The role of endoscopic ultrasound for portal hypertension in liver cirrhosis

Journal of Medical Ultrasonics - Chronic liver disease is still a major problem because disease progression will ultimately lead to liver cirrhosis. Portal hypertension is the hallmark in advanced...     

Deletion of the Major Proteolytic Site of the Helicobacter pylori Cytotoxin Does Not Influence Toxin Activity but Favors Assembly of the Toxin into Hexameric Structures

The Helicobacter pylori cytotoxin is proteolytically cleaved at a flexible hydrophilic loop into two subunits. Deletion of the loop sequences had no effect on biological activity of the toxin in the HeLa cell vacuolation assay but favored the organization of the protein into hexameric rather than heptameric structures.     

N19 polyepitope as a carrier for enhanced immunogenicity and protective efficacy of meningococcal conjugate vaccines

N19, a string of human universal CD4 T-cell epitopes from various pathogen-derived antigens, was shown to exert a stronger carrier effect than CRM197 for the induction of anti-group C Neisseria meningitidis capsular polysaccharide (MenC), after immunization of mice with various dosages of N19-MenC or CRM-MenC conjugate vaccines. After two immunizations, the N19-based construct induced anti-MenC antibody and protective bactericidal antibody titers higher than those induced by three doses of the CRM-MenC conjugate and required lower amounts of conjugate. N19-based conjugates are superior to CRM-based conjugates to induce protective immune responses to MenC conjugates.     

Protective levels of diphtheria-neutralizing antibody induced in healthy volunteers by unilateral priming-boosting intranasal immunization associated with restricted ipsilateral mucosal secretory immunoglobulin a

Subunit intranasal vaccines offer the prospect of inducing combined systemic-mucosal immunity against mucosally transmitted infections such as human immunodeficiency virus. However, although human studies have demonstrated the induction of active immunity, secretory immunoglobulin A (sIgA) responses are variable, and no study has demonstrated protection by accepted vaccine-licensing criteria as measured by direct toxin-neutralizing activity. Using the genetically inactivated mutant diphtheria toxoid CRM(197) in a bioadhesive polycationic polysaccharide chitosan delivery system, we found that a single nasal immunization was well tolerated and boosted antitoxin neutralizing activity in healthy volunteers, which could be further boosted by a second immunization. The neutralizing activity far exceeded accepted protective levels and was equivalent to that induced by standard intramuscular vaccine and significantly greater than intranasal immunization with CRM(197) in the absence of chitosan. A striking but unexpected observation was that although unilateral intranasal immunization induced circulating antitoxin antibody-secreting cells, a nasal antitoxin sIgA response was seen only after the second immunization and only in the vaccinated nostril. If these data are reproduced in larger studies, an intranasal diphtheria vaccine based on CRM(197)-chitosan could be rapidly licensed for human use. However, a restricted sIgA response suggests that care must be taken in the priming-boosting strategy and clinical sampling techniques when evaluating such vaccines for the induction of local mucosal immunity.     

Levels of Expression and Immunogenicity of Attenuated Salmonella enterica Serovar Typhimurium Strains Expressing Escherichia coli Mutant Heat-Labile Enterotoxin

The effects of heterologous gene dosage as well as Salmonella typhimurium strain variability on immune response toward both the heterologous antigen, the nontoxic mutant of the Escherichia coli heat-labile enterotoxin LTK63, and the carrier Salmonella strain have been analyzed. Effects of a single integration into the host DNA and different-copy-number episomal vectors were compared in S. typhimurium Δcya Δcrp Δasd strains of two different serotypes, UK-1 and SR-11. Expression of the enterotoxin in the different Salmonella isolates in vitro was found to vary considerably and, for the episomal vectors, to correlate with the plasmid copy number. LTK63-specific serum immunoglobulin G (IgG) and mucosal immunoglobulin A (IgA) antibodies were highest in mice immunized with the high-level-expression strain. High anti-LTK63 IgG and IgA titers were found to correspond to higher anti-Salmonella immunity, suggesting that LTK63 exerts an adjuvant effect on response to the carrier. Statistically significant differences in anti-LTK63 immune response were observed between groups of mice immunized with the attenuated Δcya Δcrp UK-1 and SR-11 derivatives producing the antigen at the same rate. These data indicate that the same attenuation in S. typhimurium strains of different genetic backgrounds can influence significantly the immune response toward the heterologous antigen. Moreover, delivery of the LTK63 enterotoxin to the immune system by attenuated S. typhimurium strains is effective only when synthesis of the antigen is very high during the initial phase of invasion, while persistence of the S. typhimurium strain in deep tissues has only marginal influence.

Enterotoxigenic Escherichia coli strains produce a plasmid-encoded heat-labile enterotoxin (LT) (15, 34) related to cholera toxin (CT) (9, 35). LT is composed of two subunits, A and B, which are exported to the periplasmic space, where they assemble into an AB₅ multimeric complex (16). Several mutants of LT-A have been constructed, and in particular, a nontoxic mutant which contains a substitution of serine 63 with lysine (LTK63) has been shown to maintain the structural and immunogenic properties of wild-type LT (21, 27, 28). LTK63 has also been found to display the strong mucosal adjuvant activity pertaining to wild-type LT. Efficient induction of mucosal immune response, specifically in the mouse vagina, has been achieved via the intranasal route of immunization (10). For the development of oral vaccines, however, it would be desirable to exploit the properties of LTK63 for enhancing antigen-specific immune response in the intestinal mucosa by means of oral delivery of the potent mucosal adjuvant.Oral delivery of antigens by live vaccines is known to lead to a more effective production of antigen-specific antibodies in mucosal secretions than oral administration of the soluble antigen (36, 39). Several antigen delivery systems which use as carriers mutant intracellular pathogens that have lost the ability to persist and produce the disease while retaining limited growth in vivo have been developed. In particular, attenuated Salmonella mutants are suitable immunological carriers for virulence determinants from other enteric bacteria in that they can induce humoral immune response selectively at the site of colonization, the gut mucosa. Vaccine strains of Salmonella have been successfully attenuated by introducing different types of mutations (5, 8, 23, 26). Notably, Salmonella strains with a galactose epimerase (galE) mutation (18) or deletions in genes for the biosynthesis of aromatic compounds (aro mutants) (11, 12, 17, 19) or in the adenylate cyclase (cya) and cyclic AMP receptor protein (crp) genes (6) are the most extensively characterized.Delivery of the B subunit of the E. coli enterotoxin (LT-B) by a galE mutant of Salmonella typhimurium has been shown to elicit low levels of anti-LT-B serum and mucosal antibodies. Since the vector used for expression of LT-B was rapidly lost in vivo, i.e., in the absence of the antibiotic required for selection of the plasmid, the level of immune response could be correlated only with the amount of antigen expressed during the initial phase of invasion (3).Recently, direct comparison between the aroA aroD/pnirB and the Δcya Δcrp Δasd/asd⁺ delivery systems for the ability to induce humoral and cellular immunity after a single immunization showed that the former vaccine strain had greater potential as a carrier for antigen delivery (20). However, the balanced lethal asd system for in vivo selection of plasmids expressing heterologous antigens in the attenuated Δcya Δcrp Δasd strains is still very attractive in that asd⁺ plasmids do not require antibiotic resistance markers for selection while stably maintained in vivo (24). In addition, the Δcya Δcrp Δasd/asd⁺ delivery system has been reported to induce protective immunity against several pathogens (25, 29, 40). Most of these studies have restricted analysis of the immune response to antigens expressed from the same asd⁺ plasmid carried by Δcya Δcrp Δasd mutants usually of the same S. typhimurium serotype. In this work, we have analyzed the influence of heterologous gene dosage, and thus level of expression, as well as S. typhimurium strain variability on immune response toward both the heterologous antigen, a nontoxic mutant of E. coli LT, and the carrier Salmonella strain. Effects of a single integration into the host DNA and episomal vectors at different copy numbers were compared in S. typhimurium strains of two different Δcya Δcrp Δasd serotypes, UK-1 and SR-11.     

Localization of neurons projecting into the extrinsic penile smooth musculature of the pig: an experimental study on the retractor penis muscle

The aim of this study was to locate in male pigs the sensory and autonomic ganglia innervating the retractor penis muscle (RPM), which was taken as an experimental model of the genital smooth musculature. The retrograde neuronal tracers horseradish peroxidase (HRP), Fast Blue (FB), and diamidino yellow (DY) were injected into the bulbopenile portion of the left RPM. The tracers highlighted a different affinity for the neuronal structures, although labelled cells supplying the RPM were generally found in bilateral dorsal root ganglia (DRGs, S1-S3), in bilateral paravertebral ganglia (PaGs, L2-S3), and in the left and right caudal mesenteric ganglia (CMGs). The mean number of labelled FB cells was 795 (range, 645-952) in DRGs, 16046.25 (range, 10226-18742) in PaGs, and 635.25 (range, 333-786) in CMGs. The mean diameter of pseudounipolar DRG cells was 60-75 microm, while the multipolar neurons of PaGs and CMGs had dimensions varying between 20-50 microm and 20-30 microm, respectively.     

Expression of CA19-9, SLX, STN and CEA in relatively early gastric carcinoma

Expression and presence of the carbohydrate antigens CA19-9, SLX and STN, and CEA in tissues and serum were examined in 132 patients with early or propria muscle invaded gastric cancer. The seropositive rate was not different in patients with cancer or gastritis. In tumor tissue, the positive rate for these antigens was 28.8% in CA19-9, 9.1% in SLX, 47.0% in STN and 72.9% in CEA. Results showed that gastric cancers, even at an early stage, produce abnormal carbohydrate antigens not detected in normal tissues. However, transfer of antigens into the circulation was not observed in patients with early gastric cancer, suggesting the possibility that number of carcinoma cells may be involved in the transfer of antigens into blood.     

Amikacin and ceftazidime as empirical antibiotic therapy in severely neutropenic patients: analysis of prognostic factors

This study aimed to evaluate the efficacy of amikacine and ceftazidime as an empirical antibiotic therapy for neutropenic patients affected by haematological neoplasms and to investigate the presence of prognostic features suggesting a poor outcome with this antibiotic combination at the onset of infection. This could allow the identification of subgroups of patients with a low rate of response to amikacin/ceftazidime therapy; in these patients different initial empirical therapy may be indicated. The study population comprised 166 severely neutropenic (absolute neutrophil count below 500/l) oncohaematological patients with fever or clinical signs of infection. Multivariate analysis confirmed four negative prognostic factors: 3 or more days of hospitalization at the onset of an infectious episode, a diagnosis of acute myeloid leukaemia, a haematological disease status different from complete remission, the presence of pneumonia. Depending on how many factors are present, cases can be stratified into three groups, of significantly different prognosis: favourable (0 or 1 factor) 76% success; intermediate (2 factors) 52% success; unfavourable (3 or 4 factors) 19% success. At the onset of an infectious episode a subgroup of patients with a very low response rate to empirical amikacin/ceftazidime antibiotic therapy is identifiable, for whom a different therapy is indicated. Because of the high rate of proven or probable fungal infections in this group, the immediate administration of a systemic antifungal therapy, in addition to antibacterial agents, could be considered in these high-risk patients. Studies should be specifically addressed to evaluating a stratification of empirical antibiotic therapy according to risk factors present at the onset of infection.     

Intrathoracic omental herniation through the esophageal hiatus: Report of a case

(Received for publication on Dec. 8, 1997; accepted on July 7, 1998)