On-person adaptive evolution of Staphylococcus aureus during treatment for atopic dermatitis

The opportunistic pathogen Staphylococcus aureus frequently colonizes the inflamed skin of people with atopic dermatitis (AD) and worsens disease severity by promoting skin damage. Here, we show, by longitudinally tracking 23 children treated for AD, that S. aureus adapts via de novo mutations during colonization. Each patient's S. aureus population is dominated by a single lineage, with infrequent invasion by distant lineages. Mutations emerge within each lineage at rates similar to those of S. aureus in other contexts. Some variants spread across the body within months, with signatures of adaptive evolution. Most strikingly, mutations in capsule synthesis gene capD underwent parallel evolution in one patient and across-body sweeps in two patients. We confirm that capD negativity is more common in AD than in other contexts, via reanalysis of S. aureus genomes from 276 people. Together, these findings highlight the importance of the mutation level when dissecting the role of microbes in complex disease.

The Skin Microbiome of Patients With Atopic Dermatitis Normalizes Gradually During Treatment

Background

Atopic dermatitis (AD) is characterized by an altered skin microbiome dominantly colonized by S. aureus. Standard treatment includes emollients, anti-inflammatory medications and antiseptics.

Objectives

To characterize changes in the skin microbiome during treatment for AD.

Methods

The skin microbiomes of children with moderate-to-severe AD and healthy children were investigated in a longitudinal prospective study. Patients with AD were randomized to receive either standard treatment with emollients and topical corticosteroids or standard treatment with the addition of dilute bleach baths (DBB) and sampled at four visits over a three-month period. At each visit, severity of AD was measured, swabs were taken from four body sites and the composition of the microbiome at those sites was assessed using 16S rRNA amplification.

Results

We included 14 healthy controls and 28 patients. We found high relative abundances of S. aureus in patients, which correlated with AD severity and reduced apparent alpha diversity. As disease severity improved with treatment, the abundance of S. aureus decreased, gradually becoming more similar to the microbiomes of healthy controls. After treatment, patients who received DBB had a significantly lower abundance of S. aureus than those who received only standard treatment.

Conclusions

There are clear differences in the skin microbiome of healthy controls and AD patients that diminish with treatment. After three months, the addition of DBB to standard treatment had significantly decreased the S. aureus burden, supporting its use as a therapeutic option. Further study in double-blinded trials is needed.

Parasitic Protozoa and Interactions with the Host Intestinal Microbiota

Parasitic protozoan infections represent a major health burden in the developing world and contribute significantly to morbidity and mortality. These infections are often associated with considerable variability in clinical presentation. An emerging body of work suggests that the intestinal microbiota may help to explain some of these differences in disease expression. The objective of this minireview is to synthesize recent progress in this rapidly advancing field. Studies of humans and animals and in vitro studies of the contribution of the intestinal microbiota to infectious disease are discussed. We hope to provide an understanding of the human-protozoal pathogen-microbiome interaction and to speculate on how that might be leveraged for treatment.

Antibody to Epstein-Barr virus-specific DNase as a marker for field survey of patients with nasopharyngeal carcinoma in Taiwan

A serological survey using antibody to Epstein-Barr virus (EBV)-specific DNase activity as a marker for the identification of patients with nasopharyngeal carcinoma (NPC) has been carried out on healthy subjects who visited Government Employees' Clinic Center (GECC) for routine health examination and on individuals residing in NPC high-risk areas (HRA) in Taiwan. During a 3-year prospective study, 22,596 and 9,869 sera were collected from the GECC and HRA groups, respectively. Taking neutralization of 2 or more units of EBV DNase activity as a positive response, the positivity rates in the GECC and HRA groups were 5.4% and 11.92%, respectively. Among the antibody-positive individuals, three cases of NPC were found in the GECC group (detection rate 0.63%) and 11 in the HRA group (detection rate 1.32%). A further patient at stage III of the disease was found in the first year of following up of 1,005 antibody-positive individuals. Among the 12 NPC patients in the HRA, five were newly diagnosed as having stage II (three patients) and stage III (two patients) NPC. These results support the hypothesis that antibody against EBV-specific DNase activity may be a useful marker for detection of patients with NPC, and they imply that individuals having high levels of antibody to EBV DNase activity may have an increased risk of development of NPC.

[Detection of serum gamma interferon in nasopharyngeal carcinoma patients using reversed passive hemagglutination method]

In order to detect the difference in serum gamma-interferon levels between patients with nasopharyngeal carcinoma (NPC) and normal controls, the reversed passive hemagglutination (RPHA) method was used. Serum gamma-interferon level was determined in 93 patients with NPC, of these, 47 were newly diagnosed, untreated patients. Of the treated patients, 15 had received radiotherapy but were proved later to have distant metastasis. Thirty-one patients had received radiotherapy and survived over 5 years without local recurrence or distant metastasis. Another 47 healthy subjects, age and sex matched with fresh NPC cases, were used as control group. The results revealed that the concentration of gamma-interferon in the serum of neither males nor females showed significant difference (p greater than 0.1). Among the NPC fresh cases, the concentration of gamma-interferon also showed no significant difference in patient serum in either early stages (stages I and II) or later stages (stages III-V) (p greater than 0.1). The serum gamma-interferon level was significantly increased in fresh NPC patients compared with normal controls (p less than 0.05). Concerning the irradiated patients, serum gamma-interferon level was not increased in patients who survived over five years, without relapse, compared with normal controls (p greater than 0.1). However, the serum gamma-interferon level in patients with distant metastasis was higher than in normal controls (p less than 0.05). Also, the serum gamma-interferon level was significantly increased in distant metastatic patients compared with patients without relapse (p less than 0.05).

[Natural killer cell activity in nasopharyngeal carcinoma before and after radiotherapy]

From 1984 through 1986, a total of 20 patients with biopsy confirmed nasopharyngeal carcinoma (NPC) were randomly selected for studies on natural killer cell (NK) activity before and at the end of radiotherapy. Lymphocyte separation was done by centrifuge of heparinized peripheral blood with Ficoll-Hypaque and monocytes were removed by Petri dish adhesion. K562 cells were used as target cells of NK activity. The lymphocyte-target reaction of 4 hours was done and the ratio was 50:1, 25:1, and 12.5:1. The results of 50:1 was taken as the NK activity. The mean value of NK activity in NPC patients after radiotherapy was 43.0 +/- 21.1%, this is not significantly different from 41.2 +/- 23.6% before radiotherapy. On the other hand, before radiotherapy, the patients with too high NK activity (greater than 40%) or too low NK activity (less than 20%) had a mild tendency toward median value (20%-40%) after radiotherapy.

Antibodies to Epstein-Barr virus-specific DNase in patients with nasopharyngeal carcinoma and control groups

Serum samples from 154 patients with nasopharyngeal carcinoma (NPC), 374 with other cancers, 1,000 normal controls from Government Employees' Clinic Center (GECC), and 3,642 individuals of various ethnic-dialect groups living in high-risk areas for NPC were collected and the concentration of antibodies to Epstein-Barr virus (EBV)-specific DNase activity was determined. Taking a serum sample where 1 ml will neutralize two or more units of the DNase activity as positive, 2-4 units as low level, 4-6 units as medium level, and more than 6 units as a high level of antibody, 90.3% of the NPC patients contained significant amounts of antibodies to EBV-specific DNase activity and most of those had high levels of the antibody. In contrast, only 11% of sera from patients with cancers other than NPC contained antibodies to EBV-specific DNase activity, and high levels were very rare (2.1%). The difference in positive rates between these two groups is highly significant according to the chi 2 test (P less than 0.001). The positive rate of this antibody in the control group (GECC) was 5.3% with 0.0%, 0.8%, and 4.5% having high, medium, and low levels of antibodies, respectively. Again, the difference in positive rates between the GECC group and the NPC group is statistically significant (P less than 0.001). Taken separately, the positive rates of anti-EBV DNase activity in the three high-risk groups were 11.7%, 13.0%, and 13.1%. No significant difference in age distribution for the levels of this antibody was observed in the control GECC group or the three high-risk groups. However, the positive rates of the three high-risk groups are more than twice those of the GECC group (11.7% approximately 13.1% vs 5.3%). This ratio coincides with the ratio of the probability of developing NPC in high-risk groups compared to that of the GECC group (also more than two times). The significance of this coincidence is discussed.

Pathology of nasopharyngeal carcinoma. Proposal of a new histologic classification correlated with prognosis

To establish a new histologic classification with better correlation with patient prognosis, the histologic features of nasopharyngeal carcinoma (NPC) were correlated with prognosis and clinical stage among 494 patients who had been followed a minimum of 5 years after initial radiotherapy. A slight modification of World Health Organization (WHO) classification by the separation of spindle cell variant from the nonkeratinizing (NK) and undifferentiated carcinomas (UD) provided a better prognostic correlation: keratinizing squamous cell carcinoma (KS), spindle cell carcinoma (SP), round cell carcinoma (RC), and mixed cell carcinoma (Mix, or NK); 5-year survival rates were 21%, 41%, 51.8%, and 54%, respectively. This prognostic distinction was further improved by dividing the three nonkeratinizing carcinomas (SP, RC, and Mix) into two subtypes each, according to the degree of cell anaplasia and pleomorphism: Type A (with marked anaplasia and/or pleomorphism), and Type B (with moderate or little anaplasia). The three Type A carcinomas had very similar 5-year survival rates (33.3 to 38.6%), as did the three Type B carcinomas (60% to 71.8%). Therefore, a working formulation for the malignancy of NPC emerged: high-grade malignancy (KS; 5-year survival, 21%), intermediate malignancy (Type A carcinomas, 5-year survival, 30%-40%), and low-grade malignancy (Type B carcinomas, 5-year survival rate, 60%-72%). The prognostic distinction remained true after stratification by clinical stage. Therefore, the histologic condition of the tumor of NPC correlated with patient's prognosis.

[Natural killer cell activity in patients with nasopharyngeal carcinoma]

In 1984 and 1985, a total of 30 patients with biopsy confirmed nasopharyngeal carcinoma (NPC) were randomly selected for studies on natural killer cell (NK) activity. Control study on 30 normal subjects were also done. Lymphocyte separation was done by centrifuge of heparinized peripheral blood with Ficoll-Hypaque and monocytes were removed by Petri dish adhesion. K562 cells were used as target cells of NK activity. The lymphocyte-target reaction of 4 hours was done and the ratio was 50:1, 25:1 and 12.5:1. The results of 50:1 was taken as the NK activity. The mean value of NK activity in NPC patients was 34.8 +/- 22.7%, this is significantly different (t = 2.90, p less than 0.01) from 51.6 +/- 22.1% of the controls. If NK activity of 20% or more are taken for the normal standard, then the positive rate in NPC patients was 63.3% and that in the controls was 90.0%. The difference is significant, as chi 2 = 4.56, p less than 0.05. The NK activity in NPC patients is not correlated with the sex and age of the patients, the disease extent and the EB virus associated antibody titers.

Nasopharyngeal cancer: study III. A review of 1206 patients treated with combined modalities

A combination of radiation therapy and chemotherapy was used in an attempt to improve the control of nasopharyngeal cancer (NPC). From 1979 through 1983, 1206 patients with histologically proven NPC were treated with routine radiation along with 5 combinations of drug or drugs in small to maintenance doses. The drugs used were: 1) cyclophosphamide p.o. (CTX), 2) methotrexate p.o. (MTX), 3) CTX + MTX, 4) bleomycin i.v. (BLM), and 5) cisplatin + BLM i.v. (BP). The actuarial survival rates and recurrence rates were chosen as endpoints for comparison to previous studies. The overall survival rate increased from 43.5% in study I, and 56% in study II to 70.6% in the present study. The recurrence rate declined to 13%, but was less impressive. The encouraging results were more obvious in groups of patients with bilateral large cervical lymph nodes, reaching statistical significance (p less than 0.01).

Lymphocyte subsets and EB virus antibodies in nasopharyngeal carcinoma

Lymphocyte subsets and Epstein-Barr virus (EBV)-associated antibodies were studied in 108 patients with nasopharyngeal carcinoma (NPC) and in 34 normal controls. Lymphocyte subsets were identified with monoclonal antibodies (Ortho Co.) by indirect immunofluorescent antibody (IFA) method. The helper T lymphocytes (OKT4+) in NPC patients comprised 38.2 +/- 10.5% which is significantly different from 45.2 +/- 8.0% in controls. The helper/suppressor ratio in NPC patients was 1.33 +/- 0.65 which is significantly different from 1.64 +/- 0.48 in controls, but the ratio was not correlated with disease extent, sex, age, total lymphocyte counts, WBC counts and EBV-associated antibodies of NPC patients. There were no remarkable differences between NPC patients and controls in B lymphocytes (OKIa+), total T lymphocytes (OKT3+), and suppressor lymphocyte (OKT8+) percentages, total lymphocyte counts and WBC counts. The EBV-associated antibodies were titrated by the IFA method using P3HR-1 cells and Raji cells induced by IUdR as target. Mean antibody titers and seropositive rates showed significant increase in NPC patients (1:12-1:502 and 45.4%-68.5%, respectively) compared with controls (1:1-1:87 and 1.0%-5.9%, respectively). The increase in antibodies was positively correlated with NPC disease extent, but was not correlated with the sex, age, total lymphocyte counts, helper/suppressor ratio, and WBC counts of NPC patients.

Epstein-Barr virus-associated antibodies and serum biochemistry in nasopharyngeal carcinoma

Nasopharyngeal carcinoma is difficult to diagnose in its early stages. It also has frequent recurrences and/or distant metastases after radiotherapy. Extensive clinical, serological and biochemical studies were done during 1980-1982 on 351 patients to aid in the diagnosis of the disease, especially with recurrence or metastasis. Seropositive rates of the antibody titers against viral capsid antigens (VCA) and early antigens (EA) of Epstein-Barr virus (EBV) in IgG and IgA classes were 41.7%-100%. They ranked, in order of frequency: anti-VCA/IgA, anti-VCA/IgG, anti-EA/IgG, and anti-EA/IgA. Mean total serum IgG and IgA levels were moderately increased in all patients. Serum GOT, GPT, alkaline phosphatase, lactate dehydrogenase and mucoprotein were elevated either alone or in combination in a few patients before treatment, in many patients with recurrence or metastases, and in all patients with liver metastasis.

Antibody to Epstein-Barr virus specific DNase in sera of nasopharyngeal carcinoma and other nine most common cancer patients in Taiwan

Sera from 119 patients with nasopharyngeal carcinoma (NPC), 33 patients with other cancers of the head and neck, 220 normal subjects and various numbers of patients with each of the other nine most common cancers in Taiwan were examined for their serum antibody response to Epstein-Barr virus (EBV)-specific DNase. The positive rate (neutralizing activity greater than 2 units) in normal subjects was 5.5%; 12.1% in patients with other cancers of the head and neck, 87.4% in NPC patients and 0% (colon or rectal cancer) to 30% (lung cancer) in the other nine cancer patients. There is statistically significant difference of positive rates between NPC patients and lung cancer patients (p less than 0.001). Briefly, the test has 87% sensitivity and 95% specificity for NPC patients. Therefore titration of the serum antibody reactivity to EBV-specific DNase can be used as a method for massive screening for the early diagnosis of NPC.

Anti-HTLV antibodies in cancer patients, hemophiliacs and uremics: a preliminary report

A total of 132 sera were studied for anti-HTLV antibodies using the Biotech ELISA test. Among the HTL group, two were, one, and the other two (+/-). Among 23 hemophiliacs one was. None of the lympho- and myelo-proliferative disorders, chronic uremics and normal controls showed positive results. Our results show that the ELISA anti-HTLV test is quite specific for HTL and related disorders, but the antibody titers may be low in some cases in the late stage. The significance of frequent high ELISA readings in hepatomas and NPCs awaits for further studies. The occurrence of one hemophiliac with definite positive anti-HTLV calls for a routine screening of the blood preparations for HTLV.

Humoral and cellular immunity in patients with nasopharyngeal carcinoma

Clinical, serological and lymphocyte studies were done on 435 patients with biopsy proved anaplastic nasopharyngeal carcinoma (NPC) in various clinical status, at the National Taiwan University Hospital, from January 1980 through June 1983. Studies on 134 normal control were also done. Using immunofluorescent antibody method, seropsitive rates of the antibody titers against viral capsid antigens (VCA) and early antigens (EA) of Epstein-Barr (EB) virus were 70.8%-100% for anti-VCA/IgG titers (greater than or equal to 1:640), 81.0%-100% for anti-VCA/IgA titers (greater than or equal to 1:40), 66.7%-93.8% for anti-EA/IgG titers (greater than or equal to 1:160), and 40.0%-87.5% for anti-EA/IgA titers (greater than or equal to 1:40) in NPC patients with disease. They decreased to 10.5%-21.7% in remission patients. In contrast, they were less than 5% in the control. Mean total serum IgG and IgA levels were moderately increased to around 1,500 mg/dl and 300 mg/dl respectively, in all patients. The increase was most remarkable in patients with liver metastases. In control the values were 1,211 mg/dl and 223 mg/dl, respectively. Mean serum IgM, C3 and C4 amounts of NPC patients were not significantly different from those of the normal control, the latter were 129, 80.3 and 43.2 mg/dl, respectively. Serum acid phosphatase and calcium levels of NPC patients were all in the normal range of 0.1-2.0 BU/ml and 2.0-3.0 mmol/dl, respectively. Serum GOT, GPT, alkaline phosphatase, lactate dehydrogenase and mucoprotein were elevated either alone or in combination in some patients before treatment, in many patients with neck recurrence or distant metastases, but in all patients with liver metastases. Using monoclonal antibodies (Ortho Inc., U.S.A.) to define lymphocyte subsets, B lymphocytes comprised about 12% and T lymphocytes about 60% in the patients, whereas they were 11.9% and 73.1% in the control. The helper/suppressor ratio was 1.7 in the control and about 1.0 in NPC patients, and was only 0.8 in remission patients. The lack of correlation between the seropositive rates of anti-VCA antibodies and the helper/suppressor ratio might indicate different manifestations of humoral and cellular immunity in patients with NPC.

[Serological and biochemical studies in late stage of nasopharyngeal carcinoma]

Serological and biochemical studies were done at the National Taiwan University Hospital, on 243 patients with biopsy-proved anaplastic nasopharyngeal carcinoma (NPC) in various clinical conditions. The remarkable elevation of both IgG and IgA antibody titers against EB virus was specific for NPC patients. The seropositive rates ranged from 75% to 100% in various stages of NPC patients. Serum IgG and IgA levels were also increased moderately and nonspecifically in stages II-IV and recurrent patients. Peripheral white blood cell count was also slightly increased in these patients. Peripheral lymphocyte counts were slightly decreased in patients with neck recurrence or distant metastasis. Serum IgM, C3, C4 and Acid phosphatase levels were within normal range in all the patients. Serum GOT, GPT, alkaline phosphatase, and lactate dehydrogenase were elevated in some of patients with distant metastasis and in most of those with liver metastasis. Mucoprotein was elevated in about 10% of stage II-IV patients but in about 50% of patients with recurrent neck metastasis or distant metastasis. in conclusion, serological and biochemical examinations are important in the diagnosis of late stages and recurrence or metastasis of NPC.

Antibody to Epstein-Barr virus-specific DNase in patients with nasopharyngeal carcinoma

Sera from 99 patients with nasopharyngeal carcinoma (NPC), 17 patients with diseases other than NPC and 24 healthy individuals were examined for their antibody activities to Epstein-Barr virus (EBV) DNase. Most of the sera from NPC patients showed high level of antibody activity even in the stage I of the disease. On the contrary, sera from healthy donors and patients with diseases other than NPC showed only very little or none of the activity. The results strongly suggest that the test for EBV DNase activity could be used for the early diagnosis of NPC.

The survival of patients with nasopharyngeal carcinoma

The survival rates following treatment of 1,555 consecutive, previously untreated patients with nasopharyngeal carcinoma were studied. A 92.5% follow-up rate in 11 years is reported. Overall survival rates were 82.7% at one year, 67.4% at two years, 47.8% at five years, and 39.8% at ten years. Computer analysis revealed various factors influencing the survivals and hence prognosis. The outcomes in this series revealed five categories; clinical staging of nasopharyngeal carcinoma in five stages is, therefore, suggested.

Immunologic reactivity in patients with nasopharyngeal carcinoma

Immunologic reactivity was measured in 344 patients with nasopharyngeal carcinoma (NPC), before treatment, and in 398 age-matched control subjects. The data recorded suggest that depressed cell-mediated immunity in patients with NPC is a consequence rather than a cause of the disease. In order to reduce tumor burden in patients with NPC, radiation therapy with chemotherapy or immunopotentiation or both is recommended.

[Immunotherapy of Friend leukemia with antiserum (author's transl)]

Friend leukemia is caused by Friend leukemia virus (FLV) in susceptible mice. The malignant cells are of erythrocyte and lymphoid cell origin. Spleen enlargement could be detected within two weeks of FLV inoculation. The diseased mice usually die in the third or fourth month. Specific antisera were prepared from chimpanzee or rabbit by injection of FLV or FLV gp 71 in Freund's adjuvant. In the study of immunotherapy, DBA/2J mice were used. Normally, DBA/2J mice have an average spleen weight of 100 mg. After inoculation with FLV, the spleen enlarged to around 1,000 mg. Chimpanzee anti-FLV and chimpanzee anti-FLV gp 71 antisera were effective in treatment of FLV infection. The spleen enlargement could be recovered to normal range. The survival also was remarkably prolonged. Rabbit anti-FLV gp 71 antiserum was partially effective in retardation of spleen enlargement after FLV inoculation. On the contrary, 2 lots of rabbits anti-FLV antisera were found to accelerate spleen enlargement. Possibility of the presence of enhancement factor is considered. Therefore, different reactions in different species of animal to FLV vaccination are evident.

IgG and IgA antibodies to Epstein-Barr virus in nasopharyngeal carcinoma patients

Immunoglobulin levels and IgG and IgA antibodies to Epstein-Barr virus (EBV), viral capsid antigens (VCA) and early antigens (EA) were tested in 67 untreated (5 stage I, 32 stage II, 16 stage III and 14 stage IV), 21 treated and 7 recurrent nasopharyngeal carcinoma (NPC) patients and 54 normal subjects. The mean serum concentrations of IgG, IgA and IgM in NPC patients were higher than those of the normal control. 41.1, 86.3, 94.7 and 95.8% of NPC patients had anti-VCA titers of greater than or equal to 1:640 and greater than or equal to 1:40 in IgG and IgA, and anti-EA titers of greater than or equal to 1:40 and greater than or equal to 1:10 in IgG and IgA, respectively. But none of the control had such titers. IgG and IgA levels, anti-VCA titers in IgG and IgA, and anti-EA titers in IgG increased with advances of the disease in untreated NPC patients. Untreated patients had higher anti-VCA titers in IgG, and anti-EA titers in IgG and IgA than 60Co-treated cases, but lower than recurrent patients. Anti-VCA in IgA and IgG was more closely correlated than anti-EA in IgA and IgG. Anti-VCA and anti-EA antibodies in IgA were detected from the throat washing of a NPC patient at clinical stage III.

Nasopharyngeal carcinoma and Epstein-Barr virus. III. The detection of anti-nuclear antibodies

The presence of anti-nuclear antibodies (ANA) has been studied in 433 sera from 305 patients with anaplastic nasopharyngeal carcinoma (NPC) in Taiwan, by means of indirect fluorescent antibody method. Another 134 sera from normal adults or from patients with other diseases served as controls. Patients with NPC showed positive rate of 23.1%. Forty-two patients with other malignant and 25 patients with benign tumors of the head and neck showed positive rates of 9.5% and 8.0%, respectively. Forty-eight patients with inflammatory diseases and 19 normal adults were negative. The presence of ANA in 103 NPC patients before treatment was analyzed in detail. The positive rate was not significantly influenced by the age and sex of the patients, by the duration of the disease, by the extent of primary tumor and the presence of neck metastasis. But the positive rate rose as the anti-EB-VCA titer increased. This positive correlation of ANA and anti-EB-VCA antibodies was also significant in all the NPC sera. During and at the end of irradiation therapy, the ANA positive rates showed no remarkable variation. After treatment of the disease, ANA positive rate decreased gradually and this reduction became apparent after three years of remission of the disease. But the presence of ANA in NPC patients was not related to the prognosis of the patients. The possible mechanism in production of ANA in NPC patients was discussed with special reference to EB virus.