Development of Lectin-Linked Immunomagnetic Separation for the Detection of Hepatitis A Virus

The accuracy and sensitivity of PCR-based methods for detection of hepatitis A virus (HAV) are dependent on the methods used to separate and concentrate the HAV from the infected cells. The pH and ionic strength affect the binding affinity of the virus to cells. In this study, we initially investigated the effects of pH (4.0–10.0) and metal ions (Fe²⁺, Co²⁺, Cu²⁺, Mg²⁺, K⁺, and Ca²⁺) on the binding of HAV to oyster digestive cells. The lowest relative binding (RB) of HAV to the cells was found at pH 4.0 and in FeSO₄ solution (64.6% and 68.1%, respectively). To develop an alternative to antibody-dependent immunomagnetic separation prior to detection of HAV using RT-PCR, the binding of HAV to five lectins, peanut agglutinin (PNA), Dolichos biflorus agglutinin (DBA), Helix pomatia agglutinin (HPA), Ulex europaeus agglutinin (UEA-1) and soybean agglutinin (SBA), was evaluated using ELISAs. SBA showed significantly higher RB to HAV than the other lectins tested. In addition, HAV could be concentrated within 30 min using SBA-linked magnetic bead separation (SMS) prior to the RT-PCR assay. Our findings demonstrate the feasibility of using SMS combined with RT-PCR to detect HAV at dilutions ranging from 10⁻¹–10⁻⁴ of a HAV stock (titer: 10⁴ TCID₅₀/mL).     

Pulmonary function assessment in the early phase of patients with smoke inhalation injury from fire

Objectives

Fire smoke contains toxic gases and numerous chemical compounds produced by incomplete combustion, and may cause injury to the airways. Increased airway reactivity, as well as a decrease in lung function, has been reported as a sequela of smoke inhalation injury. This study was undertaken to assess lung functions in the early phase of patients with smoke inhalation damage from fires.

Methods

A total of 15 patients with fire smoke inhalation (fire smoke group) and 15 subjects with chronic cough but no previous history of lung disease (chronic cough group) were enrolled. For diagnosis of inhalation injury, we performed bronchoscopy, high-resolution computed tomography (HRCT), as well as arterial carboxyhemoglobin (COHb) at admission. Clinical characteristics, pulmonary function tests (PFTs) and mannitol bronchial provocation tests (BPTs) were analyzed and compared between the two groups.

Results

In fire smoke group, initial COHb levels and the PaO₂/FiO₂ ratio were (14.8±18.49)% and 425.7±123.68, respectively. Of seven patients performing HRCT, 4 (57.1%) showed the CT findings compatible with lung involvement of inhalation injury. Post bronchodilator value of the percent of forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV₁) were (76.0±24.27)% and (79.8±27.82)%, respectively. Pre-and post- bronchodilator forced expiratory flow between 25% and 75% of the FVC (FEF_25-75) and the percent predicted FEF_25-75 were 2.41±1.47 vs. 2.65±1.45 L (P=0.045), and (68.7±37.29)% vs. (76.4±36.70)% (P=0.031), respectively. Two patients (13.3%) had positive bronchodilator response (BDR). In fire smoke and chronic cough group, all the subjects showed mannitol BPTs within normal limits.

Conclusions

Fire smoke inhalation leads to mild obstructive small airway disease pattern of pulmonary function in the early phase of patients with fire smoke damage. Further studies, however, need to be followed to identify the relationship between airway narrowing to inhaled mannitol and smoke inhalation injury.     

Application of veno-arterial-venous extracorporeal membrane oxygenation in differential hypoxia

Veno-arterial extracorporeal membrane oxygenation (ECMO) through the femoral vein and artery may cause differential hypoxia, i.e., lower PaO₂ in the upper body than in the lower body, because of normal cardiac output with severe impairment of pulmonary function. Hereby, we report the diagnosis and the treatment of differential hypoxia caused by veno-arterial ECMO. A 39-year-old man received cardiopulmonary resuscitation from a cardiac arrest due to acute myocardial infarction. Even after more than 30 min of resuscitation, spontaneous circulation had not resumed. Next, we performed veno-arterial ECMO through the femoral artery and vein, and the patient recovered consciousness on the second day of ECMO. On day 5 of ECMO, he lost consciousness again and presented a generalized tonic-clonic seizure, and an electroencephalogram showed delta waves suggesting diffuse cerebral cortical dysfunction. While an echocardiogram revealed improvements in myocardial function, a follow up chest radiograph showed increasing massive parenchymal infiltrations, and gas analysis of blood from the right radial artery revealed severe hypoxemia. These findings indicated a definite diagnosis of differential hypoxia, and therefore, we inserted a 17-Fr cannula into the left subclavian vein as a return cannula. The patient’s consciousness and pulmonary infiltrations were improved 2 days after veno-arterial-venous ECMO, and the electroencephalogram showed normal findings. To our knowledge, this is the first report of successful clinical management of differential hypoxia. We suggest that veno-arterial-venous ECMO could be the treatment of choice for differential hypoxia resulting from veno-arterial ECMO.     

CD1d-unrestricted NKT cells are endowed with a hybrid function far superior than that of iNKT cells

Invariant natural killer T (iNKT) cells to date represent the best example of cells known to have a hybrid function, representing both innate and adaptive immunity. Shared phenotypic similarities with NK cells together with a rapid response to a cytokine stimulus and a productive TCR engagement are the features that underline the hybrid nature of iNKT cells. Using these criteria, we provide molecular and functional evidence demonstrating that CD1d-independent (CD1d^ind) NKT cells, a population of CD1d-unrestricted NKT cells, are endowed with a hybrid function far superior to that of iNKT cells: (i) an extensive shared program with NK cells, (ii) a closer Euclidian distance with NK cells, and (iii) the ability to respond to innate stimuli (Poly:IC) with cytotoxic potential in the same manner as NK cells identify a hybrid feature in CD1d^indNKT cells that truly fulfills the dual function of an NK and a T cell. Our finding that CD1d^indNKT cells are programmed to act like NK cells in response to innate signals while being capable of adaptive responses is unprecedented, and thus might reemphasize CD1d-unrestricted NKT cells as a subset of lymphocytes that could affect biological processes of antimicrobial and tumor immunity in a unique way.Natural killer T (NKT) cells are increasingly regarded as cells endowed with a hybrid function between an NK cell and a T cell (1, 2). The current classification of NKT cells places them into three categories: type I, type II, and NKT-like cells (1). Type I comprises invariant NKT (iNKT) cells that recognize the glycolipid α-galactosylceramide (α-GalCer) loaded into the MHC class I molecule, CD1d, and contain an invariant TCR repertoire of Vα14-Jα18 (3–5). Type II NKT cells are also CD1d dependent but do not respond to α-GalCer in the same way as iNKT cells do (6, 7). NKT-like cells encompass all other NKT cells and are CD1d independent (CD1d^ind) (8); they are by far the most heterogeneous and the least characterized.Recent studies have increasingly shown a shared expression of NK cell-related receptors on other effector cells. CD8⁺ T cells are known to up-regulate NK markers, such as NK1.1, and can even respond quickly like NK cells (9). Other work has described NKT cells that express NKp46 (10), a marker selectively associated with conventional NK cells and NK22 cells in the gut (11). Moreover, γδ T cells have been shown to express NK markers and display an innate-like response (12). Collectively, these reports converge to raise the following key questions. What qualifies as an NKT cell? Do the cells need to express only NK1.1 and CD3 to be eligible for NKT nomenclature? With the continuous development of both NK and T-cell fields, the simplistic definition that NKT cells are subsets of T cells that express the NK1.1 marker is becoming increasingly misleading and even inaccurate. For instance, NK1.1 complex is expressed in the BALB/c strain but there are allelic divergences with the polymorphism leading to the PK136 antibody not reacting to the BALB/c NK.1.1 (NKrp1) complex (13). This definition is also limited in the C57BL/6 strain because of the discovery of NK1.1⁻CD1d⁺ NKT cells (14). Although phenotypic similarities can be misleading, the criteria that best describes an NKT cell is the ability to perform with a hybrid function between an NK cell and a T cell (2).Nonetheless, the concept of hybrid function is also an elusive notion allowing for a gradient of functions. A number of works refer to an NKT hybrid function as the ability of a T cell with phenotypic similarities to NK cells to perform with innate-like response. The best example of cells endowed with a hybrid NKT cell function are thought to be iNKT cells (2). In this study, we provide molecular and functional evidence demonstrating that CD1d^indNKT cells—a population of MHC-unrestricted T cells—are endowed with a hybrid function that associates them to the NK cell lineage in a manner far superior to the known link between NK and iNKT cells. An extensive shared program with NK cells, a similarity in the gene expression profile with NK cells, and their ability to respond (like NK cells) not only to cytokine signals (IL-12 plus IL-18) but also to innate stimuli [in vivo treatment with Poly:IC (Fisher)] with massive production of key effector players of the cytotoxic pathway collectively identify a hybrid feature in CD1d^indNKT cells that uniquely fulfills the function of an NK cell and a T cell.