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Zurek Munk-Madsen M, Toft L, Kube T, Richter R, Ostergaard L, Søgaard OS, Tolstrup M, Kaufmann AM. Cellular immunogenicity of human papillomavirus vaccines Cervarix and Gardasil in adults with HIV infection. Hum Vaccin Immunother 2017; 14:909-916. [PMID: 29172992 PMCID: PMC5893199 DOI: 10.1080/21645515.2017.1407896] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 01/13/2023] Open
Abstract
Human papillomavirus (HPV) infection is a frequent cause of malignant and non-malignant disease, in particular among persons with HIV. HPV serotype-specific anti L1 antibodies protect against HPV infection but little is known about prophylactic HPV vaccine-induced cell-mediated immunity against HPV in high-risk individuals. We recently showed that both HPV vaccines (Gardasil® and Cervarix®) induce solid, serological immune responses in HIV-infected persons. This study aimed to characterize HPV-specific CD4 T cells in HIV-infected HPV-vaccine recipients, T cell responses being critical for B cell activation and antibody-isotype switching. Thirty HIV-infected patients on long-term antiretroviral treatment (ART) received 3 doses of either Cervarix (n = 15) or Gardasil (n = 15) vaccine at month 0, 1.5 and 6. Cryopreserved peripheral blood mononuclear cells (PBMC) from baseline, 7 and 12 months were subjected to 24-hour stimulation with specific pools of HPV L1-peptides (HPV6, 11, 16, 18, 31 and 45) and HPV E6/E7-peptide pools (HPV6/11 and HPV16/18). Fluorescence-activated cell sorting with intracellular staining (IC-FACS) against CD4, CD154, IL-2, and IFNγ was performed. Frequencies (%) of HPV-antigen specific CD4+ T cells (CD154+/IL-2+ or CD154+/ IFNγ+) were determined. Both HPV-vaccines significantly and comparably enhanced cell-mediated vaccine L1 antigen-specific immunity in HIV-positive adults receiving ART therapy at month 7 and 12 after first vaccine dose. This suggests that the vaccines induce CD4 T cellular memory despite HIV-induced immune compromisation.
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Affiliation(s)
- Maria Zurek Munk-Madsen
- a Clinic for Gynecology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health , Berlin , Germany.,b Department of Infectious Diseases , Aarhus University Hospital , Aarhus , Denmark
| | - Lars Toft
- b Department of Infectious Diseases , Aarhus University Hospital , Aarhus , Denmark
| | - Tina Kube
- a Clinic for Gynecology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health , Berlin , Germany
| | - Rolf Richter
- a Clinic for Gynecology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health , Berlin , Germany
| | - Lars Ostergaard
- b Department of Infectious Diseases , Aarhus University Hospital , Aarhus , Denmark
| | - Ole S Søgaard
- b Department of Infectious Diseases , Aarhus University Hospital , Aarhus , Denmark
| | - Martin Tolstrup
- b Department of Infectious Diseases , Aarhus University Hospital , Aarhus , Denmark
| | - Andreas M Kaufmann
- a Clinic for Gynecology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health , Berlin , Germany
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Faust H, Toft L, Sehr P, Müller M, Bonde J, Forslund O, Østergaard L, Tolstrup M, Dillner J. Human Papillomavirus neutralizing and cross-reactive antibodies induced in HIV-positive subjects after vaccination with quadrivalent and bivalent HPV vaccines. Vaccine 2016; 34:1559-1565. [PMID: 26896686 DOI: 10.1016/j.vaccine.2016.02.019] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [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: 11/02/2015] [Revised: 01/18/2016] [Accepted: 02/04/2016] [Indexed: 01/10/2023]
Abstract
Ninety-one HIV-infected individuals (61 men and 30 women) were randomized to vaccination either with quadrivalent (Gardasil™) or bivalent (Cervarix™) HPV vaccine. Neutralizing and specific HPV-binding serum antibodies were measured at baseline and 12 months after the first vaccine dose. Presence of neutralizing and binding antibodies had good agreement (average Kappa for HPV types 6, 11, 16, 18, 31, 33 and 45 was 0.65). At baseline, 88% of subjects had antibodies against at least one genital HPV. Following vaccination with Cervarix™, all subjects became seropositive for HPV16 and 18. After Gardasil™ vaccination, 96% of subjects seroconverted for HPV16 and 73% for HPV18. Levels of HPV16-specific antibodies were <1 international unit (IU) in 87% of study subjects before vaccination but >10IU in 85% of study subjects after vaccination. Antibodies against non-vaccine HPV types appeared after Gardasil™ vaccination for >50% of vaccinated females for HPV 31, 35 and 73 and for >50% of Cervarix™-vaccinated females for HPV 31, 33, 35, 45, 56 and 58. Cross-reactivity with non-genital HPV types was also detected. In conclusion, HIV-infected subjects responded to HPV vaccination with induction of neutralizing antibodies against both vaccine and non-vaccine types.
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Affiliation(s)
- Helena Faust
- Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden
| | - Lars Toft
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Peter Sehr
- European Molecular Biology Laboratory, Heidelberg, Germany
| | | | - Jesper Bonde
- Molecular Pathology Laboratory, Department of Pathology, Copenhagen University Hospital, Hvidovre, Denmark
| | - Ola Forslund
- Department of Laboratory Medicine, Lund University, Malmö, Sweden
| | - Lars Østergaard
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Martin Tolstrup
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Joakim Dillner
- Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden.
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Toft L, Tolstrup M, Müller M, Sehr P, Bonde J, Storgaard M, Østergaard L, Søgaard OS. Comparison of the immunogenicity of Cervarix® and Gardasil® human papillomavirus vaccines for oncogenic non-vaccine serotypes HPV-31, HPV-33, and HPV-45 in HIV-infected adults. Hum Vaccin Immunother 2014; 10:1147-54. [PMID: 24553190 DOI: 10.4161/hv.27925] [Citation(s) in RCA: 38] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Individuals infected with human immunodeficiency virus (HIV) have excess risk of developing human papillomavirus (HPV)-related disease. A substantial fraction of HPV-associated cancers is caused by HPV serotypes not included in the currently available vaccines. Among healthy women, both Cervarix(®) (HPV-16/18, GlaxoSmithKline Biologicals, GSK) and Gardasil(®) (HPV-6/11/16/18, Merck) have demonstrated partial cross-protection against certain oncogenic non-vaccine HPV-types. Currently, there are no available data on vaccine-induced cross-protection in men and little is known about cross-reactive immunity after HPV-vaccination of HIV-infected individuals. In an investigator-initiated trial, we randomized 91 HIV-positive men and women to receive vaccination with Cervarix(®) or Gardasil(®). The HPV-DNA status of the participants was determined with pcr before and after immunization. Cross-reactive antibody responses against HPV-31, HPV-33, and HPV-45 were evaluated for up to 12 months using a pseudovirion-based neutralization assay (PBNA). Geometric mean antibody titers (GMTs) were compared among vaccine groups and genders at 7 and 12 months.: Both vaccines induced anti-HPV-31, -33, and -45 neutralizing antibodies in participants who were seronegative and HPV-DNA negative for those types at study entry. Geometric mean antibody titers were comparable between vaccine groups. Interestingly, anti-HPV-31 and -33 antibody titers were higher among women compared with men at 7 and 12 months.: In conclusion, both licensed HPV-vaccines induced cross-neutralizing antibodies against frequent oncogenic non-vaccine serotypes HPV-31, HPV-33, and HPV-45 in HIV-infected adults, and women had greater serological responses against HPV-31 and -33 compared with men.
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Affiliation(s)
- Lars Toft
- Department of Infectious Diseases; Aarhus University Hospital; Aarhus, Denmark
| | - Martin Tolstrup
- Department of Infectious Diseases; Aarhus University Hospital; Aarhus, Denmark
| | - Martin Müller
- Research Program Infection and Cancer; German Cancer Research Center; Heidelberg, Germany
| | - Peter Sehr
- Chemical Biology Core Facility; European Molecular Biology Laboratory; Heidelberg, Germany
| | - Jesper Bonde
- Department of Pathology; Copenhagen University Hospital; Hvidovre, Denmark; Clinical Research Centre; Copenhagen University Hospital; Hvidovre, Denmark
| | - Merete Storgaard
- Department of Infectious Diseases; Aarhus University Hospital; Aarhus, Denmark
| | - Lars Østergaard
- Department of Infectious Diseases; Aarhus University Hospital; Aarhus, Denmark
| | - Ole S Søgaard
- Department of Infectious Diseases; Aarhus University Hospital; Aarhus, Denmark
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Toft L, Tolstrup M, Storgaard M, Ostergaard L, Søgaard OS. Vaccination against oncogenic human papillomavirus infection in HIV-infected populations: review of current status and future perspectives. Sex Health 2014; 11:511-23. [PMID: 25218800 DOI: 10.1071/sh14015] [Citation(s) in RCA: 23] [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] [Received: 01/14/2014] [Accepted: 08/05/2014] [Indexed: 12/30/2022]
Abstract
UNLABELLED Background Men and women with HIV infection are at increased risk of developing cancers associated with human papillomavirus (HPV). The two licensed prophylactic HPV vaccines protect against de novo infection with HPV-16 and HPV-18, which cause the majority of HPV-associated cancers. Currently, no vaccine efficacy data are available for persons with HIV infection. Nevertheless, some countries have implemented specific HPV vaccination recommendations for HIV-positive populations. To specifically recommend prophylactic HPV vaccination in people with HIV, the vaccines must be safe and immunogenic in immunosuppressed people at a high risk of HPV infection. This review aims to summarise the current knowledge from published HPV vaccine trials in HIV-infected populations, to compile scheduled and ongoing HPV vaccine trials with HIV-positive study populations and to extrapolate the relevant knowledge about HPV vaccine efficacy in HIV-negative populations to an HIV context. METHODS The databases PubMed, Scopus and ClinicalTrials.gov were searched for peer-reviewed articles and scheduled or ongoing clinical HPV vaccine trials enrolling HIV-positive persons. RESULTS Current data indicate that prophylactic HPV vaccines are safe and immunogenic in different HIV-positive populations (children, female adolescents, adults). Increased immunogenicity has been reported in persons on antiretroviral therapy compared with antiretroviral-naïve persons, whereas no clear association has been found between CD4(+) cell count at immunisation and vaccine response. Several scheduled and ongoing HPV vaccine trials aim to determine vaccine efficacy against disease endpoints in HIV-infected study populations. CONCLUSION Prophylactic HPV vaccination appears safe, immunogenic and, by extrapolation, likely to reduce HPV-associated cancer development among persons with HIV infection.
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Affiliation(s)
- Lars Toft
- Department of Infectious Diseases, Aarhus University Hospital, Skejby, 8200 Aarhus, Denmark
| | - Martin Tolstrup
- Department of Infectious Diseases, Aarhus University Hospital, Skejby, 8200 Aarhus, Denmark
| | - Merete Storgaard
- Department of Infectious Diseases, Aarhus University Hospital, Skejby, 8200 Aarhus, Denmark
| | - Lars Ostergaard
- Department of Infectious Diseases, Aarhus University Hospital, Skejby, 8200 Aarhus, Denmark
| | - Ole S Søgaard
- Department of Infectious Diseases, Aarhus University Hospital, Skejby, 8200 Aarhus, Denmark
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Toft L, Storgaard M, Müller M, Sehr P, Bonde J, Tolstrup M, Østergaard L, Søgaard OS. Comparison of the immunogenicity and reactogenicity of Cervarix and Gardasil human papillomavirus vaccines in HIV-infected adults: a randomized, double-blind clinical trial. J Infect Dis 2013; 209:1165-73. [PMID: 24273179 DOI: 10.1093/infdis/jit657] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [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: 01/06/2023] Open
Abstract
BACKGROUND We compared the immunogenicity and reactogenicity of Cervarix or Gardasil human papillomavirus (HPV) vaccines in adults infected with the human immunodeficiency virus (HIV). METHODS This was a double-blind, controlled trial randomizing HIV-positive adults to receive 3 doses of Cervarix or Gardasil at 0, 1.5, and 6 months. Immunogenicity was evaluated for up to 12 months. Neutralizing anti-HPV-16/18 antibodies were measured by pseudovirion-based neutralization assay. Laboratory tests and diary cards were used for safety assessment. The HPV-DNA status of the participants was determined before and after immunization. RESULTS Ninety-two participants were included in the study. Anti-HPV-18 antibody titers were higher in the Cervarix group compared with the Gardasil group at 7 and 12 months. No significant differences in anti-HPV-16 antibody titers were found among vaccine groups. Among Cervarix vaccinees, women had higher anti-HPV-16/18 antibody titers compared to men. No sex-specific differences in antibody titers were found in the Gardasil group. Mild injection site reactions were more common in the Cervarix group than in the Gardasil group (91.1% vs 69.6%; P = .02). No serious adverse events occurred. CONCLUSIONS Both vaccines were immunogenic and well tolerated. Compared with Gardasil, Cervarix induced superior vaccine responses among HIV-infected women, whereas in HIV-infected men the difference in immunogenicity was less pronounced.
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Affiliation(s)
- Lars Toft
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
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Tolstrup M, Johansen C, Toft L, Pedersen FS, Funding A, Bahrami S, Iversen L, Østergaard L, Duch M. Anti-inflammatory effect of a retrovirus-derived immunosuppressive peptide in mouse models. BMC Immunol 2013; 14:51. [PMID: 24245569 PMCID: PMC3840592 DOI: 10.1186/1471-2172-14-51] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [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: 08/09/2013] [Accepted: 11/12/2013] [Indexed: 11/11/2022] Open
Abstract
Background Short dimeric or mulitmeric peptides derived from a highly conserved stretch of amino acids from gammaretroviral envelope proteins has been found to have immunosuppressive properties in vitro. Here we test the hypothesis that such immunosuppressive peptides may serve as immunomodulatory reagents for treatment of inflammatory disorders. Results The anti-inflammatory effect of a synthetic retrovirus-derived immunosuppressive peptide of 17 amino acids was tested in two murine skin inflammation models, a TPA-induced acute toxic contact eczema model and an oxazolone-induced allergic contact dermatitis. Overall, mice (n = 24) treated with a topically applied cream containing the dimeric immunosuppressive peptide exhibited a reduction of 28.8% in ear thickness (range 20.1-42.5), whereas the application of a scrambled peptide dimer or a monomer of the immunosuppressive peptide remained without effect (p = 0.028). Furthermore, ear biopsies from mice treated with the dimeric immunosuppressive peptide showed a significant reduction in mRNA of the pro-inflammatory cytokines TNF-α, IL-17C, and IL-6 as well as the chemokine CXCL2 compared to mice treated with control peptides. Conclusion Using two murine skin inflammation models, we show that an immunosuppressive retroviral peptide is capable of reducing inflammatory disorders. The results indicate that virus-derived immunosuppressive peptides capable of down-regulating several proinflammatory cytokines may represent a novel class of drugs for the treatment of excess inflammation.
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Affiliation(s)
- Martin Tolstrup
- Department of Infectious Diseases, Aarhus University Hospital, Brendstrupgaardsvej 100, 8200 Aarhus, Denmark.
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Toft L, Landström PO. [SOS International's work in Thailand: all high-priority patients were selected for air transport home on New Year's Eve]. Lakartidningen 2005; 102:245-6. [PMID: 15743138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
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Toft L, Landström PO. [Patients with chronic disease should be in certain cases advised not to travel abroad]. Lakartidningen 2002; 99:4293-4. [PMID: 12448323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
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Toft L, Landström PO. [SOS-International answers: Collum fracture is usually nailed locally. Air ambulance should be extremely expensive]. Lakartidningen 2002; 99:206. [PMID: 11838080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
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Hicks JL, Ribbans WJ, Buzzard B, Kelley SS, Toft L, Torri G, Wiedel JD, York J. Infected joint replacements in HIV-positive patients with haemophilia. ACTA ACUST UNITED AC 2001. [DOI: 10.1302/0301-620x.83b7.0831050] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Joint replacement in HIV-positive patients remains uncommon, with most experience gained in patients with haemophilia. We analysed retrospectively the outcome of 102 replacement arthroplasties in 73 HIV-positive patients from eight specialist haemophilia centres. Of these, 91 were primary procedures. The mean age of the patients at surgery was 39 years, and the median follow-up was for five years. The overall rate of deep sepsis was 18.7% for primary procedures and 36.3% for revisions. This is a much higher rate of infection than that seen in normal populations. A total of 44% of infections resolved fully after medical and/or surgical treatment. The benefits of arthroplasty in haemophilic patients are well established but the rates of complications are high. As this large study has demonstrated, high rates of infection occur, but survivorship analysis strongly suggests that most patients already diagnosed with HIV infection at the time of surgery should derive many years of symptomatic relief after a successful joint replacement. Careful counselling and education of both patients and healthcare workers before operation are therefore essential.
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Affiliation(s)
- J. L. Hicks
- Nuffield Orthopaedic Centre NHS Trust, Windmill Road, Headington, Oxford OX3 7LD, UK
| | - W. J. Ribbans
- Northampton General Hospital NHS Trust, Cliftonville, Northampton NN1 5BD, UK
| | - B. Buzzard
- Newcastle Haemophilia Comprehensive Care Centre, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP, UK
| | - S. S. Kelley
- University of North Carolina, Department of Orthopaedic Surgery, 242 Burnett-Womack, CB 7055, Chapel Hill, North Carolina 27599, USA
| | - L. Toft
- Watkins Medical Centre, 225 Wickham Terrace, Brisbane 4000, Australia
| | - G. Torri
- Institute of Clinical Orthopaedics, 1 Via Bignami, Milan 20126, Italy
| | - J. D. Wiedel
- University of Colorado Health Sciences Centre, Department of Orthopaedics, 4701 East Ninth Avenue, E203, Denver, Colorado 80262, USA
| | - J. York
- Department of Rheumatology, Rachel Forster Hospital, PO Box 1127, Strawberry Hills, Sydney, New South Wales 2012, Australia
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Hicks JL, Ribbans WJ, Buzzard B, Kelley SS, Toft L, Torri G, Wiedel JD, York J. Infected joint replacements in HIV-positive patients with haemophilia. J Bone Joint Surg Br 2001; 83:1050-4. [PMID: 11603522 DOI: 10.1302/0301-620x.83b7.11242] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Joint replacement in HIV-positive patients remains uncommon, with most experience gained in patients with haemophilia. We analysed retrospectively the outcome of 102 replacement arthroplasties in 73 HIV-positive patients from eight specialist haemophilia centres. Of these, 91 were primary procedures. The mean age of the patients at surgery was 39 years, and the median follow-up was for five years. The overall rate of deep sepsis was 18.7% for primary procedures and 36.3% for revisions. This is a much higher rate of infection than that seen in normal populations. A total of 44% of infections resolved fully after medical and/or surgical treatment. The benefits of arthroplasty in haemophilic patients are well established but the rates of complications are high. As this large study has demonstrated, high rates of infection occur, but survivorship analysis strongly suggests that most patients already diagnosed with HIV infection at the time of surgery should derive many years of symptomatic relief after a successful joint replacement. Careful counselling and education of both patients and healthcare workers before operation are therefore essential.
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Affiliation(s)
- J L Hicks
- Northampton General Hospital NHS Trust, Cliftonville, England
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Abstract
The cobalamin-binding proteins in amniotic fluid are determined by assaying the unsaturated cobalamin-binding capacity of haptocorrin (R-proteins, cobalophilin, or transcobalamin I-like protein and any coexisting intrinsic factor) and non-haptocorrin. Forty-five specimens obtained by amniocentesis, and ninety-two obtained at parturition are analysed. The haptocorrin cobalamin-binding capacity increases rapidly after a gestational age of about 15 weeks. At parturition the concentration varies from 1.4 to 26.8 nmol/l. The non-haptocorrin cobalamin-binding capacity is less than 1% of the total binding capacity. The unsaturated cobalamin-binding capacities do not correlate significantly with birth weight, placental weight, or total protein concentration of the amniotic fluid. The ratio between haptocorrin concentration in amniotic fluid and maternal plasma is about 3:1. The unsaturated cobalamin-binding capacity of haptocorrin in amniotic fluid is significantly higher in pregnancies with female than with male fetuses, and is relatively high in one case of twins. It is suggested that haptocorrin in amniotic fluid originates mainly from the fetus, and may have a bacteriostatic effect.
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Toft L. [Child psychiatry today: aggressive behavior may be well-intentioned bid for attention]. Sygeplejersken 1976; 76:16-20. [PMID: 1050100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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