Active tuberculosis patients have high levels of IgA anti-alpha-crystallin and isocitrate lyase proteins.

SETTING: Mexico City, Mexico. OBJECTIVE: To identify proteins synthetised by Mycobacterium tuberculosis in hypoxic culture, which resemble more closely a granuloma environment than aerobic culture, and to determine if they are recognised by antibodies from patients with active pulmonary tuberculosis (PTB). DESIGN: Soluble extracts from M. tuberculosis H37Rv cultured under aerobic or hypoxic conditions were analysed using two-dimensional polyacrylamide gel electrophoresis, and proteins over-expressed under hypoxia were identified by mass spectrometry. The presence of immunoglobulin (Ig) G, IgA and IgM antibodies against these proteins was determined in the serum of 42 patients with active PTB and 42 healthy controls. RESULTS: We selected three M. tuberculosis H37Rv proteins (alpha-crystallin protein [Acr, Rv2031c], universal stress protein Rv2623 and isocitrate lyase [ICL, RV0467]) that were over-expressed under hypoxia. Titres of anti-Acr and anti-ICL IgA antibodies were higher in patients than in healthy controls, with an area under the receiver operating characteristic curve of 0.71 for anti-ICL IgA antibodies. CONCLUSION: ICL could be used in combination with other M. tuberculosis antigens to improve the sensitivity and specificity of current serological TB diagnostic methods.

Low-dose amphotericin B and murine dialyzable spleen extracts protect against systemic candida infection in mice.

Candida albicans causes opportunistic systemic infections with high mortality (30%-50%). Despite significant nephrotoxicity, amphotericin (AmB) is still used for the treatment of this serious fungal infection. Therefore, alternative treatments are urgently needed. Dialyzable leukocyte extracts have been used successfully to treat patients with mucocutaneous candidiasis, but their effectiveness in systemic candidiasis has not been evaluated. In this study, low-dose AmB (0.1 mg/kg) plus 10 pg of murine dialyzable spleen extracts (mDSE) were tested in a systemic candidiasis mouse model. Survival, tissue fungal burden, kidney damage, kidney cytokines, and serum levels of IL-6 and hepcidin were evaluated. Our results showed that the combined treatment of low-dose AmB plus mDSE improved survival and reduced kidney fungal burden and histopathology; these effects correlated with increased kidney concentration of IFN- γ and TGF- ß 1, decreased levels of TNF- α , IL-6, and IL-10, as well as high levels of systemic IL-6 and hepcidin. Low-dose AmB and mDSE synergized to clear the infectious agent and reduced tissue damage, confirming the efficacy of a low dose of AmB, which might decrease the risk of drug toxicity. Further studies are necessary to explore these findings and its implications in future therapeutic approaches.

Immunotherapeutic effects of recombinant adenovirus encoding granulocyte-macrophage colony-stimulating factor in experimental pulmonary tuberculosis.

BALB/c mice with pulmonary tuberculosis (TB) develop a T helper cell type 1 that temporarily controls bacterial growth. Bacterial proliferation increases, accompanied by decreasing expression of interferon (IFN)-γ, tumour necrosis factor (TNF)-α and inducible nitric oxide synthase (iNOS). Activation of dendritic cells (DCs) is delayed. Intratracheal administration of only one dose of recombinant adenoviruses encoding granulocyte-macrophage colony-stimulating factor (AdGM-CSF) 1 day before Mycobacterium tuberculosis (Mtb) infection produced a significant decrease of pulmonary bacterial loads, higher activated DCs and increased expression of TNF-α, IFN-γ and iNOS. When AdGM-CSF was given in female mice B6D2F1 (C57BL/6J X DBA/2J) infected with a low Mtb dose to induce chronic infection similar to latent infection and corticosterone was used to induce reactivation, a very low bacilli burden in lungs was detected, and the same effect was observed in healthy mice co-housed with mice infected with mild and highly virulent bacteria in a model of transmissibility. Thus, GM-CSF is a significant cytokine in the immune protection against Mtb and gene therapy with AdGM-CSF increased protective immunity when administered in a single dose 1 day before Mtb infection in a model of progressive disease, and when used to prevent reactivation of latent infection or transmission.

Differential pattern of cytokine expression by macrophages infected in vitro with different Mycobacterium tuberculosis genotypes.

It has been shown recently that different genotypes of Mycobacterium tuberculosis induce distinct immune responses in the host, as reflected by variations in cytokine and iNOS expression. Because these molecules are probably regulated by multiple factors in vivo this complex phenomenon was partially analysed by assessing cytokine and iNOS expression by real-time polymerase chain reaction (PCR) and enzyme-linked immunosorbent assay (ELISA) in an in vitro model of bone marrow-derived macrophages infected with three different M. tuberculosis genotypes: Canetti, H37 Rv and Beijing. Although the three genotypes induced production of iNOS and the different cytokines tested at 24 h post-infection, macrophages infected with the Beijing isolate expressed the highest levels of mRNA for iNOS, interleukin (IL)-1beta, tumour necrosis factor (TNF)-alpha, IL-12 cytokines and lower levels of IL-10 compared with cells infected with other genotypes. This expression pattern has been associated with infection control, but during infection in vivo with the Beijing genotype it is lost upon progression to chronic phase. The failure to control infection is likely to be influenced by cytokines produced by other cell types and bacterial molecules expressed during the course of disease. Results presented in this work show that each genotype has the ability to induce different levels of cytokine expression that could be related to its pathogenesis during infection.

[Transfer factor as specific immunomodulator in the treatment of moderate-severe atopic dermatitis]. / Factor de transferencia como inmunomodulador específico en el tratamiento de la dermatitis atópica moderada a severa.

BACKGROUND: Atopic dermatitis is a skin inflammatory disease which has been associated to high levels of IgE, eosinophiles and change of T lymphocytes. The transfer factor is an immunomodulator active substance and decreases the number of inflammatory cells and the severity of the symptoms of atopic dermatitis. OBJECTIVE: To determine the efficacy of the transfer factor as treatment of moderate and severe atopic dermatitis. MATERIAL AND METHODS: Articles related to treatment with transfer factor in the atopic dermatitis were looked up in Medline and EMBASE, and the ones referring to controlled studies in patients with moderate and severe atopic dermatitis in accord to SCORAD. RESULTS: We found seven articles with 121 patients and 88 controls demonstrating significant decrease in the symptoms of the SCORAD index, decreased IgE, and eosinophils in patients treated with transfer factor. CONCLUSIONS: The transfer factor is a choice treatment for moderate and severe atopic dermatitis.

The effect of iron on the expression of cytokines in macrophages infected with Mycobacterium tuberculosis.

Iron is known to play an important role in different bacterial infections and, in particular, in their development. One example is infection with Mycobacterium tuberculosis where iron contributes to growth and survival of the bacteria within the host cell. The majority of studies performed on tuberculosis have focused on the direct effect of iron on bacterial growth; however, little is known about how iron modifies the mycobacterial-host interaction. In order to address this, we have investigated the effect of iron on intracellular growth of M. tuberculosis in J774 macrophages and the molecular mechanisms that are affected during this interaction. We observed that iron modifies intracellular growth of the mycobacteria and that their growth kinetics was modified from that observed for the extracellular situation in the presence of iron. Similarly, when iron was present during the infection, there was a reduced release of tumour necrosis factor-alpha and it was related to a higher number of bacilli inside the host cell and low expression of interleukin-1 (IL-1) and IL-6 mRNA. Hence, this work demonstrates that iron, besides promoting mycobacterial growth, also regulates the relationship between macrophage and bacteria.

Transfer factors as immunotherapy and supplement of chemotherapy in experimental pulmonary tuberculosis.

Problems of logistics, compliance and drug resistance point to an urgent need for immunotherapeutic strategies capable of shortening the current six month antibiotic regimens used to treat tuberculosis. One potential immunotherapeutic agent is transfer factors. Transfer factors (TF) are low molecular weight dialysable products from immune cells which transmit the ability to express delayed-type hypersensitivity (DTH) and cell mediated immunity from sensitized donors to nonimmune recipients. In this study we determined the efficiency of TF as immunotherapy to treat experimental tuberculosis. When BALB/c mice are infected via the trachea with Mycobacterium tuberculosis H37Rv there is an initial phase of partial resistance dominated by Th-1 type cytokines plus tumour necrosis factor-alpha (TNFalpha) and the inducible isoform of nitric oxide synthase (iNOS), followed by a phase of progressive disease characterized by increasing expression of IL-4, diminished expression of TNFalpha and iNOS, and low DTH. Animals in this late progressive phase of the disease (day 60) were treated with different doses of TF (one injection per week) obtained from spleen cells when the peak of immune protection in this animal model is reached (day 21), or with different doses of TF from peripheral leucocytes of PPD + healthy subjects. We show here that the treatment with murine or human TF restored the expression of Th-1 cytokines, TNFalpha and iNOS provoking inhibition of bacterial proliferation and significant increase of DTH and survival. This beneficial effect was dose dependent. Interestingly, murine TF in combination with conventional chemotherapy had a synergistic effect producing significant faster elimination of lung bacteria loads than chemotherapy alone.

Immunomodulatory properties of Mycoplasma pulmonis. II. Studies on the mechanisms of immunomodulation.

Mycoplasma infection affects the host's immune system in different ways. In this work, a kinetic approach was used to try to determine the mechanisms by which Mycoplasma cause these effects. Experiments were performed using Balb/c mice infected with Mycoplasma pulmonis and several immunological parameters were determined. It was found that at days 10 and 15 post-infection, there were significant changes in the percentages of CD4+ and CD8 + cells, in both peripheral blood and the thymus. Significant sequential increases in concentrations of both IFN-gamma and IL-4 were detected in sera, such that at day 15, there was a peak in IFN-gamma, concentration and at day 38, IL-4 concentration also peaked. By day 46, both IFN-gamma and IL-4 fell to control levels despite continued infection. Delayed hypersensitivity (DTH) was reduced in infected animals compared to non-infected controls. A small recovery in DTH was observed at day 30, which was reduced again by day 40. Altogether, the results show features of a transitional shift from Th1 to Th2 in animals that are ultimately immunologically incompetent (in both cellular and humoral immunity). It appears to be this state of incompetence that allows the microorganism to survive and thus provides an explanation for the chronic state of the disease, which is a characteristic of Mycoplasma infection.

[Safety and efficacy of treatment for severe atopic dermatitis with cyclosporin A and transfer factor]. / Seguridad y eficacia en el tratamiento de la dermatitis atópica severa con ciclosporina A y factor de transferencia.

BACKGROUND: The atopic dermatitis is a chronic skin disease that appears in patients with a personal or family history of allergic asthma and rhinitis. It is associated to the specific activation of a gene group. In most instances, the response to the conventional treatment is adequate. The are cases, though, know as refractory, where that is not the case. The study of two therapeutic alternatives, Transfer Factor (TF) and Cyclosporin A (CyA), was elaborated for this type of patients. MATERIAL AND METHODS: Patients with severe refractory AD were studied, being admitted to the Allergic Service to the ISSSTE Lic. Adolfo López Mateos, ISSSTE, between September 1997 and june 1998. They were randomly divided in two groups. The first one was subjected to CyA, on a 4 mg/kg/day dosage, with monthly surveillance of kidney and hepatic functions and blood pressure twice a week. Group two was subjected to TF, as follows: one unit every third day for the first week, two units per week for the next three weeks and one monthly unit to complete six months. Initial and final clinical and immunologic testing was performed on both groups (eosinophils, total IgE, CD4 and CD8). RESULTS: Six patients included group A, and 12 patients in group B. Both groups showed a significant statistic reduction in the total eosinophils count, without an statistic difference between them. None showed changes in the total IgE. CyA reduced the CD4 levels, while the TF increased the levels of CD8 cells, both with a p < 0.05. Both groups showed clinical improvement satistically significant, but no differences with a p > 0.05 appeared between them. Tolerance to the treatments was adequate, and there was not need to suspend the treatment in any case. Only three patients showed hypertricosis and other one presented headaches, with CyA. CONCLUSION: Both treatments showed therapeutic benefits in the treatment of patients with severe refractory AD, with similar immunologic improvement. Both drugs present different action mechanisms, so their joint application could offer clinical benefit to the patient (synergetic action), cost reduction, and long term treatments with reduced adverse effects.

IgG antibody subclasses, tumor necrosis factor and IFN-gamma levels in patients with type II lepra reaction on thalidomide treatment.

A group of 9 Mexican lepromatous leprosy patients was studied at the beginning of a type II reaction (erythema nodosum leprosum, ENL) and after 1 or 2 months of thalidomide treatment. ENL patients at the onset of the reaction had slightly higher amounts of anti-Mycobacterium leprae IgG1 and IgG2 antibodies, compared to similar lepromatous patients that did not develop ENL. Neither these antibody levels nor IgM and the other IgG subclasses were importantly modified after thalidomide treatment. Serum TNF was significantly higher in the patients that developed ENL compared to those that did not develop the reaction. TNF levels were slightly decreased after 1 month of thalidomide treatment and significantly decreased after 2 months of treatment. Serum IFN-gamma was significantly lower in patients at the onset of ENL and was increased after 1 and 2 months of thalidomide treatment.

Purification of the lipophosphoglycan from two Leishmania mexicana strains by lectin affinity chromatography.

Two lipophosphoglycans (LPG) from two Leishmania mexicana (Soberano and Yucatan) strains, isolated in Mexico, were purified by affinity chromatography with the Con A lectin. The LPG from each strain, with a 10 kDa molecular weight, possesses two fractions: one with high mannose concentrations and the other with a more heterogeneous saccharidic composition; the mannose-rich fraction and the heterogeneous fraction from the Yucatan strain show a single band of identity with rabbit IgG against promastigotes from L. mexicana Yucatan. Antigen recognition was abolished by treating the high mannose LPGs with alpha-mannosidase. The presence of non reductor alpha-mannose sequences, as determinant epitopes in L. mexicana Soberano and Yucatan strains, was determined by mass spectrometry analysis and enzymatic cleavage.

[Transference factor in moderate and severe atopic dermatitis]. / Factor de transferencia en dermatitis atópica moderada y severa.

We did a prospective, comparative, experimental study with 30 patients with moderate to severe atopic dermatitis from the allergy section from September 1994 to March, 1995. The test laboratory examination was performed in all patients: complete blood cell count, immunoglobulins A, G, M and E determination, lymphocyte subpopulations CD3, CD4, CD8, CD4-CD8 proportion, CD25, rosette formation for B and T lymphocytes, coproparasitoscopic examination, throat and nose cultures, nasal cytology, skin tests of cellular immunity to PPD, thrichophytin, candidine, varidasa; skin prick test to poliens, fungi, inhalants and foods. All patients underwent to a sign and symptom grading score system as follows: the parameters were erythema, pruritus, eczema, papule valorated on a scale from 0 a 4+( O = no symptoms, + = mild, ++ = moderate, + ++= severe, ++ ++ = very severe). Initially all patients received one placebo unit every 15 days orally 3 times, then one after 30 days. Laboratory examination was performed and then treatment with transfer factor was initiated, initially 1 unit every 15 days three times and the fourth 30 days after. 15 days after the last dose a new immunological valoration was done. Results demonstrate a CD4 cell decrement, blood eosinophil and lgE dissemination although they're not statistically significative. There was a statistically significative improvement in the 4 clinical parameters: erythema, eczema, pruritus and populous with the use of Transfer Factor.

Recognition of lipid antigens by sera of mice infected with Mycobacterium lepraemurium.

Lipids extracted from mouse tissues infected with Mycobacterium lepraemurium (MLM) were analyzed by thin-layer chromatography. Although the extracted lipids were heterogeneous in polarity, the lipids of intermediate polarity were the ones that predominated. All of the lipids of intermediate polarity were glycosylated species. There were also lipids of low and high polarity, the latter being glycolipids. Compared to lipids extracted from normal tissue (mostly to lipids of high and low polarity), all of the additional lipids extracted from the infected tissue corresponded to lipids present in the purified bacteria. Enzyme-linked immunoassays (ELISAs) were then performed with the whole lipids extracted from purified bacilli, the lipids of high, intermediate and low polarity, and the sera from 20 normal and 20 MLM-infected mice. Lipids of intermediate polarity were specifically recognized by MLM-infected mice. Neither sera (diluted 1:500) from normal mice nor infected mice reacted with the lipids of high or low polarity, but a higher concentration (sera diluted 1:100) of some sera from mice in both groups reacted significantly with these lipids. In the ELISAs the whole-lipid extract and the lipids of intermediate polarity were similarly recognized by the sera of the infected mice. Thus, as observed in human leprosy, the mycobacterial disease in the mouse (murine leprosy) is also accompanied by the development of antibodies to the glycolipids of the infecting microorganism.

Thalidomide and its metabolites have no effect on human lymphocyte proliferation.

Thalidomide is a drug that is being used in several diseases with an immunological component, but the effects on the different immune functions have only been studied partially. Therefore, we studied the effect of thalidomide on PPD-or Con-A-induced proliferation of human mononuclear cells. We found no direct effect of thalidomide at up to 50 micrograms/ml on the cultures. Cells taken from subjects 6 h after ingestion of 200 mg of thalidomide proliferated equally well to PPD and Con-A than cells taken prior to drug administration. Plasma taken from subjects that ingested 200 mg of thalidomide 6 h before did not affect the proliferative response of their own cells when added to the cultures. Plasma from rabbits that were injected with doses 5 or 15 times higher than the dose given to humans did not diminish the proliferative response of human mononuclear cells to PPD. We conclude that neither thalidomide nor its metabolites affect the proliferative response of human mononuclear cells.

Evolution of lymphocyte populations in armadillos (Dasypus novemcinctus) inoculated with M. leprae.

In human leprosy patients there are changes in the percentages of T and B lymphocytes in peripheral blood, and there is a correlation with the clinical characteristics or manifestations of the disease. These phenomena still require clarification regarding the triggering mechanism involved that may lead to one or the other clinical entities. Much has yet to be learned about the intricacies of whether the changes in subpopulations of T and B lymphocytes are a causative factor or an effect attributable to the microorganism itself. The armadillo is an excellent animal model to study how Mycobacterium leprae spread, turning into an established infection. The application of modifications in percentages of the subpopulations of B and T lymphocytes in armadillos may well lead to extrapolation of the results obtained in this animal model in an attempt to be able to manipulate the course of the disease in humans. The purpose of the study was to evaluate changes in the percentages of rosette-forming and sIgM+ mononuclear cells during a full year in groups of armadillos: five randomly chosen animals formed the control group and 11 armadillos were inoculated with M. leprae obtained from a human leproma at the onset of the 12-month period of the study. Of the 11 randomly selected armadillos that were inoculated, only five developed an active and disseminated infection. The percentage of rosette-forming cells did not show statistically significant variations during the first 6 months of the study. However, at months 8 and 12 a significant increment in this parameter was observed (p < 0.05) in the animals with active infection. In regard to the variations in the numbers of sIgM+ cells, significant changes occurred in the armadillos with active infection at month 2. However, results returned to normal and no changes were seen at later times. No significant changes occurred in the group of animals inoculated but not developing active infection compared with the other groups. The results are considered sufficiently interesting to encourage further study on the cell-mediated immune system of the armadillo and the changes that occur during the development and dissemination of an inoculated infection with M. leprae. Since this mammal is of great value as an effective animal model in the experimental research of M. leprae, there is an urgent need to obtain, as quickly as possible, a thorough understanding of the cellular branch of its immune system and, thereby, be in a position to extrapolate immune modulation to benefit human leprosy patients.

Immune response of armadillos (Dasypus novemcinctus). I. Use of lectins to identify lymphocyte subpopulations and to evaluate cell proliferation.

Lectins have been used to study populations and discrete differentiation stages of lymphocytes. Likewise, lectins have been of practical importance in promoting mitogenic stimulation of lymphocytes in numerous species. In this research project, we took advantage of these tools in an attempt to identify specific subsets of peripheral blood lymphocytes obtained from healthy nine-banded armadillos (Dasypus novemcinctus). The same cell source served to evaluate mitogenic stimulation. Twelve FITC-labeled lectins were used; 5 (ConA, LcH, RCA, WGA and UEA) reacted with almost 100% of the lymphocytes and 7 (PNA, DBA, SBA, PCA, PHA-L, PWM and VVA) recognized variable percentages (< 100% of these cells). This latter group of lectins may be useful in the identification of armadillo lymphocyte subsets, or may correlate with discrete stages of differentiation of these cells. The same lectins served to evaluate mitogenic stimulation in an aliquot of the same peripheral blood mononuclear cells. Of the 12 lectins studied, 5 (ConA, PHA-L, PWM, DBA and SBA) had the capacity to induce mitogenic stimulation in the whole mixture of mononuclear cells, giving rise to variable degrees in the corresponding mitogenic index obtained for each of the 5 lectins. Those lectins that gave an indication of selective identification of lymphocytes, that is, the percentages at or below 75%, may prove useful in the evaluation of the immune response of healthy armadillos as well as the evolution of progression stages of lepromatous leprosy in armadillos inoculated with the same strain of Mycobacterium leprae that affects humans.

Identification and purification of armadillo (Dasypus novemcinctus) immunoglobulins: preparation of specific antisera to evaluate the immune response in these animals.

In this work we describe the purification and characterization of armadillo immunoglobulins. The IgM was precipitated using low-strength ionic solution and further purified by filtration through Sephadex G-200. The IgG was obtained in pure form by precipitation of serum with ammonium sulfate and DEAE-cellulose ion exchange chromatography. The purity of these immunoglobulins was evaluated by polyacrylamide gel electrophoresis. The results showed 28-kDa light chains and 55-kDa and 70-kDa heavy chains for IgG and IgM, respectively. The rabbit antibodies against these molecules were used to prepare fluorescein (FITC) and peroxidase conjugates. The FITC conjugate was used to quantify IgM-bearing lymphocytes. An average of 17% of peripheral blood lymphocytes were sIgM+ from 14 healthy animals. Additionally, in the same animals we quantified lymphocytes with the capacity to form rosettes with sheep red-blood cells; the average for this marker was 10%. Also, the production of crossreacting antibodies to BCG was evaluated in healthy and Mycobacterium leprae-inoculated animals using the peroxidase conjugates. All animals with active infection recognized BCG antigens.