Improving antibiotic treatment of bacterial biofilm by hyperbaric oxygen therapy: Not just hot air.

Bacteria and fungi show substantial increased recalcitrance when growing as infectious biofilms. Chronic infections caused by biofilm growing microorganisms is considered a major problem of modern medicine. New strategies are needed to improve antibiotic treatment of biofilms. We have improved antibiotic treatment of bacterial biofilms by reviving the dormant bacteria and thereby make them susceptible to antibiotics by means of reoxygenation. Here we review the rationale for associating lack of oxygen with low susceptibility in infectious biofilm, and how hyperbaric oxygen therapy may result in reoxygenation leading to enhanced bactericidal activity of antibiotics. We address issues of feasibility and potential adverse effects regarding patient safety and development of resistance. Finally, we propose means for supplying reoxygenation to antibiotic treatment of infectious biofilm with the potential to benefit large groups of patients.

Bispecific-monoclonal-antibody-directed lysis of ovarian carcinoma cells by activated human T lymphocytes.

Two different bispecific hybrid antibodies were established by fusing a hybridoma producing monoclonal antibody (mAb) against the pancarcinoma antigen KS1/4 with either of the two hybridomas OKT3 and 9.3, secreting antibodies reactive with the T cell determinants CD3 and CD28, respectively. The KS1/4 antibody reacts with a 40-kDa cell-surface glycoprotein antigen that is expressed on the surface of a variety of adenocarcinoma cells, including ovarian carcinoma. The ability of the bispecific antibodies 9.3 x KS1/4 and OKT3 x KS1/4 to direct peripheral blood mononuclear cells (PBMC) specifically against OVCAR-3 ovarian carcinoma target cells was measured in a 4-h 51Cr-release assay. The bispecific antibodies were four to six times more potent in killing the OVCAR-3 target cells when compared to their parental antibodies either alone or in combination. A dose-dependent response was observed in the 10-10,000 ng/ml range. The specificity of the targeting was demonstrated by the complete inhibition of cytotoxic activity following pre-incubation of tumor target cells with the parental mAb and by the lack of killing of KS1/4-negative target cell lines. An evaluation of the efficacy of PBMC from ovarian cancer patients as effector cells revealed that their specific cytotoxicity against OVCAR-3 cells was enhanced severalfold by bispecific antibodies as compared to parental antibodies. Furthermore, stimulation of PBMC with immobilized CD3 and interleukin-2 for 4 days resulted in an enhanced directed killing of human ovarian carcinoma cells by human T effector cells and the bispecific antibodies.

A high-affinity human monoclonal IgM antibody reacting with multiple strains of Mycoplasma hominis.

Human monoclonal antibodies were produced against Mycoplasma hominis by in vitro immunization of peripheral blood lymphocytes from a healthy seropositive donor using low amounts of antigen (5 ng/ml). The immune B lymphocytes were subsequently immortalized by Epstein-Barr virus transformation followed by somatic cell fusion. Using this procedure, several specific anti-M. hominis monoclonal antibodies of mu isotype were obtained exhibiting apparent affinity constants as high as 3 x 10(9)M-1. The productivity of a number of different hybridomas was determined to be in the range 7-22 micrograms x (24 hr x 10(6) cells)-1. The specificity of one antibody, 129.1, was further characterized by enzyme-linked immunosorbent assay against several different species of Mycoplasma and by Western blot analysis. The antibody specifically bound to a protein of Mr 100,000 present in 10 of 12 different strains of M. hominis.

Human monoclonal antibodies produced by primary in vitro immunization of peripheral blood lymphocytes.

A general procedure is described for the production of human monoclonal antibodies from peripheral blood lymphocytes immunized in vitro against T-cell-dependent antigens. These lymphocytes immunized in culture were used to produce human-human or human-mouse hybridomas secreting monoclonal antibodies specific for digoxin, hemocyanin, a recombinant fragment of the gp120 envelope glycoprotein of human immunodeficiency virus (PB1), or a melanoma-associated antigen (p97). Depletion of a lysosome-rich cell population, containing large granular lymphocytes, monocytes, cytotoxic T cells, and a subset of CD8-positive T cells, was shown to be crucial before the cells could be immunized in vitro. This depletion was accomplished by treating the peripheral blood lymphocytes with the lysosomotropic agent L-leucine methyl ester. In addition, the in vitro immunization had to be supported by interleukin 2, gamma-interferon, and B-cell growth and differentiation factors, derived from irradiated, pokeweed-mitogen-stimulated human T cells. The production of human monoclonal antibodies from primary, antigen-specifically activated peripheral lymphocytes might obviate the need to immunize volunteers or patients.

Human monoclonal antibodies produced from L-leucine methyl ester-treated and in vitro immunized peripheral blood lymphocytes.

Primary in vitro immunization of peripheral blood lymphocytes has been studied for the production of human monoclonal antibodies. Depletion of a lysosome-rich cell population, containing large granular lymphocytes, monocytes, and a subset of T suppressor cells, was shown to be crucial before the cells could be immunized in vitro. The in vitro immunized lymphocytes were used to produce human x human and human x mouse hybridomas secreting monoclonal antibodies specific for digoxin, hemocyanin, or a recombinant fragment of gp120 of human immunodeficiency virus.

Effect of cytokines on specific in vitro immunization of human peripheral B lymphocytes against T-cell dependent antigens.

The requirements for a primary, antigen-specific in vitro immunization of human peripheral lymphocytes using haemocyanin, a T-cell dependent antigen, have been studied. In order to obtain a specific response in vitro the peripheral lymphocytes had to be separated into B, T, accessory (A) and dendritic (D) cells. These cells were activated and reconstituted to give a population with a B:T ratio of 1:2. If the induction was supported by MHC-restricted, radioresistant T cells, this cell population could then be antigen-specifically activated using haemocyanin. The immunization had also to be supported by cytokines, such as B-cell growth and differentiation factors, interleukin-2 and gamma-interferon. A 5-day in vitro immunization using 2 micrograms haemocyanin/ml resulted in 200-300 cells secreting anti-haemocyanin-specific antibodies per 10(6) B cells.

In vitro immunization. Effect of growth and differentiation factors on antigen-specific B cell activation and production of monoclonal antibodies to autologous antigens and weak immunogens.

The antigen-specific activation of murine nonimmunized B lymphocytes subsequently used in hybridization experiments has been investigated by using phylogenetically conserved antigens or autologous immunogens. This in vitro immunization was supported by B cell growth and differentiation factors derived from phorbol myristate acetate-stimulated EL-4 thymoma cells and mixed lymphocyte cultures (MLC). A filter immuno-plaque assay was used to evaluate the effect of different activation procedures on the number of antigen-specific plaque-forming cells (PFC). We first determined the requirement for MLC-derived lymphokines in the in vitro immunization. An optimal number of antigen-specific PFC was obtained when using 33 to 50% of the supernatant from a 48-hr MLC to support the activation. B cell growth and differentiation factors derived from EL-4 cultures were then tested for their abilities to potentiate the number of PFC by using both unseparated spleen cells and highly purified Ig-positive B cells as target cells. The combination of lymphokines found in supernatants from 25% EL-4 thymoma culture and 33% MLC yielded the highest number of PFC when used to support an in vitro immunization. This optimal factor preparation was used to determine the kinetics (4 to 7 days) and the dose response (0.01 to 10 micrograms antigen/ml) of antigen-specific B cell activation before using the immunized splenocytes as parental cells in cell fusion experiments. Mouse albumin and hemoglobin, actin (25 micrograms/ml), RNA polymerase II (5 micrograms/ml), as well as syngeneic mouse serum were used to immunize BALB/c spleen cells in vitro. We obtained antigen-specific PFC by using all of the different immunogens, including syngeneic mouse serum, and the in vitro immunized cells were then used in hybridization experiments. The specific efficiencies of each fusion that made use of cells immunized with mouse albumin, hemoglobin, syngeneic mouse serum, actin, or RNA polymerase II were 12, 31, 33, 52, and 22%, respectively, which illustrated the apparent lack of immune tolerance found when the immunization was performed in culture.

Concanavalin A-induced B-cell proliferation mediated by allogeneically derived helper factors.

Highly purified, small, resting murine Ig-positive spleen cells could be induced to proliferate by concanavalin A (Con A) if the activation was supported by allogeneic helper factors (AHF). Con A or AHF alone was unable to induce cell proliferation as determined by incorporation of [methyl-3H] thymidine. However, if AHF produced by a mixed lymphocyte culture was present together with Con A, the B lymphocytes were strongly activated exhibiting a stimulation index of approximately 2000 as compared to Con A alone. The dose-response maximum was obtained after a 4-day culture using 25% of a supernatant from a mixed lymphocyte culture as a source of AHF. The kinetics of the AHF-supported B-cell activation was also investigated. The activation could be completely inhibited by the addition of 100 mM methyl alpha-D-mannopyranoside at the initiation of the culture, but, if added 14-18 hr later, the cells have had the necessary induction period and a proliferation could be recorded. AHF had to be present at the initiation of the cultures, otherwise the response immediately diminished, whereas Con A could be added up to 6 hr after initiation without affecting the proliferative response.

A filter immuno-plaque assay for the detection of antibody-secreting cells in vitro.

A plaque assay has been developed that is based on enzyme immunoassay principles and capable of screening several hundred samples in one day. Single cell suspensions of in vivo or in vitro immunized mouse splenocytes are incubated on antigen-coated nitrocellulose membranes in microfilter plates or in petri dishes. The antibody production of individual cells is detected using a horse radish peroxidase-labeled second antibody, and the insoluble products of the enzymatic reaction are visualized as blue plaques on the membranes. The nitrocellulose membrane of the microfilter plates, which readily absorb a variety of antigens, and the filtration unit used for the washing steps greatly facilitates the plaque assay. Furthermore, this procedure only needs small amounts of antigen for the enumeration of isotype-specific antibody-secreting cells in a defined medium containing low protein levels or in a completely serum-free medium. The plaque assay may be used to evaluate the optimal conditions required for in vitro immunizations.