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Biomedical subjects

M Forsgren

Publications and source records attributed to M Forsgren.

At least 37 records · Page 2Linked to original sources

Identification of framework residues in a secreted recombinant antibody fragment that control production level and localization in Escherichia coli.

The monoclonal antibody 5T4, directed against a human tumor-associated antigen, was expressed as a secreted Fab superantigen fusion protein in Escherichia coli. The product is a putative agent for immunotherapy of non-small cell lung cancer. During fermentation, most of the fusion protein leaked out from the periplasm to the growth medium at a level of approximately 40 mg/liter. This level was notably low compared with similar products containing identical CH1, CL, and superantigen moieties, and the Fv framework was therefore engineered. Using hybrid molecules, the light chain was found to limit high expression levels. Substituting five residues in VL increased the level almost 15 times, exceeding 500 mg/liter in the growth medium. Here, the substitutions Phe-10 --> Ser, Thr-45 --> Lys, Thr-77 --> Ser, and Leu-78 --> Val were most powerful. In addition, replacing four VH residues diminished cell lysis during fermentation. Thereby the product was preferentially located in the periplasm instead of the growth medium, and the total yield was more than 700 mg/liter. All engineered products retained a high affinity for the tumor-associated antigen. It is suggested that at least some of the identified framework residues generally have to be replaced to obtain high level production of recombinant Fab products in E. coli.

Amino Acid Sequence↗

Tick-bone encephalitis in Sweden in relation to aseptic meningo-encephalitis of other etiology: a prospective study of clinical course and outcome.

A total of 149 patients with clinical symptoms of acute viral meningo-encephalitis were enrolled in this study from June 1991 to December 1993. Tick-borne encephalitis (TBE) was diagnosed in 85 of the 149 patients (males 54%, median age 42 years (range 15-78)). The initial clinical appearance of TBE was classified as mild (mainly meningeal; (n = 47), moderate (n = 31) or severe (n = 7), more or less encephalitic. The most common acute symptoms of encephalitis were ataxia (26%), altered consciousness (20%), decreased concentration or memory (9%), irritable response to light and sound (28%), tremor (9%) and dysphasia (9%). Spinal nerve paralysis (11%) occurred in all three clinical stages and did not correlate with the severity or duration of encephalitis. The duration of hospitalisation, the time on the sick-list and the time to recovery were significantly longer in TBE patients. All patients survived, but many patients with TBE suffered an extended period of neurological dysfunction. Of patients with TBE 80% (68/85) showed persisting symptoms of CNS dysfunction on follow-up at week 6, compared with 55% (35/64) of the patients with aseptic meningitis of other aetiology. The corresponding figures after 1 year were 40% (33/83) and 20% (13/64). One year after TBE 13 (28%) patients with initially mild, meningeal symptoms had decreased memory and decreased concentration capacity, dysphasia or ataxia. Spinal nerve paralysis persisted after 1 year in 5 of 9 patients with TBE. In conclusion, TBE in Sweden is associated with a significant morbidity and a post-TBE syndrome existed after 1 year in more than one third of the patients.

Adolescent↗

Twenty years' experience of rubella vaccination in Sweden: 10 years of selective vaccination (of 12-year-old girls and of women postpartum) and 13 years of a general two-dose vaccination.

Two different strategies for the prevention of rubella-induced malformations have now been practised in Sweden, both reaching 90% or more of the target populations. The first was initiated in 1973-1974 and targeted schoolgirls, susceptible women after pregnancy and women at special risk. The second programme-a two-dose measles, mumps, rubella vaccination (MMR) of both boys and girls at the ages of 18 months and 12 years-was introduced in 1982. The percentage of susceptible pregnant women was gradually reduced from 12% in 1975 to 2.8% in 1987 and to just below 2% in 1994. The majority of the non immune are unvaccinated, these being either Swedes born before 1963 or immigrants. Before 1974 on average 14 severely rubella damaged children were reported yearly. Between 1975 and 1985 only a mean of two cases per year were recorded. Since 1985 no child with the rubella syndrome has been registered.

Adolescent↗

Intrathecal IgM, IgA and IgG antibody response in tick-borne encephalitis. Long-term follow-up related to clinical course and outcome.

BACKGROUND: Tick-borne encephalitis (TBE) of western subtype causes long-term morbidity and is considered a health problem in Scandinavia, eastern and central parts of Europe and Russia. The pathophysiology is not fully elucidated. As TBE RNA is rarely demonstrable in cerebrospinal fluid (CSF) the kinetics of the CSF antibody response to the disease has attracted attention. OBJECTIVES: To investigate the intrathecal TBE-specific antibody response and to correlate its intensity and persistence to the clinical course. To compare indirect, commercially-based ELISA methods indexed against albumin ratio or IgG ratio with the capture ELISA method for the establishment of CSF response. STUDY DESIGN: The specific IgM, IgG and IgA antibody responses in serum and CSF were analysed in 69 Swedish patients included in a prospective study of TBE from the acute phase up to 11-13 months after onset. RESULTS: Antibody response by all three classes was demonstrable in serum and CSF. All methods were useful, but capture technique was the most sensitive and results were easiest to interpret. Peak IgM activity was seen early during the disease and persisted after 6 weeks. Maximum IgG levels were encountered in late convalescent samples (median 6 weeks). Intrathecal antibody production was demonstrable in nearly all patients: in 41% days 0-6, in 97% days 7-19, in 98% days 21-61 and-at lower levels-in 84% of the patients after 1 year (50/52 of CSF-serum sampled in the interval 11-61 days). Day 9 after onset, patients with dominating encephalitic symptoms showed significantly lower intrathecal IgM activity. The persistence of serum and CSF antibodies did not correlate to severity of disease. CONCLUSIONS: Capture IgM and IgG assays were superior to indirect ELISA. Low early CSF IgM response correlated to encephalitic symptoms, otherwise the intensity and duration of intrathecal antibody response were of limited value for the prediction of clinical course and long-term outcome.

Adolescent↗

Influence of maternal infections with viral agents or Toxoplasma gondii during pregnancy on fetal IgE production.

The importance of maternal infections with Toxoplasma gondii, cytomegalovirus (CMV), Parvovirus B19, respiratory syncytial virus (RSV), and influenza A and B on fetal IgE synthesis was studied in 153 pregnant women. No case of specific IgM activity or viral DNA in cord blood, indicating a congenital infection, was found. From gestational week 15 to delivery, maternal IgG-Ab seroconversion to Parvovirus B19, RSV, influenza A, or influenza B occurred in 47 women. At delivery, serologic signs of past infection with T. gondii were observed in 29 (19%) women, and the corresponding figure for CMV was 117 (77%). The number of women with positive IgG seroconversion during pregnancy or positive IgG-Ab activity toward the studied infectious agents at delivery did not differ significantly among infants with an increased (> or = 1.3 kU/l; n = 51) or with an undetectable (< 0.1 kU/l; n = 102) cord-blood IgE level. These results show that genetic and other environmental factors probably have a greater influence on fetal IgE synthesis than do maternal infections during pregnancy.

Adolescent↗

A 10-year follow-up study of tick-borne encephalitis in the Stockholm area and a review of the literature: need for a vaccination strategy.

143 people treated for tick-borne encephalitis (TBE) were included in a retrospective follow-up study. Sequelae and epidemiological characteristics in 114 individuals were analysed. The case fatality rate and the prevalence of residual paresis were low, 1.4 and 2.7%, respectively. However, 40 (35.7%) individuals were found to have a postencephalitic syndrome after a median follow-up time of 47 months, and a majority (77.5%) of these were classified as moderate to severe. Various mental disorders, balance and co-ordination disorders and headache were the most frequently reported symptoms. Increasing age was correlated to a longer duration of hospital stay, longer convalescence and increased risk of permanent sequelae. Results from a neuropsychiatric questionnaire showed marked differences between the subjects with sequelae compared to controls. 57% had noticed a tick bite before admission, and 48% were aware of at least one person in their environment who previously had contracted TBE. 79% were permanent residents or visited endemic areas often and regularly. In conclusion, we have found that TBE in the Stockholm area has a low case fatality rate, but gives rise to a considerable number of different neurological and mental sequelae, which justifies vaccination of a defined risk population in endemic areas.

Adolescent↗

Vertical transmission of hepatitis C virus infection.

Vertical transmission of hepatitis C virus (HCV) was studied in 58 infants of 55 mothers (3 sets of twins). HCV RNA analyses by the polymerase chain reaction (PCR) and alanine aminotransferase (ALT) were performed on consecutive blood samples from birth to 18 months of age (0, 3, 9 and 18 months). Data on factors possibly influencing mother-to-infant transmission of HCV, such as concomitant human immunodeficiency virus (HIV) and hepatitis B virus infection during pregnancy, maternal HCV RNA status at delivery, mode of delivery, prematurity and breastfeeding habits were collected. In addition, 6 older siblings (age 4-10 years) of the infants were tested once for anti-HCV. Of the 55 mothers 52 (95%) had a history of intravenous drug use (IVDU). Two mothers were HIV positive. 40/54 (75%) tested mothers were HCV RNA positive. 16 (27%) infants were delivered by Caesarean section, and 50 (86%) infants were breastfed. All infants were HCV RNA negative on all occasions and anti-HCV negative at the age of 18 months. Maternally acquired anti-HCV antibodies disappeared and were not detected by 9 months in 78%. One of the 6 older siblings was anti-HCV and HCV RNA positive. We conclude that the risk of vertical HCV transmission is low in infants of HCV-positive/HIV-negative mothers, and that breastfeeding seems to be safe in this group.

Adult↗

Intrathecal production of neopterin and beta 2 microglobulin in tick-borne encephalitis (TBE) compared to meningoencephalitis of other etiology.

To study the pathophysiology of tick-borne encephalitis (TBE), the kinetics of neopterin and beta 2 microglobulin (beta 2M) production were measured in sequential, cerebrospinal fluid (CSF) and serum samples in 133 patients with aseptic meningoencephalitis (TBE, n = 72; non-TBE, n = 61). Intrathecal production of neopterin was demonstrable in all patients. Neopterin levels in CSF were elevated already at day 2: geometric mean value in TBE 36 nmol/l (range 1-253), in the non-TBE group 29 nmol/l (0.2-96). At day 9 and week 6 the neopterin level was significantly higher in TBE (86 (19-725) and 17 (4-122) nmol/l) than in non-TBE (28 (5-109) and 3 (0.2-58) nmol/l) (p < 0.001). After 1 year CSF levels were within the normal range. The beta 2M response in CSF followed the pattern of neopterin. The intensity and duration of neopterin and beta 2M was not correlated to the clinical course. Neopterin seems to be a more sensitive indicator of intrathecal T-cell response and inflammatory reaction than beta 2M. The results indicate that a long-lasting strong inflammatory reaction is of pathophysiological significance in TBE.

Adolescent↗

Herpes simplex virus and pregnancy.

Although herpes simplex virus (HSV) infections are common in pregnant women, they are rarely serious. The complication, however, is viral transmission to the infant and morbidity and mortality in neonatal herpes remains considerable, in spite of the availability of antiviral therapy. Early recognition and treatment of the infected child is of the utmost importance to inhibit viral replication and thus limit the severity of the disease. Moreover, prevention is the ultimate challenge. Unfortunately, in many cases this is not achievable since the infection in the mother and child often presents without typical herpes symptoms. This was illustrated in a follow-up study of neonatal herpes in Sweden. In nearly half of the cases of neonatal herpes, neither mother nor child had typical herpes symptoms. The herpes simplex virus type 2 (HSV-2) infections were more often atypical or asymptomatic in nature in the mother and child than the HSV-1 infections. Outcome was more serious in HSV-2 infections, and a large proportion of children with this type did not have skin lesions. Neonatal herpes transmitted from recurrent maternal infection had a long incubation period (mean 14 days) and was often localized to the brain. Disease due to primary infection was disseminated, with a mean incubation time of 6 days. Preventive strategies are discussed. In the majority of cases, clinical recognition of risk factors for transmission in the mother--a prerequisite for preventive measurements --is not possible.

Female↗

Indications that maternal coxsackie B virus infection during pregnancy is a risk factor for childhood-onset IDDM.

In a population-based setting, we traced serum samples collected at time of birth from 55 mothers whose children later developed insulin-dependent diabetes (IDDM) and matched them pairwise to control subjects who gave birth at the same hospital during the same month. The sera were analysed for IgM antibodies to coxsackie B virus serotypes 2, 3 and 4 (CBV-2, 3 and 4) using a type-specific mu-antibody-capture radioimmunoassay. Despite a decreased power due to the close matching by time of birth we found a significantly higher frequency of CBV-3 IgM at delivery in mothers whose children later became diabetic compared to their matched control subjects. When using the presence of CBV-3 IgM as a risk factor the Mantel-Haenszel odds ratio estimate (95% confidence limits) was 2.57 (1.02; 7.31), p = 0.043. For CBV-2 and CBV-4, respectively no significant difference was found between mothers of patients and control subjects. According to the odds ratio estimate for CBV-3 and the proportion of exposed mothers among patients estimated in this study the aetiological fraction for this risk determinant would be 27%. In conclusion, this study indicates that children of mothers who expressed CBV IgM at delivery are at increased risk for developing childhood onset IDDM. A fetal infection with CBV similar to rubella virus may initiate autoimmunity or cause persistent infection that may lead to progressive beta-cell destruction.

Adolescent↗

Sequence analysis of echoviruses in a major antigenic region eliciting enteroviral cross-reactive antibodies.

The amino acid sequence of an antigenic region known to elicit cross-reactive enteroviral IgG antibodies in VP1 is known for poliovirus and cox-sackievirus A and B. However, no corresponding data has been available for prevalent echovirus serotypes with great clinical impact. Such information was obtained by amplification of this region of the echovirus genome by PCR using biotinylated primers. The amplicon was subjected to solid phase sequencing using the dideoxy chain-termination method. Translated amino acid sequences for residues 26-55 of VP1 of the echoviruses revealed that the known cross-reactive region is highly conserved also in the echovirus serotypes.

Amino Acid Sequence↗

Seroepidemiology of Toxoplasma gondii among pregnant women in different parts of Sweden.

Surveys of pregnant women in four areas of Sweden in 1987-88, reveal a significant trend for decrease in Toxoplasma seroprevalence from Gotland island (26%, n = 467) in the south through Orebro county (18%, n = 1413) and Stockholm area (18%, n = 939), to Northern Sweden (12%, n = 837). No within area differences were observed between samples from rural and urban localities. Quantitative antibody data indicate marginally higher levels in the north than in the south, and a significant declining trend by age only in Orebro county. Incidence models are used to describe age-seroprevalence profiles for each area, using different assumptions about age- and time-specific infection rates, and to estimate the risk of maternal infection at the time of the survey. It is shown that the patterns of seroprevalence with age in Orebro county and Northern Sweden, but not Gotland island or Stockholm, strongly implicate time-dependent changes in Toxoplasma incidence, consistent with a declining incidence in the past which has possibly been reversed in recent years. The estimates of Toxoplasma incidence and risk of maternal toxoplasmosis are strongly dependent upon the underlying assumption of temporal change in incidence, with wide ranges in the predicted values. These studies demonstrate the difficulties in interpretation of horizontal cross-sectional data and the need for longitudinal studies of age-prevalence and seroconversion in the determination of the true risk of maternal toxoplasmosis.

Adolescent↗

Radiographic patterns and viral studies in childhood pneumonia at various ages.

We aimed at evaluating the relationship between microbial etiology and chest radiograph appearance in various types of pneumonia. In a prospective study, the radiographic findings in 479 cases of acute pneumonia in children were compared with viral etiology and growth of potential bacterial pathogens in nasopharyngeal secretion. As the basis for viral etiology was most conclusive, the material was here classified according to the viral findings. The patients were divided into three age groups: 0-2, 3-5 and 6-15 years. The chest radiograms were analyzed blindly for the presence of hyperinflation and interstitial, alveolar and mixed interstitial-alveolar infiltrates. There was a statistically significant relationship between low age and occurrence of hyperinflation and interstitial infiltrates, and between high age and alveolar infiltrates. No unequivocal relationship was found between type of infiltrates or presence of atelectasis and proven viral etiology. We conclude that chest radiographs are not a useful indicator of microbial etiology in childhood pneumonia.

Acute Disease↗

Longitudinal study of cytomegalovirus antibodies in individuals infected with the human immunodeficiency virus.

Cytomegalovirus (CMV) antibody profiles were studied in 25 HIV-infected patients over periods of up to 56 months. Specific antibodies against CMV antigen components were monitored by complement-fixation (CF) test, EIA, Western blot and a neutralization assay. Three subjects remained CMV seronegative throughout the study. Marked fluctuations were observed in anti-CMV antibodies assayed by the CF test as compared to a control group. Fluctuations on immunoblots of purified virion antigens were also observed in the HIV-infected patients; neutralizing antibodies and anti-CMV nucleocapsid antibodies showed less variability. Seven of 22 individuals exhibited an increase in CF-test titre of up to 64-fold without clinically apparent CMV disease. On Western-blot testing of IgG reactivity with disrupted virions, ten individuals exhibited increasing reactivity to pp65, and only three of these also showed a titre rise in the CF test. In contrast, 7 of 22 showed low reactivity to the pp28 antigen. The homosexual patient group exhibited the highest levels of anti-CMV antibody. In conclusion, many asymptomatic HIV-infected subjects showed fluctuations at different levels of their antibody response to CMV, thought to be indicative of CMV reactivation/reinfection. Western-blot findings indicated that some CMV antibodies increased in level while others were lost.

AIDS-Related Opportunistic Infections↗

Neonatal herpes simplex: clinical findings and outcome in relation to type of maternal infection.

In 39 mothers of children with neonatal herpes simplex virus infection, maternal infection was serologically characterized retrospectively and was related to maternal clinical symptoms and to the clinical findings and outcome in the child. Thirteen mothers had a primary infection (six type 1, seven type 2), mostly with clinical symptoms. The mean age of onset of the disease of the infants was 7 days and a disseminated disease was most commonly found. Most of the type 1-infected children recovered completely, whereas all but one of the type 2-infected children died. Twenty mothers had a recurrent (2 type 1, 18 type 2) and 4 an intermediate infection (primary type 2, prior infection with type 1), mostly asymptomatic. Their children had a localized disease (of the skin-eye-mouth or the central nervous system) with onset at a mean age of 14 or 13 days, respectively. The frequency of neurological sequelae was high. Two mothers had no serological signs of herpes infection.

Age Factors↗