Combination of BauA and OmpA elicit immunoprotection against Acinetobacter baumannii in a murine sepsis model.

AIMS: Acinetobacter baumannii causes severe nosocomial infections and is a difficult-to-treat pathogen due to the development of multidrug-resistant (MDR) strains. Vaccines and antibody therapy represent alternative promising strategies for the control of infections caused by A. baumannii or its MDR strains. OmpA and BauA have been assigned as protective antigens. However, the efficacy of the combination of these antigens is yet to be investigated. In this study, we targeted two critical antigens of A. baumannii (BauA and OmpA) to enhance immunoprotecting against A. baumannii. METHODS AND RESULTS: The recombinant BauA and OmpA were expressed and purified. The purified proteins were administered to BALB/c mice alone and in combination. Immune sera were assessed against BauA, OmpA and two constructs harboring immunogenic loops of these antigen. The mice were then challenged with a clinical isolate of A. baumannii. Indirect ELISA confirmed significant antibody rise to the antigens. The immunogenic loops were detected in the hybrid construct. The specific sera detected OmpA, BauA and constructs harboring immunogenic loops of these antigen with different affinities. A significant decrease in the bacterial loads was noted in the spleen, liver, and lungs of the immunized mice groups. However, the group received combination of BauA and OmpA showed lower bacterial burden in the spleen and liver. CONCLUSIONS: Combination of BauA and OmpA enhances immunoprotection against A. baumannii infections.

Hybrid antigens expressing surface loops of BauA from Acinetobacter baumannii are capable of inducing protection against infection.

Acinetobacter baumannii is a human bacterial pathogen of increasing concern in clinical settings due to the emergence of antibiotic resistant strains and the lack of effective therapeutics. Researchers have been exploring new treatment options such as novel drug candidates and vaccines to prevent severe infections and mortality. Bacterial surface antigens that are essential to A. baumannii for acquiring micronutrients (e.g. iron, zinc) from nutrient restricted environments are being considered as targets for vaccines or immunotherapy due to their crucial role for growth and pathogenesis in the human host. BauA, the outer membrane receptor for the siderophore acinetobactin was targeted for vaccine development in this study. Due to challenges in the commercial production of membrane proteins for vaccines, a novel hybrid antigen method developed by our group was used. Exposed loops of BauA were selected and displayed on a foreign scaffold to generate novel hybrid antigens designed to elicit an immune response against the native BauA protein. The potential epitopes were incorporated into a scaffold derived from the C-lobe of Neisseria meningitidis transferrin binding protein B (TbpB), named the loopless C-lobe (LCL). Hybrid proteins displaying three selected loops (5, 7 and 8) individually or in combination were designed and produced and evaluated in an A. baumannii murine sepsis model as vaccine antigens. Immunization with the recombinant BauA protein protected 100% of the mice while immunization with hybrid antigens displaying individual loops achieved between 50 and 100% protection. The LCL scaffold did not induce a protective immune response, enabling us to attribute the observed protection elicited by the hybrid antigens to the displayed loops. Notably, the mice immunized with the hybrid antigen displaying loop 7 were completely protected from infection. Taken together, these results suggest that our hybrid antigen approach is a viable method for generating novel vaccine antigens that target membrane surface proteins necessary for bacterial growth and pathogenesis and the loop 7 hybrid antigen can be a foundation for approaches to combat A. baumannii infections.

Systemic Fibrinolytic Therapy in the Presence of Absolute Contraindication; a Case Series.

In massive pulmonary embolism (PE), fibrinolytic therapy is a potential lifesaving treatment; therefore, if other treatments are not available, the physicians encounter this question: can we accept the risk of complications from fibrinolytic therapy, especially intracranial hemorrhage, in the presence of absolute contraindication, in order to save the patient's life? Here, we describe three cases of massive PE with absolute contraindication for fibrinolytic therapy who presented to emergency department following dyspnea. Since, surgical or catheter embolectomy were not available and patients were very high risk for transferring to another hospital, systemic fibrinolytic was administered. The patients improved clinically and were discharged from hospital. It seems that, if no other acceptable treatments are available, physicians could consider fibrinolytic therapy, even at the presence of contraindication, to save the patient's life.