In vitro susceptibility of fungi to killing by neutrophil granulocytes discriminates between primary pathogenicity and opportunism.

Pathogenic fungi, according to their propensity to cause infection of apparently normal individuals, can be grouped into either primary pathogens (e.g., Coccidioides, Histoplasma, Paracoccidioides, Blastomyces, and Sporothrix) or opportunists (e.g., Candida, Mucoraceae, Aspergillus spp., Petriellidium, and Trichosporon). There is, however, no unifying concept explaining the difference between the virulence of the two fungal categories. Previously we have speculated that neutrophils are the common denominator of the high natural resistance to opportunistic fungi. Accordingly, we then compared the susceptibility to killing by neutrophil granulocytes of Histoplasma, Blastomyces, Paracoccidioides, and Sporothrix with that of 14 opportunistic fungi. We found the four virulent dimorphic yeasts, in contrast to opportunistic fungi, to be resistant to killing by neutrophils. Virulent dimorphic yeasts were ingested by neutrophils, and triggered a respiratory burst comparably to opportunists but were less susceptible to hydrogen peroxide, suggesting that differences in the susceptibility to microbicidal products of leukocytes may explain the difference in virulence.

Differentiation of Cryptococcus neoformans serotypes by isoenzyme electrophoresis.

Cryptococcus neoformans has been divided into four serotypes by specific agglutination in immune rabbit sera. Based on mating characteristics of the perfect state and epidemiologic and biochemical differences, the serotypes have been divided into two major pairs. In an attempt to characterize the serotypes further, the authors studied 22 strains of C. neoformans by the technic of horizontal starch-gel isoenzyme electrophoresis. The glucose-phosphate isomerase and phosphoglucomutase of serotypes A, C, D, and a subset of the serotype B strains migrated to distinguishable locations in this system. The activities of the remainder of the serotype B strains co-migrated with the serotype C strains. Thus, this technic distinguishes all the serotypes of C. neoformans except for a subset of serotype B and should be a useful adjunct for further elucidation of the epidemiologic and biochemical differences among serotypes.

Activation of complement by pathogenic and nonpathogenic Entamoeba histolytica.

Previous studies had demonstrated that strains of Entamoeba histolytica isolated from patients with colitis or amebic liver abscess were resistant to complement-mediated killing, whereas strains from asymptomatic patients were readily lysed by non-immune serum. Both serum-sensitive and serum-resistant strains of E. histolytica depleted complement rapidly as assessed by CH50, C3, and C7, and C5-9 hemolytic activities. Activation of the alternative pathway was important in lysis of nonpathogenic strains, as demonstrated by lysis by NHS (60.9 +/- 15.6%) and NHS + 5 mM EGTA (59.3 +/- 4.5%) as well as by C4-deficient guinea pig serum (72.8 +/- 7.1%) and C2-deficient human serum (64.4 +/- 11.1%), but not by NHS + 5 mM EDTA. Classical pathway activation also occurs as both pathogenic and nonpathogenic strains deplete greater than 98% of C4 activity, although it is not necessary for lysis. Pathogenic strains are not lysed by either the classical or the alternative pathway. These results suggest that pathogenic strains of E. histolytica activate complement but are able to evade an important host defense, complement-mediated lysis.

Protection against gram-negative bacteremia and endotoxemia with human monoclonal IgM antibodies.

Hybridomas producing human monoclonal IgM antibodies (mAbs) against bacterial lipopolysaccharide (LPS) were generated by fusion of B lymphocytes from sensitized human spleen with heteromyeloma cells. The splenocytes were from patients undergoing splenectomy during staging for Hodgkin disease after vaccination with the J5 mutant of Escherichia coli, which is deficient in O antigenic side chains. This deficiency exposes the core oligosaccharide, common to LPS of all Gram-negative bacteria. The mAbs cross-reacted strongly with endotoxins from a wide range of unrelated species of Gram-negative bacteria. The mAbs also gave strong protection against LPS in the dermal Shwartzman reaction and against lethal Gram-negative bacteremia in mice. These findings indicate that monoclonal IgM against LPS endotoxin can neutralize its toxicity in vivo and might be valuable for treatment of patients with Gram-negative bacteremia. Analysis of one of the hybridoma clones, A6(H4C5), showed that the IgM mAb is directed against the covalently bound lipid A, which represents the most conservative and least variable structural element of LPS.

Specific cross-protective antigonococcal immunity in the murine genital tract.

Specific acquired immunity to gonococci was studied in systemically immunized mice, challenged with 10(7) gonococci by intrauterine inoculation. Protection after intraperitoneal immunization was monitored by vaginal cultures taken 24 h post-challenge, since events during the first 24 h postexposure to gonococci are crucial in determining the outcome of infection. Mice were protected against gonococcal challenge by two inoculations with either live or boiled gonococci given 4 weeks apart, whereas immunization with one inoculation did not protect against challenge 1 week later. Protection was correlated with high titers of IgG antibody in serum after two immunizations, but not with the high titers of serum IgM antibody found after the one immunization. IgG antibodies, but not IgM antibodies, were shown to pass into genital secretions. Protection could be passively transferred by serum with high titers of antibody. Of most practical importance was the finding that not only were heat-stable antigens protective, but also heterologous protection resulted after immunization with three strains differing in source (disseminated gonococcal infection versus gonorrhea), opacity-transparency characteristics, and serum sensitivity. The data indicate that IgG antibodies resulting from systemic immunization with heat-stable antigens may be able to provide cross-protection immunity against gonorrhea.

Killing of Aspergillus spores depends on the anatomical source of the macrophage.

To resolve the controversy over the capacity of macrophages to kill or inhibit germination of Aspergillus spores, we compared this function in peritoneal and alveolar macrophages. Alveolar macrophages from rabbits killed 82 to 90% and completely digested 72 to 82% of spores of Aspergillus fumigatus in 30 h. In contrast, peritoneal macrophages could not even inhibit the germination of ingested spores; more than 85% transformed into mycelia within 24 h. Killing by alveolar macrophages was delayed for 3 to 6 h after phagocytosis and was independent of oxidative killing mechanisms and immune activation. The ability of alveolar macrophages to kill Aspergillus spores without modulation by T lymphocytes or the generation of oxygen intermediates points out that concepts built on studies of peritoneal macrophages may be misleading and underscores the importance of studying the role of macrophages in immunity with cells from the appropriate anatomical site.

Differentiation of neisseriaceae by isoenzyme electrophoresis.

Analysis of 71 strains of Neisseriaceae by starch-gel electrophoresis of hexokinase, phosphoglucomutase, glucose phosphate isomerase, and L-malate-nicotinamide adenine dinucleotide phosphate oxidoreductase showed that all gonococci and all memingococci have a characteristic hexokinase isoenzyme that is specific for each species and clearly distinguishes meningococci and gonococci from each other and from other species of Neisseriaceae. Strains of gonococci that were transformed into maltose utilizers by DNA from Neisseria lactamica and Neisseria meningitidis showed no change in the isoenzymes so that they could still be differentiated from meningococci and other Neisseriaceae by isoenzyme electrophoresis. In view of the limited sensitivity and specificity of conventional tests for the identification of gonococci and the possibility that gonococci may be transformed into maltose utilizers by DNA from normal throat flora, electrophoresis of hexokinase isoenzymes should be useful for the precise laboratory identification of the pathogenic neisseriae, especially those from atypical sites and those giving indeterminate reactions.

Ineffectiveness of single-dose human antiserum to core glycolipid (E. coli J5) for prophylaxis of bacteremic, gram-negative infections in patients with prolonged neutropenia.

It has been recently established that serum from human volunteers immunized with E. coli J5 vaccine prevents death of patients with gram-negative shock. The present study addressed the question whether the prophylactic administration of a similar amount of J5 antiserum could protect neutropenic patients from acquiring gram-negative infections. One hundred patients, the majority of which had acute non-lymphoblastic (63%) and lymphoblastic (29%) leukemia, presented 109 episodes of neutropenia. Sixty of the 100 patients underwent bone marrow transplantation. All patients were given one unit of either pre-immune (control) or J5 antiserum serum from volunteers at the onset of neutropenia. When compared to control serum, J5 antiserum given prophylactically did not reduce the number of febrile days, the number of gram-negative bacteremic episodes, or death from these infections. This inability to demonstrate a beneficial effect of prophylaxis with a single unit of J5 antiserum in prolonged neutropenia may have several explanations that are discussed.

Resistance to lysis by human serum of pathogenic Entamoeba histolytica.

A comparison was made of susceptibility to lysis by human sera among five non-pathogenic and 11 pathogenic strains of Entamoeba histolytica already characterized into zymodemes. The nonpathogenic strains were found to be uniformly susceptible to lysis. Nine of 11 pathogenic strains, including five strains isolated from liver abscesses, were found to be resistant to lysis by serum under identical conditions. Resistance to complement-mediated lysis may be an inherent property of most pathogenic strains and may prove to be a necessary virulence factor for dissemination.

Treatment of gram-negative bacteremia and shock with human antiserum to a mutant Escherichia coli.

In an effort to decrease deaths from gram-negative bacteremia and endotoxin shock, we treated bacteremic patients with human antiserum to endotoxin (lipopolysaccharide) core. Antiserum was prepared by vaccinating healthy men with heat-killed Escherichia coli J5; this mutant lacks lipopolysaccharide oligosaccharide side chains, so that the core, which is nearly identical to that of most other gram-negative bacteria, is exposed for antibody formation. In a randomized controlled trial, patients were given either J5 antiserum or preimmune control serum intravenously, near the onset of illness. The number of deaths in the bacteremic patients was 42 of 109 (39 per cent) in controls and 23 of 103 (22 per cent) in recipients of J5 antiserum (P = 0.011). In those with profound shock, mortality was 30 of 39 (77 per cent) in controls and 18 of 41 (44 per cent) in recipients of J5 antiserum (P = 0.003). We conclude that human antiserum to the lipopolysaccharide core can substantially reduce deaths from gram-negative bacteremia.

Activation of complement by serum-resistant Neisseria gonorrhoeae. Assembly of the membrane attack complex without subsequent cell death.

Interaction of the human complement system in normal human serum (NHS) with serum-resistant and -sensitive Neisseria gonorrhoeae was evaluated to better understand the mechanism of serum-resistance. Complement activity (CH50) was depleted from NHS in a dose-dependent fashion by both serum-resistant and -sensitive N. gonorrhoeae. No detectable CH50 remained in NHS incubated with 10(9) colony-forming units (CFU)/ml serum of either resistant or sensitive strains. When smaller numbers of bacteria were incubated with NHS, lesser, yet comparable, amounts of CH50 were depleted by both resistant and sensitive strains. Hemolytic C2 activity was diminished by 33% in the case of resistant N. gonorrhoeae (10(8) CFU/ml serum) and by 48% in the case of a sensitive strain. No detectable decreases in hemolytic C4 or C7 activities were found with either sensitive or resistant strains at this concentration. Both resistant and sensitive strains activated C1s in NHS. Resistant strains specifically activated 19-21% of radiolabeled C1s in NHS, whereas sensitive strains activated 18-32%. Both resistant and sensitive strains also activated C5 in NHS. In binding assays using radiolabeled C5 and C9 in NHS, resistant and sensitive strains bound comparable amounts of C5 and C9. The number of bound C5 and C9 molecules varied according to the number of bacteria or amount of serum used in the assay. The ratio of C9/C5 bound to a sensitive strain was 6.8, and to a resistant strain was 8.2, suggesting that C5 and C9 were incorporated into membrane attack complexes (MAC). Electron microscopic examination of resistant and sensitive strains incubated with NHS revealed that MAC is bound to the surfaces of the resistant strain as well as the sensitive strain.

Induction of immunity against lethal Haemophilus influenzae type b infection by Escherichia coli core lipopolysaccharide.

Efforts to prevent Haemophilus influenzae type b (HIB) infections in infancy have been hampered by the low immunogenicity of capsular polysaccharide vaccines in children younger than 18 mos. In searching for alternate immunogens, we have studied the protective potential of polysaccharide-poor, lipid-rich endotoxin (LPS) core in experimental HIB infections. Because all gram-negative bacteria have similar LPS core structures, we were able to use as vaccine the J5 mutant of Escherichia coli 0111, the LPS of which consists only of core components, and thus to avoid problems in interpretation arising from vaccine contamination with non-LPS HIB immunogens. Mice were given graded inocula of HIB and developed lethal infection analogous to human HIB disease when virulence was enhanced with mucin and hemoglobin. After active immunization with heat-killed E. coli J5, 40/50 (80%) of infected mice survived, compared with 14/50 (28%) of saline-immunized controls (P less than 0.005). Passive immunization with rabbit antiserum against E. coli J5 prevented lethal HIB infection when administered 24 or 72 h before or 3 h after infection. This protection was abolished by adsorption of antiserum with purified J5 LPS, with survival reduced from 14/24 to 0/24 (P less than 0.005). Furthermore, rabbit antiserum to purified J5 LPS gave just as potent protection against death as antiserum to whole J5 cells. These studies demonstrate that immunity to core LPS confers protection against experimental murine HIB infection and provide the framework for a new approach to prevention of human disease from HIB.

The role of C9 in complement-mediated killing of Neisseria.

During the routine examination of a healthy 31-yr-old woman, we found an incomplete deficiency of the 9th component of complement (C9). By hemolytic assay her serum C9 activity was 10 to 15% of normal. Limited family studies suggested that she inherited the deficiency as an autosomal codominant trait. She had no history of unusual or severe infections. When tested for bactericidal activity against serum-sensitive Neisseria gonorrhoeae and N. meningitidis, her serum reacted comparably to normal serum. Normal serum depleted immunochemically of C9 and sera from congenitally C9-deficient patients were also bactericidal against serum-sensitive Neisseria but required 120 min to kill the same numbers of gonococci that intact serum killed within 30 min. In the electron microscope, N. gonorrhoeae incubated with C9-depleted serum were fragmented but lacked the typical C lesions. Therefore, serum lacking C9 can kill serum-sensitive Neisseria, unlike sera deficient in the other terminal C components.

Immunization against nosocomial infection.

Overwhelming infection with gram-negative bacteremia has become the most serious nosocomial infection in compromised patients. Because gram-negative bacteria share a common core lipopolysaccharide, we tried to develop a single vaccine or antiserum that might control these infections regardless of species. We used a mutant of Escherichia coli 0111 (J5) deficient in uridine diphosphate-galactose (UDP-GAL) epimerase and thus unable to attach "0" side chains, so that core lipopolysaccharide was exposed. A vaccine composed of this mutant produced antibody that gave broad protection against lethal infections by different gram-negative bacteria in immunosuppressed animals. The J5 vaccine protected against 98 percent lethal doses of Pseudomonas aeruginosa, and J5 antiserum improved survival tenfold in animals dying of Esch. coli, Klebsiella and Pseudomonas bacteremia. The protection with vaccine or prophylactic antiserum was undiminished in animals challenged six weeks after immunization. Encouraged by these results, we conducted a double-blind trial in patients with gram-negative bacteremia. In those given J5 antiserum, the mortality rate was cut in half and survival from deep shock increased from 28 percent to 82 percent. Because of these preliminary results in 136 patients, the study has been extended to 300 patients and the double blind code will be examined again to see if the early favorable results are confirmed and extended.