliation(s)
- Andrew D. White
- Public Health England, National Infections Service, Porton Down, Salisbury SP4 0JG, UK; (A.D.W.); (J.G.); (C.S.); (S.C.); (F.J.S.); (M.D.); (S.S.)
| | - Laura Sibley
- Public Health England, National Infections Service, Porton Down, Salisbury SP4 0JG, UK; (A.D.W.); (J.G.); (C.S.); (S.C.); (F.J.S.); (M.D.); (S.S.)
| | - Jennie Gullick
- Public Health England, National Infections Service, Porton Down, Salisbury SP4 0JG, UK; (A.D.W.); (J.G.); (C.S.); (S.C.); (F.J.S.); (M.D.); (S.S.)
| | - Charlotte Sarfas
- Public Health England, National Infections Service, Porton Down, Salisbury SP4 0JG, UK; (A.D.W.); (J.G.); (C.S.); (S.C.); (F.J.S.); (M.D.); (S.S.)
| | - Simon Clark
- Public Health England, National Infections Service, Porton Down, Salisbury SP4 0JG, UK; (A.D.W.); (J.G.); (C.S.); (S.C.); (F.J.S.); (M.D.); (S.S.)
| | - Zahra Fagrouch
- Department of Virology, Biomedical Primate Research Centre, Lange Kleiweg 161, 2288 GJ Rijswijk, The Netherlands; (Z.F.); (E.V.)
| | - Ernst Verschoor
- Department of Virology, Biomedical Primate Research Centre, Lange Kleiweg 161, 2288 GJ Rijswijk, The Netherlands; (Z.F.); (E.V.)
| | - Francisco J. Salguero
- Public Health England, National Infections Service, Porton Down, Salisbury SP4 0JG, UK; (A.D.W.); (J.G.); (C.S.); (S.C.); (F.J.S.); (M.D.); (S.S.)
| | - Mike Dennis
- Public Health England, National Infections Service, Porton Down, Salisbury SP4 0JG, UK; (A.D.W.); (J.G.); (C.S.); (S.C.); (F.J.S.); (M.D.); (S.S.)
| | - Sally Sharpe
- Public Health England, National Infections Service, Porton Down, Salisbury SP4 0JG, UK; (A.D.W.); (J.G.); (C.S.); (S.C.); (F.J.S.); (M.D.); (S.S.)
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7
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Lambe T, Spencer AJ, Thomas KM, Gooch KE, Thomas S, White AD, Humphries HE, Wright D, Belij-Rammerstorfer S, Thakur N, Conceicao C, Watson R, Alden L, Allen L, Aram M, Bewley KR, Brunt E, Brown P, Cavell BE, Cobb R, Fotheringham SA, Gilbride C, Harris DJ, Ho CMK, Hunter L, Kennard CL, Leung S, Lucas V, Ngabo D, Ryan KA, Sharpe H, Sarfas C, Sibley L, Slack GS, Ulaszewska M, Wand N, Wiblin NR, Gleeson FV, Bailey D, Sharpe S, Charlton S, Salguero FJ, Carroll MW, Gilbert SC. ChAdOx1 nCoV-19 protection against SARS-CoV-2 in rhesus macaque and ferret challenge models. Commun Biol 2021; 4:915. [PMID: 34312487 PMCID: PMC8313674 DOI: 10.1038/s42003-021-02443-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 07/08/2021] [Indexed: 01/10/2023] Open
Abstract
Vaccines against SARS-CoV-2 are urgently required, but early development of vaccines against SARS-CoV-1 resulted in enhanced disease after vaccination. Careful assessment of this phenomena is warranted for vaccine development against SARS CoV-2. Here we report detailed immune profiling after ChAdOx1 nCoV-19 (AZD1222) and subsequent high dose challenge in two animal models of SARS-CoV-2 mediated disease. We demonstrate in rhesus macaques the lung pathology caused by SARS-CoV-2 mediated pneumonia is reduced by prior vaccination with ChAdOx1 nCoV-19 which induced neutralising antibody responses after a single intramuscular administration. In a second animal model, ferrets, ChAdOx1 nCoV-19 reduced both virus shedding and lung pathology. Antibody titre were boosted by a second dose. Data from these challenge models on the absence of enhanced disease and the detailed immune profiling, support the continued clinical evaluation of ChAdOx1 nCoV-19.
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Affiliation(s)
- Teresa Lambe
- The Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Alexandra J Spencer
- The Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Kelly M Thomas
- National Infection Service, Public Health England, Salisbury, UK
| | - Karen E Gooch
- National Infection Service, Public Health England, Salisbury, UK
| | - Stephen Thomas
- National Infection Service, Public Health England, Salisbury, UK
| | - Andrew D White
- National Infection Service, Public Health England, Salisbury, UK
| | | | - Daniel Wright
- The Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | | | | | | | - Robert Watson
- National Infection Service, Public Health England, Salisbury, UK
| | - Leonie Alden
- National Infection Service, Public Health England, Salisbury, UK
| | - Lauren Allen
- National Infection Service, Public Health England, Salisbury, UK
| | - Marilyn Aram
- National Infection Service, Public Health England, Salisbury, UK
| | - Kevin R Bewley
- National Infection Service, Public Health England, Salisbury, UK
| | - Emily Brunt
- National Infection Service, Public Health England, Salisbury, UK
| | - Phillip Brown
- National Infection Service, Public Health England, Salisbury, UK
| | - Breeze E Cavell
- National Infection Service, Public Health England, Salisbury, UK
| | - Rebecca Cobb
- National Infection Service, Public Health England, Salisbury, UK
| | | | - Ciaran Gilbride
- The Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Debbie J Harris
- National Infection Service, Public Health England, Salisbury, UK
| | - Catherine M K Ho
- National Infection Service, Public Health England, Salisbury, UK
| | - Laura Hunter
- National Infection Service, Public Health England, Salisbury, UK
| | | | - Stephanie Leung
- National Infection Service, Public Health England, Salisbury, UK
| | - Vanessa Lucas
- National Infection Service, Public Health England, Salisbury, UK
| | - Didier Ngabo
- National Infection Service, Public Health England, Salisbury, UK
| | - Kathryn A Ryan
- National Infection Service, Public Health England, Salisbury, UK
| | - Hannah Sharpe
- The Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Charlotte Sarfas
- National Infection Service, Public Health England, Salisbury, UK
| | - Laura Sibley
- National Infection Service, Public Health England, Salisbury, UK
| | - Gillian S Slack
- National Infection Service, Public Health England, Salisbury, UK
| | - Marta Ulaszewska
- The Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Nadina Wand
- National Infection Service, Public Health England, Salisbury, UK
| | - Nathan R Wiblin
- National Infection Service, Public Health England, Salisbury, UK
| | | | | | - Sally Sharpe
- National Infection Service, Public Health England, Salisbury, UK
| | - Sue Charlton
- National Infection Service, Public Health England, Salisbury, UK
| | | | - Miles W Carroll
- National Infection Service, Public Health England, Salisbury, UK
- Wellcome Trust Centre for Human Genetics, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Sarah C Gilbert
- The Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
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8
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Gooch KE, Smith TRF, Salguero FJ, Fotheringham SA, Watson RJ, Dennis MJ, Handley A, Humphries HE, Longet S, Tipton T, Sarfas C, Sibley L, Slack GS, Rayner E, Ryan KA, Schultheis K, Ramos SJ, White A, Charlton S, Sharpe SA, Gleeson F, Humeau LM, Hall Y, Broderick KE, Carroll MW. One or two dose regimen of the SARS-CoV-2 synthetic DNA vaccine INO-4800 protects against respiratory tract disease burden in nonhuman primate challenge model. Vaccine 2021; 39:4885-4894. [PMID: 34253420 PMCID: PMC8220992 DOI: 10.1016/j.vaccine.2021.06.057] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 06/17/2021] [Accepted: 06/20/2021] [Indexed: 01/31/2023]
Abstract
Safe and effective vaccines will provide essential medical countermeasures to tackle the COVID-19 pandemic. Here, we assessed the safety, immunogenicity and efficacy of the intradermal delivery of INO-4800, a synthetic DNA vaccine candidate encoding the SARS-CoV-2 spike protein in the rhesus macaque model. Single and 2 dose vaccination regimens were evaluated. Vaccination induced both binding and neutralizing antibodies, along with IFN-γ-producing T cells against SARS-CoV-2. Upon administration of a high viral dose (5 × 106 pfu) via the intranasal and intratracheal routes we observed significantly reduced virus load in the lung and throat, in the vaccinated animals compared to controls. 2 doses of INO-4800 was associated with more robust vaccine-induced immune responses and improved viral protection. Importantly, histopathological examination of lung tissue provided no indication of vaccine-enhanced disease following SARS-CoV-2 challenge in INO-4800 immunized animals. This vaccine candidate is currently under clinical evaluation as a 2 dose regimen.
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Affiliation(s)
- Karen E Gooch
- Public Health England (PHE), Porton Down, Salisbury, Wiltshire SP4 0JG, United Kingdom
| | | | - Francisco J Salguero
- Public Health England (PHE), Porton Down, Salisbury, Wiltshire SP4 0JG, United Kingdom
| | - Susan A Fotheringham
- Public Health England (PHE), Porton Down, Salisbury, Wiltshire SP4 0JG, United Kingdom
| | - Robert J Watson
- Public Health England (PHE), Porton Down, Salisbury, Wiltshire SP4 0JG, United Kingdom
| | - Mike J Dennis
- Public Health England (PHE), Porton Down, Salisbury, Wiltshire SP4 0JG, United Kingdom
| | - Alastair Handley
- Public Health England (PHE), Porton Down, Salisbury, Wiltshire SP4 0JG, United Kingdom
| | - Holly E Humphries
- Public Health England (PHE), Porton Down, Salisbury, Wiltshire SP4 0JG, United Kingdom
| | - Stephanie Longet
- Public Health England (PHE), Porton Down, Salisbury, Wiltshire SP4 0JG, United Kingdom
| | - Tom Tipton
- Public Health England (PHE), Porton Down, Salisbury, Wiltshire SP4 0JG, United Kingdom
| | - Charlotte Sarfas
- Public Health England (PHE), Porton Down, Salisbury, Wiltshire SP4 0JG, United Kingdom
| | - Laura Sibley
- Public Health England (PHE), Porton Down, Salisbury, Wiltshire SP4 0JG, United Kingdom
| | - Gillian S Slack
- Public Health England (PHE), Porton Down, Salisbury, Wiltshire SP4 0JG, United Kingdom
| | - Emma Rayner
- Public Health England (PHE), Porton Down, Salisbury, Wiltshire SP4 0JG, United Kingdom
| | - Kathryn A Ryan
- Public Health England (PHE), Porton Down, Salisbury, Wiltshire SP4 0JG, United Kingdom
| | | | | | - Andrew White
- Public Health England (PHE), Porton Down, Salisbury, Wiltshire SP4 0JG, United Kingdom
| | - Sue Charlton
- Public Health England (PHE), Porton Down, Salisbury, Wiltshire SP4 0JG, United Kingdom
| | - Sally A Sharpe
- Public Health England (PHE), Porton Down, Salisbury, Wiltshire SP4 0JG, United Kingdom
| | | | | | - Yper Hall
- Public Health England (PHE), Porton Down, Salisbury, Wiltshire SP4 0JG, United Kingdom
| | | | - Miles W Carroll
- Public Health England (PHE), Porton Down, Salisbury, Wiltshire SP4 0JG, United Kingdom; Wellcome Centre for Human Genetics, Nuffield Dept of Medicine, Oxford University, OX3 7BN, UK
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9
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Sibley L, Daykin-Pont O, Sarfas C, Pascoe J, White AD, Sharpe S. Differences in host immune populations between rhesus macaques and cynomolgus macaque subspecies in relation to susceptibility to Mycobacterium tuberculosis infection. Sci Rep 2021; 11:8810. [PMID: 33893359 PMCID: PMC8065127 DOI: 10.1038/s41598-021-87872-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 04/01/2021] [Indexed: 12/22/2022] Open
Abstract
Rhesus (Macaca mulatta) and cynomolgus (Macaca fasicularis) macaques of distinct genetic origin are understood to vary in susceptibility to Mycobacterium tuberculosis, and therefore differences in their immune systems may account for the differences in disease control. Monocyte:lymphocyte (M:L) ratio has been identified as a risk factor for M. tuberculosis infection and is known to vary between macaque species. We aimed to characterise the constituent monocyte and lymphocyte populations between macaque species, and profile other major immune cell subsets including: CD4+ and CD8+ T-cells, NK-cells, B-cells, monocyte subsets and myeloid dendritic cells. We found immune cell subsets to vary significantly between macaque species. Frequencies of CD4+ and CD8+ T-cells and the CD4:CD8 ratio showed significant separation between species, while myeloid dendritic cells best associated macaque populations by M. tuberculosis susceptibility. A more comprehensive understanding of the immune parameters between macaque species may contribute to the identification of new biomarkers and correlates of protection.
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Affiliation(s)
- Laura Sibley
- Public Health England - Porton, National Infections Service, Porton Down, Salisbury, Wiltshire, SP4 0JG, UK.
| | - Owen Daykin-Pont
- Public Health England - Porton, National Infections Service, Porton Down, Salisbury, Wiltshire, SP4 0JG, UK
| | - Charlotte Sarfas
- Public Health England - Porton, National Infections Service, Porton Down, Salisbury, Wiltshire, SP4 0JG, UK
| | - Jordan Pascoe
- Public Health England - Porton, National Infections Service, Porton Down, Salisbury, Wiltshire, SP4 0JG, UK
| | - Andrew D White
- Public Health England - Porton, National Infections Service, Porton Down, Salisbury, Wiltshire, SP4 0JG, UK
| | - Sally Sharpe
- Public Health England - Porton, National Infections Service, Porton Down, Salisbury, Wiltshire, SP4 0JG, UK
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10
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Salguero FJ, White AD, Slack GS, Fotheringham SA, Bewley KR, Gooch KE, Longet S, Humphries HE, Watson RJ, Hunter L, Ryan KA, Hall Y, Sibley L, Sarfas C, Allen L, Aram M, Brunt E, Brown P, Buttigieg KR, Cavell BE, Cobb R, Coombes NS, Darby A, Daykin-Pont O, Elmore MJ, Garcia-Dorival I, Gkolfinos K, Godwin KJ, Gouriet J, Halkerston R, Harris DJ, Hender T, Ho CMK, Kennard CL, Knott D, Leung S, Lucas V, Mabbutt A, Morrison AL, Nelson C, Ngabo D, Paterson J, Penn EJ, Pullan S, Taylor I, Tipton T, Thomas S, Tree JA, Turner C, Vamos E, Wand N, Wiblin NR, Charlton S, Dong X, Hallis B, Pearson G, Rayner EL, Nicholson AG, Funnell SG, Hiscox JA, Dennis MJ, Gleeson FV, Sharpe S, Carroll MW. Comparison of rhesus and cynomolgus macaques as an infection model for COVID-19. Nat Commun 2021; 12:1260. [PMID: 33627662 PMCID: PMC7904795 DOI: 10.1038/s41467-021-21389-9] [Citation(s) in RCA: 96] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 01/26/2021] [Indexed: 02/06/2023] Open
Abstract
A novel coronavirus, SARS-CoV-2, has been identified as the causative agent of the current COVID-19 pandemic. Animal models, and in particular non-human primates, are essential to understand the pathogenesis of emerging diseases and to assess the safety and efficacy of novel vaccines and therapeutics. Here, we show that SARS-CoV-2 replicates in the upper and lower respiratory tract and causes pulmonary lesions in both rhesus and cynomolgus macaques. Immune responses against SARS-CoV-2 are also similar in both species and equivalent to those reported in milder infections and convalescent human patients. This finding is reiterated by our transcriptional analysis of respiratory samples revealing the global response to infection. We describe a new method for lung histopathology scoring that will provide a metric to enable clearer decision making for this key endpoint. In contrast to prior publications, in which rhesus are accepted to be the preferred study species, we provide convincing evidence that both macaque species authentically represent mild to moderate forms of COVID-19 observed in the majority of the human population and both species should be used to evaluate the safety and efficacy of interventions against SARS-CoV-2. Importantly, accessing cynomolgus macaques will greatly alleviate the pressures on current rhesus stocks.
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Affiliation(s)
- Francisco J Salguero
- National Infection Service, Public Health England (PHE), Porton Down, Salisbury, Wiltshire, UK
| | - Andrew D White
- National Infection Service, Public Health England (PHE), Porton Down, Salisbury, Wiltshire, UK
| | - Gillian S Slack
- National Infection Service, Public Health England (PHE), Porton Down, Salisbury, Wiltshire, UK
| | - Susan A Fotheringham
- National Infection Service, Public Health England (PHE), Porton Down, Salisbury, Wiltshire, UK
| | - Kevin R Bewley
- National Infection Service, Public Health England (PHE), Porton Down, Salisbury, Wiltshire, UK
| | - Karen E Gooch
- National Infection Service, Public Health England (PHE), Porton Down, Salisbury, Wiltshire, UK
| | - Stephanie Longet
- National Infection Service, Public Health England (PHE), Porton Down, Salisbury, Wiltshire, UK
| | - Holly E Humphries
- National Infection Service, Public Health England (PHE), Porton Down, Salisbury, Wiltshire, UK
| | - Robert J Watson
- National Infection Service, Public Health England (PHE), Porton Down, Salisbury, Wiltshire, UK
| | - Laura Hunter
- National Infection Service, Public Health England (PHE), Porton Down, Salisbury, Wiltshire, UK
| | - Kathryn A Ryan
- National Infection Service, Public Health England (PHE), Porton Down, Salisbury, Wiltshire, UK
| | - Yper Hall
- National Infection Service, Public Health England (PHE), Porton Down, Salisbury, Wiltshire, UK
| | - Laura Sibley
- National Infection Service, Public Health England (PHE), Porton Down, Salisbury, Wiltshire, UK
| | - Charlotte Sarfas
- National Infection Service, Public Health England (PHE), Porton Down, Salisbury, Wiltshire, UK
| | - Lauren Allen
- National Infection Service, Public Health England (PHE), Porton Down, Salisbury, Wiltshire, UK
| | - Marilyn Aram
- National Infection Service, Public Health England (PHE), Porton Down, Salisbury, Wiltshire, UK
| | - Emily Brunt
- National Infection Service, Public Health England (PHE), Porton Down, Salisbury, Wiltshire, UK
| | - Phillip Brown
- National Infection Service, Public Health England (PHE), Porton Down, Salisbury, Wiltshire, UK
| | - Karen R Buttigieg
- National Infection Service, Public Health England (PHE), Porton Down, Salisbury, Wiltshire, UK
| | - Breeze E Cavell
- National Infection Service, Public Health England (PHE), Porton Down, Salisbury, Wiltshire, UK
| | - Rebecca Cobb
- National Infection Service, Public Health England (PHE), Porton Down, Salisbury, Wiltshire, UK
| | - Naomi S Coombes
- National Infection Service, Public Health England (PHE), Porton Down, Salisbury, Wiltshire, UK
| | - Alistair Darby
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
| | - Owen Daykin-Pont
- National Infection Service, Public Health England (PHE), Porton Down, Salisbury, Wiltshire, UK
| | - Michael J Elmore
- National Infection Service, Public Health England (PHE), Porton Down, Salisbury, Wiltshire, UK
| | - Isabel Garcia-Dorival
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
| | - Konstantinos Gkolfinos
- National Infection Service, Public Health England (PHE), Porton Down, Salisbury, Wiltshire, UK
| | - Kerry J Godwin
- National Infection Service, Public Health England (PHE), Porton Down, Salisbury, Wiltshire, UK
| | - Jade Gouriet
- National Infection Service, Public Health England (PHE), Porton Down, Salisbury, Wiltshire, UK
| | - Rachel Halkerston
- National Infection Service, Public Health England (PHE), Porton Down, Salisbury, Wiltshire, UK
| | - Debbie J Harris
- National Infection Service, Public Health England (PHE), Porton Down, Salisbury, Wiltshire, UK
| | - Thomas Hender
- National Infection Service, Public Health England (PHE), Porton Down, Salisbury, Wiltshire, UK
| | - Catherine M K Ho
- National Infection Service, Public Health England (PHE), Porton Down, Salisbury, Wiltshire, UK
| | - Chelsea L Kennard
- National Infection Service, Public Health England (PHE), Porton Down, Salisbury, Wiltshire, UK
| | - Daniel Knott
- National Infection Service, Public Health England (PHE), Porton Down, Salisbury, Wiltshire, UK
| | - Stephanie Leung
- National Infection Service, Public Health England (PHE), Porton Down, Salisbury, Wiltshire, UK
| | - Vanessa Lucas
- National Infection Service, Public Health England (PHE), Porton Down, Salisbury, Wiltshire, UK
| | - Adam Mabbutt
- National Infection Service, Public Health England (PHE), Porton Down, Salisbury, Wiltshire, UK
| | - Alexandra L Morrison
- National Infection Service, Public Health England (PHE), Porton Down, Salisbury, Wiltshire, UK
| | - Charlotte Nelson
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
| | - Didier Ngabo
- National Infection Service, Public Health England (PHE), Porton Down, Salisbury, Wiltshire, UK
| | - Jemma Paterson
- National Infection Service, Public Health England (PHE), Porton Down, Salisbury, Wiltshire, UK
| | - Elizabeth J Penn
- National Infection Service, Public Health England (PHE), Porton Down, Salisbury, Wiltshire, UK
| | - Steve Pullan
- National Infection Service, Public Health England (PHE), Porton Down, Salisbury, Wiltshire, UK
| | - Irene Taylor
- National Infection Service, Public Health England (PHE), Porton Down, Salisbury, Wiltshire, UK
| | - Tom Tipton
- National Infection Service, Public Health England (PHE), Porton Down, Salisbury, Wiltshire, UK
| | - Stephen Thomas
- National Infection Service, Public Health England (PHE), Porton Down, Salisbury, Wiltshire, UK
| | - Julia A Tree
- National Infection Service, Public Health England (PHE), Porton Down, Salisbury, Wiltshire, UK
| | - Carrie Turner
- National Infection Service, Public Health England (PHE), Porton Down, Salisbury, Wiltshire, UK
| | - Edith Vamos
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
| | - Nadina Wand
- National Infection Service, Public Health England (PHE), Porton Down, Salisbury, Wiltshire, UK
| | - Nathan R Wiblin
- National Infection Service, Public Health England (PHE), Porton Down, Salisbury, Wiltshire, UK
| | - Sue Charlton
- National Infection Service, Public Health England (PHE), Porton Down, Salisbury, Wiltshire, UK
| | - Xiaofeng Dong
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
| | - Bassam Hallis
- National Infection Service, Public Health England (PHE), Porton Down, Salisbury, Wiltshire, UK
| | - Geoffrey Pearson
- National Infection Service, Public Health England (PHE), Porton Down, Salisbury, Wiltshire, UK
| | - Emma L Rayner
- National Infection Service, Public Health England (PHE), Porton Down, Salisbury, Wiltshire, UK
| | - Andrew G Nicholson
- Royal Brompton and Harefield NHS Foundation Trust, and National Heart and Lung Institute, Imperial College, London, UK
| | - Simon G Funnell
- National Infection Service, Public Health England (PHE), Porton Down, Salisbury, Wiltshire, UK
| | - Julian A Hiscox
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
- Infectious Diseases Horizontal Technology Centre (ID HTC), A*STAR, Singapore, Singapore
| | - Mike J Dennis
- National Infection Service, Public Health England (PHE), Porton Down, Salisbury, Wiltshire, UK
| | | | - Sally Sharpe
- National Infection Service, Public Health England (PHE), Porton Down, Salisbury, Wiltshire, UK
| | - Miles W Carroll
- National Infection Service, Public Health England (PHE), Porton Down, Salisbury, Wiltshire, UK.
- Nuffield Department of Medicine, Wellcome Trust Centre for Human Genetics, Oxford University, Oxford, OX3 7BN, UK.
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11
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Harris SA, White A, Stockdale L, Tanner R, Sibley L, Sarfas C, Meyer J, Peter J, O'Shea MK, Manjaly Thomas ZR, Hamidi A, Satti I, Dennis MJ, McShane H, Sharpe S. Development of a non-human primate BCG infection model for the evaluation of candidate tuberculosis vaccines. Tuberculosis (Edinb) 2018; 108:99-105. [PMID: 29523335 PMCID: PMC5854371 DOI: 10.1016/j.tube.2017.11.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 11/09/2017] [Accepted: 11/14/2017] [Indexed: 12/18/2022]
Abstract
The lack of validated immunological correlates of protection makes tuberculosis vaccine development difficult and expensive. Using intradermal bacille Calmette-Guréin (BCG) as a surrogate for aerosol Mycobacterium tuberculosis (M.tb) in a controlled human infection model could facilitate vaccine development, but such a model requires preclinical validation. Non-human primates (NHPs) may provide the best model in which to do this. Cynomolgus and rhesus macaques were infected with BCG by intradermal injection. BCG was quantified from a skin biopsy of the infection site and from draining axillary lymph nodes, by culture on solid agar and quantitative polymerase chain reaction. BCG was detected up to 28 days post-infection, with higher amounts of BCG detected in lymph nodes after high dose compared to standard dose infection. Quantifying BCG from lymph nodes of cynomolgus macaques 14 days post-high dose infection showed a significant reduction in the amount of BCG detected in the BCG-vaccinated compared to BCG-naïve animals. Demonstrating a detectable vaccine effect in the lymph nodes of cynomolgus macaques, which is similar in magnitude to that seen in an aerosol M.tb infection model, provides support for proof-of-concept of an intradermal BCG infection model and evidence to support the further evaluation of a human BCG infection model.
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Affiliation(s)
- Stephanie A. Harris
- Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7DQ, UK
| | | | - Lisa Stockdale
- Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7DQ, UK
| | - Rachel Tanner
- Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7DQ, UK
| | | | | | - Joel Meyer
- Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7DQ, UK
| | - Jonathan Peter
- Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7DQ, UK
| | - Matthew K. O'Shea
- Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7DQ, UK
| | | | - Ali Hamidi
- Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7DQ, UK
| | - Iman Satti
- Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7DQ, UK
| | | | - Helen McShane
- Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7DQ, UK
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12
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Sharpe SA, White AD, Sibley L, Gleeson F, Hall GA, Basaraba RJ, McIntyre A, Clark SO, Gooch K, Marsh PD, Williams A, Dennis MJ. An aerosol challenge model of tuberculosis in Mauritian cynomolgus macaques. PLoS One 2017; 12:e0171906. [PMID: 28273087 PMCID: PMC5342172 DOI: 10.1371/journal.pone.0171906] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 01/27/2017] [Indexed: 11/21/2022] Open
Abstract
Background New interventions for tuberculosis are urgently needed. Non-human primate (NHP) models provide the most relevant pre-clinical models of human disease and play a critical role in vaccine development. Models utilising Asian cynomolgus macaque populations are well established but the restricted genetic diversity of the Mauritian cynomolgus macaques may be of added value. Methods Mauritian cynomolgus macaques were exposed to a range of doses of M. tuberculosis delivered by aerosol, and the outcome was assessed using clinical, imaging and pathology-based measures. Results All macaques developed characteristic clinical signs and disease features of tuberculosis (TB). Disease burden and the ability to control disease were dependent on exposure dose. Mauritian cynomolgus macaques showed less variation in pulmonary disease burden and total gross pathology scores within exposure dose groups than either Indian rhesus macaques or Chinese cynomolgus macaques Conclusions The genetic homogeneity of Mauritian cynomolgus macaques makes them a potentially useful model of human tuberculosis.
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Affiliation(s)
- S. A. Sharpe
- Public Health England, National Infection Service, Porton Down, Salisbury, SP4 0JG, United Kingdom
- * E-mail:
| | - A. D. White
- Public Health England, National Infection Service, Porton Down, Salisbury, SP4 0JG, United Kingdom
| | - L. Sibley
- Public Health England, National Infection Service, Porton Down, Salisbury, SP4 0JG, United Kingdom
| | - F. Gleeson
- The Churchill Hospital, Headington, Oxford, United Kingdom
| | - G. A. Hall
- Public Health England, National Infection Service, Porton Down, Salisbury, SP4 0JG, United Kingdom
| | - R. J. Basaraba
- Department of Microbiology Immunology and Pathology, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, United States of America
| | - A. McIntyre
- The Churchill Hospital, Headington, Oxford, United Kingdom
| | - S. O. Clark
- Public Health England, National Infection Service, Porton Down, Salisbury, SP4 0JG, United Kingdom
| | - K. Gooch
- Public Health England, National Infection Service, Porton Down, Salisbury, SP4 0JG, United Kingdom
| | - P. D. Marsh
- Public Health England, National Infection Service, Porton Down, Salisbury, SP4 0JG, United Kingdom
| | - A. Williams
- Public Health England, National Infection Service, Porton Down, Salisbury, SP4 0JG, United Kingdom
| | - M. J. Dennis
- Public Health England, National Infection Service, Porton Down, Salisbury, SP4 0JG, United Kingdom
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13
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Sharpe S, White A, Sarfas C, Sibley L, Gleeson F, McIntyre A, Basaraba R, Clark S, Hall G, Rayner E, Williams A, Marsh PD, Dennis M. Alternative BCG delivery strategies improve protection against Mycobacterium tuberculosis in non-human primates: Protection associated with mycobacterial antigen-specific CD4 effector memory T-cell populations. Tuberculosis (Edinb) 2016; 101:174-190. [PMID: 27865390 PMCID: PMC5120991 DOI: 10.1016/j.tube.2016.09.004] [Citation(s) in RCA: 105] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 09/11/2016] [Indexed: 12/01/2022]
Abstract
Intradermal (ID) BCG injection provides incomplete protection against TB in humans and experimental models. Alternative BCG vaccination strategies may improve protection in model species, including rhesus macaques. This study compares the immunogenicity and efficacy of BCG administered by ID and intravenous (IV) injection, or as an intratracheal mucosal boost (ID + IT), against aerosol challenge with Mycobacterium tuberculosis Erdman strain. Disease pathology was significantly reduced, and survival improved, by each BCG vaccination strategy, relative to unvaccinated animals. However, IV induced protection surpassed that achieved by all other routes, providing an opportunity to explore protective immunological mechanisms using antigen-specific IFN-γ ELISpot and polychromatic flow cytometry assays. IFN-γ spot forming units and multifunctional CD4 T-cell frequencies increased significantly following each vaccination regimen and were greatest following IV immunisation. Vaccine-induced multifunctional CD4 T-cells producing IFN-γ and TNF-α were associated with reduced disease pathology following subsequent M.tb challenge; however, high frequencies of this population following M.tb infection correlated with increased pathology. Cytokine producing T-cells primarily occupied the CD4 transitional effector memory phenotype, implicating this population as central to the mycobacterial response, potentially contributing to the stringent control observed in IV vaccinated animals. This study demonstrates the protective efficacy of IV BCG vaccination in rhesus macaques, offering a valuable tool for the interrogation of immunological mechanisms and potential correlates of protection.
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Affiliation(s)
- S Sharpe
- Public Health England, Porton Down, Wiltshire, SP4 0JG, UK.
| | - A White
- Public Health England, Porton Down, Wiltshire, SP4 0JG, UK
| | - C Sarfas
- Public Health England, Porton Down, Wiltshire, SP4 0JG, UK
| | - L Sibley
- Public Health England, Porton Down, Wiltshire, SP4 0JG, UK
| | - F Gleeson
- Churchill Hospital, Headington, Oxford, UK
| | - A McIntyre
- Churchill Hospital, Headington, Oxford, UK
| | - R Basaraba
- Colorado State University, Fort Collins, CO, USA
| | - S Clark
- Public Health England, Porton Down, Wiltshire, SP4 0JG, UK
| | - G Hall
- Public Health England, Porton Down, Wiltshire, SP4 0JG, UK
| | - E Rayner
- Public Health England, Porton Down, Wiltshire, SP4 0JG, UK
| | - A Williams
- Public Health England, Porton Down, Wiltshire, SP4 0JG, UK
| | - P D Marsh
- Public Health England, Porton Down, Wiltshire, SP4 0JG, UK
| | - M Dennis
- Public Health England, Porton Down, Wiltshire, SP4 0JG, UK
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14
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Pepponi I, Diogo GR, Stylianou E, van Dolleweerd CJ, Drake PMW, Paul MJ, Sibley L, Ma JKC, Reljic R. Plant-derived recombinant immune complexes as self-adjuvanting TB immunogens for mucosal boosting of BCG. Plant Biotechnol J 2014; 12:840-50. [PMID: 24629003 DOI: 10.1111/pbi.12185] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Revised: 02/12/2014] [Accepted: 02/18/2014] [Indexed: 06/03/2023]
Abstract
Progress with protein-based tuberculosis (TB) vaccines has been limited by poor availability of adjuvants suitable for human application. Here, we developed and tested a novel approach to molecular engineering of adjuvanticity that circumvents the need for exogenous adjuvants. Thus, we generated and expressed in transgenic tobacco plants the recombinant immune complexes (RICs) incorporating the early secreted Ag85B and the latency-associated Acr antigen of Mycobacterium tuberculosis, genetically fused as a single polypeptide to the heavy chain of a monoclonal antibody to Acr. The RICs were formed by virtue of the antibody binding to Acr from adjacent molecules, thus allowing self-polymerization of the complexes. TB-RICs were purified from the plant extracts and shown to be biologically active by demonstrating that they could bind to C1q component of the complement and also to the surface of antigen-presenting cells. Mice immunized with BCG and then boosted with two intranasal immunizations with TB-RICs developed antigen-specific serum IgG antibody responses with mean end-point titres of 1 : 8100 (Acr) and 1 : 24 300 (Ag85B) and their splenocytes responded to in vitro stimulation by producing interferon gamma. 25% of CD4+ proliferating cells simultaneously produced IFN-γ, IL-2 and TNF-α, a phenotype that has been linked with protective immune responses in TB. Importantly, mucosal boosting of BCG-immunized mice with TB-RICs led to a reduced M. tuberculosis infection in their lungs from log10 mean = 5.69 ± 0.1 to 5.04 ± 0.2, which was statistically significant. We therefore propose that the plant-expressed TB-RICs represent a novel molecular platform for developing self-adjuvanting mucosal vaccines.
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Affiliation(s)
- Ilaria Pepponi
- St George's University of London, London, UK; Jenner Institute, University of Oxford, Oxford, UK
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15
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Sibley L, Reljic R, Radford DS, Huang JM, Hong HA, Cranenburgh RM, Cutting SM. RecombinantBacillus subtilisspores expressing MPT64 evaluated as a vaccine against tuberculosis in the murine model. FEMS Microbiol Lett 2014; 358:170-9. [DOI: 10.1111/1574-6968.12525] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 06/26/2014] [Accepted: 07/01/2014] [Indexed: 11/28/2022] Open
Affiliation(s)
- Laura Sibley
- School of Biological Sciences; Royal Holloway, University of London; Egham UK
| | - Rajko Reljic
- Infection and Immunity Research Centre; St George's University of London; London UK
| | - David S. Radford
- Cobra Biologics Ltd; Keele Science Park; Keele UK
- Prokarium Ltd; Keele Science Park; Keele UK
| | - Jen-Min Huang
- School of Biological Sciences; Royal Holloway, University of London; Egham UK
| | - Huynh A. Hong
- School of Biological Sciences; Royal Holloway, University of London; Egham UK
| | | | - Simon M. Cutting
- School of Biological Sciences; Royal Holloway, University of London; Egham UK
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16
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Stylianou E, Diogo GR, Pepponi I, Dolleweerd C, Arias MA, Locht C, Rider CC, Sibley L, Cutting SM, Loxley A, Ma JK, Reljic R. Mucosal delivery of antigen‐coated nanoparticles to lungs confers protective immunity against tuberculosis infection in mice. Eur J Immunol 2013; 44:440-9. [DOI: 10.1002/eji.201343887] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Revised: 09/25/2013] [Accepted: 11/05/2013] [Indexed: 11/09/2022]
Affiliation(s)
- Elena Stylianou
- Infection and Immunity Research CentreSt George's University of London London UK
- Jenner InstituteJohn Radcliffe HospitalUniversity of Oxford Oxford UK
| | - Gil R. Diogo
- Infection and Immunity Research CentreSt George's University of London London UK
| | - Ilaria Pepponi
- Infection and Immunity Research CentreSt George's University of London London UK
- Jenner InstituteJohn Radcliffe HospitalUniversity of Oxford Oxford UK
| | - Craig Dolleweerd
- Infection and Immunity Research CentreSt George's University of London London UK
| | - Mauricio A. Arias
- Infection and Immunity Research CentreSt George's University of London London UK
| | - Camille Locht
- Institute Pasteur de Lille Lille France
- Inserm U1019 Lille France
- CNRS UMR8204 Lille France
- Université Lille Nord de France Lille France
| | | | - Laura Sibley
- School of Biological SciencesRoyal Holloway University of London Egham UK
| | - Simon M. Cutting
- School of Biological SciencesRoyal Holloway University of London Egham UK
| | - Andrew Loxley
- Particle Sciences, Inc Pennsylvania, Bethlehem PA USA
| | - Julian K.C. Ma
- Infection and Immunity Research CentreSt George's University of London London UK
| | - Rajko Reljic
- Infection and Immunity Research CentreSt George's University of London London UK
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17
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18
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Volkmann D, Zent W, Little T, Riddle T, Durenberger J, Durenbereger J, Potenza K, Sibley L, Roser J. Hormone profiles of mares affected by the mare reproductive loss syndrome. Reprod Domest Anim 2008; 43:578-83. [PMID: 18363606 DOI: 10.1111/j.1439-0531.2007.00955.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
While searching for the cause of the Mare Reproductive Loss syndrome (MRLS), we postulated that 1 of 3 tissues in 40-120 D pregnant mares was the likely primary target of the noxious factor that caused early abortions: The corpora lutea (CL), the endometrium or the fetus and/or its membranes. At this stage of gestation, progesterone (P4) is solely produced by luteal tissue, eCG by endometrial cups in the endometrium and oestrogens by the feto-placental unit. We determined whether concentrations of P4, eCG and/or total conjugated oestrogens (CE) would indicate which tissue was targeted during the MRLS. P4, eCG and CE were measured in single serum samples collected from 216 mares, 60-110 D after ovulation during the 2001 MRLS outbreak. All mares had previously been confirmed pregnant by ultrasonography. The following data was obtained from each mare: Interval from ovulation, pregnancy status and normalcy of fetal fluids at the time of sampling, and pregnancy status 3 weeks after sampling and at term. There were no meaningful differences in hormone concentrations between pregnant mares that had normal and excessively echogenic fetal fluids at the time of sampling. CE were lower (p < 0.05) in mares that aborted after sample collection than in mares the carried to term. In 8 mares from which multiple samples were obtained, CE consistently decreased prior to any decreases in P4 or eCG. Arguments are presented that lead to the hypothesis that the fetal trophoblast was the primary target of the MRLS agent.
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Affiliation(s)
- D Volkmann
- Department of Veterinary Medicine & Surgery, University of Missouri, Columbia, MO 65211, USA.
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19
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Parker AA, Stephenson R, Riley PL, Ombeki S, Komolleh C, Sibley L, Quick R. Sustained high levels of stored drinking water treatment and retention of hand-washing knowledge in rural Kenyan households following a clinic-based intervention. Epidemiol Infect 2006; 134:1029-36. [PMID: 16438747 PMCID: PMC2870483 DOI: 10.1017/s0950268806005954] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2005] [Indexed: 11/06/2022] Open
Abstract
Nyanza Province, Kenya is characterized by poor water quality and high diarrhoea prevalence. To address these problems, nurses in a maternal and child health clinic in Homa Bay, Kenya were trained in household water chlorination with a locally available, social marketed product, and in six steps of proper hand washing. They were asked to communicate this information to their clients. Interviews immediately following the training by nurses were conducted on 220 clients, of whom 168 (76%) reported being taught both procedures during their clinic visit. After 2 weeks, free chlorine residuals were present in stored drinking water in 67 out of 98 (68%) clients' homes and, 1 year later, in 36 out of 51 (71%) clients' homes. After 2 weeks, all six hand-washing steps were correctly demonstrated by 41 (44%) out of 93 clients, and by 17 out of 51 (34%) 1 year later. This brief, practical intervention shows promise for vulnerable populations.
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Affiliation(s)
- A A Parker
- Center for Global Safe Water at Rollins School of Public Health, Emory University, Atlanta, GA, USA.
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20
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Abstract
AIM To describe both the initial and the subsequent impact of the 2001 Global Nursing Partnerships Conference: 'Strategies for a Sustainable Workforce', the first ever forum of its type, on the key challenges facing the global nursing community. DESIGN Identification of short- and long-term outcomes through descriptive review of immediate post-conference evaluations and follow-up questionnaires sent out 13 months later to nursing leaders in the participating countries. METHODS Content analysis of quantitative data from 61 immediate post-conference evaluations and 13 follow-up questionnaires, as well as qualitative data from participant comments on the evaluation forms and questionnaires. FINDINGS Analysis indicated conference participants viewed the conference as a beneficial forum to collaboratively examine nursing workforce issues and trends, develop country-specific nursing action plans, establish and strengthen national and international partnerships, and build stronger international nursing bodies. CONCLUSION The Global Nursing Partnerships Conference was an international success--addressing the unique challenges facing nursing leaders in developed and developing countries and the needs of nurses throughout the world.
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Affiliation(s)
- M J Swenson
- The Nell Hodgson Woodruff School of Nursing, The Rollins School of Public Health, Emory University, Atlanta, GA, USA.
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Sibley L, Buffington ST, Beck D, Armbruster D. Home based life saving skills: promoting safe motherhood through innovative community-based interventions. J Midwifery Womens Health 2001; 46:258-66. [PMID: 11603641 DOI: 10.1016/s1526-9523(01)00139-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In much of the developing world, home birth with unskilled attendants is the norm, and maternal and neonatal mortality rates are high. A comprehensive approach to address this problem needs to upgrade referral facilities and strengthen the skills of trained health care providers. To improve pregnancy outcomes, a program must also provide education, motivation, and mobilization of pregnant women, families, and communities (whose members must come to a common understanding of the need for and the means to prevent death of a woman or neonate). Consequently, the American College of Nurse Midwives (ACNM) has expanded the Life Savings Skills Series to include Home Based Life Saving Skills (HBLSS). HBLSS is a community and competency-based program that aims to reduce maternal and neonatal mortality by increasing access to basic life saving measures within the home and community and by decreasing delays in reaching referral facilities where life-threatening problems can be managed.
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Affiliation(s)
- L Sibley
- Department of Global Outreach of the American College of Nurse-Midwives, Emory University, Atlanta, Georgia, USA
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22
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Sibley L, Armbruster D. Obstetric first aid in the community--partners in safe motherhood. A strategy for reducing maternal mortality. J Nurse Midwifery 1997; 42:117-21. [PMID: 9107120 DOI: 10.1016/s0091-2182(97)00022-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The unacceptably high levels of maternal mortality that are prevalent throughout the developing world are a product of many factors; most notably, these include nonexistent, inaccessible or inadequate facility-based emergency care, poorly developed referral linkages, predominance of home-based care by attendants and family members who are poorly equipped to respond to emergencies, and the complexities of problem recognition and decision making during emergencies leading to inappropriate or delayed action. This paper describes an innovative community-oriented strategy that has been designed to reduce maternal mortality and that targets women, families, and traditional birth attendants (TBAs) using two complimentary training interventions. The strategy reflects the authors' conviction that the training of professional and paraprofessional health workers in emergency care is essential, but that it must be complemented by the education and mobilization of families, communities, and TBAs who must, in turn, come to common perceptions on the need for and means of intervening to prevent a maternal death. Collaborating with partners in the US Agency for International Development-funded Primary Providers Training and Education in Reproductive Health Project. Special Project staff of the American College of Nurse-Midwives will lead development and testing of the strategy through operations research activities in selected countries.
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Affiliation(s)
- L Sibley
- Emory University, Atlanta, Georgia, USA.
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23
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Wiig H, Kaysen GA, al-Bander HA, De Carlo M, Sibley L, Renkin EM. Interstitial exclusion of IgG in rat tissues estimated by continuous infusion. Am J Physiol 1994; 266:H212-9. [PMID: 8304502 DOI: 10.1152/ajpheart.1994.266.1.h212] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Interstitial exclusion, defined as the fraction of interstitial fluid volume inaccessible to a solute, was evaluated for immunoglobulin G (IgG) in selected tissues of rats by a method previously applied to serum albumin (29). IgG distribution volumes were also measured for intestine. 125I-labeled rat IgG was infused for 5 or 7 days (n = 4 rats each) with an implanted osmotic pump (Alzet). At the termination of infusion, the rat was anesthetized, nephrectomized, and injected with 51Cr-labeled EDTA (4 h) to label total extracellular fluid volume and 131I-labeled bovine IgG (5 min) to label plasma volume. Samples of skin, muscle, and tendon were assayed for total and extractable tracer activity. Interstitial fluid from these tissues was sampled postmortem with nylon wicks for assay of 125I-labeled IgG and endogenous albumin and IgG. Exclusion of IgG was calculated from the difference between extravascular 125I-labeled IgG and 51Cr-labeled EDTA distribution volumes. In contrast to our previous experience with tracer albumin, 125I-labeled IgG was not fully extractable from minced skin, muscle, or tendon by isotonic saline; only 71-83% was recovered under conditions that eluted 92-96% of tracer albumin and 94-99% of tracer EDTA. We conclude that approximately 20% of extravascular 125I-labeled IgG in these tissues is sequestered or bound in the interstitium. Calculation of IgG fractional exclusion from extractable tracer yielded the following values (means +/- SE, n = 8 rats): leg muscles 0.37 +/- 0.09, leg skin 0.44 +/- 0.03, back skin 0.36 +/- 0.04, tail skin 0.40 +/- 0.08, and tail tendon 0.55 +/- 0.04.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- H Wiig
- Department of Human Physiology, University of California, Davis 95616
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24
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Renkin EM, Tucker VL, Wiig H, Kaysen G, Sibley L, DeCarlo M, Simanonok K, Wong M. Blood-tissue transport of exogenous albumin and immunoglobulin G in genetically analbuminemic rats. J Appl Physiol (1985) 1993; 74:559-66. [PMID: 7681428 DOI: 10.1152/jappl.1993.74.2.559] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Tracer uptake studies were carried out in adult female Nagase (NA) strain analbuminemic rats [derived from Sprague-Dawley (SD) stock] and in adult female SD controls to determine the extent to which capillary permeability to plasma proteins is altered in the absence of endogenous albumin. Accessory measurements (arterial pressure, central venous pressure, plasma and interstitial fluid protein concentrations and oncotic pressures, plasma volume, and interstitial fluid volume) confirm the report of Joles et al. [Am. J. Physiol. 257 (Renal Fluid Electrolyte Physiol. 26): F23-F28, 1989] that shows elevated plasma volumes, normal interstitial fluid volumes, nearly normal plasma oncotic pressures (due to elevated globulin concentrations), and lower interstitial fluid oncotic pressures. In skin, skeletal muscles, and heart muscle, clearances of exogenous heterologous (bovine) albumin were 20-40% higher in NA than in SD controls. In intestine, albumin clearances were 20-30% lower. In NA rats blood-to-tissue clearances of heterologous (bovine) immunoglobulin G in skin and heart were higher and in the intestine they were lower than in SD controls; however, clearances in skeletal muscles were not elevated. The differences between NA and SD are small compared with the large increases in macromolecular permeabilities reported by others for organs and single microvessels perfused with albumin-free fluids.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- E M Renkin
- Department of Human Physiology, School of Medicine, University of California, Davis 95616
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25
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Abstract
Steady-state 125I-labeled rat serum albumin (125I-labeled RSA) concentration in plasma was maintained by intravenous infusion of tracer for 72-168 h with an implanted osmotic pump. At the end of the infusion period, the rat was anesthetized and nephrectomized, and extracellular fluid was equilibrated with intravenous 51Cr-labeled EDTA for 4 h. Five minutes before final plasma and tissue sampling, 131I-labeled bovine serum albumin (131I-labeled BSA) was injected intravenously as a plasma volume marker. Samples of skin, muscle, tendon, and intestine were assayed for all three tracers. Apparent distribution volumes were calculated as tissue tracer content/plasma tracer concentration. Interstitial fluid volume (Vi) was calculated as V51Cr-EDTA-V131I-BSA. Steady-state extravascular distribution of 125I-labeled RSA as plasma equivalent volume (Va,p) was calculated as V125I-RSA-V131I-BSA. Steady-state interstitial fluid concentrations of 125I-labeled RSA in skin, muscles, and tendon were measured with nylon wicks implanted postmortem, and steady-state interstitial albumin distribution volumes were recalculated as wick-fluid equivalent volumes (Va,w). Relative albumin exclusion fraction (Ve/Vi) was calculated as 1-Va,w/Vi. For skin and muscle, steady-state 125I-labeled RSA tissue concentrations were reached at 72 h. Ve/Vi for albumin averaged 26% in hindlimb muscle, 41% in hindlimb skin, 30% in back skin, 39% in tail skin, and 54% in tail tendon. For muscle, Ve/Vi corresponds to expectation if all tissue collagen and hyaluronan is dispersed in the interstitium. However, for skin and tendon, albumin exclusion is considerably lower than expected on this basis, suggesting that much of their collagen is organized into dense bundles of fibers containing no fluid accessible to 51Cr-labeled EDTA or 125I-labeled RSA.
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Affiliation(s)
- H Wiig
- Department of Human Physiology, University of California, Davis 95616
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26
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Renkin EM, Tucker V, Rew K, O'Loughlin D, Wong M, Sibley L. Plasma volume expansion with colloids increases blood-tissue albumin transport. Am J Physiol 1992; 262:H1054-67. [PMID: 1566888 DOI: 10.1152/ajpheart.1992.262.4.h1054] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Extravasation of plasma proteins is increased after volume expansion with whole blood or plasma. To investigate the mechanisms responsible for this phenomenon, we measured extravascular accumulation of exogenous 131I-labeled bovine serum albumin in several tissues and organs of anesthetized rats. Plasma volume was increased acutely by infusion of isoncotic albumin or polyvinylpyrrolidone, with or without subsequent infusion of a 1:10 dilution of the colloid to induce blood-to-tissue fluid movement. Controls were given only a slow sustaining infusion of saline. The amounts of fluid and plasma protein lost from the circulation were followed simultaneously by two methods: 1) material balance in the whole animal, and 2) changes in 131I-labeled albumin uptake (VA) and water content (VW) in the individual tissues. Plasma volume expansion of 80-90% increased plasma protein extravasation in the whole rat by an average of 2.7-fold over a 30-min period. Of the protein extravasated, 42% entered the abdominal cavity. The rest was distributed in the interstitial compartment of various tissues and organs. Tracer albumin accumulation (averaged over 30 min) was increased 38-82% in skin and paw, 40-59% in skeletal muscles, 131% in hearts, and 167-230% in different parts of the intestine. Increased convective transport does not appear to be a major factor. There was little or no relation of albumin transport increase to the magnitude or direction of net fluid transfer. Coupling of albumin transport to volume flow was not greater than previously reported for saline infusion or venous congestion. Convective redistribution (convective transport without net fluid transfer, "volume recirculation") is estimated to increase albumin transport no more than 10% under the conditions of our experiments. The greater part of the increase is thus dissipative, i.e., attributable to increased diffusion or increased vesicular exchange. Control of dissipative transport of albumin may play an important role in regulating plasma volume.
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Affiliation(s)
- E M Renkin
- Department of Human Physiology, University of California, Davis 95616
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Abstract
Medical anthropology has developed distinct and separate biological and cultural approaches to the study of health and disease in human populations. Within cultural anthropology a major focus has been the ethnomedical perspective that analyzes the process of defining disease and describing the social response to disease. In biological anthropology, an ecological perspective considers the interaction of the population, the insult and the environment at the core of the disease process. There has been limited success in integrating the cultural and biological perspective. Some cultural anthropologists claim that the ecological perspective relies on a biomedical model and therefore is not useful in studying non-Western societies. Others are critical of the adaptivist perspective that they believe fails to consider political economic factors that affect the disease process. The lack of a biocultural integration has hindered the systematic analysis of health and disease in contemporary traditional and non-Western groups. An ecological model that addresses these problems will provide a biocultural integration of the disease process.
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Affiliation(s)
- G J Armelagos
- Department of Anthropology, University of Florida, Gainesville 32611
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28
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Abstract
A modification of the implanted wick method (K. Aukland and H. O. Fadnes. Acta Physiol. Scand. 88: 350-358, 1973) was devised to sample interstitial fluid from rat muscles. Dry nylon wicks were inserted postmortem into intermuscular spaces between leg muscles by means of a plastic catheter, which was subsequently withdrawn. Inserting the wicks postmortem avoids contaminating wick fluid with proteins extravasated as a result of local inflammatory reactions; placing them intermuscularly avoids contamination by fluid and proteins from damaged muscle cells. Wick fluid protein concentrations (mg/ml) averaged 24.1 +/- 1.1 and 28.5 +/- 1.5 (means +/- SE) in medial and lateral hindlimbs muscles, respectively. The corresponding albumin concentrations were 13.0 +/- 0.7 and 13.9 +/- 0.7 mg/ml. Total protein and albumin concentrations in plasma were 54.1 +/- 0.8 and 22.5 +/- 0.3 mg/ml. Electrophoresis of wick fluid showed a pattern of peaks similar to that of plasma, with albumin relatively high and larger molecules relatively low. Proteins from muscle cells were not detected. Isotope studies (125I-labeled albumin, 51Cr-EDTA) showed that less than 2% of the albumin in wick fluid came directly from plasma and that wick fluid was not concentrated by cell swelling postmortem. Wick fluid from intermuscular wicks implanted in anesthetized rats in vivo had nearly the same total protein concentration as fluid from postmortem wicks, but albumin-to-globulin (A/G) ratios were slightly lower (1.22 +/- 0.07 vs. 1.53 +/- 0.21 measured by gel electrophoresis), and more significantly, nearly 50% of the albumin leaked to wick fluid from plasma as a result of wick implantation.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- H Wiig
- Department of Human Physiology, School of Medicine, University of California, Davis 95616
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Abstract
Anesthetized rats were infused with lactated Ringer solution (LR) at constant rate for 30 or 60 min; delivered volume loads ranged from 0.03 to 0.08 ml/g body wt. Controls were given only a sustaining infusion of saline at 0.002 ml.g-1.h-1. Only 7-14% of the LR remained in the plasma at the end of the infusion; 76-88% entered the interstitial compartment, and 7-17% was excreted. The amount of plasma protein lost from the circulation with the extravasated fluid was studied simultaneously by two methods: 1) material balance in the whole animal and 2) changes in 131I-labeled albumin uptake (VA) and water content (VW) in individual tissues. The extravasation of 0.03-0.06 ml fluid/g body wt (75-160% initial plasma volume) did not significantly increase plasma protein extravasation in the whole rat. Nearly all of the sampled tissues of LR-infused rats had higher VW than controls. Tissue VA tended to increase with VW, but the regression slopes (delta VA/delta VW), a measure of the tracer albumin concentration of capillary filtrate relative to plasma, were low; skin, 0.006; paw, 0.018; skeletal muscles, 0.007; heart, 0.057; jejunum, 0.095; ileum, 0.045; cecum, 0.026; and colon, 0.027. These ratios are consistent with the very small loss of total plasma protein observed and attest to high solvent-drag reflection coefficients (sigma approximately equal to 1 - delta VA/delta VW): greater than 0.98 in capillaries of skeletal muscles, skin, and paw and 0.91-0.97 in heart and intestine.
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Affiliation(s)
- E M Renkin
- Department of Human Physiology, School of Medicine, University of California, Davis 95616
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Renkin EM, Joyner WL, Gustafson-Sgro M, Plopper G, Sibley L. Albumin extravasation rates in tissues of anesthetized and unanesthetized rats. J Appl Physiol (1985) 1989; 66:2056-60. [PMID: 2745274 DOI: 10.1152/jappl.1989.66.5.2056] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Bovine serum albumin (BSA) labeled with 131I was injected intravenously in chronically prepared, unanesthetized rats and into pentobarbital-anesthetized rats that had received 2 ml 5% BSA to help sustain plasma volume. Initial uptake rates (clearances) in skin, skeletal muscles, diaphragm, and heart (left ventricle) were measured over 1 h. BSA labeled with 125I was injected terminally to correct for intravascular 131I-BSA. Observed clearances were in the following order in both groups of animals: heart much greater than diaphragm approximately equal to skin greater than resting skeletal muscles. Differences between unanesthetized and anesthetized animals were small and inconsistently directed. Our results suggest that the lower albumin clearances reported in the literature for anesthetized rats are not the result of their immobility or any direct effect of anesthesia on albumin transport in these tissues. The lower transport rates appear to result indirectly from changes produced by anesthesia and/or surgery in controllable parameters such as plasma volume and intravascular protein mass.
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Affiliation(s)
- E M Renkin
- Department of Human Physiology, School of Medicine, University of California, Davis 95616
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Sibley L. Confidence with incontinence. Nurs Times 1988; 84:42-3. [PMID: 3211776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Abstract
Bovine serum albumin (BSA) labeled with 131I or 125I was injected intravenously in pentobarbital sodium-anesthetized rats, and tracer clearances into leg skin and muscles were measured over 30, 60, and 120 min. BSA labeled with the alternate tracer was used as vascular volume reference. Two minutes before injection of the tracer, a ligature was tied around one femoral vein to occlude outflow partially and raise capillary pressure in that leg. The unoccluded leg served as control. Skin and muscles of the occluded leg had variably and substantially higher water contents (delta W) than paired control tissues and slightly but consistently increased albumin clearances (CA). The delta CA/delta W, equivalent to the albumin concentration of capillary filtrate relative to plasma determined by linear regression, were as follows: leg skin 0.004 (95% confidence limits -0.001 to +0.009), muscle biceps femoris 0.005 (0.001-0.010), muscle gastrocnemius 0.011 (0.004-0.019), muscle tibialis anterior 0.016 (0.012-0.021). All these values are significantly less than 0.10, which corresponds to a reflection coefficient for serum albumin (sigma A) of 0.90. Convective coupling of albumin flux to volume flux in skin and muscles of intact, anesthetized rats is low, with sigma AS in the range 0.98 to greater than 0.99.
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Affiliation(s)
- E M Renkin
- Department of Human Physiology, School of Medicine, University of California, Davis 95616
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Hambidge KM, Krebs NF, Sibley L, English J. Acute effects of iron therapy on zinc status during pregnancy. Obstet Gynecol 1987; 70:593-6. [PMID: 3627628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The acute effects of iron therapy on zinc status during pregnancy were investigated. The 20 subjects studied were healthy and had unremarkable obstetric histories. The mean stage of gestation was 27 weeks (range 21-33 weeks). Initial hematologic indices (mean +/- SEM) were: hematocrit 36.5 +/- 0.4%, serum ferritin 32.6 +/- 6.1 ng/mL, and serum iron 117 +/- 13 micrograms/dL. Iron therapy, prescribed by the obstetric caregivers, provided a total average daily elemental iron intake of 261 mg (range 164-395 mg) from therapy and routine supplements. Laboratory studies of zinc status were obtained immediately before iron therapy and at one and four weeks thereafter. Initial plasma zinc was 62.9 +/- 2.1 micrograms/dL. A mean decline in plasma zinc of 4.0 +/- 1.8 micrograms/dL (P less than .05) was observed from baseline to one week. The decline remained statistically significant after adjustment for the expected physiologic decline over the same interval of gestation. No further decline occurred from one to four weeks. No significant treatment-related effects were observed for neutrophil zinc, mononuclear leukocyte zinc, or serum alkaline phosphatase activity. These results indicate that iron therapy in doses typically prescribed by obstetric caregivers in this country has an acute, measurable effect on maternal zinc status.
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Abstract
UNLABELLED We compared modifications of the wick technique for analysis of interstitial fluid in rat subcutis. Nylon wicks were implanted for 60 min in back skin of rats after anesthesia with pentobarbital or after sacrifice by potassium chloride injection. Wicks were implanted dry or loaded with saline or varied dilutions of rat serum. Implantation of dry wicks and wicks loaded with diluted serum in living, anesthetized animals produced similar results; the protein concentration of wick fluid averaged about 60% that of the plasma protein concentration. The saline loaded wicks produced wick fluid with a lower protein concentration, average about 45% that of plasma protein concentration. The lower concentrations apparently resulted from simple dilution. Wick fluid sampled from dead animals had similar total protein concentrations, but in the dead animals there was a lower concentration of the large plasma proteins and a relatively higher concentration of the smaller proteins. CONCLUSIONS Wick implantation in living animals causes a transitory inflammatory reaction and a decrease in the size selectivity of macromolecular sieving, but local osmotic forces bring about a concentration equilibrium with undisturbed interstitium. Implantation of dry wicks in subcutis either in vivo or post mortem provides a simple, direct method for sampling the total protein concentration and colloid osmotic pressure of interstitial fluid. Implantation of dry wicks postmortem permits measurement of individual component protein concentrations and evaluation of molecular selectivity between plasma and interstitium.
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Ruhling RO, Cameron J, Sibley L, Christensen CL, Bolen T. 8: 30 a.m.: MAINTAINING AEROBIC FITNESS WHILE JOGGING THROUGH A PREGNANCY: A CASE STUDY. Med Sci Sports Exerc 1981. [DOI: 10.1249/00005768-198101320-00123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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