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Identification of T cell epitopes occurring in a meningococcal class 1 outer membrane protein using overlapping peptides assembled with simultaneous multiple peptide synthesis.

The meningococcal class 1 outer membrane protein (OMP) plays an important role in the development of protective immunity against meningococcal infection, and is therefore considered to be a promising candidate antigen (Ag) for a meningococcal vaccine. The induction of an effective antibody response entirely depends upon T helper cells. To identify T cell epitopes of the OMP, we prepared 45 overlapping synthetic peptides representing the entire sequence of the class 1 protein of reference strain H44/76. Fully automated simultaneous multiple peptide synthesis (SMPS) was used to assemble the 45 twenty mer which overlapped by 12 amino acid residues on a 12 mumol scale. The peptides were tested for recognition by peripheral blood mononuclear cells (PBMC) obtained from 34 volunteers. Surprisingly, all synthetic peptides induced proliferative responses of PBMC isolated from one or more human histocompatibility leukocyte antigen (HLA)-typed immune adults. With PBMC from seven nonimmune donors, no proliferative response was observed. Immunodominant regions were found, recognized by PBMC from many volunteers, irrespective of their HLA type. Most of the immunodominant T cell epitopes are located outside the variable regions and, thus, will be conserved among different meningococcal (and gonococcal) strains. Furthermore, the overlapping peptides could be used to identify the epitopes recognized by OMP-specific T cell clones with known HLA restriction. It is interesting that the epitopes defined with the clones occur in highly conserved areas, shared by all neisserial porin proteins. In summary, this analysis of the T cell response to the meningococcal class 1 OMP constitutes a complete study of reactivity to a foreign protein, and illustrates some important features of Ag recognition by T cells. Our data demonstrate unexpected diversity in the T cell recognition of the OMP, and imply that the T cell repertoire against foreign Ag may be greater than previously assumed. This observation is supported by recent data on the interaction of peptide and major histocompatibility complex (MHC) class II, the latter being much less selective than MHC class I. Finally, a comparative analysis pointed out the limitations of algorithms predicting T cell determinants, and the importance of the empirical methodology provided by SMPS.

Adult↗

Anti-idiotype induced protection against Neisseria meningitidis serogroup C bacteremia.

We have developed a monoclonal anti-idiotypic antibody, designated 6F9, which acts as the surrogate image of the meningococcal group C capsular polysaccharide (MCP). Murine immunization with 6F9 results in a T-dependent anti-MCP antibody response. To examine the protective nature of the antibody response elicited by 6F9 we performed a series of live challenge studies using a murine model for meningococcal infection in which mice were iron dextran treated and challenged with 10 x LD50 of meningococcal group C strain 35E. Adult BALB/c mice immunized with 6F9 had a 100% survival and a significantly reduced level of bacteremia at 24 h. Mice immunized with MCP had an 80% survival rate, all survivors were bacteremic at 24 h. Neonatal mice primed within 24 h of birth and immunized at 4 weeks of age with 6F9 had a 100% survival and cleared their bacteremia by 8 h, which was significantly faster than the MCP primed and immunized mice. Neonatal mice primed with 6F9 and challenged at 5 weeks of age had a survival rate of 90% which was significantly higher than mice primed with MCP and the control group (60% and 50% survival, respectively). Mice primed at birth and immunized at 8 days had a 100% survival and 90% of these mice had sterile blood cultures by 8 h. Mice primed and immunized with MCP all remained bacteremic at 24 h. These data indicate that the anti-Id 6F9 which mimics the capsular polysaccharide of group C meningococci is capable of inducing protective immunity in immunologically mature as well as immature animals.

Animals↗

Deficiency of the seventh component of complement in a Taiwanese boy.

Inherited complement deficiencies are rare, particularly those associated with late components of the complement cascade. We report a 5-year-4-month-old Taiwanese boy with systemic meningococcal infection who had undetectable CH50 level of < 6 U/mL (normal, 32.6-39.8 U/mL). Levels of C3, C4, C5, C6 and C8 were normal, but C7 was undetectable (< 5.8 mg/dL; reference, 55-85 mg/dL). The patient's sister was also C7-deficient (CH50 < 6 U/mL, C7 < 5.8 mg/dL). His father's CH50 was 25.9 U/mL and C7 was 27.8 mg/dL. His mother's CH50 was 31.2 U/mL and C7 was 22.7 mg/dL. His parents thus both had a partial complement deficiency, indicating an autosomal codominant inheritance pattern. Awareness of the possibility of late complement deficiency is important as they comprise a small percentage of patients who present with disseminated meningococcal disease or other serious infections caused by encapsulated organisms.

Anti-Bacterial Agents↗

Doctors' knowledge of post-splenectomy prophylaxis.

A questionnaire was sent to 160 hospital doctors and 200 general practitioners about post-splenectomy prophylaxis during the month of September 1995. A total of 118 questionnaires were returned (43% hospital doctors and 25% GPs). Most doctors (99%) knew that splenectomised patients were at risk of pneumococcal infection; 72% of hospital doctors and 50% of GPs knew of the risk of Haemophilus influenza infection but only 50% of hospital doctors and 33% of GPs knew of the same risks involving meningococcal infection and malaria. Half of the GPs were not aware of H. influenzae type B (Hib) vaccine for prophylaxis and 85% of these and 50% of hospital doctors did not know prophylaxis should be lifelong. There was no significant difference in the knowledge between hospital doctors and GPs.

Anti-Bacterial Agents↗

T-cell responses to outer membrane proteins of Neisseria meningitidis: comparative study of the Opa, Opc, and PorA proteins.

Former studies have shown that the class 5 outer membranes proteins (Opa and Opc proteins) of Neisseria meningitidis are at least as immunogenic as meningococcal porin proteins. High antibody titers to class 5 proteins have been observed in sera obtained during convalescence after meningococcal infection. A strong increase in anti-class 5 antibodies has also been observed in vaccinees who received a meningococcal outer membrane vesicle preparation. The enhanced B-cell response to class 5 proteins may be due to the presence of immunodominant helper T-cell epitopes in these proteins. In order to investigate this hypothesis, we tested purified Opa, Opc, and class 1 proteins for recognition by human T cells. a hierarchy of T-cell immunogenicity was observed among the outer membrane proteins, the Opa protein being more immunogenic than the other proteins. In most cases, the proliferative responses elicited by Opc were higher than the responses observed for the class 1 protein. The epitopes recognized by the immune T cells were identified by using overlapping synthetic peptides spanning the protein sequences of OpaB, Opa5d, and Opc.

Adult↗

[Pneumococcal septic arthritis in HIV infection].

Infections due to pneumococci are frequent in patients infected with the human immunodeficiency virus (HIV), but joint infections are rare. We observed two cases of septic arthritis due to pneumococci in two non-haemophilic HIV seropositive patients. In the first case, a 31-year old drug addict who had undergone splenectomy, developed hip joint infection during an episode of meningitis due to pneumococci. The germ was moderately sensitive to ampicillin. The second case involved the knee joint in a 29-year-old woman who developed pneumococcal pneumonia after a trip to Zaire. In both cases, joint infection developed after antibiotics had been initiated, and in the first case, after the infection appear to be under control. This would be similar to "post-infectious" arthritis described in gonococcal and meningococcal infections. In HIV positive patients, joint infections are rare compared with other types of immunodepression, but can be observed in all stages of the disease. A total of 75 cases have been reported in the literature, including 8 cases due to pneumococci. These joint infections could be another argument in favour of anti-pneumococcal vaccination in HIV positive patients.

AIDS-Related Opportunistic Infections↗

Meningococcal vaccine against serogroups A, C, Y and W-135: new preparation. Encouraging immunogenicity studies.

(1) Prevention of meningococcal meningitis is based on vaccination, and chemoprophylaxis in case contacts. The five main meningococcal serogroups known to be pathogenic for humans are A, B, C, Y and W-135. Their geographic distribution is variable. In France, two-thirds of cases are due to serogroup B, which is poorly immunogenic and for which there is no vaccine; the only licensed vaccine offers protection solely against serogroups A and C. (2) A meningococcal polysaccharide vaccine directed against serogroups A, C, Y and W-135 has been granted temporary authorization for use by pilgrims to Mecca and for case contacts. (3) The vaccine elicits antibodies against the four serogroups in most adults, at least in the short term. It is poorly immunogenic in children under two years of age, especially against serogroup C. (4) The preventive efficacy of the vaccine against meningitis due to serogroups Y and W-135 is not known, and few data are available on serogroups A and C. Protection has not been shown beyond two years after vaccination. At one year the vaccine provides about 95% protection against serogroup A and 65% against serogroup C. (5) Systemic and local reactions to vaccination with the four-valent vaccine appear to be acceptable. (6) In practice, for want of anything better, the four valent vaccine (A, C, Y and W-135) is better than the two-valent vaccine (A+C) for protecting pilgrims to Mecca and contacts of patients with serogroup A, C, Y or W-135 meningococcal infection.

Adult↗

Another Swedish family with complete properdin deficiency: association with fulminant meningococcal disease in one male family member.

Inherited deficiency of the complement component properdin is described in a Swedish family without any previous history of meningococcal infections. The properdin-deficient index patient died from a fulminant infection caused by Neisseria meningitidis serogroup Y. Family investigation revealed properdin deficiency in the patient's half-brother and in the maternal grandfather. The half-brother had a history of pneumococcal pneumonia and meningitis probably caused by Borrelia burgdorferi. Opsonic and bactericidal functions of serum were examined in the half-brother after immunization with tetravalent meningococcal vaccine. Vaccination promoted opsonization of N. meningitidis serogroups C and Y but not of serogroups A and W-135. The serum bactericidal activity increased against serogroup C and to some extent against serogroup W-135. This report emphasizes the importance of investigating the complement system even in families with single cases of fulminant meningococcal disease. Individuals with properdin deficiency might be protected from infection by immunization.

Adolescent↗

Protection by meningococcal outer membrane protein PorA-specific antibodies and a serogroup B capsular polysaccharide-specific antibody in complement-sufficient and C6-deficient infant rats.

The relative contributions of antibody-induced complement-mediated bacterial lysis and antibody/complement-mediated phagocytosis to host immunity against meningococcal infections are currently unclear. Further, the in vivo effector functions of antibodies may vary depending on their specificity and Fc heavy-chain isotype. In this study, a mouse immunoglobulin G2a (mIgG2a) monoclonal antibody (MN12H2) to meningococcal outer membrane protein PorA (P1.16), its human IgG subclass derivatives (hIgG1 to hIgG4), and an mIgG2a monoclonal antibody (Nmb735) to serogroup B capsular polysaccharide (B-PS) were evaluated for passive protection against meningococcal serogroup B strain 44/76-SL (B:15:P1.7,16) in an infant rat infection model. Complement component C6-deficient (PVG/c-) rats were used to assess the importance of complement-mediated bacterial lysis for protection. The PorA-specific parental mIgG2a and the hIgG1 to hIgG3 derivatives all induced efficient bactericidal activity in vitro in the presence of human or infant rat complement and augmented bacterial clearance in complement-sufficient HsdBrlHan:WIST rats, while the hIgG4 was unable to do so. In C6-deficient PVG/c- rats, lacking complement-mediated bacterial lysis, the augmentation of bacterial clearance by PorA-specific mIgG2a and hIgG1 antibodies was impaired compared to that in the syngeneic complement-sufficient PVG/c+ rat strain. This was in contrast to the case for B-PS-specific mIgG2a, which conferred similar protective activity in both rat strains. These data suggest that while anti-B-PS antibody can provide protection in the infant rats without membrane attack complex formation, the protection afforded by anti-PorA antibody is more dependent on the activation of the whole complement pathway and subsequent bacterial lysis.

Animals↗

[Typing and sensitivity of meningococci isolated in Switzerland 1988-1990].

Since 1906 severe infections due to Neisseria meningitidis have been reported in Switzerland. The clinical application of antimicrobial agents reduced the mortality rate due to meningococcal infections from 82% before 1939 to 22% after 1942. However, the annual incidence remained at about 1.5 cases per 100,000 inhabitants. During the years 1988 to 1990, 177 strains isolated in Switzerland have been typed with a dot ELISA using 15 different monoclonal antibodies. The distribution of serogroups was as follows: A (0.6%), B (70.6%), C (22.6%), and W135 (0.6%), while 5.6% could not be assigned to a serogroup. The most common associations of serogroup, serotype and subtype were: B:15:P1.16 (15.3%), B:4:P1.15 (13.6%), and C:2a:P1.2 (9.0%). The susceptibility of 174 strains was determined by an agar-dilution procedure. All strains were susceptible to cefuroxime, ceftriaxone, ciprofloxacin, minocycline and spiramycin. One strain showed reduced sensitivity to penicillin (MIC = 0.25 mg/l), while another strain was resistant to rifampicin, 3% were resistant of erythromycin and 75% to sulfadiazine.

Drug Resistance, Microbial↗

Inhibition of the growth of Neisseria meningitidis by reduced ferritin and other iron-binding agents.

Serogroups of N. meningitidis were characterized as virulent or avirulent according to their capacity to establish meningococcal infection in mice. An agar plate diffusion technique demonstrated that iron had a definite growth-supporting role for both of these meningococcal types. The avirulent strains could use ionic or chelated iron as well as the virulent strains. Iron-reversible growth inhibition occurred to the same extent for both bacterial types in the presence of the synthetic iron-chelating agents Desferal and ethylenediamine-di-orthohydroxy phenylacetic acid. A difference in response was demonstrated for these bacterial types when grown in the presence of various iron-binding proteins from animal body fluids and tissues. The growth of the avirulent strain was inhibited to a greater degree by egg white conalbumin. The humoral iron-binding protein transferrin showed a significant inhibitory capacity only when used in conjunction with bicarbonate. Under conditions of increased iron saturation of this protein, the avirulent strain was inhibited to the furthest extent. In the presence of ferritin, the cellular iron-binding protein, which had been reduced, inhibition of the growth of either strain type did not occur on iron-poor media (less than 5 micrograms/100 ml). However, with the incorporation of iron into the media, the inhibitory effect of the protein became evident. As the concentration of iron increased, the inhibition increased to a certain level and subsequently declined. A substantial difference in the ability of the avirulent type to grow in the presence of reduced horse spleen ferritin was observed. For this microorganism, a correlation appears to exist between the capacity to grow by utilizing the available iron in the presence of reduced ferritin and the ability to establish infection. The host protein ferritin, in the reduced state, apart from simply being a storage protein for iron, can prevent the growth of a procaryotic organism. Our experiments suggest a role for ferritin in the prevention of emningococcal disease. A cehmotherapeutic potential for Desferal is also implied.

Conalbumin↗

Mannose binding lectin enhances IL-1beta and IL-10 induction by non-lipopolysaccharide (LPS) components of Neisseria meningitidis.

Mannose binding lectin (MBL) is a key molecule in the lectin pathway of complement activation, and likely of importance in our innate defence against meningococcal infection. We evaluated the role of MBL in cytokine induction by LPS or non-LPS components of Neisseria meningitidis, using a meningococcal mutant deficient for LPS. Binding experiments showed that MBL exhibited low, but significant binding to encapsulated LPS+ meningococci (H44/76) and LPS-deficient (LPS-) meningococci (H44/76lpxA). Experiments with human mononuclear cells (PBMCs) showed that MBL significantly augmented IL-1beta production after stimulation with LPS+ and LPS- meningococci, in a dose-dependent fashion. In addition, IL-10 production was enhanced after stimulation with LPS- meningococci. In contrast, TNFalpha, IL-6 and IFNgamma productions were unaffected. No effect of MBL was observed on cytokine induction by meningococcal LPS. MBL enhanced cytokine production at concentrations >10(7) meningococci. It is concluded that MBL interacts with non-LPS components of N. meningitidis and in this way modulates the cytokine response.

Cells, Cultured↗

Invasive meningococcal and pneumococcal disease in Switzerland: cost-utility analysis of different vaccine strategies.

We performed a cost-utility analysis for various vaccination strategies against meningococcal and pneumococcal diseases (MenC or MenC/PCV-9) in Switzerland. The analysis compared the current recommendations of vaccinating only children with medical risks to the introduction of the vaccination with either the MenC or the MenC/PCV-9 vaccine, administered at 12 or 2, 4 and 6 months of age, into the existing immunisation programme. For a birth cohort of 80,000 children and assuming a vaccine coverage of 80%, the introduction of a generalised vaccination would be cost-effective. The strategy using three doses of MenC/PCV-9 would achieve the highest health benefit, with 440 quality-adjusted life years (QALYs) gained at costs of 34,000 per QALY.

Child↗

[Survey on vaccination strategies used in different Italian Regions, for the 7-valent conjugate pneumococcal, meningococcal C and varicella vaccines].

A survey was performed to obtain information regarding regional vaccination strategies in Italy, for 7-valent conjugate pneumococcal, meningococcal C and varicella vaccines. A questionnaire was sent to the person in charge of infectious disease control and vaccination activities in each of the 21 regions. All 21 regions replied to the questionnaire. Twenty regions offer pneumococcal 7-valent conjugate vaccine free only to high-risk children, while 9 of these regions offer it to all newborns as well. Seventeen regions offer meningococcal C vaccine only to high-risk individuals while 9 regions offer it to all newborns. All 19 regions that have deliberated on varicella vaccination offer it to high-risk subjects only while 3 offer it also to all newborns. Local health authorities were found to widely adhere to regional deliberations regarding these vaccinations. Vaccination strategies for the three vaccines are not uniform across Italy. Additional efforts are required to ensure that high-risk subjects in all regions receive these vaccines and to homogenize immunization strategies aimed at other target groups. Monitoring of coverage levels and disease surveillance will allow evaluation of the impact of vaccination strategies implemented in the different regions.

Chickenpox↗

[Parameters for constructing a test system for the isoenzymatic detection of meningococcal antibodies].

The optimum conditions for the detection of specific humoral antibodies in patients with meningococcal infection by the immunoenzymatic method have been determined: the sensitizing dose of the antigen is 20 microgram of protein per 1 ml for group A meningococcal antigen and 25 microgram of protein per 1 ml for group C meningococcal antigen, the pH of the buffer solutions is 5.0-6.0 for group A meningococcal antigen and 12.0 for group C meningococcal antigen, the time and temperature of incubation should be 18-20 hours at 14 degrees C. The diagnostic test system developed in this research is capable of detecting antibodies with the accuracy of several ng.

Antibodies, Bacterial↗