Effects of Helminth Eradication on the Immune System

Introduction:

Helminth infection has a profound effect on the immune system. However, the precise nature of the immune changes that are elicited by helminth infection have not been sufficiently characterized. Furthermore, the reversibility of these changes after treatment has not been documented sufficiently. We studied the immune profiles of Ethiopian immigrants to Israel at baseline, that is on arrival and at one-year follow-up and compared individuals who received antihelminth treatment during the study period with those who missed the treatment.

Methods:

A longitudinal follow up study involving different groups of subjects was conducted. Baseline data was recorded from the newly arrived Ethiopian immigrants for a series of peripheral blood tests, including: IgE and Eosinophil levels, T-cell populations, T-cell receptor phenotypes, and cytokine measurement. These tests were all repeated after a 1-year interval. Results were compared between the newly arrived Ethiopian immigrants (NEW-Eth-Il), long term Ethiopian immigrants (LT-Eth-Il), and non Ethiopian Israeli controls (NON-Imm-Il).

Results:

Of the 184 individuals, 111 were NEW-Eth-Il, who had a high prevalence of helminth infection, the immunological changes were elevated IgE levels and eosinophil counts, decreased CD4/CD8 ratio, increased proportion of HLA-DR+CD3+, HLA-DR+CD4+ and HLA-DR+CD8+ cells, decreased proportion of CD45RA+CD4+ (naive) and CD28+CD8+ cells, increased proportion of CD45RO+CD4+ (memory) cells, and increased secretion of IL-4 and IL-5 (Th2 type cytokines). In the 42 LT-Eth-Il participants, who all had negative tests for helminth infection, we did not observe these immune changes and their immune profile did not differ markedly from that of the NON-Imm-Il controls. The follow-up immune profiles of 33 NEW-Eth-Il who received succesful antihelminth treatment, showed a significant normalization in the above-mentioned variables that was not observed in the 19 NEW-Eth-Il who missed and did not receive the antihelminth treatment.

Conclusions:

These findings demonstrate that helminth infection is associated with profound immune changes that are normalized within a short time after helminth eradication. They also strengthen the hypothesis that effective antihelminth interventions, in areas endemic for intestinal helminths, may have an impact on AIDS and tuberculosis epidemics.

The Role of Helminth Infection and Environment in the Development of Allergy: A Prospective Study of Newly-Arrived Ethiopian Immigrants in Israel

Helminth infection may be protective against allergy and account for the low prevalence of allergy in developing countries. We studied prospectively the prevalence of allergy in Ethiopian immigrants with heavy helminth infection on arrival in Israel, and again after a year of adjustment to an urban industrialized setting, to explore the roles of helminth infection, changed environment and background immunity on the manifestations of allergy. 126 newly arrived Ethiopian immigrants were studied at baseline and 115 after a year of follow up in Israel. Allergic symptoms, Skin prick tests (SPT), Tuberculin (PPD) skin tests, stool and blood samples were obtained for determining parasites, blood IgE and eosinophil levels, respectively. Anti-helminthic therapy was offered to the entire infected individuals, but only 50/108 (46.3%) took the medication. At baseline, there was a significant negative association between helminth infection and allergy, 4/18 (22.2%) of uninfected participants were allergic compared to 7/108 (6.5%) of helminth-infected participants (p = 0.028), as well as between helminth infection and SPT reactivity, 12/18 (66.6%) of uninfected participants compared to 43/108 (39.8%) of helminth-infected participants (p = 0.033). After one year, a significant general increase in allergy and SPT was observed. While only 11/126 (8.7%) were allergic at baseline, 30/115 (26.1%) became allergic at follow-up (p<0.0001), and while 55/126 (43.7%) were SPT+ at baseline, 79/115 (68.7%) became SPT+ at follow-up (p<0.001). A twofold increase in allergen sensitization was also observed after one year in Israel, particularly for dust mites, grasses and olive tree (p<0.001). These results show that: a) Helminth infection is significantly associated with low allergy and low SPT reactivity; b) One year after immigration to Israel, allergy and SPT reactivity increased significantly in all immigrants; c) Higher increases in positive SPT and allergy were observed after a year in the group that remained infected with helminths, even though they had a lowered helminth load; d) The reasons for the increased allergy one year after immigration needs further investigation but probably reflects the combined influence of the decreased helminth load and novel environmental factors.

The role of intestinal parasitic infections in allergy is of great interest since it has been suggested that they suppress the development of allergy. Urbanization has also been claimed to cause allergy because of air pollution and higher exposure to allergens. The present study took advantage of the special opportunity presented by the recent Ethiopian immigration to Israel in order to study this question. A cohort of newly arrived Ethiopian immigrants to Israel, highly infected with parasites, was studied prospectively for the presence of allergy and response to allergens on arrival and after a year of follow up in Israel. The results showed clearly a significant inverse association between the presence of parasitic infections and allergy on arrival, while after a year of living in Israel, accompanied by a lowered parasitic infection load, a general increase of allergy was observed in all immigrant groups, and not only in those that had parasitic infections on arrival. These results lend support to the suppressive effect of intestinal parasites on allergy, but suggest that additional factors, most probably environmental, also play a role in the generation of allergy.

[What is the link between the sister of the "Titanic" and the history of medicine in Palestine?]

On 21st November 1916, the Royal Navy Hospital ship 'Britannic' (the sister ship of the 'Titanic') was torpedoed near the island of Kea in the Aegean Sea. Captain Dr. John Cropper, aged 52, was one of 30 people who drowned of the 1100 on board. Dr. Cropper was born in 1864, at Guisborough, England. He obtained his medical degree from Cambridge University in 1891. After his marriage to Anne Ellen Walker in 1895, the Church Missionary Society sent him on a medical mission to Palestine. Dr. Cropper stayed in Palestine for about 10 years working in Acre, Nablus, Ramallah and Jerusalem. He published his experiences in 35 articles and letters in English medical periodicals, more than anyone else did in Palestine at that time. In those publications, he described various operations that he carried out and observations on infectious diseases, most of which were the first descriptions from that remote and unhealthy country. His prominent research was in the field of malaria - the most common and important disease in Palestine during that period. It was less than two years after Grassi's discovery of the role of Anopheles mosquitoes as the vector of human malaria that Dr. Cropper carried out surveys of larval and adult mosquitoes in correlation with malarial distribution in Palestine. Dr. Cropper was the first who routinely examined slides microscopically in Palestine and correctly diagnosed the type of malaria. Dr. Cropper was also the first in Palestine to suggest antimalarial measures aimed directly at the mosquito vector and paid attention to ecological aspects such as breeding places and the daily behavior of adult mosquitoes. Dr. Cropper noted the common antimalarial measurements of that time, such as covering of wells, planting of Eucalyptus trees to drain swamps and the routine use of quinine as a preventive medicine, but he wrote that those measures were not effective under the local conditions. He suggested that the only effective measures must be aimed against the larval mosquitoes and he recommended the use of a sulphur compound in order to destroy the larvae. Only many years later were those observations recognized as being correct. In our local public scientific memory, we remember early researchers such as Dr. Hillel Jaffe, Prof. Peter Muehlens, Prof. Israel Kligler, Prof. Gideon Mer, Dr. Zvi Saliternik and many others. Dr. Cropper preceded all of them. The comprehensive contributions of this English doctor to the medical research in Palestine should not be forgotten.

Serum immunoglobulin E levels in Israeli-Ethiopian children: environment and genetics

BACKGROUND

Since 1984, several waves of Ethiopian immigrants have settled in Israel. On arrival they were found to be highly infected with intestinal parasites and to have increased serum immunoglobulin E and eosinophilia.

OBJECTIVES

To study serum IgE levels in Ethiopian children growing up in the environment of Israel.

METHODS

We assessed four groups of children of Ethiopian origin: a) adolescents examined on their arrival to Israel (group 1, n=11); b) adolescents born in Ethiopia and living in Israel for more than 7 years (group 2, n=10); c) children of Ethiopian origin born in Israel, without a history of allergy or asthma (group 3, n=15); and d) asthmatic children of Ethiopian origin born in Israel (group 4, n=8). A thorough clinical interview and examination as well as laboratory work up (including serum IgE levels, stool parasites and absolute eosinophil count) were performed.

RESULTS

Group 1 (11 newly arrived Ethiopian adolescents) had a mean eosinophil count of 688 cells/ml (0-1739) and a mean serum IgE of 1043 IU/ml (253-2932), P< 0.0009 as compared to group 2. Helminthic parasites were observed in 8/11 individuals; after 1 year of follow-up and anti-parasitic treatment, serum IgE levels did not change significantly. Group 2 (10 Ethiopian born adolescents living in Israel for on average 10 years, 7-15 years) had a normal leukocyte count, MEC 192 cells/ml (range 54-289), serum IgE 142 IU/ml (range 14-399 IU/ml) and no parasites in stool. Group 3 (15 Ethiopian children born in Israel) had a normal leukocyte count, MEC 128 cells/ml (0-324), serum IgE 55 IU/ml (7-189 IU/ml), similar to age-matched Israeli controls. In group 4 (8 Israeli born children of Ethiopian descent diagnosed with asthma), serum IgE showed significant elevation compared to Israeli age-matched asthmatic children (P< 0.005).

CONCLUSIONS

High levels of IgE found in Ethiopian children on arrival to Israel declined to Israeli control levels after several years of living in the new environment. Ethiopian children born in Israel had normal levels of IgE, suggesting that environment is the main factor affecting IgE levels in this population. Israeli born Ethiopian children with asthma had significantly increased serum IgE levels compared to asthmatics of Israeli origin. These findings suggest that both environmental and genetic factors determine the level of serum IgE in these children.

Onchocerciasis among Ethiopian immigrants in Israel

BACKGROUND

Onchocerciasis results from infestation by the nematode Onchocerca volvulus, and is characterized clinically by troublesome itching, skin lesions and eye manifestations. Since 1992, approximately 9,000 immigrants have arrived in Israel from the Kuwara province of northwest Ethiopia where the prevalence of onchocerciasis is particularly high.

OBJECTIVES

To determine whether onchocerciasis is the cause of cutaneous and ocular symptoms among recent immigrants from the Kuwara province in Ethiopia.

METHODS

We examined 1,200 recent immigrants from the Kuwara province residing at the Mevasseret Zion immigration center outside Jerusalem. Among them, patients with cutaneous signs suggestive of onchocerciasis underwent a skin-snip biopsy and a thorough eye examination.

RESULTS

In the detailed skin examination performed in 83 patients, the most common skin finding was chronic papular onchodermatitis, found in more than 46 patients (55%); depigmentation and atrophy was found in 13 (15%) and 12 (14%), respectively. In 40 patients (48%), living microfilaria were detected in their skin snips. Of the 65 patients who underwent a through eye examination, 45 patients (66%) had ocular complaints. Corneal abnormalities were found in 55 of the 130 eyes (42%), active anterior segment intraocular inflammation and live microfilariae were found in 4 eyes (3%) and lens changes in 16 eyes (1%). Eleven eyes (9%) showed retinal or choroidal changes.

CONCLUSIONS

Skin and eye manifestations associated with onchocerciasis are prevalent among symptomatic Ethiopians who immigrated to Israel from the Kuwara province.

Mapping the bimolecular interface of the parathyroid hormone (PTH)-PTH1 receptor complex: spatial proximity between Lys(27) (of the hormone principal binding domain) and leu(261) (of the first extracellular loop) of the human PTH1 receptor

In an effort to characterize the bimolecular interface between parathyroid hormone (PTH) and its human receptor PTH1-Rc (hPTH1-Rc), we previously identified two contact sites in the receptor: one for position 1 and another for position 13 (located at the ends of the principal activation domain) in PTH(1-34). The present study reports a third, novel "contact site" between hPTH1-Rc and Lys(27) of PTH(1-34). Lys(27) is located in the principal binding domain of the hormone (residues 25-34). The photoreactive PTH(1-34) analogue K27 contains a benzophenone (BP) moiety on Lys(27). The analogue binds to stably transfected HEK 293/C-21 cells (which express a high level of recombinant hPTH1-Rc) and stimulates adenylyl cyclase activity with a potency similar to PTH(1-34). In addition, (125)I-K27 cross-links effectively and specifically to the hPTH1-Rc. Enzymatic (Glu-C and Lys-C) and chemical (CNBr and BNPS-skatole) digestions of the photoconjugate between (125)I-K27 and hPTH1-Rc were performed. In addition, photoconjugates involving the bioactive mutants [L261M]- and [R262K]-hPTH1-Rc, transiently expressed in COS-7 cells, were also digested. The data obtained clearly identify L(261) or R(262) of the first extracellular loop of hPTH1-Rc as the contact site for Lys(27) in the hormone. On the basis of (i) the similarity in molecular mass between the CNBr digest of the (125)I-K27-[L261M]hPTH1-Rc conjugate and free (125)I-K27 and (ii) the failure to cross-link (125)I-K27 to a bioactive mutant receptor [L261A]hPTH1-Rc, we conclude that L(261) is the cross-linking site. These results provide the first demonstration of an interaction between the principal binding domain of PTH and the first extracellular loop of hPTH1-Rc. Revealing proximity of Lys(27) (in PTH) to L(261) (in hPTH1-Rc) provides additional insight into the nature of the ligand-receptor bimolecular interface and clearly illustrates that the extracellular loops of the receptor contribute to the specificity of the PTH-PTH1-Rc interaction. Taken together with previous studies, the new findings add important constraints on the possible positioning of the C-terminal helix of PTH (which contains the principal binding domain) relative to the first extracellular loop and the distal C-terminal helix of the large extracellular amino terminal domain of the PTH1-Rc.

Isolation of mitogenically active C-terminal truncated pentapeptide of osteogenic growth peptide from human plasma and culture medium of murine osteoblastic cells

The osteogenic growth peptide (OGP) is a 14-amino acid stromal cell mitogen that stimulates in vivo osteogenesis and hematopoiesis. In the blood circulation and cell culture conditioned medium immunoreactive OGP (irOGP), identified using antibodies raised against the OGP C-terminal region, presents free and bound forms. The bound form consists entirely of the full length peptide. The present study was designed to investigate the identity of free irOGP under nondenaturing conditions. Fresh human serum and culture medium conditioned with murine osteoblastic MC3T3 E1 cells were fractionated using ultrafiltration (3000 molecular weight cut-off). Hydrophobic chromatography of the ultrafiltrate, immunoscreening of chromatographic fractions with antibodies directed against the OGP C-terminal region and amino acid sequencing of immunoreactive peaks demonstrated the presence of two mitogens, the full length OGP and a C-terminal truncated form, OGP(10-14). The OGP(10-14) derived from both serum and conditioned medium, as well as the synthetic pentapeptide [sOGP(10-14)], shared the in vitro OGP proliferative activity. However, in a competitive binding assay, devised to assess the OGP-OGP binding protein (OGPBP) complex formation, sOGP(10-14) failed to compete out radiolabeled OGP from the complex. It is concluded that OGP(10-14) is a naturally occurring human and murine mitogen. In addition, the data suggests that the OGP(10-14) is generated from OGP by proteolytic cleavage upon dissociation of the OGP-OGPBP complexes.

Increased CCR5 expression with decreased beta chemokine secretion in Ethiopians: relevance to AIDS in Africa

OBJECTIVE

This study was undertaken to determine the contribution of HIV co-receptors and beta chemokine secretion to the increased susceptibility for human immunodeficiency virus (HIV) infection of peripheral blood mononuclear cells (PBMC) obtained from HIV-seronegative Ethiopian immigrants in Israel (ETH).

STUDY DESIGN

Immune activation markers and HIV co-receptor expression on lymphocytes and monocytes, and beta chemokine secretion by CD8+ cells, were compared between ETH and non-Ethiopian Israeli (IS) HIV-negative individuals.

RESULTS

The percentage of lymphocytes and monocytes expressing CCR5 was 1.6 and 3.0 times higher in ETH (n = 83) than in IS (n = 45), respectively (P < .001), whereas RANTES and MIP-1alpha secretion was 0.5 and 0.7 times lower (P < .01 and P < .05). The percentage of CCR5-expressing cells and RANTES secretion were inversely correlated (r = -0.7; P < .002). No differences were found in the proportion of CXCR4-expressing cells. No correlation between CCR5 expression and cell activation profile in the whole ETH population was found. However, in highly activated individuals (HLA-DR/CD3 > 7%), a significant decrease in CCR5 expression was observed.

CONCLUSIONS

An increased proportion of CCR5-expressing cells with decreased beta chemokine secretion observed in ETH may account for the increased susceptibility to HIV infection of cells obtained from this group. These findings may partly explain the higher susceptibility for HIV infection in Africa and thus the rapid spread of acquired immunodeficiency syndrome (AIDS) in that continent.

Development of a photoreactive parathyroid hormone antagonist to probe antagonist-receptor bimolecular interaction

Parathyroid hormone (PTH) and PTH-related protein (PTHrP) exert their calciotropic activities by binding to a specific seven-transmembrane-helix-containing G protein-coupled receptor mainly located in bone and kidney cells. In order to map in detail the nature of hormone-receptor interaction, we are employing 'photoaffinity scanning' of the bimolecular interface. To this end, we have developed photoreactive benzophenone (BP)-containing PTH analogs which can be specifically and efficiently cross-linked to the human (h) PTH/PTHrP receptor. In this report, we describe the photocross-linking of a BP-containing PTH antagonist, [Nle8,18,D-2-Nal12,Lys13(epsilon-BP),2-Nal23,Tyr34]bPT H(7-34)NH2 (ANT) to the recombinant hPTH/PTHrP receptor stably expressed in human embryonic kidney cells (HEK-293, clone C-21). This photoreactive antagonist has high affinity for the hPTH/PTHrP receptor and inhibits agonist-induced cyclase activity and intracellular calcium release. The photo-induced cross-linking of the radioiodinated antagonist (125I-ANT) to the recombinant hPTH/PTHrP receptor followed by SDS-PAGE analysis reveals a single radiolabeled band of approximately 85kDa, similar to that observed after cross-linking of a radioiodinated BP-containing agonist. The formation of this covalent 125I-ANT - hPTH/PTHrP receptor conjugate is competed dose-dependently by a variety of unlabelled PTH- and PTHrP-derived agonists and antagonists. This is the first report of a specific and efficient photocross-linking of a radioiodinated PTH antagonist to the hPTH/PTHrP receptor. Therefore, it provides the opportunity to study directly the nature of the bimolecular interaction of PTH antagonist with the hPTH/PTHrP receptor.

Infection by different HIV-1 subtypes (B and C) results in a similar immune activation profile despite distinct immune backgrounds

We compared the immune activation profile of 46 HIV-negative and 75 HIV-positive Israelis infected with HIV-1 subtype B, with 85 HIV-negative and 102 HIV-positive Ethiopian immigrants to Israel, who were infected with HIV subtype C. The HIV-negative Ethiopians had exceedingly high blood levels of eosinophils, immunoglobulin E (IgE), and p75s tumor-necrosis factor receptors (p75sTNFR); secretion of interleukin-4 (IL-4) and IL-10 by peripheral blood mononuclear cells (PBMC); proportion of human leukocyte antigen (HLA)-DR+ cells within CD3+, CD4+, and CD8+ T-cell subsets; and proportion of CD45RO+ CD4+ cells; while having significantly lower secretion of interferon-gamma (IFN-gamma) by PBMC and percentage of CD45RA+ CD4+ and CD28+ CD8+ cells. HIV infection in both populations was associated with reduced IL-2, IL-4, IL-10, and IL-12 secretion, number of CD28+ and CD45RA+ CD8+ cells, and increased number of HLA-DR+-CD3+, CD4+, and CD8+ cells, and CD45RO+ CD8+ cells. Thus, infection with HIV-1 subtypes B and C of studied Israelis and Ethiopians, respectively, results in a similar immune activation profile at all stages of the infection when living in the same environment, despite the striking different immune profile observed in the HIV-negative Israeli and Ethiopian populations. Together with our previous observations, this indicates that HIV subtype is not a major determinant in the natural course of HIV infection.

Mapping the integrin alpha V beta 3-ligand interface by photoaffinity cross-linking

Integrins are cell surface adhesion molecules involved in mediating cell-extracellular matrix interactions. High-resolution structural data are not available for these heterodimeric receptors. Previous cross-linking studies of integrins aimed at elucidating the nature of the receptor-ligand interface have been limited to identification of relatively large binding domains. To create reagents for "photoaffinity scanning" of the RGD-binding site of human integrin alpha V beta 3, new conformationally constrained ligands were designed. These photoreactive ligands are based on cyclo Ac-[Cys-Asn-Dmt-Arg-Gly-Asp-Cys]-OH, which displays an affinity of 50 nM for alpha V beta 3. This molecular scaffold was modified at the C-terminus by a benzophenone-containing amino acid residue, L-4-benzoylphenylalanine (Bpa). At the N-terminus, a molecular tag was introduced in the form of radioactive iodine or biotin. The newly designed tagged photoreactive RGD-containing ligands display an affinity of 0.5-0.7 microM for alpha V beta 3, and cross-link efficiently and specifically to the receptor. A 100 kDa band corresponding to the beta 3 subunit-ligand conjugate was detected as the major cross-linking product. Cross-linking was dependent upon the presence of Ca2+ and Mg2+ ions, and was competitively inhibited by a nonphotoreactive ligand. Enzymatic and chemical digestions of the radiolabeled photoconjugate enabled identification of a 20-amino acid fragment between positions 99 and 118 in the beta 3 chain of the integrin as the contact domain for ligand at a site adjacent to the C-terminal portion of the RGD triad.

Covalent immobilization of recombinant human alphavbeta3 integrin on a solid support with retention of functionality

Alphavbeta3 is the major receptor mediating the attachment of osteoclasts to bone surface and plays a critical role in bone resorption and remodeling. Interfering with alphavbeta3 binding inhibits osteoclast-mediated bone resorption, and thus demonstrates the potential utility of alphavbeta3 antagonists for therapy of osteoporosis. This report describes the generation of an alphavbeta3 affinity column which was created to enable screening of collections of large numbers of ligands, e.g., combinatorial libraries (previously prepared by us), to sort and identify ligands with the highest affinity for alphavbeta3. We demonstrate that covalent immobilization of the heterodimeric alphavbeta3 receptor can be achieved with retention of characteristic ligand binding properties. Human alphavbeta3 was isolated from human embryonic kidney cells (HEK 293) that stably express high levels of the recombinant receptor and then affinity purified to homogeneity. Purified alphavbeta3 receptor was linked covalently to activated CH-Sepharose 4B beads. Quantification of immobilized functional receptor was determined by Scatchard analysis. The immobilized functional receptor maintains binding properties similar to the membrane-embedded and soluble receptor. The immobilized receptor also can be used to select the highest affinity ligand from among a mixture of peptides which differ in their binding affinity, structure, and hydrophobicity, both when the peptides are loaded in equimolar concentrations in a mixture and when the concentration of the highest affinity ligand is reduced 10-fold. Liquid chromatography-mass spectrometry was utilized to confirm selective ligand binding and to demonstrate that preferential binding was not due to nonspecific hydrophobic interactions with immobilized alphavbeta3 receptor or the affinity column. This approach may be of general use for affinity-based screening of ligands for other integrins and should enable practical screening of combinatorial libraries containing large numbers of potential ligands for the human alphavbeta3 integrin receptor, including linear peptides, cyclic peptides, and peptidomimetics.

Decreased CD4 and increased CD8 counts with T cell activation is associated with chronic helminth infection

We have previously reported the presence of marked immune dysregulation with a dominant Th2 profile, in a population of Ethiopian immigrants (ETH) in Israel heavily infected with helminths. In order to characterize better this immune dysregulation we studied by flow cytometry the expression of several activation markers on peripheral T cell populations, and lymphocyte apoptosis, in blood samples obtained from 63 'new' ETH (recently arrived), 18 'old' ETH (> 5 years since immigration) and 34 non-Ethiopian Israelis. The main findings in the 'new' ETH group in comparison with the non-Ethiopian controls were: (i) decreased CD4 and increased CD8 lymphocyte counts; (ii) elevated levels of activated T cells (CD3, CD4 and CD8) expressing HLA-DR; (iii) decreased levels of 'naive' CD4+ cells (CD45RA+), with increased levels of 'memory' CD4+ cells (CD45RO+); (iv) decreased numbers of CD28+ CD8+ lymphocytes; (v) marked increase in lymphocyte apoptosis. These T cell alterations and activation profile remained unchanged in 10 'new' ETH in whom the helminth infections persisted for 6-11 months. In contrast, in 18 'old' ETH, without helminth infections, the T cell activation profile was within the normal range. These findings suggest that chronic helminth infections may have a profound effect on the immune system of the host that disappears after eradication of these infections and adjustment to the new environment. It should therefore be taken into consideration for every immunomodulation therapy and especially in vaccine design and trials, in regions endemic for helminth infections.

An epidemiological survey of Echinococcus granulosus and other helminths in animal populations in northern Israel

In a survey carried out during the period May 1995 to November 1996, in communities of various ethnic groups in northern Israel, 206 dogs were examined for Echinococcus granulosus and other intestinal helminth parasites by arecoline hydrobromide purges and the coproantigen-ELISA. The arecoline test was performed close to the owners' homes, using plastic sheets secured to the ground. From 56 dogs examined in the Muslim town of Tamra, six (10.7%) were found to be infected with E. granulosus. Four of them also had a mixed infection of Taenia hydatigena and Dipylidium caninum (two dogs), and the remaining two dogs were infected with either D. caninum or Taenia pisiformis. An additional 18 dogs were infected with either T. pisiformis (eight dogs), D. Caninum (seven dogs), or T. hydatigena (three dogs). Two of these dogs harboured mixed infections whereas the remaining 32 dogs were free of helminths. In the Jewish villages, none of the 150 dogs examined were infected with E. granulosus, although 26 (17.3%) were infected with D. caninum, four (2.7%) with Ancylostoma spp. and one (0.7%) with Toxocara canis. Only one of the 22 stray dogs and none of the 15 jackals examined were infected with E. granulosus. However, 21 (95.4%) of the dogs and 12 (80%) of the jackals harboured helminth infections, including: D. caninum (16 dogs and seven jackals), Ancylostoma spp. (five jackals), T. hydatigena (three dogs), and T. canis (one dog). Approximately 18% of the dogs and 33% of the jackals showed mixed infections with two or more of the above helminths. In the abattoirs, 52 (5.9%) of the 874 sheep and 33 (5.3%) of the 616 goats from 17 herds slaughtered in the Muslim and Druze villages were found to be infected with E. granulosus, compared with a 0% infection rate observed in 93 sheep from two herds in Jewish villages.

Human alpha 2-macroglobulin is an osteogenic growth peptide-binding protein

The osteogenic growth peptide (OGP) is a 14mer mitogen of osteoblastic and fibroblastic cells. Physiologically, OGP is present in high abundance in human and other mammalian sera. Most of the serum OGP is complexed noncovalently to heat sensitive, high molecular weight OGP-binding proteins (OGPBPs). Changes in serum OGP levels that follow bone marrow ablation and the low doses of exogenous OGP required for the stimulation of bone formation suggest a regulatory role for the OGPBPs. In the present work, the OGP binding activity was monitored by competitive binding to [3-125I(Tyr10)]-sOGP and the corresponding complexes were demonstrated on nondenaturing cathodic polyacrylamide gel electrophoresis. We show that OGP binds to both native and activated human plasma alpha 2-macroglobulin (alpha 2M). alpha 2M was also immunoidentified in reduced and nonreduced SDS-polyacrylamide gel electrophoresis of OGP-affinity purified plasma-derived proteins. Immunoreactive OGP was detected in commercial preparations of both forms of alpha 2M; OGP was purified to homogeneity from the commercial preparation of activated alpha 2M. In MC3T3 E1 cells, native alpha 2M, at concentrations < 50 ng/mL, had a substantially increased mitogenic effect in the presence of synthetic, native-like, OGP (sOGP). Similar amounts of activated alpha 2M inhibited the sOGP proliferative effect. These results suggest that the native alpha 2M enhances the immediate availability of OGP to its target cells. Activated alpha 2M may participate in the removal of OGP from the system.

Isolation of osteogenic growth peptide from osteoblastic MC3T3 E1 cell cultures and demonstration of osteogenic growth peptide binding proteins

The osteogenic growth peptide (OGP) was recently characterized in regenerating bone marrow. In experimental animals in increases osteogenesis and hemopoiesis. In stromal cell cultures OGP stimulates proliferation, alkaline phosphatase activity, and matrix mineralization. OGP in high abundance is present in normal human and animal serum mainly complexed to OGP binding protein (OGPBP) or proteins. Here we show the presence of two OGPBPs, OGPBP-1, and OGPBP-2, in cultures of osteoblastic MC3T3 E1 cells. Immunoreactive OGP (irOGP) also accumulates in the medium of these cultures and in cultures of NIH 3T3 fibroblasts. A large amount of irOGP was released by heat inactivation of OGPBP-2 and purified by ultrafiltration and hydrophobic HPLC. The purified irOGP was identical to OGP obtained previously from rat regenerating bone marrow and human serum in terms of its amino acid sequence, immunoreactivity, and mitogenicity. Osteoblastic and fibroblastic cell proliferation can be arrested by anti-OGP antibodies and rescued by exogenous OGP, indicating that in the absence of serum or other exogenous growth stimulators the endogenously produced OGP is both necessary and sufficient for baseline proliferation. The OGP production is up- and down-regulated, respectively, by low and high doses of exogenous OGP in a manner consistent with an autoregulated feedback mechanism. The most effective OGP dose in MC3T3 E1 cells is at least two orders of magnitude lower than that in non-osteoblastic cell systems. This differential sensitivity of the osteoblastic cells could result in a preferential anabolic effect of OGP in bone.

Role of glycosylation in expression and function of the human parathyroid hormone/parathyroid hormone-related protein receptor

Parathyroid hormone (PTH) regulates calcium metabolism through a specific G protein-coupled, seven-transmembrane helix-containing receptor. This receptor also binds and is activated by PTH-related protein (PTHrP). The human (h) PTH/PTHrP receptor is a membrane glycoprotein with an apparent molecular weight of approximately 85000 which contains four putative N-glycosylation sites. To elucidate the functional role of receptor glycosylation, if any, we studied hormone binding and signal transduction in human embryonic kidney cells transfected with hPTH/PTHrP receptor (HEK-293/C-21). These cells stably express 300000-400000 receptors per cell. Inhibition of N-glycosylation with an optimized concentration of tunicamycin yielded completely nonglycosylated hPTH/PTHrP receptor (approximately 60 kDa). This receptor form is fully functional; it maintains nanomolar binding affinity for PTH- and PTHrP-derived agonists and antagonists. PTH and PTHrP agonists stimulate cyclic AMP accumulation and increases in cytosolic calcium levels. In addition, the highly potent benzophenone (pBz2)-containing PTH-derived radioligand [Nle8,18,Lys13(epsilon-pBz2),L-2-Nal23,Tyr34 3-125I)]bPTH(1-34)NH2 can photoaffinity cross-link specifically to the nonglycosylated receptor. The molecular weight (approximately 60000) of the band representing the photo-cross-linked, nonglycosylated receptor (obtained from the tunicamycin-treated HEK-293/C-21 cells) was similar to that of the deglycosylated photo-cross-linked receptor (obtained by enzymatic treatment with Endoglycosidase-F/N-glycosidase-F). Our findings indicate that glycosylation of the hPTH/PTHrP receptor is not essential for its effective expression on the plasma membrane or for the binding of ligands known to interact with the native receptor. The nonglycosylated hPTH/PTHrP receptor remains fully functional with regard to both of its known signal transduction pathways: cAMP-protein kinase A and phospholipase C-cytosolic calcium.

Histidine at position 5 is the specificity "switch" between two parathyroid hormone receptor subtypes

The PTH and PTH-related protein (PTHrP) system consists of two hormones, at least two G protein-coupled seven-transmembrane domain receptors, and at least two intracellular signal transduction pathways for each receptor. The PTH/PTHrP receptor is present in the conventional target tissues of PTH action, namely kidney and bone. Both PTH and PTHrP bind to and activate the PTH/PTHrP receptor with equal affinity and efficacy. The newly discovered receptor, termed the human (h) PTH2 receptor, has 70% homology with the PTH/PTHrP receptor, but is found predominantly in brain and pancreas. It interacts selectively with PTH and not with PTHrP. PTH and PTHrP differ in several positions, including position 5 (Ile in PTH; His in PTHrP). To define the role of position 5 in receptor selectivity, we designed and synthesized a series of hybrid analogs containing specific elements of both the PTH and PTHrP sequences. Using human cell lines stably expressing either human receptor subtype, we evaluated the biological profile of the hybrids in assays of receptor binding and action. Both point-mutated hybrids, [Ile5]PTH-(1-34) and [His5]PTH-(1-34), bind to and stimulate cAMP accumulation and the release of cytosolic free calcium in HEK293/C-21, a clonal human embryonic kidney cell line stably expressing the recombinant hPTH/PTHrP receptor. However, only [Ile5]PTHrP-(1-34), and not [His5]PTH-(1-34), binds to and stimulates cAMP accumulation and the release of cytosolic free calcium in HEK293/BP-16, a clonal human embryonic kidney cell line stably expressing the recombinant hPTH2 receptor. The segmental hybrid PTHrP-(1-14)-PTH-(15-34) binds to and activates the hPTH/PTHrP receptor, but not the hPTH2 receptor, similar to the biological profile of His5-containing ligands: PTHrP-(1-34) and [His5]PTH-(1-34). Exchanging Ile5 for His5 in the segmental hybrid produces the analog [Ile5]PTHrP-(1-14)-PTH-(15-34), which interacts with both receptor subtypes. We conclude that His5 in PTHrP is the major structural determinant of receptor subtype specificity in the hPTH/PTHrP and hPTH2 two-receptor system. The mechanism of the specificity "switch" remains to be elucidated, but may result from a subtle perturbation of the bioactive conformation and/or from a direct steric hindrance at the hPTH2 receptor-ligand interface created by histidine at position 5. The hPTH2, but not the hPTH/PTHrP, receptor can discriminate between the two hormones based on the structural differences generated at position 5.

The human PTH2 receptor: binding and signal transduction properties of the stably expressed recombinant receptor

We have generated a series of stably transfected HEK-293 cell lines expressing the newly identified alternate human PTH receptor (hPTH2 receptor). This receptor subtype is selectively activated by N-terminal PTH-(1-34) and not the corresponding N-terminal (1-34) region of the functionally and structurally related hormone, PTH-related protein (PTHrP). A total of 20 distinct clones displaying different levels of PTH-responsive cAMP production were analyzed. None responded to PTHrP-(1-34). One of these clones (BP-16), displaying maximal PTH responsiveness, was chosen for more detailed evaluation. The BP-16 clone (and the parental HEK-293 cell line lacking both the hPTH/PTHrP receptor and the hPTH2 receptor) were examined for PTH binding, PTH-stimulated cAMP accumulation, PTH-stimulated changes in intracellular calcium ([Ca2+]i) levels, and hPTH2 receptor messenger RNA expression. In addition, we studied the photomediated cross-linking of a potent PTH agonist, namely [Nle8,18,Lys13 (epsilon-pBz2), 2-L-Nal23,Tyr34]bPTH(1-34)NH2 (K13), to the hPTH2 receptor on BP-16 cells. Photoaffinity cross-linking identified an approximately 90-kDa cell membrane component that was specifically competed by PTH-(1-34) and other receptor-interacting ligands. PTH-(1-34) and K13 are potent stimulators of both cAMP accumulation and increases in (Ca2+]i levels, and both bind to the hPTH2 receptor with high affinity (apparent Kd, 2.8 +/- 0.9 x 10(-8) and 8.5 +/- 1.7 x 10(-8) M, respectively). There was no apparent binding, cAMP-stimulating activity, or [Ca 2+]i signaling observed, nor was specific competition vs. binding of a PTH-(1-34) radioligand ([125I]PTH) with PTHrP-(1-34)NH2 found. PTHrP-(1-34) failed to inhibit cross-linking of the hPTH2 receptor by radiolabeled K13 ([125I]K13). However, effective competition vs. [125I]PTH and [125I]K13 binding and [125I]K13 cross-linking were observed with the potent PTH/PTHrP receptor antagonists, PTHrP-(7-34)NH2 and PTH-(7-34)NH2. PTHrP-(7-34)NH2 was shown to be a partial agonist that weakly stimulates both cAMP accumulation and increases in [Ca 2+]i levels in BP-16 cells. These data suggest that the hPTH2 receptor is distinct from the hPTH/PTHrP receptor in the structural features it requires for ligand binding in the family of PTH and PTHrP peptides.

Structural and functional characterization of osteogenic growth peptide from human serum: identity with rat and mouse homologs

The osteogenic growth peptide (OGP) was recently characterized in regenerating bone marrow. In experimental animals, OGP increases osteogenesis. Immunoreactive OGP (irOGP) in high abundance was demonstrated in normal animal serum mainly as an OGP-OGP-binding protein (OGPBP) complex. Here we show the presence of an OGP-OGPBP system in normal human serum. The total irOGP content, of which the bound peptide comprises at least 80-90%, ranged from 480-4460 mumol/L, several orders of magnitude higher than that of other regulatory polypeptides. The steady state/total irOGP ratio declined between 23 and 49 yr of age. The bound irOGP, purified by boiling, ultrafiltration, and hydrophobic high pressure liquid chromatography, was identical to OGP obtained previously from rat regenerating marrow and mouse stromal cell cultures in terms of its amino acid sequence, immunoreactivity, and mitogenicity. These data demonstrate the usefulness of our immunoassay to measure circulating OGP. More importantly, the identity of the human OGP with that of other species indicates the peptide's evolutionary conservation and, thus, its biological importance. The natural occurrence of OGP in man signifies its potential role in the prevention of bone loss and rescue of bone mass, especially in osteoporosis.

Geographic information system in malaria surveillance: mosquito breeding and imported cases in Israel, 1992

Although a significant resurgence of malaria in Israel is unlikely at present, the risk for a localized outbreak of malaria cases due to infection of local anopheline mosquitoes by imported cases does exist. A national computerized surveillance system of breeding sites of Anopheles mosquitoes and imported malaria cases was established in 1992 using a geographic information system (GIS). Distances between population centers and breeding sites were calculated, and maps associating epidemiologic and entomologic data were generated. Risk of malaria transmission was assessed with consideration of vectorial capacity and flight range of each Anopheles species. The GIS-based surveillance system ensures that if a localized outbreak does occur, it will be associated rapidly with a likely breeding site, a specific Anopheles vector, and a probable human source, so that prompt control measures can be most efficiently targeted. This cost-effective GIS-based surveillance system can be expanded and adapted for countries with indigenous malaria transmission.

[Prevalence of intestinal parasites among Thais in Israel]

Stool samples from 93 Thais working in Israel were examined for the presence of parasites. The overall prevalence of infection by 1 or more species was 74%. Opisthorchis viverrini and hookworm were the most prevalent parasites (51.6% and 44.1%, respectively). They were also the parasites most frequently found in mixed infections; about a quarter of the workers were infected with both. Other helminths found in only a few cases were: Fasciolopsis buski (3 cases), Taenia sp. (3), Paragonimus sp. (1), Ascaris lumbricoides (1), Trichuris trichiura (1) and Trichostrongylus sp. (1).

The development of new foci of echinococcosis in northern Israel: prevalence in domestic animals

In a survey carried out in 1991-1992 in the town of Yirka in Northern Israel, 49 dogs were examined for Echinococcus granulosus infection and abattoir data, based on organs condemned for the presence of parasites, was collected. The presence of E. granulosus by arecoline test was demonstrated in 7 (14.2%) of the dogs examined, but not parasites were found in the intestines of five stray dogs shot in the area. A survey of sheep slaughtered in the local abattoir during a one-month period revealed Echinococcus cysts in 10% of the 255 animals examined. No Echinococcus parasites were detected in 21 dogs examined 3 months after the initiation of praziquantel treatment. Echinococcosis seems to be a very serious public health problem in Israel and a control programme needs to be given a high priority.

Mitogenic action of osteogenic growth peptide (OGP): role of amino and carboxy-terminal regions and charge

We have recently reported the discovery of a 14-amino-acid osteogenic growth peptide (OGP). In vivo OGP increases bone formation and trabecular bone density. Physiologically it is found in serum complexed to an OGP binding protein (OGPBP). In vitro OGP has a biphasic effect on osteoblastic MC 3T3 E1 and fibroblastic NIH 3T3 cell proliferation; at low concentrations (0.01-1.0 and 1.0-100.0 pM, respectively) it is highly stimulatory with an inhibition at higher doses. To assess possibilities of labeling synthetic OGP to obtain radio- or fluorescent ligands, OGP analogues were extended at the N- or C-termini with Cys or Cys(S-NEtSucc) or the OGP Tyr-10 replaced by 3-I(Tyr). All analogues with N-terminal modifications, as well as the [Cys15]OGP-NH2 retained the OGP-like dose-dependent effect on proliferation of the MC 3T3 E1 and NIH 3T3 cells, although the magnitude of stimulation was lower, approx. 2/3 that of the native-like synthetic OGP. The [Cys15(S-NEtSucc)]OGP-NH2 and [3-I(Tyr10)]OGP shared only the inhibitory activity of OGP. This suppression is further shared by a number of other positively and negatively net charged, but not net neutral, peptides. Both N-terminal-modified analogues displayed a decreased binding activity to the OGPBP. All analogues except reverse OGP, [3-I(Tyr10)]OGP and [Cys15(S-NEtSucc)]OGP-NH2 reacted with anti-OGP antibodies. These data are not only important for labeling purposes but suggest a respective role for the OGP N-and C-terminal regions in binding to the OGPBP and putative OGP receptor. It appears that the OGP proliferative activity represents the net effect of stimulation specific to the OGP structure and nonspecific inhibition associated with the peptide's high positive net charge.

Intestinal parasitic infection in operation Solomon immigrants

Previous studies have documented a high infection rate of intestinal parasites in Ethiopian immigrants to Israel. As a result, current treatment recommendations are for mass treatment without prior screening tests. However, the group of 15,400 Ethiopian immigrants who arrived in Israel in May 1991 (Operation Solomon) represents a somewhat different population from those who had immigrated earlier. The 1991 immigrants had spent 9-12 months in Addis Ababa before their evacuation; the conditions there, together with the provision of medical care, may have resulted in lower infection rates for intestinal parasites. The purpose of this study was to determine the prevalence of intestinal parasites in these recent immigrants to assess whether mass treatment would still be appropriate. Random stool specimens were obtained from 80 residents of a population of 650 Ethiopian immigrants who were cared for at a Jerusalem clinic. Specimens were examined at the Ministry of Health Laboratory. Of the 80 specimens 45 had sufficient quantity of stool to perform the standard Richie concentration method. Pooling results from all 80 individuals revealed 60 (75.0%) positive specimens, 53 (66.3%) with at least one pathogenic parasite, and 21 (26.3%) with multiple pathogenic parasites. These data provide the first systematic information on intestinal parasitosis in immigrants from Operation Solomon and suggest that mass treatment in this group is appropriate.

Health profile of Ethiopian immigrants in Israel: an overview

The health profile of two groups of Ethiopian immigrants in Israel was evaluated. Trichophytosis and active trachoma were observed in 5%-8.7% of prepubertal children. Among adults 13% had corneal opacities and 10.4% had cataracts. Goiter, spastic bronchitis, valvular heart disease, leprosy and onchocerciasis were prevalent. Malnutrition was common, with average body weights ranging from 72.4% to 85.2% of normal. Anemia was observed in 6.3% of young children and 70% of all immigrants. Fifty percent of children over 12 years and 98% of adults over 40 years of age had been exposed to hepatitis B virus; 9.8%-11.8% were HBsAg carriers. Tuberculin tests were positive in 9.8%-13%; and intestinal parasites were identified in 86%-98%. Hospitalization was required for 15.7% of immigrants arriving during the period 1978-90, and for 3.7% of those arriving in mid-1991 (Operation Solomon).

Imported malaria from Ethiopia--end of an era?

The immigration of Ethiopian Jews to Israel in the 1980s resulted in the importation of over 2,000 cases of malaria, a major challenge to clinicians and public health officials alike. In contrast, in the massive airlift from Ethiopia in May 1991 and in the sporadic immigration that followed it, malaria prevalence was extremely low, reflecting the routing of the more recent immigrants through nonendemic areas. The dramatic fall in the appearance of new imported malaria cases should not lead to complacency, however, as malaria may still appear in Ethiopians and other immigrants as well as in Israelis returning from regions of the world where the disease is still highly prevalent. A corollary of this caveat is that vigilance in finding and eliminating Anopheles breeding places in Israel must not be allowed to falter.

[Hydatid disease in Israel]

The prevalence pattern of hydatid disease (echinococcosis) in Israel has changed during the past 40 years. Until 1948 it was mainly common in the non-Jewish community; after 1948 its prevalence was high in Jews who immigrated to Israel from Arab countries; and since 1967 endemicity has gradually increased in some rural and semirural Arab and Druze communities. Of 224 surgically-confirmed cases of hydatid disease from these communities during 1960-1989, 52 were from Yirka, a Druze community with a population of 8200. In that town 8% of 63 dogs tested after an arecoline purge and 10% of 255 sheep at the local abattoir were found to be infected. Randomized serosurvey of 758 inhabitants indicated a 1.6% cumulative percentage of hydatid infections, leading to an extrapolated rate of 1583/100,000. Yirka thus is one of the most highly endemic areas for hydatid disease in the world.

Histone H4-related osteogenic growth peptide (OGP): a novel circulating stimulator of osteoblastic activity

It has been established that regenerating marrow induces an osteogenic response in distant skeletal sites and that this activity is mediated by factors released into the circulation by the healing tissue. In the present study we have characterized one of these factors, a 14 amino acid peptide named osteogenic growth peptide (OGP). Synthetic OGP, identical in structure to the native molecule, stimulates the proliferation and alkaline phosphatase activity of osteoblastic cells in vitro and increases bone mass in rats when injected in vivo. Immunoreactive OGP in high abundance is present physiologically in the serum, mainly in the form of an OGP-OGP binding protein complex. A marked increase in serum bound and unbound OGP accompanies the osteogenic phase of post-ablation marrow regeneration and associated systemic osteogenic response. Authentic OGP is identical to the C-terminus of histone H4 and shares a five residue motif with a T-cell receptor beta-chain V-region and the Bacillus subtilis outB locus. Since these latter proteins have not been implicated previously in the control of cell proliferation or differentiation, OGP may belong to a novel, heretofore unrecognized family of regulatory peptides. Perhaps more importantly, OGP appears to represent a new class of molecules involved in the systemic control of osteoblast proliferation and differentiation.

Mass treatment of intestinal parasites among Ethiopian immigrants

Intestinal parasites are common among the Ethiopian immigrants to Israel and mass treatment is necessary to prevent local transmission. For this purpose, stool samples obtained from the immigrants in absorption centers were examined. Of 5,412 samples obtained, 4,399 (81.3%) were positive: 2,644 (54.2%) for Necator americanus, 2,273 (46.6%) for Schistosoma mansoni, 990 (20.3%) for Ascaris lumbricoides, 1,040 (21.3%) for Hymenolepsis nana, 940 (19.2%) for Trichuris trichiura, 219 (4.5%) for Strongyloides stercoralis, 17 (0.4%) for Fasciola hepatica, 551 (11.3%) for Giardia lamblia, and 499 (9.2%) for Entamoeba histolytica. The cure rate for necatoriasis by treatment with 400 mg of albendazole was 84.4% (better than with other drugs), either alone or in combination (pyrantel with bephenium or pyrantel with praziquantel, or praziquantel with albendazole). Albendazole, 400 mg for 3 days, cured 92% of the cases of S. stercoralis infection. Praziquantel, 40 mg/kg body weight, in a single dose was effective in 89.7% of cases of S. mansoni, and 60% of cases of H. nana, although a 100% cure rate for H. nana was achieved with praziquantel at a dose of 20 mg/kg per day for 2 days. Two persons infected with F. hepatica were cured by 40 mg/kg praziquantel for 7 days. Tinidazole, 2 g in a single dose, cured 100% of persons infected with G. lamblia, while 60% of persons infected with E. histolytica were cured when treated with 2 g tinidazole for 3 days. Mass treatment of all the immigrants with 400 mg albendazole and 40 mg/kg praziquantel concomitantly resulted in a cure rate of 84.4% of all intestinal worms.

Malaria in Israel: the Ethiopian connection

Over 2,000 cases of imported malaria were diagnosed in Israel in the last decade, the vast majority in immigrants from Ethiopia, making malaria a continuing public health problem of significance. In 1988, more than one- fifth of imported cases were caused by chloroquine-resistant Plasmodium falciparum. Since the Anopheles vector is still present in many areas of the country, it is necessary to detect and treat all cases quickly and effectively and to strengthen anti-malaria vector activities if local transmission is to be prevented. Despite massive and continuous importation of the disease, the Ministry of Health has had substantial success in the area of malaria control, through administration of presumptive treatment to Ethiopian immigrants, rapid diagnosis of imported cases and strict vector control.

Persistent Schistosoma mansoni infection in Yemeni immigrants to Israel

Following sporadic reports on persistent Schistosoma mansoni (S.m) infections in Israelis of Yemeni origin, we systematically surveyed a group of 129 individuals who immigrated to Israel 38 years ago. Physical examination was uneventful in all members of the study group. A single stool examination revealed S.m eggs in 15 of 129 subjects (12%). Specific anti-S.m. IgE was detected in the sera of 48 individuals (37%). Among the 15 egg-positives, 14 had specific IgE (sensitivity 93.3%), but only 80 of the 114 egg-negatives were also negative for specific IgE (specificity 70%). This specific IgE positivity among egg-negatives in the study group (34/114) and its complete absence from two control groups, one of them comprising Yemenites born in Israel, suggest either an S.m infection with low egg output stemming from a low worm burden or low fecundity of senescent worms, or occult infections. Since the S.m infections could not have been contracted in Israel, our findings point to inordinately persistent infections in the members of our study group, and incidentally also to the diagnostic usefulness of specific IgE testing in such cases.

Evaluation of albendazole, pyrantel, bephenium, pyrantel-praziquantel and pyrantel-bephenium for single-dose mass treatment of necatoriasis

An effective drug for single-dose mass treatment of necatoriasis was sought by testing three drugs and two drug combinations in Ethiopian immigrants to Israel found to have light infections. The drugs tested sequentially in single-doses were pyrantel pamoate (20 mg kg-1, 81 subjects); bephenium hydroxynaphthoate (2.5-5 g, 65 subjects); combined pyrantel and bephenium (25 subjects); combined pyrantel (20 mg kg-1) and praziquantel (40 mg kg-1) (16 subjects); and albendazole (400 mg, 77 subjects). Follow-up under conditions without likelihood of reinfection was by one stool examination. Cure rates with albendazole, pyrantel-bephenium and pyrantel-praziquantel were 84, 80 and 81% respectively; these rates were significantly higher than the 49% found for bephenium and the 51% for pyrantel (P less than 0.05). Egg reductions in those not cured were pyrantel (22%), bephenium (6%), pyrantel-bephenium (34%), pyrantel-praziquantel (3%) and albendazole (6%). Albendazole was the most promising single drug treatment; unexpected was the high effectiveness of pyrantel-praziquantel in combination.

Induction of anesthesia with propofol in urological outpatient surgery

Propofol (Diprivan) in a new formulation, a short-acting intravenous anesthetic, was used as an induction agent for short urological procedures. Forty unpremedicated patients were treated with either propofol or thiopental in a randomized study. The onset of anesthesia and duration of apneic period were prolonged and the decrease in systolic blood pressure was more profound in the propofol group. Heart rate was less stable and recovery time was longer in the thiopental group. Other parameters, such as quality of anesthesia, acceptability of the drug or rate of side effects, were similar in both groups. These results suggest that propofol in a new formulation is a suitable agent for short urological procedures in outpatient surgery.

Waterborne outbreak of Campylobacter enteritis

A report is given on an outbreak of enteritis which occurred in July 1982 in a kibbutz near Jerusalem. About 150 of the 512 inhabitants were affected. Campylobacter jejuni was isolated from ten out of 42 stool samples examined toward the end of the outbreak. No other enteric pathogen was found. Strong circumstantial evidence indicated an association between the outbreak and the use of water from an unprotected reservoir, but no bacteriological confirmation was obtained.

Serotype distribution of penicillin-resistant pneumococci and their susceptibilities to seven antimicrobial agents

A total of 229 clinical isolates of Streptococcus pneumoniae recovered from 225 patients were serotyped and tested for susceptibility to penicillin G, ampicillin, mezlocillin, cefazolin, erythromycin, clindamycin, chloramphenicol, and sulfamethoxazole-trimethoprim. Of all the isolates, 48 (21.0%) showed intermediate resistance and 17 (7.4%) showed resistance to penicillin G. Penicillin-resistant strains had higher minimal inhibitory concentrations of ampicillin, mezlocillin, and cefazolin than did penicillin-susceptible strains. Resistance to erythromycin and clindamycin was rare (1.3 and 0.9%, respectively). Of the isolates, 8.7% were resistant to sulfamethoxazole-trimethoprim, and all were susceptible to chloramphenicol. Penicillin resistance was associated with 13 serotypes. Serotypes 14, 19F, 19A, and 23F were both highly prevalent and frequently penicillin resistant.

New Salmonella serovar, Salmonella eingedi [61,62,7:f,g,t:1,(2),7]

A new Salmonella serovar, Salmonella eingedi, was isolated from the intestinal content of a snake, Coluber rhodorhachis, and later also from the diarrheal stools of two children.

Six new Salmonella sub-genus III serotypes isolated from snakes in Israel

Six new Salmonella sub-genus III serotypes (Arizona) were isolated from snakes in Israel. Their antigenic structure was established as follows: S. arizonae 16:Z52:Z35 (Ar.25:26-21); S. arizonae 18:1,v:e,n,x,z15 (Ar.7a,7b:23-28); S. arizonae 21:i:1,5(7) (Ar.22:33-30); S. arizonae 41:c:e,n,x,z15 (Ar.13:32-28); S. arizonae 51:k:z35 (Ar.1,2:29-21); and S. arizonae 53:1,v:z35 (Ar.1,4:23-21).

Salmonella and Arizona from snakes in the Judean desert (1974-1975)

Ninety-four (77.7%) of the 121 snakes captured during the years 1974-1975 in the Judean desert were found to carry Salmonella and/or Arizona organism. Sixty-six snakes (54.4%) harboured only one serotype. From 19 animals (15.7%) both Salmonella and Arizona organisms were isolated. From 9 snakes (7.5%) 2 or 3 serotypes of Arizona were isolated. Only 27 snakes (22,3%) harboured no detectable Salmonella nor Arizona in their intestinal contents.

The cellular responses of the rat to an intraperitoneal inoculation of Nippostrongylus brasiliensis larvae

The cellular responses to intraperitoneal inoculation of infective (L₃) or non-infective (L₂) larvae of Nippostrongylus brasiliensis were studied in unprimed rats. Peritoneal macrophages adhered to the larvae immediately after inoculation and the coated larvae became attached to the omentum. As additional inflammatory cells, appearing in the peritoneal exudate, adhered to the larvae, nodules were formed which with time organized into granulomas.

The initial response was not specific and consisted of an intense neutrophilia which developed in all rats a few hours after inoculation and lasted 24 hours. Thereafter the cellular responses were distinctly different in the case of each larval stage. In rats receiving L₃ larvae an intense eosinophilia in the peritoneal exudate began to develop 7 days after inoculation, and islands of numerous pyroninophilic blast- and plasma cells were present at the periphery of the granuloma. The L₃ larvae survived in the granulomas for 7–10 days.

The granulomas formed around the L₂ larvae consisted mainly of macrophages; the number of eosinophils did not rise above normal and there were no pyroninophilic cells. The L₂ larvae survived in the granuloma for 3 days. In control rats, in which an intestinal infection was established by subcutaneous administration of larvae, no changes were detected in the cellular composition of the peritoneal exudate.

The significance of these responses is discussed in relation to recent reports about the cellular composition of antigenic and non-antigenic granulomas.