Immune Response to Natural and Recombinant Antigens of Helicobacter pylori in Patients with Dyspeptic Complaints

 Sera of 223 dyspeptic patients with endoscopic findings of nonulcer dyspepsia (72%), gastric ulcer (15%) and duodenal ulcer (13%) were tested for antibodies against Helicobacter pylori with an enzyme immunoassay and an immunoblot technique using lysates of Helicobacter pylori cells as antigen source. One hundred and fifty-one (68%) sera were found to be positive for Helicobacter pylori IgG with both methods; 5% of the positive results in the enzyme immunoassay were false-positive due to cross-reactions mainly of proteins with a molecular mass of 43–66 kDa. Since cross-reactivity not only reduces the diagnostic value of the immunoassay but also complicates evaluation of the immunoblot results, an attempt was made to overcome these problems by using specific purified recombinant proteins instead of the crude cell preparations as antigens. Of the commonly recognised immunogens of Helicobacter pylori, antibodies against a cell surface protein of 26 kDa, the small urease subunit (29 kDa) and the cytotoxin-associated protein (130 kDa) were identified as highly sensitive serological markers for inclusion in a recombinant antigen mixture for Helicobacter pylori screening. Only the cytotoxinassociated protein was confirmed to be an indicator immunogen for ulcerogenic strains. To assess the reliability of recombinant fragments of this protein in serological screening, the reactivity of antibody to purified fragments of the cytotoxin-associated protein was compared with that to the natural protein. A C-terminal recombinant fragment of 58 kDa showed results identical to those obtained with the natural protein and was thus considered to be an appropriate component of an antigen mixture for serological detection of Helicobacter pylori.     

Evidence for Specific Secretion Rather than Autolysis in the Release of Some Helicobacter pylori Proteins

We investigated whether Helicobacter pylori cells actively secrete proteins such as the urease subunits UreA and UreB and the GroES and GroEL homologs HspA and HspB or whether these proteins were present in the extracellular compartment as a consequence of autolysis. Using a subcellular fractionation approach associated with quantitative Western blot analyses, we showed that the supernatant protein profiles were very different from those of the cell pellets, even for bacteria harvested in the late growth phase; this suggests that the release process is selective. A typical cytoplasmic protein, a β-galactosidase homolog, was found exclusively associated with the pellet of whole-cell extracts, and no traces were found in the supernatant. In contrast, UreA, UreB, HspA, and HspB were mostly found in the pellet but significant amounts were also present in the supernatant. HspA and UreB were released into the supernatant at the same rate throughout the growth phase (3%), whereas large portions of HspB and UreA were released during the stationary phase (over 30 and 20%, respectively) rather than during the early growth phase (20% and 6, respectively). The profiles of protein obtained after water extraction of the bacteria with those of the proteins naturally released within the liquid culture supernatants demonstrated that water extraction led to the release of a large amount of protein due to artifactual lysis. Our data support the conclusion that a specific and selective mechanism(s) is involved in the secretion of some H. pylori antigens. A programmed autolysis process does not seem to make a major contribution.     

Induction of a Th17 cell response by Helicobacter pylori Urease subunit B

Th17 cells represent a novel subset of CD4⁺ T cells, which is associated with Helicobacter pylori infection. In the present study, we investigated the potential role of Urease subunit B (UreB) in the induction of Th17 cell response. Co-cultured splenic lymphocytes from H. pylori-infected mice with the recombinant UreB (rUreB) elevated IL-17 secretion and caused an increase in the number of Th17 cells. The expression of IL-6 and IL-23 p19 was significantly increased in rUreB-stimulated macrophages. Whole cell protein (WCP) of UreB-deficient strain (UreB⁻ strain) induced less Th17 cell responses than that of wild-type strain. In addition, subcutaneous and intranasal immunization of rUreB elicited antigen-specific Th17 cell responses. Intranasal immunization of rUreB reduced H. pylori colonization in the stomach, which was closely related with the increased rUreB-specific Th17 cell responses. These results suggest that UreB is an important protein which is able to elicit Th17 cell responses against H. pylori both in vivo and in vitro.     

Recombinant antigens prepared from the urease subunits of Helicobacter spp.: evidence of protection in a mouse model of gastric infection.

Urease is an important virulence factor for gastric Helicobacter spp. To elucidate the efficacy of individual urease subunits to act as mucosal immunogens, the genes encoding the respective urease subunits (UreA and UreB) of Helicobacter pylori and Helicobacter felis were cloned in an expression vector (pMAL) and expressed in Escherichia coli cells as translational fusion proteins. The recombinant UreA and UreB proteins were purified by affinity and anion-exchange chromatography techniques and had predicted molecular masses of approximately 68 and 103 kDa, respectively. Western blotting (immunoblotting) studies indicated that the urease components of the fusion proteins were strongly immunogenic and were specifically recognized by polyclonal rabbit anti-Helicobacter sp. sera. The fusion proteins (50 micrograms) were used, in combination with a mucosal adjuvant (cholera toxin), to orogastrically immunize mice against H. felis infection. Gastric tissues from H. felis-challenged mice were assessed by the biopsy urease test and by histology. In mice immunized with recombinant H. felis UreB, 60% of animals (n = 7) were histologically negative for H. felis bacteria after challenge at 17 weeks. This compared with 25% (n = 8) for mice immunized with the heterologous H. pylori UreB antigen. Neither the homologous nor the heterologous UreA subunit elicited protective responses against H. felis infection in mice. The study demonstrated that a recombinant subunit antigen could induce an immunoprotective response against gastric Helicobacter infection.     

Growth Characteristics and Influence of Antibiotics on Rough/Smooth Phenotypic Variants of Helicobacter pylori

 Helicobacter pylori shows a rather high variability of several biochemical markers including lipopolysaccharide structures. This study aimed to determine whether Helicobacter pylori has a potential for phenotypic variability and to describe its effects on bacterial pathogenesis. From colonies of three clinical strains of Helicobacter pylori with rough (R) colony morphology, spontaneous phenotypic variants with smooth (S) colony morphology were isolated that occurred with a frequency of 10^–2 to 10^–3, irrespective of growth conditions. R-variant bacteria produced exclusively low-molecular-mass lipopolysaccharide. They exhibited increased lysis in the presence of plain air. In contrast, the S variants produced low- and high-molecular-mass lipopolysaccharide and did not exhibit increased lysis in the presence of plain air. Cocultivation of bacterial cells with AGS stomach cancer cells revealed that R-variant bacteria but not S-variant bacteria effected an inhibition of high molecular-weight glycoprotein biosynthesis and secretion by the host cells. Skirrow supplement added as selective agent to liquid and/or solid media was tolerated to a similar extent among R- and S-variant bacteria, while all variants proved sensitive to metronidazole, amoxicillin and clarithromycin except for the R and S isolates of strain Hp57, which showed resistance to the latter compound. It was concluded that R- and S-variants of Helicobacter pylori may have distinct roles in pathogenesis; nevertheless, these bacteria may be isolated by traditional methods and eradicated by conventional anti-infective therapy.     

Eradication of Helicobacter pylori heals atrophic corpus gastritis caused by long-term treatment with omeprazole

 Long-term treatment with proton pump inhibitors in patients with Helicobacter pylori gastritis can lead to atrophic changes in the corpus mucosa. What is still unclear, however, is whether this atrophy can regress in response to Helicobacter pylori eradication. We report on a male patient with Helicobacter pylori gastritis receiving long-term treatment (4 years) with omeprazole for gastro-oesophageal reflux disease, who developed autoaggressive gastritis with progressive atrophy, hypochlorhydria, hypergastrinaemia and nodular ECL-cell hyperplasia. To determine whether these changes might be induced to regress, Helicobacter pylori eradication therapy was administered. Ten months after Helicobacter pylori eradication autoaggressive lymphocytic infiltrates were no longer detectable, and the glands in the corpus mucosa had normalised despite continued treatment with omeprazole – a finding that was confirmed at two further follow-up surveys performed at 6-month intervals. This case report shows that atrophy of the corpus mucosa developing under long-term treatment with a proton pump inhibitor can be cured by eradicating Helicobacter pylori. Received: 21 April 1998 / Accepted: 10 August 1998     

European Multicentre Survey of in Vitro Antimicrobial Resistance in Helicobacter pylori

A multicentre in vitro survey was carried out in 1998 in 22 European centres in order to assess the variation in the prevalence of Helicobacter pylori resistance. The susceptibility of 1,274 isolates to metronidazole, clarithromycin and amoxicillin was determined by the E test. The mean rate of resistance to metronidazole was 33.1% (95% CI, 7.5–58.9), to clarithromycin 9.9% (95% CI, 0–28.1) and to amoxicillin 0.8% (95% CI, 0–8.9). Resistance to metronidazole was significantly higher in females (P<0.001), while resistance to clarithromycin was significantly higher in children and teens (P<0.05). Resistance to both agents also tended to be higher in strains isolated from patients from southern European countries than in those isolated from patients from central or northern Europe. Overall, these results emphasize the need for further surveys of Helicobacter pylori sensitivity to antibiotics at a national and regional level. Electronic Publication     

Evaluation of a novel rapid one-step monoclonal chromatographic immunoassay for detection of <Emphasis Type="Italic">Helicobacter pylori</Emphasis> in stool from children

A new rapid office-based one-step monoclonal immunoassay (RAPID Hp StAR, DakoCytomation, Cambridge, UK) for detection of Helicobacter pylori antigen in stool was evaluated in children against invasive diagnostic methods and compared to the results of a monoclonal EIA targeting the same antigen (Amplified IDEIA Hp StAR, DakoCytomation, Cambridge, UK). Coded stool samples from 118 symptomatic children (0.3–18.8 years) were investigated prior to any anti-H. pylori therapy. Fifty-four children were H. pylori infected defined by positive culture and/or two other positive tests (¹³C- urea breath test, histology, rapid urea test), the remaining 64 children showed concordant negative results. Thirty-four infected children (4.8–17.8 years) were monitored with ¹³C- urea breath test (five remained positive) and stool test 6–8 weeks after anti-H. pylori therapy. The immunoassays were independently read by two investigators. The monoclonal EIA showed excellent sensitivity and specificity before (98% and 100%, respectively) and after therapy (100%; 96.2%). The rapid immunoassay was invalid for technical reasons in nine samples (5.9%). The two observers agreed in 31 positive and 93 negative results, but had discordant results in 17 samples (11.2%). Overall, the rapid test showed a poor sensitivity (63.8%–71.1%), but a good specificity (91.1%–96.2%) before treatment. We conclude that the new office based monoclonal enzyme immunoassay for diagnosis of H. pylori should be modified to improve sensitivity, inter-observer-variability and some technical problems. In contrast, the monoclonal EIA stool test is highly reliable, both pre- and post therapy, and equivalent to the ¹³C- urea breath test.     

Detection of <Emphasis Type="Italic">Helicobacter pylori</Emphasis> in bioptates of gastric mucosa of patients with gastritis and gastric ulcers using real-time PCR

Helicobacter pylori is currently believed to play an important role in the pathogenesis of gastritis, gastric and duodenal ulcers, and stomach cancer. The ability of H. pylori to colonize gastric mucosa and cause inflammation is determined by genetic factors, three of which are the best studied: the pathogenicity factors CagA and VacA and the adhesion factor BabA. We developed primer systems and probes for real-time polymerase chain reaction (RT PCR), which allowed us to detect H. pylori in specimens and to perform typing of H. pylori virulence factors CagA, VacA, and BabA. Comparison of two H. pylori diagnostic techniques, histological studies of bioptates and RT PCR, demonstrated the superiority of RT PCR in specificity and sensitivity. Typing of H. pylori demonstrated that 70–80% of strains had the cagA⁺/vacA s1 genotype and 10–20% had the cagA/vacA s2 genotype; babA was detected in 75–85% of all strains. H. pylori typing data did not reveal any correlations between the pathogenicity factors CagA and VacA or the adhesion factor BabA with severity of infection.     

Effect of antimicrobial therapy on the specific serological response toHelicobacter pylori infection

The systemic immune response toHelicobacter pylori was studied in 247 infected adult patients before antimicrobial therapy and at different intervals following therapy. Endoscopy with simultaneous collection of biopsies was performed in all patients immediately before treatment, 4 to 6 weeks after the end of therapy and 6 to 12 months later. A¹⁴C-urea breath test was performed 3 to 6 months after the end of treatment. Biopsy specimens were cultured and examined histologically using Giemsa stain. Sera were tested forHelicobacter pylori IgG antibodies with a commercial enzyme immunoassay using species-specific antigens. Overall,Helicobacter pylori was eradicated in 120 patients while the other 127 remained infected with the organism. The follow-up period ranged from 4 weeks to 33 months (mean 10.2 months). Pretreatment IgG levels did not differ significantly between the two groups of patients. Six weeks after the end of treatment a slight but definite decrease in the IgG antibody levels was seen irrespective of treatment success. In the 127 patients who remainedHelicobacter pylori-positive, the level of IgG antibodies remained stable or increased with time. A continuous fall in antibody levels was observed following bacterial eradication in the other 120 patients, but the difference in antibody levels between treatment responders and nonresponders became significant only more than six months after the end of treatment (p=0.001). Serological testing may be useful for monitoring the outcome of long-term treatment ofHelicobacter pylori infection and obviate the need for endoscopy.     

Mucosal humoral immune response to CagA shows a high prevalence in patients with gastric MALT-type lymphoma

In the pathogenesis of gastric mucosa-associated lymphoid tissue (MALT)-type lymphoma, CagA-positive Helicobacter pylori strains have been suspected of making a significant contribution. To investigate this hypothesis in more detail, the mucosal humoral immune response of 15 patients with gastric MALT-type lymphoma was examined in the tumor and in the tumor-free gastritis of the same patient. Mononuclear cells from different sites (antrum, corpus, lymphoma) were cultured. Culture supernatant and serum of the same patient were used for immunodetection of CagA. All patients displayed an immune response to CagA in the tissue-culture supernatants. Although the humoral immune response in the tumor was restricted to a very few H. pylori antigens, antibodies directed against CagA protein were found in most patients. The immune response to CagA in nearly all lymphoma patients – not only in the serum, but also in the mucosa, including the tumor site – support the hypothesis that CagA is involved in the pathogenesis of gastric MALT-type lymphoma. Received: 16 April 1999 / Accepted: 30 August 1999     

Lewis antigen expression by Helicobacter pylori strains colonizing different regions of the stomach of individual patients

The diversity in the expression of Lewis antigens (Le) of 226 single colonies of Helicobacter pylori isolated from four regions of the stomach of eight adults is shown. Le^y was expressed more in strains colonizing antrum than in strains colonizing fundus, whereas Le^x was more common in fundus strains. cagA⁺ strains were more associated with Le-negative strains.     

Evaluation of fingerprinting methods for identification ofHelicobacter pylori strains

Variation amongst strains ofHelicobacter pylori was examined by³⁵S-methionine-labelled protein SDS-PAGE (Radio-PAGE), immunoblot and DNA fingerprinting techniques. These methods allowed discrimination amongst isolates and showed total correlation. Pig and baboon gastricHelicobacter pylori-like organisms were found to be very similar toHelicobacter pylori by both Radio-PAGE and immunoblotting, whereas aHelicobacter mustelae isolate was markedly different. TheHindIII restriction endonuclease digest patterns ofHelicobacter pylori DNA illustrated the considerable genomic variation of this organism. The Radio-PAGE and immunoblot typing methods both gave precise identification ofHelicobacter pylori strains, but Radio-PAGE was found to give higher resolution and represents a standardised universally applicable fingerprinting method forHelicobacter pylori.     

Evaluation of Immunological Rapid Urease Testing for Detection of Helicobacter pylori

 The aim of this study was to evaluate in clinical specimens the immunological rapid urease test (IRUT), a new diagnostic system for detection of Helicobacter pylori which employs a monoclonal antibody against Helicobacter pylori urease. Helicobacter pylori urease adsorbed on a solid-phase tip coated with a monoclonal antibody against Helicobacter pylori urease after 15 min of incubation with a gastric mucus sample solution was measured by the pH change of the urea solution inside the tip. The detection limit of Helicobacter pylori urease using this system was determined and compared with that of a commercially available rapid urease test. Clinical evaluation of the system was performed in 155 patients. The IRUT could detect 0.25 milli-international units (mIU) of Helicobacter pylori urease per milliliter in less than 20 min. If a patient with at least one positive result in a standard test for Helicobacter pylori was considered to be Helicobacter pylori positive, the sensitivity, specificity, positive and negative predictive values of the system were calculated as 95.2%, 98.9%, 98.4% and 96.8%, respectively. However, 10 of 19 Helicobacter pylori-positive patients in whom the pH change was less than 0.1 had negative results in at least one of the standard tests, whereas the IRUT correctly detected Helicobacter pylori in all but 3 of these 19 patients. The IRUT accurately determined the Helicobacter pylori status of 75 (98.7%) of 76 patients who had completed treatment. This system has high sensitivity for the detection of Helicobacter pylori, especially in patients with low urease activity.     

The significance of E266K polymorphism in the NOD1 gene on Helicobacter Pylori infection: an effective force on pathogenesis?

The severity of Helicobacter pylori-related diseases varies greatly among infected individuals and seems to be influenced by both host and bacterial factors. Infection with a cytotoxin-associated gene pathogenicity island (Cag PAI)-positive H. Pylori strain causes a higher grade of gastric mucosal inflammation than an infection caused by a negative strain. Furthermore, such an infection is associated with severe atrophic gastritis and gastric adenocarcinoma. NOD1 protein is a cytosolic pattern recognition receptor that responds to peptidoglycan delivered by H. Pylori cag pathogenicity island. The aim of this study is to investigate whether the presence of the NOD1 G796A polymorphism has any influence on the clinical outcomes of Cag PAI-positive H. Pylori. Both Helicobacter pylori and CagA-positive 150 patients were considered eligible for the study. In this selected group, NOD1 G796A was detected by using polymerase chain reaction/restriction fragment length polymorphism. Activity and severity of gastritis, atrophy, intestinal metaplasia and Helicobacter pylori density were assessed in body and antral biopsies. Also post-therapy controls for predicting Helicobacter pylori persistence were done. The correlations of these parameters were determined by SPSS 15 packet program for statistical analysis. Of the 150 CagA-positive patients, 57 had (38%) heterozygote (GA), and 29 had (19.3%) homozygote (AA) mutant variants of NOD1. The other 64 patients had (42.7%) wild-type DNA(GG). NOD1 796A allele carriers had higher risk for antral atrophy (OR = 13.35, 95% CI = 5.12–34.82) and antral intestinal metaplasia (OR = 2.71, 95% CI = 1.26–5.80). Carriage of the single nucleotide polymorphism of NOD1 G796A proved to be a significant risk factor for the Helicobacter pylori therapy failure (OR = 4.62, 95% CI = 1.67–12.79). Our results suggest that carriage of the NOD1 G796A mutation increases the susceptibility of gastric epithelial cells for intestinal metaplasia and atrophy when infected by CagA-positive Helicobacter pylori strains. Additionally, it increases the ratio of eradication failure.     

Apoptosis in chronic gastritis and its correlation with antigastric autoantibodies

 In the course of time, chronic gastritis may result in gastric atrophy, as in type A gastritis, where autoimmune reactions against parietal cells result in a loss of corpus glands. Two antigastric autoantibodies have been detected in Helicobacter pylori gastritis and are described as anti-luminal and anti-canalicular autoantibodies. The aim of this study was to determine whether increased apoptosis may be responsible for the loss of gastric epithelium and whether this apoptosis is correlated with antigastric autoimmunity. Gastric biopsies from normal mucosa and Helicobacter pylori gastritis were analysed for the presence of apoptosis using the TUNEL method. Helicobacter pylori gastritis was divided into cases (1) without autoantibodies, (2) with anti-luminal, and (3) with anti-canalicular autoantibodies. Apoptotic cells of the foveolar and of the glandular epithelium in the antrum and corpus were counted. The number of apoptotic cells in the gastric mucosa was significantly increased in all cases of gastritis. The highest number of apoptotic cells was observed in the gastric glands of the corpus mucosa in Helicobacter pylori gastritis with anti-canalicular autoantibodies. Apoptosis contributes to the development of gastric atrophy and there are various types of Helicobacter pylori gastritis. The positive correlation between apoptotic cell loss in the glandular zone of the corpus mucosa and the presence of anti-canalicular autoantibodies indicates a possible link between antigastric autoimmunity and atrophy in this type of Helicobacter pylori gastritis – similar to that in classic type A gastritis. Received: 19 November 1997 / Accepted: 24 March 1998     

Early Resistance to experimental plague in animals immunized with recombinant plague vaccine

The protective properties of recombinantSalmonella minnesota R595/pFS1 strain soon after immunization (1–3 days) are studied in a model of experimental mouse plague. Unlike the commercial EV strainYersinia pestis vaccine produced at the Saratov Anti-Plague Institute (Mikrob Research-Manufacturing Conglomerate), the experimental recombinant p preparation affords a high level of protection from the 1st day postvaccination, and surpasses the commercial preparation in such parameters as LD₅₀, mean survival time, and percentage of survivors. By the 21st day the protective indexes of both preparations are comparable. Translated fromByulleten' Eksperimental'noi Biologii i Meditsiny,Vol. 119, N ^o 1, pp. 54–57, January, 1995 Presented by A. A. Vorob'ev, Member of the Russian Academy of Medical Sciences     

Evaluation of Helicobacter pylori eradication by triple therapy plus Lactobacillus acidophilus compared to triple therapy alone

The purpose of this study was to evaluate the influence of adding Lactobacillus acidophilus to a triple regimen for Helicobacter pylori eradication in untreated patients with peptic ulcers or ulcer-scars. This was a pre-randomized, single-blind, interventional, treatment-efficacy study with active controls and parallel-assignment, set in Coimbra, Portugal, on 62 consecutive H. pylori-positive untreated adults with peptic ulcers or ulcer-scars, diagnosed by gastroduodenoscopy, with pre-treatment direct Gram-staining and culture of gastric biopsies. The first 31 patients received esomeprazole 20 mg, amoxicillin 1000 mg and clarithromycin 500 mg (EAC), all b.i.d., for 8 days. The remaining 31 added L. acidophilus, 5 × 10⁹ organisms per capsule, 3 + 2 i.d. for 8 days (EACL). The main outcome measure was ¹³C urea breath test (UBT), ≥6 weeks after completion of therapy. Successful eradication (UBT-negativity after treatment), was similar in both groups (EAC = 80.6%; EACL = 83.9%, p = 0.740) by both intention-to-treat and per-protocol analysis. The non-eradicated strains were susceptible in vitro to both antibiotics. Adding L. acidophilus to EAC triple therapy did not increase H. pylori eradication rates. Considering the cost and the burden of ingesting five extra capsules daily, supplementing the EAC therapy with L. acidophilus, at this dose, shows no benefit. Further studies with different dosages and duration of treatment, and other probiotics or probiotic combinations are required to improve eradication.     

A new histological procedure for re-evaluation of the serological test forHelicobacter pylori

To re-evaluate the accuracy of the serological test forHelicobacter pylori, fixation of biopsy specimens with Carnoy's solution (preserving the mucous layer in tissue preparations) followed by immunohistochemical staining (a new histological procedure) was used as the reference histological method instead of 10% formalin fixation followed by hematoxylin-eosin staining (the conventional histological procedure). Biopsy specimens (antrum and body) from 114 patients with gastritis (including non-ulcer dyspepsia) or gastric and/or duodenal ulcers were obtained by endoscopy and used for both bacteriological culture and histological examination. Serum samples were taken from all patients at the time of endoscopy. The serum levels of specific IgG and IgA antibodies forHelicobacter pylori were measured by commercial enzyme immunoassay kits. The reliability of the IgG and IgA measurements was evaluated by analyzing receiver operating characteristic curves obtained using the two histological procedures. With the conventional histological procedure as the reference, the sensitivity and specificity levels of the serological test were 87.2% and 82.1%, respectively. With the new histological procedure as reference, sensitivity and specificity were 94% and 96.7%, respectively. The insufficient accuracy reported for the serological test could be due to false-positive or false-negative results obtained when the conventional histological procedure is used as the reference. The new histological procedure used here revealed that the serological test forHelicobacter pylori is more reliable than previously thought.     

The immunodiagnostic potential of Echinococcus granulosus adult-worm antigens in human cystic echinococcosis

 Echinococcus granulosus adult-worm antigens were characterised for assessment of their immunodiagnostic potential for human cystic echinococcosis (CE). The analysis of worm extracts by enzyme-linked immunosorbent assay (ELISA) showed a sensitivity of 83% for CE, which is comparable with data obtained for cyst-fluid-based serodiagnostic tests. Immunoprecipitation of in vitro-translated E. granulosus worm mRNA revealed a range of low-molecular-weight antigenic proteins (12–45 kDa) recognised by human CE sera. E. granulosus adult worms may provide an additional or alternative source to metacestode material for the isolation of both native and recombinant antigens to be considered for the serodiagnosis of human echinococcosis. Received: 15 April 1996 / Accepted: 22 July 1996