Humoral autoimmune response heterogeneity in the spectrum of primary biliary cirrhosis

Objective To compare autoantibody features in patients with primary biliary cirrhosis (PBC) and individuals presenting antimitochondria antibodies (AMAs) but no clinical or biochemical evidence of disease. Methods A total of 212 AMA-positive serum samples were classified into four groups: PBC (definite PBC, n = 93); PBC/autoimmune disease (AID; PBC plus other AID, n = 37); biochemically normal (BN) individuals (n = 61); and BN/AID (BN plus other AID, n = 21). Samples were tested by indirect immunofluorescence (IIF) on rat kidney (IIF-AMA) and ELISA [antibodies to pyruvate dehydrogenase E2-complex (PDC-E2), gp-210, Sp-100, and CENP-A/B]. AMA isotype was determined by IIF-AMA. Affinity of anti-PDC-E2 IgG was determined by 8 M urea-modified ELISA. Results High-titer IIF-AMA was more frequent in PBC and PBC/AID (57 and 70 %) than in BN and BN/AID samples (23 and 19 %) (p < 0.001). Triple isotype IIF-AMA (IgA/IgM/IgG) was more frequent in PBC and PBC/AID samples (35 and 43 %) than in BN sample (18 %; p = 0.008; p = 0.013, respectively). Anti-PDC-E2 levels were higher in PBC (mean 3.82; 95 % CI 3.36–4.29) and PBC/AID samples (3.89; 3.15–4.63) than in BN (2.43; 1.92–2.94) and BN/AID samples (2.52; 1.54–3.50) (p < 0.001). Anti-PDC-E2 avidity was higher in PBC (mean 64.5 %; 95 % CI 57.5–71.5 %) and PBC/AID samples (66.1 %; 54.4–77.8 %) than in BN samples (39.2 %; 30.9–37.5 %) (p < 0.001). PBC and PBC/AID recognized more cell domains (mitochondria, nuclear envelope, PML/sp-100 bodies, centromere) than BN (p = 0.008) and BN/AID samples (p = 0.002). Three variables were independently associated with established PBC: high-avidity anti-PDC-E2 (OR 4.121; 95 % CI 2.118–8.019); high-titer IIF-AMA (OR 4.890; 2.319–10.314); antibodies to three or more antigenic cell domains (OR 9.414; 1.924–46.060). Conclusion The autoantibody profile was quantitatively and qualitatively more robust in definite PBC as compared with AMA-positive biochemically normal individuals.

Community-acquired pneumonia in Chile: the clinical relevance in the detection of viruses and atypical bacteria

Background Adult community-acquired pneumonia (CAP) is a relevant worldwide cause of morbidity and mortality, however the aetiology often remains uncertain and the therapy is empirical. We applied conventional and molecular diagnostics to identify viruses and atypical bacteria associated with CAP in Chile. Methods We used sputum and blood cultures, IgG/IgM serology and molecular diagnostic techniques (PCR, reverse transcriptase PCR) for detection of classical and atypical bacteria (Mycoplasma pneumoniae, Chlamydia pneumoniae, Legionella pneumoniae) and respiratory viruses (adenovirus, respiratory syncytial virus (RSV), human metapneumovirus, influenza virus, parainfluenzavirus, rhinovirus, coronavirus) in adults >18 years old presenting with CAP in Santiago from February 2005 to September 2007. Severity was qualified at admission by Fine's pneumonia severity index. Results Overall detection in 356 enrolled adults were 92 (26%) cases of a single bacterial pathogen, 80 (22%) cases of a single viral pathogen, 60 (17%) cases with mixed bacterial and viral infection and 124 (35%) cases with no identified pathogen. Streptococcus pneumoniae and RSV were the most common bacterial and viral pathogens identified. Infectious agent detection by PCR provided greater sensitivity than conventional techniques. To our surprise, no relationship was observed between clinical severity and sole or coinfections. Conclusions The use of molecular diagnostics expanded the detection of viruses and atypical bacteria in adults with CAP, as unique or coinfections. Clinical severity and outcome were independent of the aetiological agents detected.

Comparison of flow cytometry and indirect immunofluorescence assay in the diagnosis and cure criterion after therapy of American tegumentary leishmaniasis by anti-live Leishmania (Viannia) braziliensis immunoglobulin G

The aim of this study was to compare the techniques of indirect immunofluorescence assay (IFA) and flow cytometry to clinical and laboratorial evaluation of patients before and after clinical cure and to evaluate the applicability of flow cytometry in post-therapeutic monitoring of patients with American tegumentary leishmaniasis (ATL). Sera from 14 patients before treatment (BT), 13 patients 1 year after treatment (AT), 10 patients 2 and 5 years AT were evaluated. The results from flow cytometry were expressed as levels of IgG reactivity, based on the percentage of positive fluorescent parasites (PPFP). The 1:256 sample dilution allowed us to differentiate individuals BT and AT. Comparative analysis of IFA and flow cytometry by ROC (receiver operating characteristic curve) showed, respectively, AUC (area under curve) = 0.8 (95% CI = 0.64–0.89) and AUC = 0.90 (95% CI = 0.75–0.95), demonstrating that the flow cytometry had equivalent accuracy. Our data demonstrated that 20% was the best cut-off point identified by the ROC curve for the flow cytometry assay. This test showed a sensitivity of 86% and specificity of 77% while the IFA had a sensitivity of 78% and specificity of 85%. The after-treatment screening, through comparative analysis of the technique performance indexes, 1, 2 and 5 years AT, showed an equal performance of the flow cytometry compared with the IFA. However, flow cytometry shows to be a better diagnostic alternative when applied to the study of ATL in the cure criterion. The information obtained in this work opens perspectives to monitor cure after treatment of ATL.

Follow-up Study of Unknowingly Pregnant Women Vaccinated Against Rubella in Brazil, 2001–2002

Background. Brazil conducted mass immunization of women of childbearing age in 2001 and 2002. Surveillance was initiated for vaccination of women during pregnancy to monitor the effects of rubella vaccination on fetal outcomes. Methods. Women vaccinated while pregnant or prior to conception were reported to the surveillance system. Susceptibility to rubella infection was determined by anti-rubella immunoglobulin (Ig) M and IgG immunoassays. Susceptible women were observed through delivery. Live-born infants were tested for anti-rubella IgM antibody; IgM-seropositive newborns were tested for viral shedding and observed for 12 months for signs of congenital rubella syndrome. Incidence of congenital rubella infection was calculated using data from 7 states. Results. A total of 22 708 cases of rubella vaccination during pregnancy or prior to conception were reported nationwide, 20 536 (90%) of which were from 7 of 27 states in Brazil. Of these, 2332 women were susceptible to rubella infection at vaccination. Sixty-seven (4.1%) of 1647 newborns had rubella IgM antibody (incidence rate, 4.1 congenital infections per 100 susceptible women vaccinated during pregnancy [95% confidence interval, 3.2–5.1]). None of the infants infected with rubella vaccine virus was born with congenital rubella syndrome. Conclusions. As rubella elimination goals are adopted worldwide, evidence of rubella vaccine safety aids in planning and implementation of mass adult immunization.

Antibody responses in Plasmodium falciparum malaria and their relation to protection against the disease

Protective immunity against Plasmodium falciparum may be obtained after repeated exposure to infection. Several studies indicate that immunity against the blood stages of the P. Falciparum infection is mainly antibody mediated. Protective antibodies may act either on their own, mediate antibody-dependent phagocytosis and/or cell-mediated neutralization of parasites. This thesis describes several aspects of humoral immune responses to P. falciparum infection in individuals of different age groups, different genetic background and with different degrees of malaria exposure. Several target antigens for antibody-mediated inhibition of parasite growth or invasion have been identified. One such antigen is Pf332, which appears on the surface of parasitized erythrocytes at late trophozoite and schizont stage. This surface exposure makes the antigen a possible target for opsonizing antibodies. We optimized an in vitro assay for studying cellmediated parasite neutralization in the presence of Pf332-reactive antibodies. Our data demonstrate that, Pf332 specific antibodies are able to inhibit parasite growth on their own and in cooperation with human monocytes. The P. falciparum parasites have evolved several mechanisms to evade the host neutralizing immune responses. In this thesis, we show that freshly isolated P. falciparum parasites from children living in a malaria endemic area of Burkina Faso were less sensitive for growth inhibition in vitro by autologous immunoglobulins (Ig) compared with heterologous ones. Analyses of two consecutive isolates taken 14 days apart, with regard to genotypes and sensitivity to growth inhibition in vitro, did not give any clear-cut indications on possible mechanisms leading to a reduced inhibitory activity in autologous parasite/antibody combinations. The frequent presence of persisting parasite clones in asymptomatic children indicates that the parasite possesses as yet undefined mechanisms to evade neutralizing immune responses. Transmission reducing measures such insecticide treated nets (ITNs) have been shown to be effective in reducing morbidity and mortality from malaria. However, concerns have been raised that ITNs usage could affect the acquisition of malaria immunity. We studied the effect of the use of insecticide treated curtains (ITC) on anti-malarial immune responses of children living in villages with ITC since birth. The use of ITC did neither affect the levels of parasite neutralizing immune responses nor the multiplicity of infection. These results indicate that the use of ITC does not interfere with the acquisition of anti-malarial immunity in children living in a malaria hyperendemic area. There is substantial evidence that the African Fulani tribe is markedly less susceptible to malaria infection compared to other sympatrically living ethnic tribes. We investigated the isotypic humoral responses against P. falciparum asexual blood stages in different ethnic groups living in sympatry in two countries exhibiting different malaria transmission intensities, Burkina Faso and Mali. We observed higher levels of the total malaria-specific-IgG and its cytophilic subclasses in individuals of the Fulani tribe as compared to non-Fulani individuals. Fulani individuals also showed higher levels of antibodies to measles antigen, indicating that the intertribal differences are not specific for malaria and might reflect a generally activated immune system in the Fulani.

Mercury-induced autoimmunity : Genetics and immunoregulation

The existence of immune self-tolerance allows the immune system to mount responses against infectious agents, but not against self-molecular constitutes. Although self-tolerance is a robust phenomenon, in some individuals as well as in experimental models, the self-tolerance breaks down and as a result, a self-destructive autoimmune disease emerges. The underlying mechanisms for the development of autoimmune diseases are not known, but genetic, environmental and immunological factors are suggested to be involved. In this thesis, we used murine mercury-induced autoimmunity to test this suggestion. In susceptible mice mercuric chloride induces a systemic autoimmune disease characterized by increased serum levels of IgG1 and IgE, production of anti-nucleolar autoantibodies (ANolA) and formation of renal IgG deposits. In contrast, in resistant DBA/2 (H-2d) mice, none of these characteristics develop after exposure to mercury. By crossing and backcrossing mercury-resistant DBA/2 mice to mercury susceptible strains, we found that the resistance was inherited as a dominant trait in F1 hybrids and that one gene or a cluster of genes located in the H-2 loci determined the resistance to ANolA production, whereas resistance to the other characteristics was found to be controlled by two or three non-H-2 genes. We further put forward the “cryptic peptide hypothesis” to investigate whether mercury and another xenobiotic metal use similar pathway(s) to induce the H-2 linked production of ANolA. We found that while mercury stimulated ANolA synthesis in all H-2 susceptible (H-2s, H-2q and H-2f) mouse strains, silver induced only ANolA responses in H-2s and H-2q mice, but not in H-2f mice. Further studies showed that the resistance to silver-induced ANolA production in H-2f mice was inherited as a dominant trait. We next tested the proposition that mercury induces more adverse immunological effects in mouse strains, which are genetically prone to develop autoimmune diseases, using tight-skin 1 mice, an animal model for human Scleroderma. It was found that in this strain, mercury induced a strong immune activation with autoimmune characteristics, but did not accelerate the development of dermal fibrosis, a characteristic in Tsk/1 mice. Finally we addressed the Th1/Th2 cross-regulation paradigm by examining if a Th1-type of response could interact with a Th2-type of response if simultaneous induced in susceptible mice. Our findings demonstrated that mercury-induced autoimmunity (Th2-type) and collagen-induced arthritis (CIA) (Th1-type) can interact in a synergistic, antagonistic or additive fashion, depending on at which stage of CIA mercury is administered.

Maturation of humoral immune responses : Studies on the effects of antigen type, apoptosis and age

The humoral immune response is dependent on the formation of antibodies. Antibodies are produced by terminally differentiated B cells, plasma cells. Plasma cells are generated either directly from antigen challenged B cells, memory cells or from cells that have undergone the germinal center (GC) reaction. The GC is the main site for class switch, somatic hypermutation and generation of memory cells. Different factors, both internal and external, shape the outcome of the immune response. In this thesis, we have studied a few factors that influence the maturation of the humoral response. We have studied how age affects the response, and we show that responses against thymus dependent antigens (TD) are more affected than responses to thymus independent (TI) antigens, in concordance with the view that the T cell compartment is more affected by age than the B cell compartment. Furthermore, we demonstrate that priming early in life have a big influence on the immune response in the aged individual. Priming with a TI form of the carbohydrate dextran B512 (Dx) induces a reduction of IgG levels in later TD responses against Dx. We have evaluated possible mechanisms for this reduction. The reduction does not seem to be caused by clonal exhaustion or antibody mediated mechanisms. We also showed that the reduced TD response after TI priming can be induced against another molecule than Dx. With the hypothesis that TI antigens induce a plasma cell biased maturation of the responding B cells, we examined the presence of Blimp-1, a master regulator of plasma cell differentiation, in GCs induced by TD and TI antigen. Blimp-1 was found earlier in GCs induced by TI antigen and the staining intensity in these GCs was stronger than in TD antigen induced GCs, indicating that plasma cells might be continuously recruited from these GCs. B cells undergoing the GC reaction are thought to be under a strict selection pressure that removes cells with low affinity for the antigen and also cells that have acquired self-reactivity. We investigated the effect of apoptotic deficiencies on the accumulation of somatic mutations in GC B cells. In mice lacking the death receptor Fas, lpr mice, the frequency of mutations was increased but the pattern of the mutations did not differ from wild type mice. In contrast, mice over-expressing the anti-apoptotic protein Bcl-2, had a lowered frequency of mutations and the mutations introduced had other characteristics.

Modelli di scambio termico in pozzo sulla base della caratterizzazione geotermica di un reservoir a bassa entalpia: studio di sensitività sulla efficienza dei sistemi di condizionamento a pompa di calore

Tra i temi di attualità, quello del risparmio energetico è tra i più dibattuti negli ultimi anni; tale tema è strettamente correlato al problema del riscaldamento globale, infatti, mentre sul prossimo esaurimento delle risorse energetiche tradizionali non vi sono ancora certezze assolute, per quanto riguarda l’azione nociva dei gas serra, la Comunità Scientifica Internazionale si ritrova d’accordo su una netta presa di posizione contro l’emissione di tali sostanze, provocata in larga parte dall’utilizzo dei combustibili fossili. In questo contesto, l’Unione Europea sta promuovendo la diffusione di tecnologie che non prevedano l’utilizzo di gas, petrolio o carbone, soprattutto per il settore dell’edilizia, ove una corretta progettazione e l’utilizzo di tecnologie non convenzionali può portare alla riduzione anche dell’80% dei consumi, con conseguente abbattimento delle emissioni. Tra questi interventi innovativi, il più comune e conosciuto è sicuramente quello del solare termico e fotovoltaico; ma ne esistono anche di altri, ancora non molto pubblicizzati in Italia, ma ampiamente conosciuti e utilizzati in altri paesi dell’Unione. Tra questi, vi è il sistema di riscaldamento analizzato in questa tesi: la pompa di calore geotermica. Tale sistema, come verrà spiegato nell’elaborato di laurea, ha indubbi vantaggi economici, energetici ed ambientali, a fronte di una non trascurabile spesa iniziale. Attualmente, nel Nord Italia, si incominciano a vedere impianti di questo tipo, sulla scia del successo riscontrato nei paesi confinanti (in particolare Austria e Svizzera). La progettazione si basa attualmente su modelli statici, sviluppati dall’Università Svizzera del Canton Ticino, per l’utilizzo della pompa di calore nel territorio alpino. Obiettivo della tesi, è la verifica di tali modelli, di cui si è venuto a conoscenza grazie alla collaborazione con l’Università SUPSI, sulle condizioni idrogeologiche della Pianura Padana, soffermandosi su alcuni parametri fondamentali della progettazione di una pompa di calore geotermica, quali la conduttività e la capacità termica volumetrica dei terreni incontrati, la presenza di falde, ed i parametri geometrici del pozzo, al fine di dare una valutazione tecnica ed economica dell’impianto. Tali analisi è stata infatti fino ad ora affrontata in maniera sommaria dai perforatori, che eseguono generalmente sempre lo stesso modello di pozzo geotermico, sulla base degli esempi consolidati di Svizzera e Germania. Alcune misure di temperatura in situ sono state rilevate in collaborazione con la società Geotermia SRL di Mantova, ditta specializzata nella perforazione di pozzi geotermici (tale esperienza è parte centrale dell’estratto “Laboratorio di Tesi Ls”), mentre la parte modellistica della tesi è stata sviluppata in collaborazione con lo studio di progettazione Studio Seta SRL di Faenza, il cui stabile è climatizzato in parte con una pompa di calore geotermica.

Marcatura di molecole biologiche a funzione antigenica per lo studio e la caratterizzazione di protocolli di vaccinoterapia in oncologia medica

Dendritic Cells (DCs) derived from human blood monocytes that have been nurtured in GM-CSF and IL-4, followed by maturation in a monocyte-conditioned medium, are the most potent APCs known. These DCs have many features of primary DCs, including the expression of molecules that enhance antigen capture and selective receptors that guide DCs to and from several sites in the body, where they elicit the T cell mediated immune response. For these features, immature DCs (iDC) loaded with tumor antigen and matured (mDC) with a standard cytokine cocktail, are used for therapeutic vaccination in clinical trials of different cancers. However, the efficacy of DCs in the development of immunocompetence is critically influenced by the type (whole lysate, proteins, peptides, mRNA), the amount and the time of exposure of the tumor antigens used for loading in the presentation phase. The aim of the present study was to create instruments to acquire more information about DC antigen uptake and presentation mechanisms to improve the clinical efficacy of DCbased vaccine. In particular, two different tumor antigen were studied: the monoclonal immunoglobulin (IgG or IgA) produced in Myeloma Multiple, and the whole lysate obtained from melanoma tissues. These proteins were conjugated with fluorescent probe (FITC) to evaluate the kinetic of tumor antigen capturing process and its localization into DCs, by cytofluorimetric and fluorescence microscopy analysis, respectively. iDC pulsed with 100μg of IgG-FITC/106 cells were monitored from 2 to 22 hours after loading. By the cytofluorimetric analysis it was observed that the monoclonal antibody was completely captured after 2 hours from pulsing, and was decreased into mDC in 5 hours after maturation stimulus. To monitor the lysate uptake, iDC were pulsed with 80μg of tumor lysate/106 cells, then were monitored in the 2h to 22 hours interval time after loading. Then, to reveal difference between increasing lysate concentration, iDC were loaded with 20-40-80-100-200-400μg of tumor lysate/106 cells and monitored at 2-4-8-13h from pulsing. By the cytofluorimetric analysis, it was observed that, the 20-40-80-100μg uptake, after 8 hours loading was completed reaching a plateau phase. For 200 and 400μg the mean fluorescence of cells increased until 13h from pulsing. The lysate localization into iDC was evaluated with conventional and confocal fluorescence microscopy analysis. In the 2h to 8h time interval from loading an intensive and diffuse fluorescence was observed within the cytoplasmic compartment. Moreover, after 8h, the lysate fluorescence appeared to be organized in a restricted cloudy-shaded area with a typical polarized aspect. In addition, small fluorescent spots clearly appeared with an increment in the number and fluorescence intensity. The nature of these spot-like formations and cloudy area is now being investigated detecting the colocalization of the fluorescence lysate and specific markers for lysosomes, autophagosomes, endoplasmic reticulum and MHCII positive vesicles.

Epatite E: ruolo del suino nella trasmissione dell'infezione all'uomo, studio di prevalenza in aree rurali della Bolivia

L’infezione da virus dell’ epatite E (HEV) nei suini e nell’uomo è stata segnalata in diversi Paesi. Nei suini, il virus causa infezioni asintomatiche, mentre nell’uomo è responsabile di epidemie di epatite ad andamento acuto nei Paesi a clima tropicale o subtropicale con condizioni igieniche scadenti, di casi sporadici in quelli sviluppati. HEV è stato isolato anche in diversi animali e l’analisi nucleotidica degli isolati virali di origine animale ha mostrato un elevato grado di omologia con i ceppi di HEV umani isolati nelle stesse aree geografiche, avvalorando l’ipotesi che l'infezione da HEV sia una zoonosi. In America del Sud HEV suino è stato isolato per la prima volta in suini argentini nel 2006, mentre solo dal 1998 esistono dati sull’ infezione da HEV nell’uomo in Bolivia. In questa indagine è stato eseguito uno studio di sieroprevalenza in due comunità rurali boliviane e i risultati sono stati confrontati con quelli dello studio di sieroprevalenza sopra menzionato condotto in altre zone rurali della Bolivia. Inoltre, mediante Nested RT-PCR, è stata verificata la presenza di HEV nella popolazione umana e suina. La sieroprevalenza per anticorpi IgG anti-HEV è risultata pari al 6,2%, molto simile a quella evidenziata nello studio precedente. La prevalenza maggiore (24%) si è osservata nei soggetti di età compresa tra 41 e 50 anni, confermando che l’ infezione da HEV è maggiore fra i giovani-adulti. La ricerca di anticorpi anti HEV di classe IgM eseguita su 52 sieri ha fornito 4 risultati positivi. Il genoma virale è stato identificato in uno dei 22 pool di feci umane e l'esame virologico di 30 campioni individuali fecali e 7 individuali di siero ha fornito rispettivamente risultati positivi in 4/30 e 1/7. La Nested RT-PCR eseguita sui 22 pool di feci suine ha dato esito positivo in 7 pool. L’analisi delle sequenze genomiche di tutti gli amplificati ha consentito di stabilire che gli isolati umani appartenevano allo stesso genotipo III di quelli suini e presentavano con questi una elevata omologia aminoacidica (92%).

Trasmissione post-natale del citomegalovirus attraverso il latte materno al neonato VLBW

Introduction Postnatal human cytomegalovirus (CMV) infection is usually asymptomatic in term babies, while preterm infants are more susceptible to symptomatic CMV infection. Breastfeeding plays a dominant role in the epidemiology of transmission of postnatal CMV infection, but the risk factors of symptomatic CMV infection in preterm infants are unknown. Patients and Methods Between December 2003 and August 2006, eighty Very Low Birth Weight (VLBW) preterm infants (gestational age ≤ 32 weeks and birth weight < 1500 g), admitted to the Neonatal Intensive Care Unit of St Orsola-Malpighi General Hospital, Bologna were recruited. All of them were breastfed for at least one month. During the first week of life, serological test for CMV was performed on maternal blood. Furthermore, urinary CMV culture was performed in all the infants in order to exclude a congenital CMV infection. Urine samples from each infant were collected and processed for CMV culture once a week. Once every 15 days a blood sample was taken from each infant to evaluate the complete blood count, the hepatic function and the C reactive protein. In addition, samples of fresh breast milk were processed weekly for CMV culture. A genetic analysis of virus variant was performed in the urine of the infected infants and in their mother’s milk to confirm the origin of infection. Results We evaluated 80 VLBW infants and their 68 mothers. Fifty-three mothers (78%) were positive for CMV IgG antibodies, and 15 (22%) were seronegative. In the seronegative group, CMV was never isolated in breast milk, and none of the 18 infants developed viruria; in the seropositive group, CMV was isolated in 21 out of 53 (40%) mother’s milk. CMV was detected in the urine samples of 9 out of 26 (35%) preterm infants, who were born from 21 virolactia positive mothers. Six of these infants had clinically asymptomatic CMV infection, while 3 showed a sepsis-like illness with bradycardia, tachypnea and repeated desaturations. Eight out of nine infants showed abnormal hematologic values. The detection of neutropenia was strictly related to CMV infection (8/9 infected infants vs 17/53 non infected infants, P<.005), such as the detection of an increase in conjugated bilirubin (3/9 infected infants vs 2/53 non infected infants, P<.05). The degree of neutropenia was not different between the two groups (infected/non infected). The use of hemoderivatives (plasma and/or IgM–enriched immunoglobulin) in order to treat a suspected/certain infection in newborn with GE< 28 ws was seen as protective against CMV infection (1/4 infected infants vs 18/20 non infected infants [GE<28 ws]; P<.05). Furthermore, bronchopulmonary dysplasia (defined both as oxygen-dependency at 30 days of life and 36 ws of postmenstrual age) correlated with symptomatic infection (3/3 symptomatic vs 0/6 asymptomatic: P<.05). Conclusion Our data suggest that CMV infection transmitted to preterm newborn through human milk is always asymptomatic when newborns are clinically stable. Otherwise, the infection can worsen a preexisting disease such as bronchopulmonary dysplasia. Human milk offers many nutritional and psychological advantages to preterm newborns: according to our data, there’s no reason to contraindicate it neither to pasteurize the milk of all the mothers of preterm infants who are CMV seropositive.

Studio Sperimentale e Modellazione della Separazione di Proteine con Membrane di Affinità

Chromatography represents one of the most important and widely used unit operation in the biotechnology industry. However this technique suffers from several limitations such as high pressure drop, slow mass transfer through the diffusive pores and strong dependence of the binding capacity on flow rate. In this work, affinity membranes with improved capacity have been considered as an alternative technology for the capturing step in antibody manufacturing. Several affinity membranes have been prepared starting from various membrane supports. Different affinity ligands have been utilized like Protein A, the natural ligand of choice for antibodies, as well as synthetic ligands that exhibit affinity for the Fc portion of antibodies. The membranes have been characterized in detail: binding and elution performance was evaluated in adsorption experiments using pure IgG solutions, while membrane selectivity was evaluated using complex solutions like a cell culture supernatant. The most promising affinity membranes were extensively tested in dynamic experiments. The effects of operating parameters like feed concentration and flow rate on separation performances like binding capacity, selectivity and process yield have been studied in detail in order to find the optimal conditions for binding and elution steps. The membranes have been used over several complete chromatographic cycles to evaluate the effects of ageing and of membrane regeneration on dynamic binding capacity. A novel mathematical model is proposed that can describe all the chromatographic steps involved in the membrane affinity chromatography process for protein purification. The mathematical description is based on the species continuity equation coupled with a proper binding kinetic equation, and suitable to describe adequately the dispersion phenomena occurring both in the micro-porous membranes as well as in the extra-column devices used in the system. The model considers specifically all the different chromatographic steps, namely adsorption, washing and elution. The few relevant fitting parameters of the model were derived from a calibration with the experimental affinity cycles performed with pure IgG solutions, then the model is used to describe experimental data obtained in chromatographic cycles carried out with complex feeds as the cell culture supernatant. Simulations reveal a good agreement with experimental data in all the chromatography steps, both in the case of pure IgG solutions and for the cell culture supernatant considered.

Regulation und funktionelle Bedeutung der zellulären und humoralen Immunantwort in der Pathogenese der chronischen Hepatitis C Virusinfektion

Patienten mit akuter, selbstlimitierender HCV-Infektion und solche mit IFN-a Therapieresponse (SCR) zeigten eine hochregulierte NS3-spezifische T-Helferzellantwort.Über die funktionelle Bedeutung der T-Helferzellantwort und der Antikörpersynthese besteht jedoch noch Unklarheit.In dieser Studie wurde die proliferative Antwort der PBMC von Patienten mit anhaltender Therapieresponse (SCR; n=8), Non-Respondern (NR; n=13) und unbehandelten HCV-Patienten(UTR; n=10) sowie gesunden Kontrollen (HC; n=5) auf die rekombinanten HCV-Antigene Core, Helicase, NS3, NS4 und NS5-4 bestimmt und ihre Sekretion von IFN-.

Autoallergie - ein neuer Mechanismus der Entstehung der Nesselsucht

Seit den 80er Jahren wird zunehmend über den Zusammenhang zwischen einer chronischen Urtikaria und Autoimmunerkrankungen der Schilddrüse (SD) diskutiert. Wir hatten Grund zur der Annahme, dass CU-Patienten neben IgG-Autoantikörpern (AAK) auch AAK der Klasse IgE gegen SD-Antigene wie die Thyreoperoxidase (TPO) exprimieren und haben postuliert, dass bei IgE-anti-SD-positiven CU-Patienten über den Mechanismus „Autoallergie“, Mastzellen durch SD-Antigene degranuliert werden können und so urtikarielle Symptome auslösen. In dieser Arbeit wurden deshalb 300 CU-Patientenseren auf „autoallergische“ IgE-AK untersucht. 25% der Patienten hatten erhöhte IgE-anti-TPO Titer von mehr als 3,3 IU/ml. Zum Nachweis der IgE-anti-TPO-AAK im Serum wurde ein neuer, modifizierter capture ELISA entwickelt und vorgestellt, dessen Sensitivität um das drei- bis vierfache höher ist, als die eines konventionellen ELISAs. Die Funktionalität von IgE-anti-TPO-AAK wurde in Stimulationsversuchen durch die Messung von β-Hexosaminidase erbracht. Seren mit einem IgE-anti-TPO-Titer >10 IU/ml wiesen eine spezifische Freisetzung von bis zu 11,8% auf. Die Annahme einer „Autoallergie“ wird weiterhin durch ein klinisches Fallbeispiel erhärtet. Einer CU-Patientin mit Hashimoto-Thyreoiditis, sehr hohen Titern an anti-TPO-AAK (IgG und IgE) und starker Urtikaria-Symptomatik wurde operativ die SD entfernt. Innerhalb von 10 Wochen, post-operativ, kam es sowohl zu einer raschen Verminderung der AAK-Konzentrationen, als auch zur fast vollständigen Remission der urtikariellen Beschwerden wie Quaddelbildung und Juckreiz. Die Erkenntnisse dieser Arbeit weisen erstmals darauf hin, dass die „Autoallergie“ einen möglichen neuen Mechanismus in der Entstehung der CU darstellt, und dass IgE-AAK dabei eine pathogenetisch wichtige Rolle spielen könnten.

Hepatische Überexpression des Interleukin-18 in transgenen Mäusen und dessen biologische und immunologische Funktion

In der vorliegenden Arbeit wurde die Rolle von Interleukin-18 (IL-18) in der Leber untersucht. IL-18 wurde eine Bedeutung bei verschiedenen Lebererkrankungen zugeschrieben, die genauen Mechanismen sind jedoch nicht geklärt. IL-18 kann ein wesentlicher Faktor bei der Regulierung des Th1/Th2-Gleichgewichts in der Leber sein. Es wurden transgene Mäuse mit konstitutiver Überexpression der inaktiven Form von IL-18 (proIL-18) sowie transgene Mäuse mit Expression der aktiven Form von IL-18 ohne Signalpeptid (FLAG-IL-18) und mit Signalpeptid (SP-IL-18) in Hepatozyten unter der transkriptionellen Kontrolle des murinen Albumin-Promoters etabliert. In eigenen Vorarbeiten wurde eine konstitutive Expression von proIL-18 in Wildtyp-Hepatozyten festgestellt. Bei der Überexpression von proIL-18 in Hepatozyten zeigte sich eine Akkumulierung des Proteins in der Zelle und eine spontane entzündliche und fibrotische Aktivität in der Leber. Die Expression der aktiven Form von IL-18 ohne Signalpeptid (FLAG-IL-18) in Hepatozyten führte zu einer Speicherkrankheit in der Leber. Das Fusionieren des aktiven Teils von IL-18 mit IgG-k-Leadersequenz (SP-IL-18) ermöglichte die Sezernierung von IL-18 aus der Zelle ohne Einfluß auf die Produktion von IFN-g, TNF-a, IL-4 sowie Transaminasen. Die Rolle von IL-18 bei einem LPS-abhängigen Leberschaden mit und ohne Präkonditionierung mit CpG-Oligonukleotiden in vivo wurde untersucht. Die Behandlung proIL-18-transgener Mäuse mit LPS führte zur Sezernierung von biologisch aktivem IL-18 aus Hepatozyten. IL-18 hatte bei proIL-18- sowie bei SP-IL-18-transgenen Mäusen nach der LPS-Gabe keinen Einfluß auf die Leberschädigung und Produktion von IFN-g, TNF-a, IL-4. Nach sequenzieller Behandlung mit CpG und LPS fand sich bei SP-IL-18-transgenen Tieren im Gegensatz zu proIL-18-transgenen Mäusen eine stärkere Produktion von GOT, IFN-g und TNF-a im Vergleich zu Wildtyptieren. In dieser Arbeit konnte gezeigt werden, daß IL-18 alleine keine hepatotoxische Wirkung und keinen Einfluß auf die Produktion von IFN-g, TNF-a, IL-4 hat, wofür ein zusätzlicher Stimulus notwendig ist. Die in der vorliegenden Arbeit etablierten proIL-18- und SP-IL-18-transgenen Mausmodelle liefern die Grundlage zu weiteren Untersuchungen der Rolle von IL-18 in der Leber bei der Immunmodulation.