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Kantele A, Riekkinen M, Jokiranta TS, Pakkanen SH, Pietilä JP, Patjas A, Eriksson M, Khawaja T, Klemets P, Marttinen K, Siikamäki H, Lundgren A, Holmgren J, Lissmats A, Carlin N, Svennerholm AM. Safety and immunogenicity of ETVAX®, an oral inactivated vaccine against enterotoxigenic Escherichia coli diarrhoea: a double-blinded, randomized, placebo-controlled trial amongst Finnish travellers to Benin, West Africa. J Travel Med 2023; 30:taad045. [PMID: 37099803 PMCID: PMC10658657 DOI: 10.1093/jtm/taad045] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 01/31/2023] [Accepted: 03/28/2023] [Indexed: 04/28/2023]
Abstract
BACKGROUND No licensed human vaccines are available against enterotoxigenic Escherichia coli (ETEC), a major diarrhoeal pathogen affecting children in low- and middle-income countries and foreign travellers alike. ETVAX®, a multivalent oral whole-cell vaccine containing four inactivated ETEC strains and the heat-labile enterotoxin B subunit (LTB), has proved promising in Phase 1 and Phase 1/ 2 studies. METHODS We conducted a Phase 2b double-blinded, randomized, placebo-controlled trial amongst Finnish travellers to Benin, West Africa. This report presents study design and safety and immunogenicity data. Volunteers aged 18-65 years were randomized 1:1 to receive ETVAX® or placebo. They visited Benin for 12 days, provided stool and blood samples and completed adverse event (AE) forms. IgA and IgG antibodies to LTB and O78 lipopolysaccharide (LPS) were measured by electrochemiluminescence. RESULTS The AEs did not differ significantly between vaccine (n = 374) and placebo (n = 375) recipients. Of the solicited AEs, loose stools/diarrhoea (26.7/25.9%) and stomach ache (23.0/20.0%) were reported most commonly. Of all possibly/probably vaccine-related AEs, the most frequent were gastrointestinal symptoms (54.0/48.8%) and nervous system disorders (20.3/25.1%). Serious AEs were recorded for 4.3/5.6%, all unlikely to be vaccine related. Amongst the ETVAX® recipients, LTB-specific IgA antibodies increased 22-fold. For the 370/372 vaccine/placebo recipients, the frequency of ≥2-fold increases against LTB was 81/2.4%, and against O78 LPS 69/2.7%. The majority of ETVAX® recipients (93%) responded to either LTB or O78. CONCLUSIONS This Phase 2b trial is the largest on ETVAX® undertaken amongst travellers to date. ETVAX® showed an excellent safety profile and proved strongly immunogenic, which encourages the further development of this vaccine.
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Affiliation(s)
- Anu Kantele
- Meilahti Vaccine Research Center, MeVac, University of Helsinki and Department of Infectious Diseases, Inflammation Center, HUS, Helsinki University Hospital, Helsinki, Finland
- Human Microbiome Research Unit, University of Helsinki, Helsinki, Finland
- Travel Clinic, Aava Medical Center, Helsinki, Finland
| | - Marianna Riekkinen
- Meilahti Vaccine Research Center, MeVac, University of Helsinki and Department of Infectious Diseases, Inflammation Center, HUS, Helsinki University Hospital, Helsinki, Finland
- Human Microbiome Research Unit, University of Helsinki, Helsinki, Finland
- Travel Clinic, Aava Medical Center, Helsinki, Finland
| | - T Sakari Jokiranta
- United Medix Laboratories/Synlab Finland Ltd, Helsinki, Finland
- Medicum, Department of Bacteriology and Immunology, University of Helsinki, Helsinki, Finland
- Mobidiag Ltd, Espoo, Finland
| | - Sari H Pakkanen
- Meilahti Vaccine Research Center, MeVac, University of Helsinki and Department of Infectious Diseases, Inflammation Center, HUS, Helsinki University Hospital, Helsinki, Finland
- Human Microbiome Research Unit, University of Helsinki, Helsinki, Finland
| | - Jukka-Pekka Pietilä
- Meilahti Vaccine Research Center, MeVac, University of Helsinki and Department of Infectious Diseases, Inflammation Center, HUS, Helsinki University Hospital, Helsinki, Finland
- Human Microbiome Research Unit, University of Helsinki, Helsinki, Finland
- Travel Clinic, Aava Medical Center, Helsinki, Finland
| | - Anu Patjas
- Meilahti Vaccine Research Center, MeVac, University of Helsinki and Department of Infectious Diseases, Inflammation Center, HUS, Helsinki University Hospital, Helsinki, Finland
- Human Microbiome Research Unit, University of Helsinki, Helsinki, Finland
- Travel Clinic, Aava Medical Center, Helsinki, Finland
| | - Mari Eriksson
- Meilahti Vaccine Research Center, MeVac, University of Helsinki and Department of Infectious Diseases, Inflammation Center, HUS, Helsinki University Hospital, Helsinki, Finland
| | - Tamim Khawaja
- Meilahti Vaccine Research Center, MeVac, University of Helsinki and Department of Infectious Diseases, Inflammation Center, HUS, Helsinki University Hospital, Helsinki, Finland
- Human Microbiome Research Unit, University of Helsinki, Helsinki, Finland
| | - Peter Klemets
- Meilahti Vaccine Research Center, MeVac, University of Helsinki and Department of Infectious Diseases, Inflammation Center, HUS, Helsinki University Hospital, Helsinki, Finland
| | - Kati Marttinen
- Meilahti Vaccine Research Center, MeVac, University of Helsinki and Department of Infectious Diseases, Inflammation Center, HUS, Helsinki University Hospital, Helsinki, Finland
| | - Heli Siikamäki
- Meilahti Vaccine Research Center, MeVac, University of Helsinki and Department of Infectious Diseases, Inflammation Center, HUS, Helsinki University Hospital, Helsinki, Finland
| | - Anna Lundgren
- Gothenburg University Vaccine Research Institute, Department of Microbiology and Immunology, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden
| | - Jan Holmgren
- Gothenburg University Vaccine Research Institute, Department of Microbiology and Immunology, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden
| | | | | | - Ann-Mari Svennerholm
- Gothenburg University Vaccine Research Institute, Department of Microbiology and Immunology, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden
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Lamberg T, Sipponen T, Valtanen S, Eklund KK, Mälkönen T, Aalto K, Mikola K, Kolho KL, Leinonen S, Isomäki P, Mäkinen H, Vidqvist KL, Kokko A, Huilaja L, Kyllönen M, Keskitalo P, Sard S, Vähäsalo P, Koskela R, Kröger L, Lahtinen P, Haapala AM, Korkatti K, Sokka-Isler T, Jokiranta TS. Short interruptions of TNF-inhibitor treatment can be associated with treatment failure in patients with immune-mediated diseases. Autoimmunity 2022; 55:275-284. [PMID: 35481450 DOI: 10.1080/08916934.2022.2067985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION The prevalence of immune-mediated diseases has increased in the past decades and despite the use of biological treatments all patients do not achieve remission. The aim of this study was to characterise the reasons for short interruptions during treatment with two commonly used TNF-inhibitors infliximab and adalimumab and to analyse the possible effects of the interruptions on immunisation and switching the treatment. MATERIAL AND METHODS This case-control study was based on retrospective analyses of patient records and a questionnaire survey to clinicians. A total of 370 patients (194 immunised cases and 172 non-immunised controls, 4 excluded) were enrolled from eight hospitals around Finland. Eleven different diagnoses were represented, and the largest patient groups were those with inflammatory bowel or rheumatic diseases. RESULTS Treatment interruptions were associated with immunisation in patients using infliximab (p < .001) or adalimumab (p < .000001). Patients with treatment interruptions were more likely to have been treated with more than one biological agent compared to those without treatment interruptions. This was particularly prominent among patients with a rheumatic disease (p < .00001). The most frequent reason for a treatment interruption among the cases was an infection, whereas among the control patients it was remission. The median length of one interruption was one month (interquartile range 1-3 months). CONCLUSION Our results suggest that the interruptions of the treatment with TNF-inhibitors expose patients to immunisation and increase the need for drug switching. These findings stress the importance of careful judgement of the need for a short interruption in the biological treatment in clinical work, especially during non-severe infections.
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Affiliation(s)
- Tea Lamberg
- United Medix Laboratories, Helsinki, Finland
- Department of Clinical Chemistry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Taina Sipponen
- Department of Gastroenterology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Sanna Valtanen
- United Medix Laboratories, Helsinki, Finland
- Department of Clinical Chemistry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Kari K Eklund
- Department of Rheumatology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Orton Orthopedic Hospital Helsinki, Helsinki, Finland
| | - Tarja Mälkönen
- Department of Dermatology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Kristiina Aalto
- New Children's Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Katriina Mikola
- New Children's Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Kaija-Leena Kolho
- Pediatric Gastroenterology, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Sanna Leinonen
- Tays Eye Centre, Tampere University Hospital, Tampere, Finland
| | - Pia Isomäki
- Centre for Rheumatology, Tampere University Hospital, Tampere, Finland
| | - Heidi Mäkinen
- Centre for Rheumatology, Tampere University Hospital, Tampere, Finland
| | | | - Arto Kokko
- Department of Rheumatology, Jyväskylä Central Hospital, Jyväskylä, Finland
| | - Laura Huilaja
- PEDEGO Research Unit, University of Oulu, Oulu, Finland
- Department of Dermatology and Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Minna Kyllönen
- Department of Rheumatology, Oulu University Hospital, Oulu, Finland
| | - Paula Keskitalo
- PEDEGO Research Unit, University of Oulu, Oulu, Finland
- Department of Pediatrics, Oulu University Hospital, Oulu, Finland
- Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Sirja Sard
- PEDEGO Research Unit, University of Oulu, Oulu, Finland
- Department of Pediatrics, Oulu University Hospital, Oulu, Finland
- Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Paula Vähäsalo
- PEDEGO Research Unit, University of Oulu, Oulu, Finland
- Department of Pediatrics, Oulu University Hospital, Oulu, Finland
- Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Ritva Koskela
- Department of Gastroenterology, Oulu University Hospital, Oulu, Finland
| | - Liisa Kröger
- Department of Pediatrics, Kuopio University Hospital, Kuopio, Finland
| | - Perttu Lahtinen
- Department of Gastroenterology, Päijät-Häme Central Hospital, Lahti, Finland
| | - Anna-Maija Haapala
- Department of Clinical Microbiology, Fimlab Laboratories, Tampere, Finland
| | - Katja Korkatti
- Department of Pediatrics, Central Ostrobothnia Central Hospital, Kokkola, Finland
| | | | - T Sakari Jokiranta
- United Medix Laboratories, Helsinki, Finland
- Medicum, University of Helsinki, Helsinki, Finland
- Tammer BioLab Ltd, Tampere, Finland
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Hiltunen J, Parmanne P, Sokka T, Lamberg T, Isomäki P, Kaipiainen-Seppänen O, Peltomaa R, Uutela T, Pirilä L, Taimen K, Kauppi MJ, Yli-Kerttula T, Tuompo R, Relas H, Kortelainen S, Paalanen K, Asikainen J, Ekman P, Santisteban A, Vidqvist KL, Tadesse K, Romu M, Borodina J, Elfving P, Valleala H, Leirisalo-Repo M, Rantalaiho V, Kautiainen H, Jokiranta TS, Eklund KK. Immunogenicity of subcutaneous TNF inhibitors and its clinical significance in real-life setting in patients with spondyloarthritis. Rheumatol Int 2021; 42:1015-1025. [PMID: 34357455 PMCID: PMC9124652 DOI: 10.1007/s00296-021-04955-8] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 07/17/2021] [Indexed: 01/17/2023]
Abstract
Key messages Considerable proportion of patients with SpA have been immunized to the subcutaneous anti-TNF drug they are using. Concomitant use of MTX protects from immunization, whereas SASP does not. Patients with SpA using subcutaneous anti-TNF drugs can benefit from monitoring of the drug trough levels. Abstract Immunization to biological drugs can lead to decreased efficacy and increased risk of adverse effects. The objective of this cross-sectional study was to assess the extent and significance of immunization to subcutaneous tumor necrosis factor (TNF) inhibitors in axial spondyloarthritis (axSpA) patients in real-life setting. A serum sample was taken 1–2 days before the next drug injection. Drug trough concentrations, anti-drug antibodies (ADAb) and TNF-blocking capacity were measured in 273 patients with axSpA using subcutaneous anti-TNF drugs. The clinical activity of SpA was assessed using the Bath AS Disease Activity Index (BASDAI) and the Maastricht AS Entheses Score (MASES). ADAb were found in 11% of the 273 patients: in 21/99 (21%) of patients who used adalimumab, in 0/83 (0%) of those who used etanercept, in 2/79 (3%) of those who used golimumab and in 6/12 (50%) of those who used certolizumab pegol. Use of methotrexate reduced the risk of formation of ADAb, whereas sulfasalazine did not. Presence of ADAb resulted in decreased drug concentration and reduced TNF-blocking capacity. However, low levels of ADAb had no effect on TNF-blocking capacity and did not correlate with disease activity. The drug trough levels were below the consensus target level in 36% of the patients. High BMI correlated with low drug trough concentration. Patients with low drug trough levels had higher disease activity. The presence of anti-drug antibodies was associated with reduced drug trough levels, and the patients with low drug trough levels had higher disease activity. The drug trough levels were below target level in significant proportion of patients and, thus, measuring the drug concentration and ADAb could help to optimize the treatment in SpA patients. Supplementary Information The online version contains supplementary material available at 10.1007/s00296-021-04955-8.
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Affiliation(s)
- J Hiltunen
- Department of Rheumatology, Helsinki University and Helsinki University Hospital, Haartmaninkatu 4, P. O. Box 372, 00029 HUS, Helsinki, Finland.
| | - P Parmanne
- Department of Rheumatology, Helsinki University and Helsinki University Hospital, Haartmaninkatu 4, P. O. Box 372, 00029 HUS, Helsinki, Finland
| | - T Sokka
- Department of Rheumatology, Jyväskylä Central Hospital, Jyväskylä, Finland.,University of Eastern Finland, Kuopio, Finland
| | - T Lamberg
- United Medix Laboratories, Helsinki, Finland
| | - P Isomäki
- Department of Rheumatology, Tampere University Hospital, Tampere, Finland
| | | | - R Peltomaa
- Department of Rheumatology, Helsinki University and Helsinki University Hospital, Haartmaninkatu 4, P. O. Box 372, 00029 HUS, Helsinki, Finland
| | - T Uutela
- Department of Rheumatology, Central Hospital of Lapland, Rovaniemi, Finland
| | - L Pirilä
- Department of Rheumatology, Turku University Hospital, Turku, Finland
| | - K Taimen
- Department of Rheumatology, Turku University Hospital, Turku, Finland
| | - M J Kauppi
- Department of Rheumatology, Päijät-Häme Central Hospital, Lahti, Finland.,University of Tampere, Tampere, Finland
| | - T Yli-Kerttula
- Department of Rheumatology, Satakunta Central Hospital, Rauma, Finland
| | - R Tuompo
- Department of Rheumatology, Helsinki University and Helsinki University Hospital, Haartmaninkatu 4, P. O. Box 372, 00029 HUS, Helsinki, Finland
| | - H Relas
- Department of Rheumatology, Helsinki University and Helsinki University Hospital, Haartmaninkatu 4, P. O. Box 372, 00029 HUS, Helsinki, Finland
| | - S Kortelainen
- Department of Rheumatology, Turku University Hospital, Turku, Finland
| | - K Paalanen
- Department of Rheumatology, Jyväskylä Central Hospital, Jyväskylä, Finland.,University of Eastern Finland, Kuopio, Finland
| | - J Asikainen
- Department of Rheumatology, Jyväskylä Central Hospital, Jyväskylä, Finland.,University of Eastern Finland, Kuopio, Finland
| | - P Ekman
- Department of Rheumatology, Satakunta Central Hospital, Rauma, Finland
| | - A Santisteban
- Department of Rheumatology, Mikkeli Central Hospital, Mikkeli, Finland
| | - K-L Vidqvist
- Department of Rheumatology, Tampere University Hospital, Tampere, Finland
| | - K Tadesse
- Department of Rheumatology, Helsinki University and Helsinki University Hospital, Haartmaninkatu 4, P. O. Box 372, 00029 HUS, Helsinki, Finland
| | - M Romu
- Department of Rheumatology, Helsinki University and Helsinki University Hospital, Haartmaninkatu 4, P. O. Box 372, 00029 HUS, Helsinki, Finland
| | - J Borodina
- Department of Rheumatology, Jyväskylä Central Hospital, Jyväskylä, Finland.,University of Eastern Finland, Kuopio, Finland
| | - P Elfving
- Department of Rheumatology, Kuopio University Hospital, Kuopio, Finland
| | - H Valleala
- Department of Rheumatology, Helsinki University and Helsinki University Hospital, Haartmaninkatu 4, P. O. Box 372, 00029 HUS, Helsinki, Finland
| | - M Leirisalo-Repo
- Department of Rheumatology, Helsinki University and Helsinki University Hospital, Haartmaninkatu 4, P. O. Box 372, 00029 HUS, Helsinki, Finland
| | - V Rantalaiho
- Department of Rheumatology, Tampere University Hospital, Tampere, Finland
| | | | | | - K K Eklund
- Department of Rheumatology, Helsinki University and Helsinki University Hospital, Haartmaninkatu 4, P. O. Box 372, 00029 HUS, Helsinki, Finland.,Translational Immunology Research Program, Helsinki University and Orton Research Foundation, Orton Hospital, Helsinki, Finland
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Kolehmainen S, Ylisaukko-Oja T, Jokelainen J, Koivusalo M, Jokiranta TS, Sipponen T. Benefit of measuring vedolizumab concentrations in inflammatory bowel disease patients in a real-world setting. Scand J Gastroenterol 2021; 56:906-913. [PMID: 34154506 DOI: 10.1080/00365521.2021.1938206] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES We set out to determine the reasons for serum vedolizumab (VDZ) trough concentration (TC) measurements in inflammatory bowel disease (IBD) patients and to evaluate treatment modifications after therapeutic drug measurement (TDM). We also evaluated the effect of increased dosing on patients' response to VDZ therapy. METHODS We performed a retrospective cohort study of IBD patients who received VDZ therapy at Helsinki University Hospital and whose VDZ levels were measured between June 2014 and December 2018. RESULTS Altogether, 90 patients (32 Crohn's disease and 58 ulcerative colitis) and 141 VDZ TC measurements were included. 24.1% of measurements took place during induction and 75.9% during the maintenance phase. During induction, 64.7% reached the target TC >20µg/ml. During maintenance therapy, 82.2% of VDZ TCs were within or exceeded the suggested target range of 5-15µg/ml. Reasons for TDM were: secondary nonresponse (44.0%), assessment of adequate VDZ TC (25.5%), primary nonresponse (12.8%), adverse events (6.4%), and other (11.3%). No treatment changes occurred after 60.3% of VDZ measurements. Increased dose frequency was used after 25.5% of VDZ measurements and 33.3% of these patients experienced improvement. Altogether, 31 (34.4%) patients discontinued the therapy due to inadequate treatment response. No anti-vedolizumab antibodies were detected. CONCLUSIONS During the maintenance of VDZ therapy, the majority of VDZ TCs were within the suggested range. Measurement of VDZ TC did not lead to any treatment changes in two-thirds of patients. Dose optimization occurred in a quarter of patients and a third of them benefited from it.
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Affiliation(s)
| | - Tero Ylisaukko-Oja
- MedEngine Oy, Helsinki, Finland.,Faculty of Medicine, Center for Life Course Health Research, University of Oulu, Oulu, Finland
| | - Jari Jokelainen
- MedEngine Oy, Helsinki, Finland.,Faculty of Medicine, Center for Life Course Health Research, University of Oulu, Oulu, Finland
| | | | - T Sakari Jokiranta
- Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Tammer BioLab Ltd, Tampere, Finland
| | - Taina Sipponen
- Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Department of Gastroenterology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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5
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Uzonyi B, Szabó Z, Trojnár E, Hyvärinen S, Uray K, Nielsen HH, Erdei A, Jokiranta TS, Prohászka Z, Illes Z, Józsi M. Autoantibodies Against the Complement Regulator Factor H in the Serum of Patients With Neuromyelitis Optica Spectrum Disorder. Front Immunol 2021; 12:660382. [PMID: 33986750 PMCID: PMC8111293 DOI: 10.3389/fimmu.2021.660382] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 01/29/2021] [Accepted: 03/31/2021] [Indexed: 02/02/2023] Open
Abstract
Neuromyelitis optica spectrum disorder (NMOSD) is an autoimmune inflammatory disease of the central nervous system (CNS), characterized by pathogenic, complement-activating autoantibodies against the main water channel in the CNS, aquaporin 4 (AQP4). NMOSD is frequently associated with additional autoantibodies and antibody-mediated diseases. Because the alternative pathway amplifies complement activation, our aim was to evaluate the presence of autoantibodies against the alternative pathway C3 convertase, its components C3b and factor B, and the complement regulator factor H (FH) in NMOSD. Four out of 45 AQP4-seropositive NMOSD patients (~9%) had FH autoantibodies in serum and none had antibodies to C3b, factor B and C3bBb. The FH autoantibody titers were low in three and high in one of the patients, and the avidity indexes were low. FH-IgG complexes were detected in the purified IgG fractions by Western blot. The autoantibodies bound to FH domains 19-20, and also recognized the homologous FH-related protein 1 (FHR-1), similar to FH autoantibodies associated with atypical hemolytic uremic syndrome (aHUS). However, in contrast to the majority of autoantibody-positive aHUS patients, these four NMOSD patients did not lack FHR-1. Analysis of autoantibody binding to FH19-20 mutants and linear synthetic peptides of the C-terminal FH and FHR-1 domains, as well as reduced FH, revealed differences in the exact binding sites of the autoantibodies. Importantly, all four autoantibodies inhibited C3b binding to FH. In conclusion, our results demonstrate that FH autoantibodies are not uncommon in NMOSD and suggest that generation of antibodies against complement regulating factors among other autoantibodies may contribute to the complement-mediated damage in NMOSD.
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Affiliation(s)
- Barbara Uzonyi
- MTA-ELTE Immunology Research Group, Eötvös Loránd Research Network (ELKH), Department of Immunology, ELTE Eötvös Loránd University, Budapest, Hungary.,Department of Immunology, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Zsóka Szabó
- MTA-ELTE "Lendület" Complement Research Group, Department of Immunology, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Eszter Trojnár
- Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary.,Research Group for Immunology and Haematology, Semmelweis University-Eötvös Loránd Research Network (Office for Supported Research Groups), Budapest, Hungary
| | - Satu Hyvärinen
- Department of Bacteriology and Immunology, Medicum, and Immunobiology Research Program Unit, University of Helsinki and Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Katalin Uray
- MTA-ELTE Research Group of Peptide Chemistry, Eötvös Loránd Research Network (ELKH), ELTE Eötvös Loránd University, Budapest, Hungary
| | - Helle H Nielsen
- Department of Neurology, Odense University Hospital and Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | - Anna Erdei
- MTA-ELTE Immunology Research Group, Eötvös Loránd Research Network (ELKH), Department of Immunology, ELTE Eötvös Loránd University, Budapest, Hungary.,Department of Immunology, ELTE Eötvös Loránd University, Budapest, Hungary
| | - T Sakari Jokiranta
- Department of Bacteriology and Immunology, Medicum, and Immunobiology Research Program Unit, University of Helsinki and Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Zoltán Prohászka
- Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary.,Research Group for Immunology and Haematology, Semmelweis University-Eötvös Loránd Research Network (Office for Supported Research Groups), Budapest, Hungary
| | - Zsolt Illes
- Department of Neurology, Odense University Hospital and Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark.,Department of Neurology, Medical School, University of Pécs, Pécs, Hungary
| | - Mihály Józsi
- Department of Immunology, ELTE Eötvös Loránd University, Budapest, Hungary.,MTA-ELTE "Lendület" Complement Research Group, Department of Immunology, ELTE Eötvös Loránd University, Budapest, Hungary.,MTA-ELTE Complement Research Group, Eötvös Loránd Research Network (ELKH), Department of Immunology, ELTE Eötvös Loránd University, Budapest, Hungary
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Heikkilä N, Vanhanen R, Yohannes DA, Saavalainen P, Meri S, Jokiranta TS, Jarva H, Mattila IP, Hamm D, Sormunen S, Saramäki J, Arstila TP. Identifying the inheritable component of human thymic T cell repertoire generation in monozygous twins. Eur J Immunol 2020; 50:748-751. [DOI: 10.1002/eji.201948404] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 11/04/2019] [Accepted: 12/20/2019] [Indexed: 12/13/2022]
Affiliation(s)
- Nelli Heikkilä
- Research Programs UnitTranslational ImmunologyUniversity of Helsinki Helsinki Finland
- MedicumDepartment of Bacteriology and ImmunologyUniversity of Helsinki Helsinki Finland
| | - Reetta Vanhanen
- Research Programs UnitTranslational ImmunologyUniversity of Helsinki Helsinki Finland
- MedicumDepartment of Bacteriology and ImmunologyUniversity of Helsinki Helsinki Finland
| | - Dawit A. Yohannes
- Research Programs UnitTranslational ImmunologyUniversity of Helsinki Helsinki Finland
- MedicumDepartment of Medical and Clinical GeneticsUniversity of Helsinki Helsinki Finland
| | - Päivi Saavalainen
- Research Programs UnitTranslational ImmunologyUniversity of Helsinki Helsinki Finland
- MedicumDepartment of Medical and Clinical GeneticsUniversity of Helsinki Helsinki Finland
| | - Seppo Meri
- Research Programs UnitTranslational ImmunologyUniversity of Helsinki Helsinki Finland
- MedicumDepartment of Bacteriology and ImmunologyUniversity of Helsinki Helsinki Finland
| | - T. Sakari Jokiranta
- MedicumDepartment of Bacteriology and ImmunologyUniversity of Helsinki Helsinki Finland
| | - Hanna Jarva
- MedicumDepartment of Bacteriology and ImmunologyUniversity of Helsinki Helsinki Finland
| | - Ilkka P. Mattila
- Department of Pediatric Cardiac and Transplantation SurgeryHospital for Children and AdolescentsHelsinki University Central Hospital Helsinki Finland
| | - David Hamm
- Adaptive Biotechnologies Seattle Washington
| | | | - Jari Saramäki
- Department of Computer ScienceAalto University Finland
| | - T. Petteri Arstila
- Research Programs UnitTranslational ImmunologyUniversity of Helsinki Helsinki Finland
- MedicumDepartment of Bacteriology and ImmunologyUniversity of Helsinki Helsinki Finland
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7
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Pietilä JP, Meri T, Siikamäki H, Tyyni E, Kerttula AM, Pakarinen L, Jokiranta TS, Kantele A. Dientamoeba fragilis - the most common intestinal protozoan in the Helsinki Metropolitan Area, Finland, 2007 to 2017. Euro Surveill 2019; 24:1800546. [PMID: 31339096 PMCID: PMC6652114 DOI: 10.2807/1560-7917.es.2019.24.29.1800546] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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] [Indexed: 12/29/2022] Open
Abstract
BackgroundDespite the global distribution of the intestinal protozoan Dientamoeba fragilis, its clinical picture remains unclear. This results from underdiagnosis: microscopic screening methods either lack sensitivity (wet preparation) or fail to reveal Dientamoeba (formalin-fixed sample).AimIn a retrospective study setting, we characterised the clinical picture of dientamoebiasis and compared it with giardiasis. In addition, we evaluated an improved approach to formalin-fixed samples for suitability in Dientamoeba diagnostics.MethodsThis study comprised four parts: (i) a descriptive part scrutinising rates of Dientamoeba findings; (ii) a methodological part analysing an approach to detect Dientamoeba-like structures in formalin samples; (iii) a clinical part comparing demographics and symptoms between patients with dientamoebiasis (n = 352) and giardiasis (n = 272), and (iv) a therapeutic part (n = 89 patients) investigating correlation between faecal eradication and clinical improvement.ResultsThe rate of Dientamoeba findings increased 20-fold after introducing criteria for Dientamoeba-like structures in formalin-fixed samples (88.9% sensitivity and 83.3% specificity). A further increase was seen after implementing faecal PCR. Compared with patients with giardiasis, the symptoms in the Dientamoeba group lasted longer and more often included abdominal pain, cramping, faecal urgency and loose rather than watery stools. Resolved symptoms correlated with successful faecal eradication (p < 0.001).ConclusionsPreviously underdiagnosed, Dientamoeba has become the most frequently recorded pathogenic enteroparasite in Finland. This presumably results from improved diagnostics with either PCR or detection of Dientamoeba-like structures in formalin-fixed samples, an approach applicable also in resource-poor settings. Symptoms of dientamoebiasis differ slightly from those of giardiasis; patients with distressing symptoms require treatment.
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Affiliation(s)
- Jukka-Pekka Pietilä
- Inflammation Center, Infectious Diseases, Helsinki University Hospital and Helsinki University, Helsinki, Finland
| | - Taru Meri
- Molecular and Integrative Biosciences Research Programme, Faculty of Biological and Environmental Sciences, University of Helsinki, Helsinki, Finland
| | - Heli Siikamäki
- Inflammation Center, Infectious Diseases, Helsinki University Hospital and Helsinki University, Helsinki, Finland
| | - Elisabet Tyyni
- Division of Clinical Microbiology, Helsinki University Hospital, HUSLAB, Helsinki, Finland
| | - Anne-Marie Kerttula
- Division of Clinical Microbiology, Helsinki University Hospital, HUSLAB, Helsinki, Finland
| | - Laura Pakarinen
- Inflammation Center, Infectious Diseases, Helsinki University Hospital and Helsinki University, Helsinki, Finland
| | - T Sakari Jokiranta
- Medicum, University of Helsinki, Finland,SYNLAB Finland, Helsinki, Finland
| | - Anu Kantele
- Inflammation Center, Infectious Diseases, Helsinki University Hospital and Helsinki University, Helsinki, Finland,Human Microbiome Research Program, Faculty of Medicine, University of Helsinki, Finland
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8
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Syed S, Hakala P, Singh AK, Lapatto HAK, King SJ, Meri S, Jokiranta TS, Haapasalo K. Role of Pneumococcal NanA Neuraminidase Activity in Peripheral Blood. Front Cell Infect Microbiol 2019; 9:218. [PMID: 31297339 PMCID: PMC6608562 DOI: 10.3389/fcimb.2019.00218] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 03/13/2019] [Accepted: 06/06/2019] [Indexed: 12/25/2022] Open
Abstract
The most frequent form of hemolytic-uremic syndrome (HUS) is associated with infections caused by Shiga-like toxin-producing Enterohaemorrhagic Escherichia coli (STEC). In rarer cases HUS can be triggered by Streptococcus pneumoniae. While production of Shiga-like toxins explains STEC-HUS, the mechanisms of pneumococcal HUS are less well-known. S. pneumoniae produces neuraminidases with activity against cell surface sialic acids that are critical for factor H-mediated complement regulation on cells and platelets. The aim of this study was to find out whether S. pneumoniae neuraminidase NanA could trigger complement activation and hemolysis in whole blood. We studied clinical S. pneumoniae isolates and two laboratory strains, a wild-type strain expressing NanA, and a NanA deletion mutant for their ability to remove sialic acids from various human cells and platelets. Red blood cell lysis and activation of complement was measured ex vivo by incubating whole blood with bacterial culture supernatants. We show here that NanA expressing S. pneumoniae strains and isolates are able to remove sialic acids from cells, and platelets. Removal of sialic acids by NanA increased complement activity in whole blood, while absence of NanA blocked complement triggering and hemolytic activity indicating that removal of sialic acids by NanA could potentially trigger pHUS.
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Affiliation(s)
- Shahan Syed
- Department of Bacteriology and Immunology, University of Helsinki, Helsinki, Finland
| | - Pipsa Hakala
- Department of Bacteriology and Immunology, University of Helsinki, Helsinki, Finland
| | - Anirudh K Singh
- Center for Microbial Pathogenesis, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, United States.,Department of Microbiology, Medical College, All India Institute of Medical Sciences, Bhopal, India
| | - Helena A K Lapatto
- Department of Bacteriology and Immunology, University of Helsinki, Helsinki, Finland
| | - Samantha J King
- Center for Microbial Pathogenesis, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, United States.,Department of Pediatrics, The Ohio State University, Columbus, OH, United States
| | - Seppo Meri
- Department of Bacteriology and Immunology, University of Helsinki, Helsinki, Finland
| | - T Sakari Jokiranta
- Department of Bacteriology and Immunology, University of Helsinki, Helsinki, Finland.,SYNLAB Finland, Helsinki, Finland
| | - Karita Haapasalo
- Department of Bacteriology and Immunology, University of Helsinki, Helsinki, Finland
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9
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Rantakokko-Jalava K, Hokynar K, Hieta N, Keskitalo A, Jokela P, Muotiala A, Jokiranta TS, Kuusela R, Sarkkinen H, Aittoniemi J, Vuorinen T, Hakanen AJ, Puolakkainen M. Chlamydia trachomatis samples testing falsely negative in the Aptima Combo 2 test in Finland, 2019. Euro Surveill 2019; 24:1900298. [PMID: 31164192 PMCID: PMC6549458 DOI: 10.2807/1560-7917.es.2019.24.22.1900298] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [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] [Indexed: 12/29/2022] Open
Abstract
Since February 2019, over 160 Chlamydia trachomatis (CT) cases testing negative or equivocal by Aptima Combo 2 (AC2) but positive by Aptima CT test run with Panther instruments occurred in Finland. The AC2 test targets chlamydial 23S rRNA while the CT test targets 16S rRNA. Sequencing of 10 strains revealed a nucleotide substitution in 23S rRNA. The significance of this for the failure of the AC2 test to detect the variant is not yet known.
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Affiliation(s)
- Kaisu Rantakokko-Jalava
- Department of Clinical Microbiology, Turku University Hospital, Turku, Finland,University of Turku, Turku, Turku, Finland
| | - Kati Hokynar
- Department of virology, University of Helsinki, Helsinki, Finland
| | - Niina Hieta
- Venereal Diseases Outpatient Clinic, Turku University Hospital, Turku, Finland,University of Turku, Turku, Turku, Finland
| | - Anniina Keskitalo
- Department of Clinical Microbiology, Turku University Hospital, Turku, Finland,University of Turku, Turku, Turku, Finland
| | - Pia Jokela
- Department of Virology and Immunology, University of Helsinki and Helsinki University Hospital, Huslab, Helsinki, Finland
| | | | | | | | | | | | - Tytti Vuorinen
- Department of Clinical Microbiology, Turku University Hospital, Turku, Finland,University of Turku, Turku, Turku, Finland
| | - Antti J Hakanen
- Department of Clinical Microbiology, Turku University Hospital, Turku, Finland,University of Turku, Turku, Turku, Finland
| | - Mirja Puolakkainen
- Department of Virology and Immunology, University of Helsinki and Helsinki University Hospital, Huslab, Helsinki, Finland
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10
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Nissilä E, Hakala P, Leskinen K, Roig A, Syed S, Van Kessel KPM, Metso J, De Haas CJC, Saavalainen P, Meri S, Chroni A, Van Strijp JAG, Öörni K, Jauhiainen M, Jokiranta TS, Haapasalo K. Complement Factor H and Apolipoprotein E Participate in Regulation of Inflammation in THP-1 Macrophages. Front Immunol 2018; 9:2701. [PMID: 30519244 PMCID: PMC6260146 DOI: 10.3389/fimmu.2018.02701] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 11/01/2018] [Indexed: 12/28/2022] Open
Abstract
The alternative pathway (AP) of complement is constantly active in plasma and can easily be activated on self surfaces and trigger local inflammation. Host cells are protected from AP attack by Factor H (FH), the main AP regulator in plasma. Although complement is known to play a role in atherosclerosis, the mechanisms of its contribution are not fully understood. Since FH via its domains 5-7 binds apoliporotein E (apoE) and macrophages produce apoE we examined how FH could be involved in the antiatherogenic effects of apoE. We used blood peripheral monocytes and THP-1 monocyte/macrophage cells which were also loaded with acetylated low-density lipoprotein (LDL) to form foam cells. Binding of FH and apoE on these cells was analyzed by flow cytometry. High-density lipoprotein (HDL)-mediated cholesterol efflux of activated THP-1 cells was measured and transcriptomes of THP-1 cells using mRNA sequencing were determined. We found that binding of FH to human blood monocytes and cholesterol-loaded THP-1 macrophages increased apoE binding to these cells. Preincubation of fluorescent cholesterol labeled THP-1 macrophages in the presence of FH increased cholesterol efflux and cholesterol-loaded macrophages displayed reduced transcription of proinflammatory/proatherogenic factors and increased transcription of anti-inflammatory/anti-atherogenic factors. Further incubation of THP-1 cells with serum reduced C3b/iC3b deposition. Overall, our data indicate that apoE and FH interact with monocytic cells in a concerted action and this interaction reduces complement activation and inflammation in the atherosclerotic lesions. By this way FH may participate in mediating the beneficial effects of apoE in suppressing atherosclerotic lesion progression.
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Affiliation(s)
- Eija Nissilä
- Department of Bacteriology and Immunology, and Research Programs Unit, Immunobiology, University of Helsinki, Helsinki, Finland
| | - Pipsa Hakala
- Department of Bacteriology and Immunology, and Research Programs Unit, Immunobiology, University of Helsinki, Helsinki, Finland
| | - Katarzyna Leskinen
- Department of Bacteriology and Immunology, and Research Programs Unit, Immunobiology, University of Helsinki, Helsinki, Finland
| | - Angela Roig
- Department of Bacteriology and Immunology, and Research Programs Unit, Immunobiology, University of Helsinki, Helsinki, Finland
| | - Shahan Syed
- Department of Bacteriology and Immunology, and Research Programs Unit, Immunobiology, University of Helsinki, Helsinki, Finland
| | | | - Jari Metso
- Minerva Foundation Institute for Medical Research, Helsinki, Finland
| | - Carla J. C. De Haas
- Medical Microbiology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Päivi Saavalainen
- Department of Bacteriology and Immunology, and Research Programs Unit, Immunobiology, University of Helsinki, Helsinki, Finland
| | - Seppo Meri
- Department of Bacteriology and Immunology, and Research Programs Unit, Immunobiology, University of Helsinki, Helsinki, Finland
| | - Angeliki Chroni
- Institute of Biosciences and Applications, National Center for Scientific Research “Demokritos”, Athens, Greece
| | | | | | - Matti Jauhiainen
- Minerva Foundation Institute for Medical Research, Helsinki, Finland
| | - T. Sakari Jokiranta
- Department of Bacteriology and Immunology, and Research Programs Unit, Immunobiology, University of Helsinki, Helsinki, Finland
| | - Karita Haapasalo
- Department of Bacteriology and Immunology, and Research Programs Unit, Immunobiology, University of Helsinki, Helsinki, Finland
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11
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Syed S, King SJ, Jokiranta TS, Haapasalo K. Role of pneumococcal neuraminidase activity in peripheral blood. Mol Immunol 2018. [DOI: 10.1016/j.molimm.2018.06.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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12
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Nissilä E, Roig A, Öörni K, Syed S, Chroni A, de Haas C, van Kessel K, Leskinen K, van Strijp J, Saavalainen P, Jauhiainen M, Jokiranta TS, Haapasalo K. Complement Factor H down regulates complement mediated inflammation on THP-1 macrophages and monocytes. Mol Immunol 2018. [DOI: 10.1016/j.molimm.2018.06.171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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13
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Koskinen AR, Cheng ZZ, Pickering MC, Kairemo K, Meri T, Cook HT, Meri S, Jokiranta TS. Distribution of exogenous complement factor H in mice in vivo. Scand J Immunol 2018; 88:e12671. [PMID: 29706017 DOI: 10.1111/sji.12671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 04/24/2018] [Indexed: 11/29/2022]
Abstract
Factor H is an important regulator of complement activation in plasma and on cell surfaces in both humans and mice. If FH function is compromised, inappropriate complement activation on self-surfaces can have disastrous effects as seen in the kidney diseases atypical haemolytic uremic syndrome (aHUS) and C3 glomerulopathy. As FH constructs have been proposed to be used in treatment for these diseases, we studied the distribution of exogenous FH fragments in mice. Full-length mFH, mFH1-5 and mFH18-20 fragments were radiolabelled, and their distribution was examined in WT, FH-/- and FH-/- C3-/- mice in vivo. Whole body scintigraphy revealed accumulation of radioactivity in the abdominal part of the mice, but also to the thyroid gland and urinary bladder. At organ level in WT mice, some full-length FH accumulated in internal organs, but most of it remained in the circulation. Both of the mFH fragments accumulated in the kidneys and were excreted in urine. For mFH1-5, urinary secretion is the likely cause for the accumulation. Concentration of mFH18-20 to kidneys was slower, and at tissue level, mFH18-20 was localized at the proximal tubuli in WT and FH-/- C3-/- mice. No C3-independent binding to glomeruli was detected. In conclusion, these results show that glomerular glycosaminoglycans and sialic acids alone do not collect FH in kidneys. Deposition of C3 fragments is also needed, which implies that in aHUS, the problem is in simultaneous recognition of C3 fragments and glycosaminoglycans or sialic acids by FH, not just the inability of FH to recognize glomerular endothelium as such.
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Affiliation(s)
- A R Koskinen
- Department of Bacteriology and Immunology and Research Programs Unit, Immunobiology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Z-Z Cheng
- Department of Bacteriology and Immunology and Research Programs Unit, Immunobiology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - M C Pickering
- Center for Complement and Inflammation Research, Imperial College London, London, UK
| | - K Kairemo
- Department of Clinical Chemistry Institute of Clinical Medicine, University of Helsinki, Helsinki, Finland
| | - T Meri
- Department of Bacteriology and Immunology and Research Programs Unit, Immunobiology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - H T Cook
- Center for Complement and Inflammation Research, Imperial College London, London, UK
| | - S Meri
- Department of Bacteriology and Immunology and Research Programs Unit, Immunobiology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - T S Jokiranta
- Department of Bacteriology and Immunology and Research Programs Unit, Immunobiology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
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14
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Sakari Jokiranta T, Viklicky O, Al Shorafa S, Coppo R, Gasteyger C, Macia M, Pankratenko T, Shenoy M, Soylemezoglu O, Tsimaratos M, Wetzels J, Haller H. Differential diagnosis of thrombotic microangiopathy in nephrology. BMC Nephrol 2017; 18:324. [PMID: 29080561 PMCID: PMC5660444 DOI: 10.1186/s12882-017-0727-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 12/23/2016] [Accepted: 09/28/2017] [Indexed: 08/30/2023] Open
Abstract
Background The differential diagnosis of thrombotic microangiopathy (TMA) is complex however the rapid diagnosis of the underlying condition is vital to inform urgent treatment decisions. A survey was devised with the objective of understanding current practices across Europe and the Middle East, and of challenges when diagnosing the cause of TMA. Methods Over 450 clinicians, from 16 countries were invited to complete an online survey. Results Of 254 respondents, the majority were nephrologists, had >10 years’ experience in their specialty, and had diagnosed a patient with TMA. The triad of thrombocytopenia, haemolytic anaemia and acute kidney injury are the main diagnostic criteria used. Responses indicate that a differential diagnosis of TMA is usually made within 1–2 (53%) or 3–4 days (26%) of presentation. Similarly, therapy is usually initiated within the first 4 days (74%), however 13% report treatment initiation >1-week post-presentation. Extrarenal symptoms and a panoply of other conditions are considered when assessing the differential diagnosis of TMA. While 70 and 78% of respondents stated they always request complement protein levels and ADAMTS13 activity, respectively. Diagnostic considerations of paediatric and adult nephrologists varied. A greater proportion of paediatric than adult nephrologists consider extrarenal manifestations clinically related to a diagnosis of TMA; pulmonary (45% vs. 18%), gastrointestinal (67% vs. 50%), CNS (96% vs. 84%) and cardiovascular (54% vs. 42%), respectively. Variability in the availability of guidelines and extent of family history taken was also evident. Conclusions This survey reveals the variability of current practices and the need for increased urgency among physicians in the differential diagnosis of TMA, despite their experience. Above all, the survey highlights the need for international clinical guidelines to provide systematically developed recommendations for understanding the relevance of complement protein levels, complement abnormalities and ADAMTS13 testing, in making a differential diagnosis of TMA. Such clinical guidelines would enable physicians to make a more rapid and informed diagnosis of TMA, therefore initiate effective treatment earlier, with a consequent improvement in patient outcomes. Electronic supplementary material The online version of this article (doi: 10.1186/s12882-017-0727-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- T Sakari Jokiranta
- Research Programs Unit, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Ondrej Viklicky
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | | | - Rosanna Coppo
- Fondazione Ricerca Molinette, Regina Margherita Hospital, Turin, Italy
| | | | - Manuel Macia
- Hospital Virgen de la Candelaria, Santa Cruz de Tenerife, Spain
| | - Tatiana Pankratenko
- M.F. Vladimirskiy Moscow Regional Research and Clinical Institute, Moscow, Russia
| | - Mohan Shenoy
- Royal Manchester Children's Hospital, Manchester, UK
| | | | - Michel Tsimaratos
- Pédiatrie Multidisciplinaire-Hôpital de la Timone, Marseille, France
| | - Jack Wetzels
- Radboud University Medical Centre, Nijmegen, Netherlands
| | - Hermann Haller
- Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany.
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15
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Koskinen AR, Trojnar E, Csuka D, Weldatsadik R, Szilagyi A, Prohaszka Z, Jokiranta TS. Whole exome sequencing in diagnostics of atypical hemolytic uremic syndrome. Mol Immunol 2017. [DOI: 10.1016/j.molimm.2017.06.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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16
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Csincsi ÁI, Szabó Z, Bánlaki Z, Uzonyi B, Cserhalmi M, Kárpáti É, Tortajada A, Caesar JJE, Prohászka Z, Jokiranta TS, Lea SM, Rodríguez de Córdoba S, Józsi M. FHR-1 Binds to C-Reactive Protein and Enhances Rather than Inhibits Complement Activation. J Immunol 2017; 199:292-303. [PMID: 28533443 DOI: 10.4049/jimmunol.1600483] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 04/21/2017] [Indexed: 01/28/2023]
Abstract
Factor H-related protein (FHR) 1 is one of the five human FHRs that share sequence and structural homology with the alternative pathway complement inhibitor FH. Genetic studies on disease associations and functional analyses indicate that FHR-1 enhances complement activation by competitive inhibition of FH binding to some surfaces and immune proteins. We have recently shown that FHR-1 binds to pentraxin 3. In this study, our aim was to investigate whether FHR-1 binds to another pentraxin, C-reactive protein (CRP), analyze the functional relevance of this interaction, and study the role of FHR-1 in complement activation and regulation. FHR-1 did not bind to native, pentameric CRP, but it bound strongly to monomeric CRP via its C-terminal domains. FHR-1 at high concentration competed with FH for CRP binding, indicating possible complement deregulation also on this ligand. FHR-1 did not inhibit regulation of solid-phase C3 convertase by FH and did not inhibit terminal complement complex formation induced by zymosan. On the contrary, by binding C3b, FHR-1 allowed C3 convertase formation and thereby enhanced complement activation. FHR-1/CRP interactions increased complement activation via the classical and alternative pathways on surfaces such as the extracellular matrix and necrotic cells. Altogether, these results identify CRP as a ligand for FHR-1 and suggest that FHR-1 enhances, rather than inhibits, complement activation, which may explain the protective effect of FHR-1 deficiency in age-related macular degeneration.
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Affiliation(s)
- Ádám I Csincsi
- Hungarian Academy of Sciences-Eötvös Loránd University MTA-ELTE Lendület Complement Research Group, Department of Immunology, ELTE Eötvös Loránd University, 1117 Budapest, Hungary
| | - Zsóka Szabó
- Hungarian Academy of Sciences-Eötvös Loránd University MTA-ELTE Lendület Complement Research Group, Department of Immunology, ELTE Eötvös Loránd University, 1117 Budapest, Hungary
| | - Zsófia Bánlaki
- Hungarian Academy of Sciences-Eötvös Loránd University MTA-ELTE Lendület Complement Research Group, Department of Immunology, ELTE Eötvös Loránd University, 1117 Budapest, Hungary
| | - Barbara Uzonyi
- Hungarian Academy of Sciences-Eötvös Loránd University MTA-ELTE Immunology Research Group, Department of Immunology, ELTE Eötvös Loránd University, 1117 Budapest, Hungary
| | - Marcell Cserhalmi
- Hungarian Academy of Sciences-Eötvös Loránd University MTA-ELTE Lendület Complement Research Group, Department of Immunology, ELTE Eötvös Loránd University, 1117 Budapest, Hungary
| | - Éva Kárpáti
- Hungarian Academy of Sciences-Eötvös Loránd University MTA-ELTE Lendület Complement Research Group, Department of Immunology, ELTE Eötvös Loránd University, 1117 Budapest, Hungary
| | - Agustín Tortajada
- Departamento Medicina Celular y Molecular, Centro de Investigaciones Biológicas, 28040 Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Raras, 28040 Madrid, Spain
| | - Joseph J E Caesar
- Sir William Dunn School of Pathology, University of Oxford, Oxford OX1 3RE, United Kingdom
| | - Zoltán Prohászka
- Research Laboratory, 3rd Department of Internal Medicine, Semmelweis University, H-1125 Budapest, Hungary; and
| | - T Sakari Jokiranta
- Research Programs Unit, Immunobiology, Haartman Institute, University of Helsinki, FI-00014 Helsinki, Finland
| | - Susan M Lea
- Sir William Dunn School of Pathology, University of Oxford, Oxford OX1 3RE, United Kingdom
| | - Santiago Rodríguez de Córdoba
- Departamento Medicina Celular y Molecular, Centro de Investigaciones Biológicas, 28040 Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Raras, 28040 Madrid, Spain
| | - Mihály Józsi
- Hungarian Academy of Sciences-Eötvös Loránd University MTA-ELTE Lendület Complement Research Group, Department of Immunology, ELTE Eötvös Loránd University, 1117 Budapest, Hungary;
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Weldatsadik RG, Wang J, Puhakainen K, Jiao H, Jalava J, Räisänen K, Datta N, Skoog T, Vuopio J, Jokiranta TS, Kere J. Sequence analysis of pooled bacterial samples enables identification of strain variation in group A streptococcus. Sci Rep 2017; 7:45771. [PMID: 28361960 PMCID: PMC5374712 DOI: 10.1038/srep45771] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 11/15/2016] [Accepted: 03/02/2017] [Indexed: 12/30/2022] Open
Abstract
Knowledge of the genomic variation among different strains of a pathogenic microbial species can help in selecting optimal candidates for diagnostic assays and vaccine development. Pooled sequencing (Pool-seq) is a cost effective approach for population level genetic studies that require large numbers of samples such as various strains of a microbe. To test the use of Pool-seq in identifying variation, we pooled DNA of 100 Streptococcus pyogenes strains of different emm types in two pools, each containing 50 strains. We used four variant calling tools (Freebayes, UnifiedGenotyper, SNVer, and SAMtools) and one emm1 strain, SF370, as a reference genome. In total 63719 SNPs and 164 INDELs were identified in the two pools concordantly by at least two of the tools. Majority of the variants (93.4%) from six individually sequenced strains used in the pools could be identified from the two pools and 72.3% and 97.4% of the variants in the pools could be mined from the analysis of the 44 complete Str. pyogenes genomes and 3407 sequence runs deposited in the European Nucleotide Archive respectively. We conclude that DNA sequencing of pooled samples of large numbers of bacterial strains is a robust, rapid and cost-efficient way to discover sequence variation.
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Affiliation(s)
- Rigbe G Weldatsadik
- Research Programs Unit, Immunobiology, University of Helsinki, and Helsinki University Central Hospital, Helsinki, Finland
| | - Jingwen Wang
- Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Sweden
| | - Kai Puhakainen
- Bacterial Infections Unit, National Institute for Health and Welfare, Turku, Finland.,Department of Medical Microbiology and Immunology, University of Turku, Turku, Finland
| | - Hong Jiao
- Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Sweden
| | - Jari Jalava
- Bacterial Infections Unit, National Institute for Health and Welfare, Turku, Finland
| | - Kati Räisänen
- Bacterial Infections Unit, National Institute for Health and Welfare, Turku, Finland
| | - Neeta Datta
- Research Programs Unit, Immunobiology, University of Helsinki, and Helsinki University Central Hospital, Helsinki, Finland
| | - Tiina Skoog
- Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Sweden
| | - Jaana Vuopio
- Bacterial Infections Unit, National Institute for Health and Welfare, Turku, Finland.,Department of Medical Microbiology and Immunology, University of Turku, Turku, Finland
| | - T Sakari Jokiranta
- Research Programs Unit, Immunobiology, University of Helsinki, and Helsinki University Central Hospital, Helsinki, Finland
| | - Juha Kere
- Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Sweden.,Molecular Neurology Research Program, University of Helsinki, and Folkhälsan Institute of Genetics, Biomedicum Helsinki, Helsinki, Finland.,Department of Genetics and Molecular Medicine, King's College London, London, UK
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Trojnár E, Józsi M, Uray K, Csuka D, Szilágyi Á, Milosevic D, Stojanović VD, Spasojević B, Rusai K, Müller T, Arbeiter K, Kelen K, Szabó AJ, Reusz GS, Hyvärinen S, Jokiranta TS, Prohászka Z. Analysis of Linear Antibody Epitopes on Factor H and CFHR1 Using Sera of Patients with Autoimmune Atypical Hemolytic Uremic Syndrome. Front Immunol 2017; 8:302. [PMID: 28424685 PMCID: PMC5371605 DOI: 10.3389/fimmu.2017.00302] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [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: 02/15/2017] [Accepted: 03/03/2017] [Indexed: 01/13/2023] Open
Abstract
Introduction In autoimmune atypical hemolytic uremic syndrome (aHUS), the complement regulator factor H (FH) is blocked by FH autoantibodies, while 90% of the patients carry a homozygous deletion of its homolog complement FH-related protein 1 (CFHR1). The functional consequence of FH-blockade is widely established; however, the molecular basis of autoantibody binding and the role of CFHR1 deficiency in disease pathogenesis are still unknown. We performed epitope mapping of FH to provide structural insight in the autoantibody recruitment on FH and potentially CFHR1. Methods Eight anti-FH positive aHUS patients were enrolled in this study. With overlapping synthetic FH and CFHR1 peptides, we located the amino acids (aa) involved in binding of acute and convalescence stage autoantibodies. We confirmed the location of the mapped epitopes using recombinant FH domains 19–20 that carried single-aa substitutions at the suspected antibody binding sites in three of our patients. Location of the linear epitopes and the introduced point mutations was visualized using crystal structures of the corresponding domains of FH and CFHR1. Results We identified three linear epitopes on FH (aa1157–1171; aa1177–1191; and aa1207–1226) and one on CFHR1 (aa276–290) that are recognized both in the acute and convalescence stages of aHUS. We observed a similar extent of autoantibody binding to the aHUS-specific epitope aa1177–1191 on FH and aa276–290 on CFHR1, despite seven of our patients being deficient for CFHR1. Epitope mapping with the domain constructs validated the location of the linear epitopes on FH with a distinct autoantibody binding motif within aa1183–1198 in line with published observations. Summary According to the results, the linear epitopes we identified are located close to each other on the crystal structure of FH domains 19–20. This tertiary configuration contains the amino acids reported to be involved in C3b and sialic acid binding on the regulator, which may explain the functional deficiency of FH in the presence of autoantibodies. The data we provide identify the exact structures involved in autoantibody recruitment on FH and confirm the presence of an autoantibody binding epitope on CFHR1.
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Affiliation(s)
- Eszter Trojnár
- 3rd Department of Internal Medicine, Research Laboratory, Semmelweis University, Budapest, Hungary
| | - Mihály Józsi
- MTA-ELTE "Lendület" Complement Research Group, Department of Immunology, Eötvös Loránd University, Budapest, Hungary
| | - Katalin Uray
- MTA-ELTE Research Group of Peptide Chemistry, Hungarian Academy of Sciences, Eötvös Loránd University, Budapest, Hungary
| | - Dorottya Csuka
- 3rd Department of Internal Medicine, Research Laboratory, Semmelweis University, Budapest, Hungary
| | - Ágnes Szilágyi
- 3rd Department of Internal Medicine, Research Laboratory, Semmelweis University, Budapest, Hungary
| | - Danko Milosevic
- Department of Pediatric Nephrology, Dialysis and Transplantation, University of Zagreb, School of Medicine, University Hospital Center Zagreb, Zagreb, Croatia
| | - Vesna D Stojanović
- Medical Faculty, Institute for Child and Youth Health Care of Vojvodina, University of Novi Sad, Novi Sad, Serbia
| | - Brankica Spasojević
- University Children's Hospital, Nephrology, Dialysis and Transplantation Unit, Belgrade, Serbia
| | - Krisztina Rusai
- Department of Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Thomas Müller
- Department of Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Klaus Arbeiter
- Department of Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Kata Kelen
- 1st Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Attila J Szabó
- 1st Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - György S Reusz
- 1st Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Satu Hyvärinen
- Research Programs Unit, Immunobiology, University of Helsinki, Helsinki University Central Hospital, Helsinki, Finland
| | - T Sakari Jokiranta
- Research Programs Unit, Immunobiology, University of Helsinki, Helsinki University Central Hospital, Helsinki, Finland
| | - Zoltán Prohászka
- 3rd Department of Internal Medicine, Research Laboratory, Semmelweis University, Budapest, Hungary
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Amdahl H, Haapasalo K, Tan L, Meri T, Kuusela PI, van Strijp JA, Rooijakkers S, Jokiranta TS. Staphylococcal protein Ecb impairs complement receptor-1 mediated recognition of opsonized bacteria. PLoS One 2017; 12:e0172675. [PMID: 28273167 PMCID: PMC5342210 DOI: 10.1371/journal.pone.0172675] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [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: 09/17/2016] [Accepted: 02/08/2017] [Indexed: 01/01/2023] Open
Abstract
Staphyloccus aureus is a major human pathogen leading frequently to sepsis and soft tissue infections with abscesses. Multiple virulence factors including several immune modulating molecules contribute to its survival in the host. When S. aureus invades the human body, one of the first line defenses is the complement system, which opsonizes the bacteria with C3b and attract neutrophils by release of chemotactic peptides. Neutrophils express Complement receptor-1 [CR1, CD35) that interacts with the C3b-opsonized particles and thereby plays an important role in pathogen recognition by phagocytic cells. In this study we observed that a fraction of S. aureus culture supernatant prevented binding of C3b to neutrophils. This fraction consisted of S. aureus leukocidins and Efb. The C-terminus of Efb is known to bind C3b and shares significant sequence homology to the extracellular complement binding protein [Ecb). Here we show that S. aureus Ecb displays various mechanisms to block bacterial recognition by neutrophils. The presence of Ecb blocked direct interaction between soluble CR1 and C3b and reduced the cofactor activity of CR1 in proteolytic inactivation of C3b. Furthermore, Ecb could dose-dependently prevent recognition of C3b by cell-bound CR1 that lead to impaired phagocytosis of NHS-opsonized S. aureus. Phagocytosis was furthermore reduced in the presence of soluble CR1 [sCR1). These data indicate that the staphylococcal protein Ecb prevents recognition of C3b opsonized bacteria by neutrophil CR1 leading to impaired killing by phagocytosis and thereby contribute to immune evasion of S. aureus.
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Affiliation(s)
- Hanne Amdahl
- Department of Bacteriology and Immunology, Haartman Institute, University of Helsinki, Helsinki, Finland
- Research Programs Unit, Immunobiology, University of Helsinki, Helsinki, Finland
| | - Karita Haapasalo
- Department of Bacteriology and Immunology, Haartman Institute, University of Helsinki, Helsinki, Finland
- Research Programs Unit, Immunobiology, University of Helsinki, Helsinki, Finland
| | - Lydia Tan
- Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Taru Meri
- Institute of Biotechnology, University of Helsinki, Helsinki, Finland
| | - Pentti I. Kuusela
- Department of Bacteriology and Immunology, Haartman Institute, University of Helsinki, Helsinki, Finland
- Division of Clinical Microbiology, Helsinki University Central Hospital Laboratory, Helsinki, Finland
| | - Jos A. van Strijp
- Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Suzan Rooijakkers
- Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands
- * E-mail: (SR); (TSJ)
| | - T. Sakari Jokiranta
- Department of Bacteriology and Immunology, Haartman Institute, University of Helsinki, Helsinki, Finland
- Research Programs Unit, Immunobiology, University of Helsinki, Helsinki, Finland
- * E-mail: (SR); (TSJ)
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20
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Laine J, Jokiranta TS, Eklund KK, Väkeväinen M, Puolakka K. Cost-effectiveness of routine measuring of serum drug concentrations and anti-drug antibodies in treatment of rheumatoid arthritis patients with TNF-α blockers. Biologics 2016; 10:67-73. [PMID: 27099470 PMCID: PMC4824281 DOI: 10.2147/btt.s96982] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [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] [Indexed: 11/26/2022]
Abstract
Monitoring of anti-drug antibodies (ADAbs) or serum concentrations of biologicals in treatment of rheumatoid arthritis could provide an explanation for a loss of efficacy and help in the choice of subsequent medication. Current clinical practices do not generally include such monitoring of tumor necrosis factor (TNF)-α blockers on a routine basis. The main aims of this study were to estimate the probabilities of optimal and nonoptimal treatment decisions if infliximab or adalimumab drug trough level (DL) and ADAbs are tested or not in rheumatoid arthritis, and to model cost-effectiveness of performing such monitoring on a routine basis. Data on DLs and ADAbs concentrations were obtained in Finland from clinically requested monitoring analyses of 486 and 1,137 samples from patients on adalimumab and infliximab, respectively. DL was within the target range in 42% of samples from adalimumab- and 50.4% of infliximab-treated patients. ADAbs were detected in approximately 20% and 13.5% of samples from adalimumab- and infliximab-treated patients, respectively. ADAbs were found in 52.3% and 41.3% of those with low adalimumab or infliximab DLs, respectively. The monitoring data were incorporated into probabilities for making the optimal treatment decision. Economic impact of clinical decision-making was modeled in a short-term (3–6 months) scenario with 100 hypothetical patients. In the model, the combined measurement of DLs and ADAbs was cost-saving compared to the nontesting scenario when the monitoring results affected the treatment decision in at least 2–5 of 100 patients, a proportion which is easily exceeded in real-life clinical practice. This study indicates that routine monitoring of drug level and ADAbs is cost-beneficial in clinical practice, thereby improving the decision-making process in using TNF-α blockers.
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Affiliation(s)
| | - T Sakari Jokiranta
- United Medix Laboratories Ltd, Espoo, Finland; Research Programs Unit, Immunobiology, University of Helsinki, Helsinki, Finland
| | - Kari K Eklund
- Department of Rheumatology, University of Helsinki, Helsinki, Finland; Helsinki University Central Hospital, Helsinki, Finland
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21
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Nozal P, Bernabéu-Herrero ME, Uzonyi B, Szilágyi Á, Hyvärinen S, Prohászka Z, Jokiranta TS, Sánchez-Corral P, López-Trascasa M, Józsi M. Heterogeneity but individual constancy of epitopes, isotypes and avidity of factor H autoantibodies in atypical hemolytic uremic syndrome. Mol Immunol 2016; 70:47-55. [DOI: 10.1016/j.molimm.2015.12.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 11/30/2015] [Accepted: 12/02/2015] [Indexed: 01/27/2023]
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22
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Loeven MA, Rops AL, Lehtinen MJ, van Kuppevelt TH, Daha MR, Smith RJ, Bakker M, Berden JH, Rabelink TJ, Jokiranta TS, van der Vlag J. Mutations in Complement Factor H Impair Alternative Pathway Regulation on Mouse Glomerular Endothelial Cells in Vitro. J Biol Chem 2016; 291:4974-81. [PMID: 26728463 DOI: 10.1074/jbc.m115.702506] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Indexed: 01/28/2023] Open
Abstract
Complement factor H (FH) inhibits complement activation and interacts with glomerular endothelium via its complement control protein domains 19 and 20, which also recognize heparan sulfate (HS). Abnormalities in FH are associated with the renal diseases atypical hemolytic uremic syndrome and dense deposit disease and the ocular disease age-related macular degeneration. Although FH systemically controls complement activation, clinical phenotypes selectively manifest in kidneys and eyes, suggesting the presence of tissue-specific determinants of disease development. Recent results imply the importance of tissue-specifically expressed, sulfated glycosaminoglycans (GAGs), like HS, in determining FH binding to and activity on host tissues. Therefore, we investigated which GAGs mediate human FH and recombinant human FH complement control proteins domains 19 and 20 (FH19-20) binding to mouse glomerular endothelial cells (mGEnCs) in ELISA. Furthermore, we evaluated the functional defects of FH19-20 mutants during complement activation by measuring C3b deposition on mGEnCs using flow cytometry. FH and FH19-20 bound dose-dependently to mGEnCs and TNF-α treatment increased binding of both proteins, whereas heparinase digestion and competition with heparin/HS inhibited binding. Furthermore, 2-O-, and 6-O-, but not N-desulfation of heparin, significantly increased the inhibitory effect on FH19-20 binding to mGEnCs. Compared with wild type FH19-20, atypical hemolytic uremic syndrome-associated mutants were less able to compete with FH in normal human serum during complement activation on mGEnCs, confirming their potential glomerular pathogenicity. In conclusion, our study shows that FH and FH19-20 binding to glomerular endothelial cells is differentially mediated by HS but not other GAGs. Furthermore, we describe a novel, patient serum-independent competition assay for pathogenicity screening of FH19-20 mutants.
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Affiliation(s)
- Markus A Loeven
- From the Department of Nephrology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Angelique L Rops
- From the Department of Nephrology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Markus J Lehtinen
- Department of Bacteriology and Immunology, Haartman Institute, University of Helsinki, FIN-00290 Helsinki, Finland
| | - Toin H van Kuppevelt
- Department of Biochemistry, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
| | - Mohamed R Daha
- Department of Nephrology, Leiden University Medical Center, 2300 RC Leiden, The Netherlands, and
| | - Richard J Smith
- Department of Internal Medicine and Otolaryngology, University of Iowa Carver College of Medicine, Iowa City, Iowa 52242
| | - Marinka Bakker
- From the Department of Nephrology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Jo H Berden
- From the Department of Nephrology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Ton J Rabelink
- Department of Nephrology, Leiden University Medical Center, 2300 RC Leiden, The Netherlands, and
| | - T Sakari Jokiranta
- Department of Bacteriology and Immunology, Haartman Institute, University of Helsinki, FIN-00290 Helsinki, Finland
| | - Johan van der Vlag
- From the Department of Nephrology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands,
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23
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Haapasalo K, van Kessel K, Nissilä E, Metso J, Johansson T, Miettinen S, Varjosalo M, Kirveskari J, Kuusela P, Chroni A, Jauhiainen M, van Strijp J, Jokiranta TS. Complement Factor H Binds to Human Serum Apolipoprotein E and Mediates Complement Regulation on High Density Lipoprotein Particles. J Biol Chem 2015; 290:28977-87. [PMID: 26468283 DOI: 10.1074/jbc.m115.669226] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Indexed: 11/06/2022] Open
Abstract
The alternative pathway of complement is an important part of the innate immunity response against foreign particles invading the human body. To avoid damage to host cells, it needs to be efficiently down-regulated by plasma factor H (FH) as exemplified by various diseases caused by mutations in its domains 19-20 (FH19-20) and 5-7 (FH5-7). These regions are also the main interaction sites for microbial pathogens that bind host FH to evade complement attack. We previously showed that inhibition of FH binding by a recombinant FH5-7 construct impairs survival of FH binding pathogens in human blood. In this study we found that upon exposure to full blood, the addition of FH5-7 reduces survival of, surprisingly, also those microbes that are not able to bind FH. This effect was mediated by inhibition of complement regulation and subsequently enhanced neutrophil phagocytosis by FH5-7. We found that although FH5-7 does not reduce complement regulation in the actual fluid phase of plasma, it reduces regulation on HDL particles in plasma. Using affinity chromatography and mass spectrometry we revealed that FH interacts with serum apolipoprotein E (apoE) via FH5-7 domains. Furthermore, binding of FH5-7 to HDL was dependent on the concentration of apoE on the HDL particles. These findings explain why the addition of FH5-7 to plasma leads to excessive complement activation and phagocytosis of microbes in full anticoagulated blood. In conclusion, our data show how FH interacts with apoE molecules via domains 5-7 and regulates alternative pathway activation on plasma HDL particles.
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Affiliation(s)
- Karita Haapasalo
- From the Department of Bacteriology and Immunology, Haartman Institute, and Research Programs Unit, Immunobiology, University of Helsinki, FIN-00014 Helsinki, Finland, Medical Microbiology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands,
| | - Kok van Kessel
- Medical Microbiology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | - Eija Nissilä
- From the Department of Bacteriology and Immunology, Haartman Institute, and Research Programs Unit, Immunobiology, University of Helsinki, FIN-00014 Helsinki, Finland
| | - Jari Metso
- Department of Molecular Medicine, National Institute for Health and Welfare, Biomedicum, FI-00290 Helsinki, Finland
| | - Tiira Johansson
- From the Department of Bacteriology and Immunology, Haartman Institute, and Research Programs Unit, Immunobiology, University of Helsinki, FIN-00014 Helsinki, Finland
| | - Sini Miettinen
- University of Helsinki, Institute of Biotechnology, 00014 Helsinki, Finland
| | - Markku Varjosalo
- University of Helsinki, Institute of Biotechnology, 00014 Helsinki, Finland
| | - Juha Kirveskari
- HUSLAB, Helsinki University Central Hospital Laboratory, 00290 Helsinki, Finland, and
| | - Pentti Kuusela
- HUSLAB, Helsinki University Central Hospital Laboratory, 00290 Helsinki, Finland, and
| | - Angelika Chroni
- Institute of Biosciences and Applications, National Center for Scientific Research "Demokritos," 15310 Athens, Greece
| | - Matti Jauhiainen
- Department of Molecular Medicine, National Institute for Health and Welfare, Biomedicum, FI-00290 Helsinki, Finland
| | - Jos van Strijp
- Medical Microbiology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | - T Sakari Jokiranta
- From the Department of Bacteriology and Immunology, Haartman Institute, and Research Programs Unit, Immunobiology, University of Helsinki, FIN-00014 Helsinki, Finland
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24
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Blanc C, Togarsimalemath SK, Chauvet S, Le Quintrec M, Moulin B, Buchler M, Jokiranta TS, Roumenina LT, Fremeaux-Bacchi V, Dragon-Durey MA. Anti-factor H autoantibodies in C3 glomerulopathies and in atypical hemolytic uremic syndrome: one target, two diseases. J Immunol 2015; 194:5129-38. [PMID: 25917093 DOI: 10.4049/jimmunol.1402770] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 03/31/2015] [Indexed: 02/06/2023]
Abstract
Autoantibodies targeting factor H (FH), which is a main alternative complement pathway regulatory protein, have been well characterized in atypical hemolytic uremic syndrome (aHUS) but have been less well described in association with alternative pathway-mediated glomerulopathies (GP). In this study, we studied 17 patients presenting with GP who were positive for anti-FH IgG. Clinical data were collected and biological characteristics were compared with those of patients presenting with anti-FH Ab-associated aHUS. In contrast to the aHUS patients, the GP patients had no circulating FH-containing immune complexes, and their anti-FH IgG had a weaker affinity for FH. Functional studies demonstrated that these Abs induced no perturbations in FH cell surface protection or the binding of FH to its ligand. However, anti-FH IgG samples isolated from three patients were able to affect the factor I cofactor activity of FH. Epitope mapping identified the N-terminal domain of FH as the major binding site for GP patient IgG. No homozygous deletions of the CFHR1 and CFHR3 genes, which are frequently associated with the anti-FH Ab in aHUS patients, were found in the GP patients. Finally, anti-FH Abs were frequently associated with the presence of C3 nephritic factor in child GP patients and with monoclonal gammopathy in adult GP patients, who frequently showed Ig Lchain restriction during reactivity against factor H. These data provide deeper insights into the pathophysiological differences between aHUS and GP, demonstrating heterogeneity of anti-FH IgG.
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Affiliation(s)
- Caroline Blanc
- INSERM Unité Mixte de Recherche S1138, "Complément et Maladies" Équipe 10, Centre de Recherche des Cordeliers, Université Pierre et Marie Curie, 75006 Paris, France; Université Paris Diderot, 75013 Paris, France
| | - Shambhuprasad Kotresh Togarsimalemath
- INSERM Unité Mixte de Recherche S1138, "Complément et Maladies" Équipe 10, Centre de Recherche des Cordeliers, Université Pierre et Marie Curie, 75006 Paris, France; Service de Néphrologie, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, 75970 Paris Cedex 20, France
| | - Sophie Chauvet
- INSERM Unité Mixte de Recherche S1138, "Complément et Maladies" Équipe 10, Centre de Recherche des Cordeliers, Université Pierre et Marie Curie, 75006 Paris, France; Université Paris Descartes, 75006 Paris, France
| | - Moglie Le Quintrec
- INSERM Unité Mixte de Recherche S1138, "Complément et Maladies" Équipe 10, Centre de Recherche des Cordeliers, Université Pierre et Marie Curie, 75006 Paris, France; Service de Néphrologie, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, 75970 Paris Cedex 20, France
| | - Bruno Moulin
- Service de Néphrologie et Transplantation Rénale, Centre Hospitalier Universitaire Hautepierre, 67098 Strasbourg, France
| | - Matthias Buchler
- Service de Néphrologie, Immunologie Clinique, Hôpital Bretonneau, 37044 Tours, France
| | - T Sakari Jokiranta
- Department of Bacteriology and Immunology, Haartman Institute, University of Helsinki, 00014 Helsinki, Finland; and
| | - Lubka T Roumenina
- INSERM Unité Mixte de Recherche S1138, "Complément et Maladies" Équipe 10, Centre de Recherche des Cordeliers, Université Pierre et Marie Curie, 75006 Paris, France
| | - Véronique Fremeaux-Bacchi
- INSERM Unité Mixte de Recherche S1138, "Complément et Maladies" Équipe 10, Centre de Recherche des Cordeliers, Université Pierre et Marie Curie, 75006 Paris, France; Service d'Immunologie Biologique, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, 75908 Paris, France
| | - Marie-Agnès Dragon-Durey
- INSERM Unité Mixte de Recherche S1138, "Complément et Maladies" Équipe 10, Centre de Recherche des Cordeliers, Université Pierre et Marie Curie, 75006 Paris, France; Service de Néphrologie, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, 75970 Paris Cedex 20, France; Service d'Immunologie Biologique, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, 75908 Paris, France
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25
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Bhattacharjee A, Reuter S, Trojnár E, Kolodziejczyk R, Seeberger H, Hyvärinen S, Uzonyi B, Szilágyi Á, Prohászka Z, Goldman A, Józsi M, Jokiranta TS. The major autoantibody epitope on factor H in atypical hemolytic uremic syndrome is structurally different from its homologous site in factor H-related protein 1, supporting a novel model for induction of autoimmunity in this disease. J Biol Chem 2015; 290:9500-10. [PMID: 25659429 PMCID: PMC4392255 DOI: 10.1074/jbc.m114.630871] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [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: 12/06/2014] [Indexed: 01/26/2023] Open
Abstract
Atypical hemolytic uremic syndrome (aHUS) is characterized by complement attack against host cells due to mutations in complement proteins or autoantibodies against complement factor H (CFH). It is unknown why nearly all patients with autoimmune aHUS lack CFHR1 (CFH-related protein-1). These patients have autoantibodies against CFH domains 19 and 20 (CFH19–20), which are nearly identical to CFHR1 domains 4 and 5 (CFHR14–5). Here, binding site mapping of autoantibodies from 17 patients using mutant CFH19–20 constructs revealed an autoantibody epitope cluster within a loop on domain 20, next to the two buried residues that are different in CFH19–20 and CFHR14–5. The crystal structure of CFHR14–5 revealed a difference in conformation of the autoantigenic loop in the C-terminal domains of CFH and CFHR1, explaining the variation in binding of autoantibodies from some aHUS patients to CFH19–20 and CFHR14–5. The autoantigenic loop on CFH seems to be generally flexible, as its conformation in previously published structures of CFH19–20 bound to the microbial protein OspE and a sialic acid glycan is somewhat altered. Cumulatively, our data suggest that association of CFHR1 deficiency with autoimmune aHUS could be due to the structural difference between CFHR1 and the autoantigenic CFH epitope, suggesting a novel explanation for CFHR1 deficiency in the pathogenesis of autoimmune aHUS.
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Affiliation(s)
- Arnab Bhattacharjee
- From the Department of Bacteriology and Immunology, Medicum, and Immunobiology Research Program Unit, University of Helsinki and Helsinki University Hospital, 00014 University of Helsinki, Finland, the Institute of Biotechnology and
| | - Stefanie Reuter
- the Junior Research Group for Cellular Immunobiology, Leibniz Institute for Natural Product, Research and Infection Biology-Hans Knöll Institute, 07745 Jena, Germany
| | - Eszter Trojnár
- the Research Laboratory, 3rd Department of Internal Medicine, Semmelweis University, 1125 Budapest, Hungary, and
| | - Robert Kolodziejczyk
- the Institute of Biotechnology and Division of Biochemistry and Biotechnology, Department of Biosciences, University of Helsinki, 00014 University of Helsinki, Finland
| | - Harald Seeberger
- the Junior Research Group for Cellular Immunobiology, Leibniz Institute for Natural Product, Research and Infection Biology-Hans Knöll Institute, 07745 Jena, Germany
| | - Satu Hyvärinen
- From the Department of Bacteriology and Immunology, Medicum, and Immunobiology Research Program Unit, University of Helsinki and Helsinki University Hospital, 00014 University of Helsinki, Finland
| | | | - Ágnes Szilágyi
- the Research Laboratory, 3rd Department of Internal Medicine, Semmelweis University, 1125 Budapest, Hungary, and
| | - Zoltán Prohászka
- the Research Laboratory, 3rd Department of Internal Medicine, Semmelweis University, 1125 Budapest, Hungary, and
| | - Adrian Goldman
- the Institute of Biotechnology and Division of Biochemistry and Biotechnology, Department of Biosciences, University of Helsinki, 00014 University of Helsinki, Finland
| | - Mihály Józsi
- the Junior Research Group for Cellular Immunobiology, Leibniz Institute for Natural Product, Research and Infection Biology-Hans Knöll Institute, 07745 Jena, Germany, MTA-ELTE "Lendület" Complement Research Group, Department of Immunology, Eötvös Loránd University, 1117 Budapest, Hungary
| | - T Sakari Jokiranta
- From the Department of Bacteriology and Immunology, Medicum, and Immunobiology Research Program Unit, University of Helsinki and Helsinki University Hospital, 00014 University of Helsinki, Finland
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26
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Scambi C, Ugolini S, Jokiranta TS, De Franceschi L, Bortolami O, La Verde V, Guarini P, Caramaschi P, Ravagnani V, Martignoni G, Colato C, Pedron S, Benedetti F, Sorio M, Poli F, Biasi D. The local complement activation on vascular bed of patients with systemic sclerosis: a hypothesis-generating study. PLoS One 2015; 10:e0114856. [PMID: 25658605 PMCID: PMC4319765 DOI: 10.1371/journal.pone.0114856] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Accepted: 11/13/2014] [Indexed: 11/26/2022] Open
Abstract
Objective The role of complement system in the pathogenesis of systemic sclerosis (SSc) has been debated during the last decade but an evident implication in this disease has never been found. We carried out an explorative study on SSc patients to evaluate the expression of soluble and local C5b-9 complement complex and its relation with a complement regulator, the Membrane Cofactor Protein (MCP, CD46) on skin vascular bed as target distinctive of SSc disease. We also analyzed two polymorphic variants in the complement activation gene cluster involving the MCP region. Methods C5b-9 plasma levels of SSc patients and healthy subjects were analyzed by ELISA assay. Archival skin biopsies of SSc patients and controls were subjected to immunofluorescence analysis to detect C5b-9 and MCP on vascular endothelial cells. The expression of MCP was validated by immunoblot analysis with specific antibody. Polymorphic variants in the MCP gene promoter were tested by a quantitative PCR technique-based allelic discrimination method. Results Even though circulating levels of C5b-9 did not differ between SSc and controls, C5b-9 deposition was detected in skin biopsies of SSc patients but not in healthy subjects. MCP was significantly lower in skin vessels of SSc patients than in healthy controls and was associated with the over-expression of two polymorphic variants in the MCP gene promoter, which has been related to more aggressive phenotypes in other immune-mediated diseases. Conclusions Our results firsty document the local complement activation with an abnormal expression of MCP in skin vessels of SSc patients, suggesting that a subset of SSc patients might be exposed to more severe organ complications and clinical evolution due to abnormal local complement activation.
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Affiliation(s)
- Cinzia Scambi
- Department of Medicine, University of Verona, Verona, Italy
- * E-mail:
| | - Sara Ugolini
- Department of Medicine, University of Verona, Verona, Italy
| | - T. Sakari Jokiranta
- Department of Bacteriology and Immunology, Haartman Institute and Research Programs Unit, Immunobiology, University of Helsinki, Helsinki, Finland
| | | | - Oscar Bortolami
- Research Support Unit and Biostatistics, Verona University Hospital, Verona, Italy
| | | | | | | | | | - Guido Martignoni
- Department of Pathology and Diagnostics, University of Verona, Verona, Italy
| | - Chiara Colato
- Department of Pathology and Diagnostics, University of Verona, Verona, Italy
| | - Serena Pedron
- Department of Pathology and Diagnostics, University of Verona, Verona, Italy
| | | | - Marco Sorio
- Department of Medicine, University of Verona, Verona, Italy
| | - Fabio Poli
- Department of Medicine, University of Verona, Verona, Italy
| | - Domenico Biasi
- Department of Medicine, University of Verona, Verona, Italy
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Hyvärinen S, Uchida K, Varjosalo M, Jokela R, Jokiranta TS. Recognition of malondialdehyde-modified proteins by the C terminus of complement factor H is mediated via the polyanion binding site and impaired by mutations found in atypical hemolytic uremic syndrome. J Biol Chem 2013; 289:4295-306. [PMID: 24344133 DOI: 10.1074/jbc.m113.527416] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Atypical hemolytic uremic syndrome (aHUS) is a severe thrombotic microangiopathy characterized by uncontrolled complement activation against endothelial and blood cells. Mutations in the C-terminal target recognition domains 19-20 of complement regulator factor H (FH) are strongly associated with aHUS, but the mechanisms triggering disease onset have remained unresolved. Here we report that several aHUS-related mutations alter the binding of FH19-20 to proteins where lysines have reacted with malondialdehyde (MDA). Although FH19-20 did not interact with MDA-modified hexylamine, lysine-containing peptides, or a proteolytically degraded protein, it bound to MDA-modified polylysine. This suggests that FH19-20 recognizes only clustered MDA adducts. Binding of MDA-modified BSA to FH19-20 was ionic by nature, depended on positive residues of FH19-20, and competed with the polyanions heparin and DNA. This could not be explained with the mainly neutral adducts known to form in MDA modification. When positive charges of lysines were eliminated by acetic anhydride instead of MDA, the acetylated BSA started to bind FH19-20. Together, these results indicate that negative charges on the modified proteins dominate the interaction with FH19-20. This is beneficial for the physiological function of FH because by binding to the negative charges of the modified target, FH could prevent excess complement activation initiated by naturally occurring antibodies recognizing MDA epitopes with multiple different structures. We propose that oxidative stress leading to formation of MDA adducts is a common feature for triggers of aHUS and that failure of FH in protecting MDA-modified surfaces from complement activation is involved in the pathogenesis of the disease.
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Affiliation(s)
- Satu Hyvärinen
- From the Department of Bacteriology and Immunology, Haartman Institute, and Research Programs Unit, Immunobiology, University of Helsinki, FIN-00290 Helsinki, Finland
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28
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Amdahl H, Jongerius I, Meri T, Pasanen T, Hyvärinen S, Haapasalo K, van Strijp JA, Rooijakkers SH, Jokiranta TS. Staphylococcal Ecb protein and host complement regulator factor H enhance functions of each other in bacterial immune evasion. J Immunol 2013; 191:1775-84. [PMID: 23863906 DOI: 10.4049/jimmunol.1300638] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Staphylococcus aureus is a major human pathogen causing more than a tenth of all septicemia cases and often superficial and deep infections in various tissues. One of the immune evasion strategies of S. aureus is to secrete proteins that bind to the central complement opsonin C3b. One of these, extracellular complement binding protein (Ecb), is known to interfere directly with functions of C3b. Because C3b is also the target of the physiological plasma complement regulator, factor H (FH), we studied the effect of Ecb on the complement regulatory functions of FH. We show that Ecb enhances acquisition of FH from serum onto staphylococcal surfaces. Ecb and FH enhance mutual binding to C3b and also the function of each other in downregulating complement activation. Both Ecb and the C-terminal domains 19-20 of FH bind to the C3d part of C3b. We show that the mutual enhancing effect of Ecb and FH on binding to C3b depends on binding of the FH domain 19 to the C3d part of C3b next to the binding site of Ecb on C3d. Our results show that Ecb, FH, and C3b form a tripartite complex. Upon exposure of serum-sensitive Haemophilus influenzae to human serum, Ecb protected the bacteria, and this effect was enhanced by the addition of the C-terminal domains 19-20 of FH. This finding indicates that the tripartite complex formation could give additional protection to bacteria and that S. aureus is thereby able to use host FH and bacterial Ecb in a concerted action to eliminate C3b at the site of infection.
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Affiliation(s)
- Hanne Amdahl
- Department of Bacteriology and Immunology, Haartman Institute, Research Programs Unit, Immunobiology, University of Helsinki, FIN-00014 Helsinki, Finland
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29
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Hebecker M, Alba-Domínguez M, Roumenina LT, Reuter S, Hyvärinen S, Dragon-Durey MA, Jokiranta TS, Sánchez-Corral P, Józsi M. An engineered construct combining complement regulatory and surface-recognition domains represents a minimal-size functional factor H. J Immunol 2013; 191:912-21. [PMID: 23772024 DOI: 10.4049/jimmunol.1300269] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Complement is an essential humoral component of innate immunity; however, its inappropriate activation leads to pathology. Polymorphisms, mutations, and autoantibodies affecting factor H (FH), a major regulator of the alternative complement pathway, are associated with various diseases, including age-related macular degeneration, atypical hemolytic uremic syndrome, and C3 glomerulopathies. Restoring FH function could be a treatment option for such pathologies. In this article, we report on an engineered FH construct that directly combines the two major functional regions of FH: the N-terminal complement regulatory domains and the C-terminal surface-recognition domains. This minimal-size FH (mini-FH) binds C3b and has complement regulatory functions similar to those of the full-length protein. In addition, we demonstrate that mini-FH binds to the FH ligands C-reactive protein, pentraxin 3, and malondialdehyde epitopes. Mini-FH was functionally active when bound to the extracellular matrix and endothelial cells in vitro, and it inhibited C3 deposition on the cells. Furthermore, mini-FH efficiently inhibited complement-mediated lysis of host-like cells caused by a disease-associated FH mutation or by anti-FH autoantibodies. Therefore, mini-FH could potentially be used as a complement inhibitor targeting host surfaces, as well as to replace compromised FH in diseases associated with FH dysfunction.
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Affiliation(s)
- Mario Hebecker
- Leibniz Institute for Natural Product Research and Infection Biology, Hans Knöll Institute, 07745 Jena, Germany
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30
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Bhattacharjee A, Oeemig JS, Kolodziejczyk R, Meri T, Kajander T, Lehtinen MJ, Iwaï H, Jokiranta TS, Goldman A. Structural basis for complement evasion by Lyme disease pathogen Borrelia burgdorferi. J Biol Chem 2013; 288:18685-95. [PMID: 23658013 DOI: 10.1074/jbc.m113.459040] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Borrelia burgdorferi spirochetes that cause Lyme borreliosis survive for a long time in human serum because they successfully evade the complement system, an important arm of innate immunity. The outer surface protein E (OspE) of B. burgdorferi is needed for this because it recruits complement regulator factor H (FH) onto the bacterial surface to evade complement-mediated cell lysis. To understand this process at the molecular level, we used a structural approach. First, we solved the solution structure of OspE by NMR, revealing a fold that has not been seen before in proteins involved in complement regulation. Next, we solved the x-ray structure of the complex between OspE and the FH C-terminal domains 19 and 20 (FH19-20) at 2.83 Å resolution. The structure shows that OspE binds FH19-20 in a way similar to, but not identical with, that used by endothelial cells to bind FH via glycosaminoglycans. The observed interaction of OspE with FH19-20 allows the full function of FH in down-regulation of complement activation on the bacteria. This reveals the molecular basis for how B. burgdorferi evades innate immunity and suggests how OspE could be used as a potential vaccine antigen.
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Affiliation(s)
- Arnab Bhattacharjee
- Haartman Institute, Department of Bacteriology and Immunology, and Research Programs Unit, Immunobiology, University of Helsinki, FIN-00014 Helsinki, Finland
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31
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Meri T, Amdahl H, Lehtinen MJ, Hyvärinen S, McDowell JV, Bhattacharjee A, Meri S, Marconi R, Goldman A, Jokiranta TS. Microbes bind complement inhibitor factor H via a common site. PLoS Pathog 2013; 9:e1003308. [PMID: 23637600 PMCID: PMC3630169 DOI: 10.1371/journal.ppat.1003308] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2012] [Accepted: 03/02/2013] [Indexed: 11/18/2022] Open
Abstract
To cause infections microbes need to evade host defense systems, one of these being the evolutionarily old and important arm of innate immunity, the alternative pathway of complement. It can attack all kinds of targets and is tightly controlled in plasma and on host cells by plasma complement regulator factor H (FH). FH binds simultaneously to host cell surface structures such as heparin or glycosaminoglycans via domain 20 and to the main complement opsonin C3b via domain 19. Many pathogenic microbes protect themselves from complement by recruiting host FH. We analyzed how and why different microbes bind FH via domains 19–20 (FH19-20). We used a selection of FH19-20 point mutants to reveal the binding sites of several microbial proteins and whole microbes (Haemophilus influenzae, Bordetella pertussis, Pseudomonas aeruginosa, Streptococcus pneumonia, Candida albicans, Borrelia burgdorferi, and Borrelia hermsii). We show that all studied microbes use the same binding region located on one side of domain 20. Binding of FH to the microbial proteins was inhibited with heparin showing that the common microbial binding site overlaps with the heparin site needed for efficient binding of FH to host cells. Surprisingly, the microbial proteins enhanced binding of FH19-20 to C3b and down-regulation of complement activation. We show that this is caused by formation of a tripartite complex between the microbial protein, FH, and C3b. In this study we reveal that seven microbes representing different phyla utilize a common binding site on the domain 20 of FH for complement evasion. Binding via this site not only mimics the glycosaminoglycans of the host cells, but also enhances function of FH on the microbial surfaces via the novel mechanism of tripartite complex formation. This is a unique example of convergent evolution resulting in enhanced immune evasion of important pathogens via utilization of a “superevasion site.” Complement is an important arm of innate immunity. Activation of this plasma protein cascade leads to opsonization of targets for phagocytosis, direct lysis of Gram-negative bacteria, and enhancement of the inflammatory and acquired immune responses. No specific signal is needed for activation of the alternative pathway of complement, leading to its activation on all unprotected surfaces. Pathogenic microbes need to evade this pathway, and several species are known to recruit host complement inhibitor factor H (FH) to prevent the activation. FH is important for protection of host cells, too, as defects in FH lead to a severe autoreactive disease, atypical hemolytic uremic syndrome. We have now identified at the molecular level a common mechanism by which seven different microbes, Haemophilus influenzae, Bordetella pertussis, Pseudomonas aeruginosa, Streptococcus pneumoniae, Candida albicans, Borrelia burgdorferi and B. hermsii, recruit FH. All microbes bind FH via a common site on domain 20, which facilitates formation of a tripartite complex between the microbial protein, the main complement opsonin C3b, and FH. We show that, by utilizing the common microbial binding site on FH20, microbes can inhibit complement more efficiently. This detailed knowledge on mechanism of complement evasion can be used in developing novel antimicrobial chemotherapy.
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Affiliation(s)
- T Meri
- Haartman Institute, Department of Bacteriology and Immunology and Immunobiology Research Program, University of Helsinki, Helsinki, Finland.
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Blanc C, Roumenina LT, Ashraf Y, Hyvärinen S, Sethi SK, Ranchin B, Niaudet P, Loirat C, Gulati A, Bagga A, Fridman WH, Sautès-Fridman C, Jokiranta TS, Frémeaux-Bacchi V, Dragon-Durey MA. Overall neutralization of complement factor H by autoantibodies in the acute phase of the autoimmune form of atypical hemolytic uremic syndrome. J Immunol 2012; 189:3528-37. [PMID: 22922817 DOI: 10.4049/jimmunol.1200679] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Complement is a major innate immune surveillance system. One of its most important regulators is the plasma protein factor H (FH). FH inactivation by mutations or by autoantibodies is associated with a thrombotic microangiopathy disease, atypical hemolytic uremic syndrome. In this study, we report the characterization of blood samples from 19 anti-FH Ab-positive atypical hemolytic uremic syndrome patients collected at the acute phase of the disease. Analyses of the functional consequences and epitope mapping, using both fluid phase and solid phase approaches, were performed. The anti-FH Abs perturbed FH-mediated cell protection (100%), inhibited FH interaction with C3 (46%), and caused C3 consumption (47%). The Abs were directed against multiple FH epitopes located at the N and C termini. In all tested patients, high titers of FH-containing circulating immune complexes were detected. The circulating immune complex titers correlated with the disease stage better than did the Ab titers. Our results show that anti-FH autoantibodies induce neutralization of FH at acute phase of the disease, leading to an overall impairment of several functions of FH, extending the role of autoantibodies beyond the impairment of the direct cell surface protection.
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Affiliation(s)
- Caroline Blanc
- INSERM Unité Mixte de Recherche en Santé 872, Centre de Recherche des Cordeliers, 75006 Paris, France
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33
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Haapasalo K, Jarva H, Siljander T, Tewodros W, Vuopio-Varkila J, Jokiranta TS. Complement factor H allotype 402H is associated with increased C3b opsonization and phagocytosis of Streptococcus pyogenes. Mol Microbiol 2012. [DOI: 10.1111/j.1365-2958.2012.07991.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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34
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Haapasalo K, Vuopio J, Syrjänen J, Suvilehto J, Massinen S, Karppelin M, Järvelä I, Meri S, Kere J, Jokiranta TS. Acquisition of complement factor H is important for pathogenesis of Streptococcus pyogenes infections: evidence from bacterial in vitro survival and human genetic association. J Immunol 2011; 188:426-35. [PMID: 22140259 DOI: 10.4049/jimmunol.1102545] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Streptococcus pyogenes (or group A streptococcus [GAS]) is a major human pathogen causing infections, such as tonsillitis, erysipelas, and sepsis. Several GAS strains bind host complement regulator factor H (CFH) via its domain 7 and, thereby, evade complement attack and C3b-mediated opsonophagocytosis. Importance of CFH binding for survival of GAS has been poorly studied because removal of CFH from plasma or blood causes vigorous complement activation, and specific inhibitors of the interaction have not been available. In this study, we found that activation of human complement by different GAS strains (n = 38) correlated negatively with binding of CFH via its domains 5-7. The importance of acquisition of host CFH for survival of GAS in vitro was studied next by blocking the binding with recombinant CFH5-7 lacking the regulatory domains 1-4. Using this fragment in full human blood resulted in death or radically reduced multiplication of all of the studied CFH-binding GAS strains. To study the importance of CFH binding in vivo (i.e., for pathogenesis of streptococcal infections), we used our recent finding that GAS binding to CFH is diminished in vitro by polymorphism 402H, which is also associated with age-related macular degeneration. We showed that allele 402H is suggested to be associated with protection from erysipelas (n = 278) and streptococcal tonsillitis (n = 209) compared with controls (n = 455) (p < 0.05). Taken together, the bacterial in vitro survival data and human genetic association revealed that binding of CFH is important for pathogenesis of GAS infections and suggested that inhibition of CFH binding can be a novel therapeutic approach in GAS infections.
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Affiliation(s)
- Karita Haapasalo
- Department of Bacteriology and Immunology, Haartman Institute, University of Helsinki, Helsinki, Finland.
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35
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Biedzka-Sarek M, Metso J, Kateifides A, Meri T, Jokiranta TS, Muszyński A, Radziejewska-Lebrecht J, Zannis V, Skurnik M, Jauhiainen M. Apolipoprotein A-I exerts bactericidal activity against Yersinia enterocolitica serotype O:3. J Biol Chem 2011; 286:38211-38219. [PMID: 21896489 DOI: 10.1074/jbc.m111.249482] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Apolipoprotein A-I (apoA-I), the main protein component of high density lipoprotein (HDL), is well recognized for its antiatherogenic, antioxidant, and antiinflammatory properties. Here, we report a novel role for apoA-I as a host defense molecule that contributes to the complement-mediated killing of an important gastrointestinal pathogen, Gram-negative bacterium Yersinia enterocolitica. We specifically show that the C-terminal domain of apoA-I is the effector site providing the bactericidal activity. Although the presence of the lipopolysaccharide O-antigen on the bacterial surface is absolutely required for apoA-I to kill the bacteria, apoA-I does not interact with the bacteria directly. To the contrary, exposure of the bacteria by serum proteins triggers apoA-I deposition on the bacterial surface. As our data show that both purified lipid-free and HDL-associated apoA-I displays anti-bacterial potential, apoA-I mimetic peptides may be a promising therapeutic agent for the treatment of certain Gram-negative infections.
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Affiliation(s)
- Marta Biedzka-Sarek
- Department of Chronic Disease Prevention, Public Health Genomics Research Unit, National Institute for Health and Welfare, and Institute for Molecular Medicine Finland (FIMM), 00290 Helsinki, Finland.
| | - Jari Metso
- Department of Chronic Disease Prevention, Public Health Genomics Research Unit, National Institute for Health and Welfare, and Institute for Molecular Medicine Finland (FIMM), 00290 Helsinki, Finland
| | - Andreas Kateifides
- Department of Molecular Genetics, Boston University Medical Center, Boston, Massachusetts 02118
| | - Taru Meri
- Department of Bacteriology and Immunology, Haartman Institute, University of Helsinki, 00014 Helsinki, Finland; Department of Laboratory Diagnostics, Helsinki University Central Hospital, 00290 Helsinki, Finland
| | - T Sakari Jokiranta
- Department of Bacteriology and Immunology, Haartman Institute, University of Helsinki, 00014 Helsinki, Finland
| | - Artur Muszyński
- Complex Carbohydrate Research Center, University of Georgia, Athens, Georgia 30602
| | | | - Vassilis Zannis
- Department of Molecular Genetics, Boston University Medical Center, Boston, Massachusetts 02118
| | - Mikael Skurnik
- Department of Bacteriology and Immunology, Haartman Institute, University of Helsinki, 00014 Helsinki, Finland; Department of Laboratory Diagnostics, Helsinki University Central Hospital, 00290 Helsinki, Finland
| | - Matti Jauhiainen
- Department of Chronic Disease Prevention, Public Health Genomics Research Unit, National Institute for Health and Welfare, and Institute for Molecular Medicine Finland (FIMM), 00290 Helsinki, Finland
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Koskinen AR, Tukiainen E, Arola J, Nordin A, Höckerstedt HK, Nilsson B, Isoniemi H, Jokiranta TS. Complement activation during liver transplantation-special emphasis on patients with atypical hemolytic uremic syndrome. Am J Transplant 2011; 11:1885-95. [PMID: 21812916 DOI: 10.1111/j.1600-6143.2011.03612.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Atypical hemolytic uremic syndrome (aHUS) is a thrombotic microangiopathy often caused by mutations in complement factor H (CFH), the main regulator of alternative complement pathway. Because CFH is produced mainly by the liver, combined liver-kidney transplantation is a reasonable option in treatment of patients with severe aHUS. We studied complement activation by monitoring activation markers during liver transplantation in two aHUS patients treated extensively with plasma exchange and nine other liver transplantation patients. After the reperfusion, a clear increase in all the activation markers except C4d was observed indicating that the activation occurs mainly through the alternative pathway. Concentration of SC5b-9 was higher in the hepatic than the portal vein indicating complement activation in the graft. Preoperatively and early during the operation, the aHUS patients showed highest C3d concentrations but otherwise their activation markers were similar to the other patients. In the other patients, correlation was found between perioperative SC5b-9 concentration and postoperative alanine aminotransferase and histological changes. This study explains why supply of normal CFH by extensive plasma exchange is beneficial before combined liver-kidney transplantation of aHUS patients. Also the results suggest that perioperative inhibition of the terminal complement cascade might be beneficial if enhanced complement activation is expected.
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Affiliation(s)
- A R Koskinen
- Department of Bacteriology and Immunology, Haartman Institute, University of Helsinki, Helsinki, Finland
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Abstract
Human malaria has been known to be caused by 4 Plasmodium species, with Plasmodium falciparum causing the most-severe disease. Recently, numerous reports have described human malaria caused by a fifth Plasmodium species, Plasmodium knowlesi, which usually infects macaque monkeys. Hundreds of human cases have been reported from Malaysia, several cases have been reported in other Southeast Asian countries, and a few cases have been reported in travelers visiting these areas. Similarly to P. falciparum, P. knowlesi can cause severe and even fatal cases of disease that are more severe than those caused by the other Plasmodium species. Polymerase chain reaction is of value for diagnosis because P. knowlesi infection is easily misdiagnosed as less dangerous Plasmodium malariae infection with conventional microscopy. P. knowlesi infection should be suspected in patients who are infected with malaria in Southeast Asia. If human-mosquito-human transmission were to occur, the disease could spread to new areas where the mosquito vectors live, such as the popular tourist areas in western India.
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Affiliation(s)
- Anu Kantele
- Division of Infectious Diseases, Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland.
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Shaughnessy J, Ram S, Bhattacharjee A, Pedrosa J, Tran C, Horvath G, Monks B, Visintin A, Jokiranta TS, Rice PA. Molecular characterization of the interaction between sialylated Neisseria gonorrhoeae and factor H. J Biol Chem 2011; 286:22235-42. [PMID: 21531728 DOI: 10.1074/jbc.m111.225516] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Human factor H (HufH), a key inhibitor of the alternative pathway of complement, binds to Neisseria gonorrhoeae and constitutes an important mechanism of human-specific complement evasion. The C-terminal domain 20 of HufH contains the binding site for sialylated gonococci. We exploited differences in amino acid sequences between human and non-binding chimpanzee fH domain 20 to create cross-species mutations to define amino acids important for binding to sialylated gonococci. We used fH/Fc fusion constructs that contained contiguous fH domains 18-20 fused to Fc fragments of murine IgG2a. The Fc region was used both as a tag for detection of each fusion molecule on the bacterial surface and as an indicator for complement-dependent killing. Arg-1203 was critical for binding to both porin (Por) B.1A and PorB.1B strains. Modeling of the R1203N human-to-chimpanzee mutation using the crystal structure of HufH19-20 as a template showed a loss of positive charge that protrudes at the C terminus of domain 20. We tested the functional importance of Arg-1203 by incubating sialylated gonococci with normal human serum, in the presence of wild-type HufH18-20/Fc or its R1203A mutant. Gonococci bound and were killed by wild-type HufH18-20/Fc but not by the R1203A mutant. A recombinant fH/Fc molecule that contained chimpanzee domain 20, humanized only at amino acid 1203 (N1203R) also bound to sialylated gonococci and restored killing. These findings provide further insights into the species specificity of gonococcal infections and proof-of-concept of a novel therapeutic approach against gonorrhea, a disease rapidly becoming resistant to conventional antibiotics.
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Affiliation(s)
- Jutamas Shaughnessy
- Division of Infectious Diseases and Immunology, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts 01605, USA.
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Amdahl H, Jarva H, Haanperä M, Mertsola J, He Q, Jokiranta TS, Meri S. Interactions between Bordetella pertussis and the complement inhibitor factor H. Mol Immunol 2010; 48:697-705. [PMID: 21167605 DOI: 10.1016/j.molimm.2010.11.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2010] [Revised: 11/16/2010] [Accepted: 11/20/2010] [Indexed: 01/15/2023]
Abstract
Bordetella pertussis causes whooping cough in humans, a highly contagious disease of the upper respiratory tract. An increase in cases of whooping cough in adolescents and adults in many countries has been reported, despite high immunization rates in children. To efficiently colonize the host the bacteria have to resist complement, the first defence line of innate immunity. B. pertussis has previously been shown to bind the classical pathway inhibitors C4b-binding protein and C1-inhibitor being thereby able to escape the classical pathway of complement. In this study recent clinical isolates of B. pertussis and B. parapertussis were found to survive alternative pathway attack in fresh non-immune serum better than the reference B. pertussis strain, Tohama I. By using adsorption assays, flow cytometry and a radioligand binding assay we observed that both B. pertussis and B. parapertussis bound the alternative pathway inhibitor factor H (FH) from normal human serum. The surface attached FH maintained its complement regulatory activity and promoted factor I-mediated cleavage of C3b. The main binding region was located to the C-terminal part of FH, into short consensus repeat domains 19-20. In contrast, the avian pathogen B. avium did not bind FH and was sensitive to the alternative pathway of human complement. In conclusion, the human pathogens B. pertussis and B. parapertussis are able to evade the alternative complement pathway by surface acquisition of the host complement regulator FH.
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Affiliation(s)
- Hanne Amdahl
- Department of Bacteriology and Immunology, Haartman Institute, University of Helsinki, Helsinki, Finland
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40
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Oddoux O, Debourgogne A, Kantele A, Kocken CH, Jokiranta TS, Vedy S, Puyhardy JM, Machouart M. Identification of the five human Plasmodium species including P. knowlesi by real-time polymerase chain reaction. Eur J Clin Microbiol Infect Dis 2010; 30:597-601. [PMID: 21161559 DOI: 10.1007/s10096-010-1126-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2010] [Accepted: 11/25/2010] [Indexed: 11/30/2022]
Abstract
Recently, Plasmodium knowlesi has been recognised as the fifth Plasmodium species causing malaria in humans. Hundreds of human cases infected with this originally simian Plasmodium species have been described in Asian countries and increasing numbers are reported in Europe from travellers. The growing impact of tourism and economic development in South and Southeast Asia are expected to subsequently lead to a further increase in cases both among locals and among travellers. P. knowlesi is easily misidentified in microscopy as P. malariae or P. falciparum. We developed new primers for the rapid and specific detection of this species by low-cost real-time polymerase chain reaction (PCR) and added this method to an already existing panel of primers used for the molecular identification of the other four species in one reaction. Reference laboratories should now be able to identify undisputably and rapidly P. knowlesi, as it is a potentially fatal pathogen.
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Abstract
We report an unusual case of human babesiosis in Finland in a 53-year-old man with no history of splenectomy. He had a rudimentary spleen, coexisting Lyme borreliosis, exceptional dark streaks on his extremities, and subsequent disseminated aspergillosis. He was infected with Babesia divergens, which usually causes bovine babesiosis in Finland.
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42
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Shaughnessy J, Ram S, Bhattacharjee A, Tran C, Horvath G, Monks B, Visintin A, Jokiranta TS, Rice PA. Species specificity of factor H interaction with the uniquely human pathogen, Neisseria gonorrhoeae, resides in arginine substitution at position 1203 in domain 20. Mol Immunol 2010. [DOI: 10.1016/j.molimm.2010.05.151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Hyvärinen S, Lehtinen MJ, Rops A, van der Vlag J, Jokiranta TS. Enhancement of heparin binding of factor H domains 19–20 with multiple point mutations. Mol Immunol 2010. [DOI: 10.1016/j.molimm.2010.05.189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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44
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Kajander T, Bhattacharjee A, Lehtinen MJ, Hyvärinen S, Leung E, Isenman DE, Meri S, Goldman A, Sakari Jokiranta T. A new possible mechanism for target discrimination of the alternative pathway revealed by structural and functional studies of factor H domains 19–20 and C3d. Mol Immunol 2010. [DOI: 10.1016/j.molimm.2010.05.183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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45
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Amdahl H, Jongerius I, Pasanen T, Lehtinen MJ, van Strijp JA, Rooijakkers SH, Jokiranta TS. The secreted Ecb and Efb proteins of Staphylococcus aureus enhance binding of factor H to C3b and C3d. Mol Immunol 2010. [DOI: 10.1016/j.molimm.2010.05.159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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46
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Seeberger H, Strobel S, Lehtinen MJ, Jokiranta TS, Józsi M. Epitope fine mapping and isotype analysis of anti-factor H autoantibodies demonstrate antibody heterogeneity and reveal the molecular basis of autoimmune haemolytic uraemic syndrome. Mol Immunol 2010. [DOI: 10.1016/j.molimm.2010.05.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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47
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Koskinen A, Tukiainen E, Nordin A, Mäkisalo H, Höckerstedt K, Isoniemi H, Nilsson B, Jokiranta TS. Complement activation during liver transplantation has relevance for patients with atypical hemolytic uremic syndrome. Mol Immunol 2010. [DOI: 10.1016/j.molimm.2010.05.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
In all three complement pathways, the central molecule is C3, which, upon activation cleavage, forms the major opsonin C3b - the key component of complement. C3b is also essential for propagation of the complement cascade to the stage of the lytic terminal complement complexes. In order to prevent damage to self cells and tissues and restrict overconsumption of the complement components, C3b molecules need to be controlled by factor H. Defect in C3 functions leads to compromised microbial defence and increased susceptibility to certain autoimmune diseases. Deficiency of factor H, or a functional defect in its N terminus, often leads to membranoproliferative glomerulonephritis and complement depletion, owing to continuous overconsumption of C3. Defect in the factor H C terminus leads to a dramatically increased risk of atypical hemolytic uremic syndrome. In addition, recently, a polymorphism in the middle part of factor H (Y402H) has been shown to be the major risk factor for the most common cause of blindness in the industrialized world: age-related macular degeneration. In future, analysis of patient samples for defects in these key complement components may prove useful in diagnosis of these diseases and new therapeutic targets will certainly be the aim for use in the recently recognized factor H-related diseases.
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Affiliation(s)
- T Sakari Jokiranta
- Department of Bacteriology and Immunology, Haartman Institute, University of Helsinki, Helsinki, Finland.
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Rimhanen-Finne R, Hänninen ML, Vuento R, Laine J, Jokiranta TS, Snellman M, Pitkänen T, Miettinen I, Kuusi M. Contaminated water caused the first outbreak of giardiasis in Finland, 2007: A descriptive study. ACTA ACUST UNITED AC 2010; 42:613-9. [DOI: 10.3109/00365541003774608] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Bhattacharjee A, Lehtinen MJ, Kajander T, Goldman A, Jokiranta TS. Both domain 19 and domain 20 of factor H are involved in binding to complement C3b and C3d. Mol Immunol 2010; 47:1686-91. [PMID: 20378178 DOI: 10.1016/j.molimm.2010.03.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2009] [Revised: 03/10/2010] [Accepted: 03/14/2010] [Indexed: 11/29/2022]
Abstract
Factor H (FH) regulates the alternative pathway of complement in plasma and mediates discrimination of cellular surfaces to alternative pathway activators and non-activators. The carboxyl-terminal domains 19 and 20 of FH are essential in target discrimination and are known to contain binding sites for the C3d part of C3b, heparin, and endothelial cells. Mutations in FH19-20 are frequently found in patients with atypical haemolytic uremic syndrome (aHUS). Most aHUS-associated and some other mutations have been shown to lead to impaired binding to C3d and C3b by the recombinant FH19-20 fragment. Most of these mutated residues, such as R1203, are located close to each other in domain 20 but some, such as Q1139, are located in domain 19. We generated mutant proteins Q1139A and R1203A of FH19-20 and showed that their binding to C3d and C3b was clearly impaired. To show that the effects on C3d/C3b binding are due to direct interactions rather than structural changes, we solved the X-ray crystal structures of the R1203A and Q1139A mutant proteins at 1.65 and 2.0A, respectively. Neither of the mutations caused any overall structural changes in FH19-20. It is thus evident that Q1139 in domain 19 and R1203 in domain 20 are directly involved in binding to the C3d part of C3b and therefore both the domains are involved in the interaction with C3d and C3b. This explains why several aHUS-associated FH mutations are found within domain 19 in addition to domain 20.
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Affiliation(s)
- Arnab Bhattacharjee
- Department of Bacteriology and Immunology, Haartman Institute, University of Helsinki, Haartmaninkatu 3, FIN-00014, Finland
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