Do women referred for colposcopy receive adequate information from the primary care team?

The objective of this study was to assess whether women had been counselled by their primary health care team and whether or not they had received any information about colposcopy. We also asked where the best information had been obtained. The setting was the colposcopy clinic of a large district general hospital, the design of which was a cross-sectional audit using a questionnaire. The subjects were 100 women attending the colposcopy clinic. The results show that 63% of women were seen by their primary health care team before the colposcopy visit and that counselling was associated with knowledge about colposcopy (P = 0.017). However, 43% of women felt that they knew nothing about colposcopy whilst 19% of women thought that the information they had obtained was not useful. We conclude that there is scope for improving the quality, timing and provision of information for women undergoing colposcopy.

A protective glycosylphosphatidylinositol-anchored membrane protein of Plasmodium yoelii trophozoites and merozoites contains two epidermal growth factor-like domains

Using sera from mice immunized and protected against Plasmodium yoelii malaria, we identified a novel blood-stage antigen gene, pypag-2. The 2.1-kb pypag-2 cDNA contains a single open reading frame that encodes a 409-amino-acid protein with a predicted molecular mass of 46.8 kDa. Unlike many characterized plasmodial antigens, blocks of tandemly repeated amino acids are lacking in the pypAg-2 protein sequence. Recombinant pypAg-2, comprising the full-length protein minus the predicted N-terminal signal and C-terminal anchor sequences, was produced and used to raise a high-titer polyclonal rabbit antiserum. This antiserum was used to identify and characterize the native protein through immunoblotting, immunoprecipitation and immunofluorescence assays. Consistent with the presence of a glycosylphosphatidylinositol anchor, pypAg-2 fractionated with the detergent phase of Triton X-114-solubilized proteins and could be metabolically labeled with [(3)H]palmitic acid. By immunofluorescence, pypAg-2 expression was localized to both the trophozoite and merozoite membranes. Similar to Plasmodium falciparum merozoite surface protein 1, pypAg-2 contains two C-terminal epidermal growth factor (EGF)-like domains. Most importantly, immunization with recombinant pypAg-2 protected mice against lethal P. yoelii malaria. Thus, pypAg-2 is a target of protective immune responses and represents a novel addition to the family of merozoite surface proteins that contain one or more EGF-like domains.

An unusual tryptophan-rich domain characterizes two secreted antigens of Plasmodium yoelii-infected erythrocytes

Previously, we reported the characterization of pypAg-1, a novel protective membrane protein of Plasmodium yoelii-infected erythrocytes. Immunization studies indicated that pypAg-1 contained at least two protective epitopes. One of these determinants was associated with the N-terminal portion of pypAg-1, that also included a 220 amino acid domain unusually rich in tryptophan residues. Using sera from mice immunized against P. yoelii, we have identified a second related antigen, pypAg-3. The pypag-3 cDNA encodes a 43 kDa blood-stage protein that is also characterized by the presence of a 220 residue tryptophan-rich domain. Of particular interest, sequence comparisons revealed that 24 tryptophan residues are positionally conserved between pypAg-1 and pypAg-3. Otherwise, the two antigens share limited sequence similarity. Full-length recombinant pypAg-3 was expressed, purified and used to produce a high titer polyclonal rabbit antiserum. As with pypAg-1, immunofluorescence studies showed that pypAg-3 is expressed in the cytoplasm and associated with the membrane of P. yoelii infected erythrocytes. In addition, pypAg-1 and pypAg-3 appear to be secreted proteins, as both were detected in culture supernatants of P. yoelii-infected erythrocytes. Finally, metabolically labeled pypAg-1 and pypAg-3 secreted from parasitized cells bind to the surface of uninfected, normal mouse erythrocytes. As such, the conservation of the unusual tryptophan-rich domain between two blood-stage malarial proteins with similar biological properties suggests that it may be important for protein export and/or function.

Is the provision of information leaflets before colposcopy beneficial? A prospective randomised study

OBJECTIVE

To assess the usefulness of a leaflet distributed to women before colposcopy designed to reduce their anxiety and psychosexual morbidity by providing information.

DESIGN

Prospective randomised study.

SETTING

Colposcopy clinic of a large district general hospital.

SAMPLE

Two hundred consecutive women undergoing colposcopy for the first time for a cervical cytological abnormality of severity no greater than moderate dyskaryosis.

METHODS

Women were randomised into one of two groups (leaflet or control). Those in the leaflet group were sent an information leaflet prior to attending the clinic. In the colposcopy clinic all the women completed a State/Trait Anxiety Inventory (StAI/TrAI) and a modified psychosexual questionnaire before undergoing colposcopy. This was repeated at the six-month follow up visit. Women in the leaflet group also completed a further questionnaire on the leaflet.

MAIN OUTCOME MEASURES

Differences of anxiety and psychosexual scores between leaflet and control groups.

RESULTS

The leaflet was well received. There were no statistical differences in StAI and TrAI scores between the study group and the control group at either visit, although in the whole study population StAI and TrAI scores were reduced at the second visit. The leaflet group had significantly more psychosexual problems but by the second visit, the scores had improved and the two groups were similar. When the mean differences in anxiety and psychosexual scores at the initial and second visits were compared between the groups, the reduction in negative sexual feelings and deterioration of TrAI scores experienced by the leaflet group was significant.

CONCLUSIONS

This study suggests that the provision of sending an information leaflet prior to colposcopy is not beneficial in isolation. Other approaches need to be considered.

Protective immunization with a novel membrane protein of Plasmodium yoelii-infected erythrocytes

Immunization with a particulate fraction of blood-stage antigens was shown previously to protect mice against Plasmodium yoelii malaria. To identify antigens inducing the protective response, sera from immunized mice were used to screen a P. yoelii cDNA expression library. Sequence analysis of one 2.6-kb cDNA clone indicated that the identified gene, pypag-1, encoded a novel plasmodial antigen. Two nonoverlapping regions of pypag-1 were expressed in Escherichia coli. The first recombinant antigen, pAg-1N, contained the N-terminal 337 residues, which included a putative transmembrane domain and a region relatively rich in tryptophan residues. The second recombinant antigen, pAg-1C, contained the remaining C-terminal 211 residues, which included 31 copies of a 5-amino-acid degenerative repeat. Immunoblot studies using rabbit antiserum raised against recombinant pAg-1N showed that the native pypAg-1 protein migrated at approximately 98 kDa, considerably slower than its predicted molecular mass of 66 kDa. Immunofluorescence studies localized the expression of the native pypAg-1 protein both to the cytoplasm and at the surface of P. yoelii-infected erythrocytes. Immunization with either pAg-1N or pAg-1C induced a four- to sevenfold reduction in P. yoelii blood-stage parasitemia. As such, pypAg-1 appears to contain at least two distinct protective epitopes. To our knowledge, this is the first characterization of a protective antigen of P. yoelii that is associated with the erythrocyte membrane.

Protective immunity against Plasmodium yoelii malaria induced by immunization with particulate blood-stage antigens

The Plasmodium yoelii murine model was used to test several combinations of blood-stage antigens and adjuvants for the ability to induce immunity to blood-stage malaria. Upon fractionation of whole blood-stage antigen into soluble and insoluble components, only the particulate antigens (pAg) induced protective immune responses. Of a number of adjuvants tested, Quil A was the most effective. Immunization with pAg plus Quil A induced solid protection against nonlethal and lethal P. yoelii challenge infection. Analysis of cytokine production revealed mRNA for Th1-type cytokines (interleukin 2 [IL-2] and gamma interferon) as well as Th2-type cytokines (IL-4 and IL-10) in the spleens of both protected and susceptible animals. The data suggested that the protective pAg response was associated with the earlier production of cytokine mRNA with a Th2 phenotype somewhat favored. Immunization of B-cell-deficient JHD mice indicated that the protection against P. yoelii induced by pAg immunization was B cell dependent. Although immunization with pAg plus Quil A increased the levels of antigen-specific antibodies of all four immunoglobulin G (IgG) isotypes, protection correlated most closely with the presence of IgG1 and IgG2b antibodies. Sera from pAg-plus-Quil A-immunized animals recognized only a limited subset of six to eight distinct P. yoelii antigens, primarily associated with the pAg fraction. These results provide the basis for the identification and characterization of potential vaccine antigens, selected solely for their ability to immunize against blood-stage malaria.