Definition of the epitope recognized by the Plasmodium falciparum-reactive human monoclonal antibody 33G2.

The human monoclonal antibody 33G2 has earlier been shown to inhibit merozoite reinvasion of red blood cells in Plasmodium falciparum cultures in vitro and to inhibit cytoadherence of infected red blood cells to melanoma cells in vitro. 33G2 cross-reacts with a family of P. falciparum antigens, Ag332, Pf11.1 and Pf155/RESA, sharing a common feature of repeated sequences consisting of regularly spaced pairs of glutamic acid. Peptides corresponding to residues 2-19 of the known amino acid sequence of Ag332 have been shown earlier to have the highest inhibitory capacity of antibody binding to infected red blood cells. Using the PEPSCAN method, overlapping hepta-, hexa-, penta- and tetrapeptides corresponding to residues 1-19 of the known sequence of Ag332 were synthesized. Antibody fine specificity was examined by synthesizing an octapeptide (residues 1-8) and all possible single amino acid substitutions. The monoclonal antibody was shown to react with a linear 5-amino acid-long sequence corresponding to Ag332 residues 3-7: VTEEI. These amino acids were irreplaceable or only partially replaceable in the replacement set analysis. Furthermore, epitope analogs corresponding to sequences contained within the Pf11.1 repeats and overlapping heptapeptides corresponding to Pf155/RESA repeats were synthesized. Reactivity to epitope analogs and Pf155/RESA peptides provided information which may explain antibody cross-reactivity. The defined epitope of this monoclonal antibody is of interest as a potential B cell epitope for the development of a malaria subunit vaccine.     

Antigen-induced tolerance by intrathymic modulation of self-recognizing inhibitory receptors

CD1d-restricted invariant natural killer T cell (iNKT cells) have a limited T cell receptor (TCR) repertoire and share characteristics common to T cells and natural killer cells. While intrathymic selection facilitates the production of T cells carrying self major histocompatibility complex-restricted TCRs, natural killer cells carry an appropriate repertoire of self major histocompatibility complex-recognizing receptors to avoid self-reactivity. Here we show that chronic exposure to specific glycolipid antigen resulted in iNKT cell disappearance and thymus-dependent repopulation of iNKT cells with increased expression of inhibitory Ly-49 molecules that resulted in impaired responsiveness. Thymic selection of peripheral Ly-49-expressing iNKT cell repertoire inhibited cytokine production and other functions in vivo. These observations emphasize the acquisition of self-recognizing inhibitory receptors on NKT cells as a previously unknown mechanism of thymic tolerance after chronic antigen exposure.     

Studies on the specificity of anti-erythrocyte antibodies in the serum of patients with malaria

Sera from patients with Plasmodium falciparum, P. vivax or P. ovale malaria were selected according to their high levels of antibodies against human erythrocyte membranes as measured in a microELISA. The specificity of the anti-erythrocyte antibodies in these sera and two normal sera was investigated by means of an immunoblotting technique in combination with SDS-polyacrylamide gel electrophoresis. All the patients' sera as well as the control sera contained antibodies against several erythrocyte polypeptides. As compared with normal sera, most malaria sera showed elevated levels of antibodies against polypeptides of 80K, 70K, 40K and 28K molecular weights. Two sera reacted strongly against a polypeptide with an electrophoretic mobility similar to the alpha subunit of spectrin. One serum showed strong reaction and several other sera, including normal sera, showed weak reaction against a 45K molecular weight polypeptide corresponding to actin. No pervading differences were seen in the pattern of specificities of the anti-erythrocyte ghost antibodies between sera from patients with P. falciparum, P. vivax or P. ovale infections.     

Immunogenicity and antigenicity in rabbits of a repeated sequence of Plasmodium falciparum antigen Pf155/RESA fused to two immunoglobulin G-binding domains of staphylococcal protein A.

A synthetic gene encoding a tetramer of the repeated subunit EENVEHDA of the Plasmodium falciparum antigen Pf155/RESA was expressed in a dual-expression system. The resulting fusion proteins, designated ZZ-M1 and BB-M1, comprised the EENVEHDA repeats and either two immunoglobulin G-binding domains from staphylococcal protein A or the human serum albumin-binding domains from streptococcal protein G, respectively. The soluble fusion proteins were affinity purified to homogeneity in one-step procedures. ZZ-M1 was used for immunization of rabbits. The rabbit antisera reacted with BB-M1 in an enzyme-linked immunosorbent assay and with Pf155/RESA in immunofluorescence of infected erythrocytes and immunoblotting. Inhibition studies revealed that the antibodies mainly recognized epitopes formed by two or more EENVEHDA subunits and were remarkably specific for Pf155/RESA. Importantly, the antibodies also inhibited P. falciparum merozoite reinvasion in vitro efficiently, indicating that they reacted with biologically important epitopes exposed on the native antigen. Immunization with Freund complete adjuvant resulted in high levels of specific immunoglobulin G antibodies over a 1-year period, whereas the antibody response obtained after immunization without adjuvant was generally weaker, immunoglobulin G and M mediated, and not sustained for longer periods. However, these titers were restored after booster injection. Taken together, the results support the usefulness of recombinant gene constructs of this type as immunogens for malaria vaccines.     

Passive immunization of Aotus monkeys with human antibodies to the Plasmodium falciparum antigen Pf155/RESA.

In order to assess the protective effects of anti-Pf155/RESA antibodies of different specificities in vivo, passive immunizations of Aotus monkeys were performed. Antibodies reactive with the Pf155/RESA repeat sequences (EENV)2 and EENVEHDA were isolated from the immunoglobulin G (IgG) fraction of a pool of plasmas from Liberia by affinity chromatography on synthetic peptides. The two fractions of antibodies differed in specificity but displayed similar capacities to inhibit merozoite invasion in Plasmodium falciparum in vitro cultures. Four groups of monkeys (named groups I to IV) were injected with (i) 160 mg of total control IgG, (ii) 2 mg of IgG affinity purified on (EENV)2, (iii) 2 mg of IgG affinity purified on EENVEHDA, and (iv) 160 mg of total immune IgG, respectively. The monkeys were then challenged with P. falciparum-infected erythrocytes, and the levels of parasitemia and hematocrits as well as other serological parameters were determined daily. Although all groups developed parasitemia, groups II and IV tended to show lower mean daily levels. Three monkeys of group II and two monkeys (each) of groups III and IV self cured the infections, but so did one monkey from the group treated with control IgG (group I). The serum levels of transfused antibodies were low at the peak of parasitemia, suggesting that clearance of parasites was mediated by immune responses mounted by the monkeys. The results indicate that antibodies to epitopes formed by repeats of Pf155/RESA may depress P. falciparum parasitemias and thus that immunogens based on such repeats should be suitable components in a subunit vaccine against asexual stages of P. falciparum.     

Absence of antigenic diversity in Pf155, a major parasite antigen in membranes of erythrocytes infected with Plasmodium falciparum.

Pf155 is a merozoite-derived polypeptide antigen which the parasite Plasmodium falciparum deposits in the membranes of erythrocytes at invasion. Eleven laboratory strains or clones of P. falciparum and a large number of isolates obtained from patients from different parts of the world were studied for antigenic diversity in Pf155. Immunoglobulin G antibodies from different serum samples from P. falciparum-infected donors were affinity purified on monolayers of glutaraldehyde-fixed and air-dried erythrocytes infected with P. falciparum of different origins and tested in different combinations by immunoblotting, reinvasion inhibition, and a modified immunofluorescence procedure in which the membranes of recently infected erythrocytes were stained. Similar experiments were performed with monoclonal and oligoclonal antibodies specific for different epitopes in the C-terminal region of Pf155. No strain- or isolate-associated antigenic diversity or size variation of Pf155 was detected, indicating that the immunodominant regions of this antigen are highly conserved throughout the world.     

Ex‐vivo analysis of human Natural Killer T cells demonstrates heterogeneity between tissues and within established CD4+ and CD4− subsets

Our understanding of human type 1 natural killer T (NKT) cells has been heavily dependent on studies of cells from peripheral blood. These have identified two functionally distinct subsets defined by expression of CD4, although it is widely believed that this underestimates the true number of subsets. Two recent studies supporting this view have provided more detail about diversity of the human NKT cells, but relied on analysis of NKT cells from human blood that had been expanded in vitro prior to analysis. In this study we extend those findings by assessing the heterogeneity of CD4⁺ and CD4⁻ human NKT cell subsets from peripheral blood, cord blood, thymus and spleen without prior expansion ex vivo, and identifying for the first time cytokines expressed by human NKT cells from spleen and thymus. Our comparative analysis reveals highly heterogeneous expression of surface antigens by CD4⁺ and CD4⁻ NKT cell subsets and identifies several antigens whose differential expression correlates with the cytokine response. Collectively, our findings reveal that the common classification of NKT cells into CD4⁺ and CD4⁻ subsets fails to reflect the diversity of this lineage, and that more studies are needed to establish the functional significance of the antigen expression patterns and tissue residency of human NKT cells.     

Successful Two-Stage Exchange Arthroplasty for Periprosthetic Infection Following Total Knee Arthroplasty: The Impact of Timing on Eradication of Infection

Background: Periprosthetic joint infection (PJI) represents a serious complication following total knee arthroplasty. In the setting of chronic infections, the two-staged approach has traditionally been the preferred treatment method. The aim of this study was to determine the optimal period of rest between the first and second stage. Furthermore, we analyzed potentially outcome-relevant parameters, such as general and local conditions and the presence of difficult-to-treat or unidentified microorganisms, with regard to their impact on successful treatment of PJI.Patients and Methods: We performed a retrospective analysis of prospectively collected data for all patients treated for PJI at our institution. Seventy-seven patients who had undergone two-stage revision arthroplasty for PJI of the knee were included into the study. Antibiotic-loaded cement spacers were used for all patients.Results: After a median follow-up time of 24.5 months, infection had reoccurred in 14 (18.7%) patients. A prolonged spacer-retention period of more than 83 days was related to a significantly higher proportion of reinfections. Furthermore, significant compromising local conditions of the prosthetic tissue and surrounding skin, as well as repeated spacer-exchanges between first- and second-stage surgery, negatively influenced the outcome. Neither the patients'' age nor gender exerted a significant influence on the outcome regarding reinfection rates for patients'' age or gender.Conclusions: We observed the best outcome regarding infection control in patients who had undergone second-stage surgery within 12 weeks after first-stage surgery. Nearly 90% of these patients stayed free from infection until the final follow-up. An increased number of performed spacer-exchanges and a bad local extremity grade also had a negative impact on the outcome.