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Generation of cytotoxic T lymphocytes against native and altered peptides of human leukocyte antigen-A*0201 restricted epitopes from the human epithelial cell adhesion molecule.

A growing number of human tumor antigens have been described that can be recognized by CTLs in a MHC class I restricted fashion. The epithelial cell adhesion molecule (Ep-CAM) is expressed in a variety of human tumors and has attracted attention as a therapeutic target for monoclonal antibody serotherapy. We have identified immunogenic peptides derived from Ep-CAM, that bind to human leukocyte antigen-A*0201 and elicit strong peptide-specific human CTL responses, demonstrating that there is an effective T-cell repertoire against these Ep-CAM-derived peptides that can be recruited. Alterations to these peptides were made to increase their binding affinity to MHC class I molecules. The use of such "heteroclitic" peptides allowed generation of cytotoxic T cells that demonstrated increased killing of target cells pulsed not only with the heteroclitic but also with the native peptide. Most important, CTL cell lines that are generated against these peptides specifically lyse epithelial tumor cells expressing Ep-CAM but not normal hematopoietic or bronchial epithelial cells.

Antigens, Neoplasm↗

[Mathematical model of the infection process in diphtheria for determining the therapeutic dose of antitoxic anti-diphtheria serum].

It is known that administration of horse serum against diphtheria toxin can cause autoimmune and allergic complications. Therefore it is important for improvement of serotherapy to develop methods of prediction of disease course and quantity of diphtheria toxin and antitoxic antibodies in a serum. We have developed the mathematical model of diphtheria infection, which consists of six differential equations describing dynamics of diphtheria toxin and antitoxic antibodies in a serum, quantity of infection agent and macrophages in a site of inflammation. This mathematical model allows to predict the course of infectious process, the level of diphtheria toxin and antitoxic antibodies in the sera of people with diphtheria and to calculate the individual therapeutic dose of antitoxic serum for each patient.

Diphtheria↗

[Etiological research in medicine in Vienna circa 1900, at the time of Karl Landsteiner].

By the end of the 19th century theoretical etiological research became more and more important in medical science. Anton Weichselbaum focused on bacteriology in the field of pathological anatomy and Rudolf Paltauf founded an Institute of Serotherapy, thus taking account of this new development. Progress made in laboratory medicine due to the work of a number of scientists in Vienna was of both fundamental and practical significance for the advancement of medicine.

Austria↗

[Treatment of severe botulism with 3,4-diaminopyridine]].

INTRODUCTION: The specific treatments of botulism with serotherapy and with guanidine are of debatable efficacy. We report a case of nutritional toxin B botulism successfully treated with 3,4-diaminopyridine. OBSERVATION: Following a meal, a 69 year-old woman consulted for digestive disorders followed by damage to several cranial pairs, autonomous nervous system and ventilation command, motivating mechanical ventilation on tracheal intubation. Administration of symptomatic treatment with 3,4-diaminopyridine led to progressive improvement, although the diagnosis of toxin B botulism was confirmed. COMMENTS: Administration of 3,4-diaminopyridine, the efficacy of which had been suggested by the review of experimental literature, led to rapid and clear improvement, probably due to its potentiating effect on acetylcholine release in the neuromuscular junction.

4-Aminopyridine↗

[Comparative titration of three antivenin serums used against sub-Saharan African snakes].

The standardisation of serotherapy is necessary in Africa mainly because of the frequency of envenomations and the lack of alternative treatments. Comparative titrations of FAV-Afrique (Aventis Pasteur), Polyvalent serum (Serum Institute of India = SII) and Polyvalent antivenin (South African Vaccine Fabricants Ltd = SAIMR) were carried out on venoms of Echis ocellatus from Cameroun, E. ocellatus from Mali, E. leucogaster and Naja melanoleuca. The 50% protective doses (ED50) of the antivenoms were given according either to i) the in vitro method which consists of inoculating 5 batches of 5 mice with a mixture containing 3 DL50 of venom and increasing volumes of antivenom incubated for 30 mn at 37 degrees C and ii) the in vivo method which consists of successive administration of venom and then antivenom after a 30 to 60 mn interval. The three antivenoms showed a similar efficacy against all the Echis venoms. Interestingly, the SAIMR proved to be effective against the venom of E. leucogaster and E. ocellatus although no venom of Echis was used to immunise horses during the preparation of antivenom. Conversely, this paraspecificity did not exist with the Naja melanoleuca venom against which FAV Afrique showed a higher efficacy. The electrophoresis pattern of FAV-Afrique performed on acetate gel strips showed only one protein fraction (76 g.l-1), whereas both the SII and SAIMR antivenoms showed four fractions whose protein concentrations was respectively 64 g.l-1 and 145 g.l-1.

Africa South of the Sahara↗

Plague studies. VIII. Clinical aspects.

The author examines in detail the symptomatology, diagnosis, and treatment of plague, and outlines the problem of the length of the incubation period.The clinical features commonly met with in all severely-affected plague patients, regardless of the primary localization of the infection, are described. The author then deals with the symptomatology and manifestations of bubonic plague as compared to those of primary pneumonic plague.The importance of a clinical diagnosis, from the point of view of prevention, is stressed, and the differential diagnosis of various forms of the disease is described.The study contains a detailed discussion of the respective merits of antibiotic treatment, serotherapy, and sulfonamide treatment. The author points out that the outstanding success of streptomycin and some other antibiotics will probably relegate the sulfonamides to the second rank in the treatment of bubonic plague.

Anti-Bacterial Agents↗

[Rejection reaction. Elements of diagnosis, monitoring, therapeutic attitude in the case of kidney].

Allograft rejection reaction must be integrated in the broader sense of alloreactivity, i.e. involving a huge T cell repertoire with a high number of alloreactive precursors. This reaction is modulated by the particular immunological state induced by chronic renal insufficiency, by haemodialysis and by the primary kidney disease. The imperfect effect of current immunosuppressive drugs is illustrated by a sizeable proportion of grafts undergoing a chronic rejection process where many growth factors are involved. It has to be noted that allostimulating cells are different from target cells. At present, the therapeutical rejection involves corticosteroids and serotherapy, but it is hoped that new immunosuppressive drugs will increase the efficacy of the rejection crisis treatment.

Acute Kidney Injury↗

[Using the preparation "human immunoglobulin against herpes simplex virus type 1 for intramuscular injections" in the complex therapy of nervous system diseases].

The technology of obtaining of specific immunoglobulin for serotherapy of neuroinfection caused by virus herpes simplex 1 type was developed. The patients presented with the following diseases: arachnoencephalitis, encephalopolyradiculoneuritis, encephalomyelitis, encephalitis, arachnoiditis, polyneuropathy, encephalomyelopolyradiculoneuritis, meningoencephalitis. The study showed good tolerance and safety of the medicine, no adverse effects registered during the study. The assessed median score of the efficacy was 2.8 from 3. The obtained results suggest using the liquid form preparation for intramuscular injection "Immunoglobulin for treatment of neuroinfection caused by virus herpes simplex type 1". The Close corporation "Biofarma" located in Kyiv produces this medicine.

Central Nervous System Viral Diseases↗

Phase I-II trial of a monoclonal anti-tumor necrosis factor alpha antibody for the treatment of refractory severe acute graft-versus-host disease.

In a multicenter pilot study, 19 patients with severe acute graft-versus-host disease (aGVHD) refractory to conventional therapy and serotherapy with a monoclonal anti-interleukin-2 receptor antibody were treated by in vivo infusion of a monoclonal anti-tumor necrosis factor alpha (TNF alpha) antibody (B-C7). Ten patients were grafted from a genotypically identical sibling, five from an HLA-mismatched family member, and four from an HLA-matched unrelated donor. Before B-C7 treatment, 15 patients had grade IV and four had grade III GVHD. In all cases, patients received cyclosporine/methotrexate as aGVHD prophylaxis. Patients were administered increasing doses of antibody (from 0.1 to 0.4 mg/kg). The antibody was infused in bolus daily for 4 days and then every other day twice (6 doses). No side effects were observed during treatment regardless of the dose level used. Changes in peripheral blood cell counts occurred in 8 of the 19 patients and appeared to be unrelated to B-C7. No truly complete response was observed; eight patients achieved a very good partial response (42.6%) and six a partial response (31.5%). The treatment was ineffective in five patients (26.4%). When present, the response occurred early (less than 3 days). In the 14 responding patients, gut lesions responded best (100%), followed by skin (85%) and liver (35.7%) lesions. In 9 of 11 evaluable patients (81%), GVHD recurred when treatment was discontinued in a median delay of 3 days (range, 2 to 120 days). All except one died from aGVHD. Two patients did not experience GVHD recurrence and are still alive 13 and 18 months post-bone marrow transplantation. This pilot study shows that a monoclonal anti-TNF alpha antibody may be of benefit to some patients with severe refractory aGVHD, but is ineffective to prevent GVHD recurrence in the majority of cases.

Acute Disease↗

[Recombinant antibodies: a new application in scorpion envenomation?].

Serotherapy is the only specific treatment for envenomation. The antibodies are obtained after the purification of serum from hyperimmunised horses and are used after fragmentation in the form of polyclonal Fab or F(ab)'2. The anti-venom sera are heterogeneous, and their protective effect is often weak. The administration of these preparations induces risks of immediate or delayed side effects: hypersensitivity reactions, anaphylactic shock and serum sickness. This observation led us to develop new forms of antibodies produced by molecular engineering, capable of specifically neutralizing the neurotoxins responsible for the toxicity of the venom of Androctonus australis Hector. The recombinant antibody fragments are more homogeneous than conventional antivenoms and perfectly characterized in terms of specific activity. The method used to obtain them eliminates the risk of transmission by non-conventional transmissible agents. The earliest results confirm the importance of these new molecules (scFv recombinant Fab, diabody, triabody) and their ability to neutralize the action of scorpion neurotoxins. They could open the path to a new generation of more homogeneous antivenoms that are better tolerated and have well-characterized intrinsic properties.

Animals↗

[Public health and chemical-pharmaceutical companies].

This article is concerned with the establishment of the Brazilian pharmaceutical industry. It addresses some issues of relevance to social-economic history, such as the emergence of the public health system, procedures for combating infectious disease, the relations between disinfection campaigns and the chemical industry, serotherapy and the production of serums and vaccines by public research institutions and private pharmaceutical companies. Focusing on the private pharmaceutical industry in Brazil, with special reference to the Instituto Pinheiros - Produtos Terapêuticos S.A., this article highlights the relations between scientists technology and product development. It also considers the debate which involved the scientific community and some governmental research institutions for public health policy development in the state of São Paulo.

Brazil↗

Detection and distribution of scorpion (Heterometrus bengalensis) venom in rabbit tissues by enzyme-linked immunosorbent assay (ELISA).

ELISA was carried out to detect distribution of scorpion venom in experimental animal tissues. The venom content of different tissues was in the order, liver greater than kidney greater than spleen greater than lung greater than heart greater than diaphragm greater than brain. Tissue distribution of venom antigen in the envenomental subject by ELISA will provide a better approach for serotherapy.

Animals↗

Rational principles for immunoglobulin prophylaxis and therapy of neonatal infections.

Immunotherapy was a common method of treating infectious diseases in the preantibiotic era. Serotherapy was a popular approach to serious infections and employed hyperimmune globulins harvested from various large animals. Such antisera needed to be administered early in the course of the disease and unfortunately was associated with significant risks of anaphylaxis and serum sickness. Because of the allergic risks associated with animal immunoglobulin preparations, the development of methods to isolate human immunoglobulins heralded a new era in immunotherapy. This article examines the uses of immunotherapy in the treatment of neonatal infections.

Bacterial Infections↗

[The characteristics of the serological diagnosis of meningococcal infection in children in the 1st years of life].

The results of clinico-immunological examination of 181 children, aged 1 month to 6 years, with generalized forms of meningococcal infection are presented. In children under observation antimeningococcal antibodies to group-specific meningococci of the main groups A, B and C were determined over the course of the disease by passive hemagglutination (PHA) test and enzyme immunoassay (EIA). The level and frequency of seroconversion were found to depend on the patient's age and the severity of the clinical course of meningococcal infection. Antibody level was found to increase simultaneously with respect to several meningococcal polysaccharides: A, B in 18.5% and A, B, C in 3.3% of cases. In the clinical interpretation of data obtained in the PHA test and EIA not only the patient's age, the form and duration of meningococcal infection, but also serotherapy should be taken into consideration, as the latter may distort the serological results.

Aging↗

Development of a species-specific ELISA for Brazilian pit-viper venoms.

Antigenic cross-reactivity between venoms of the genus Bothrops has been shown to be an extensive problem. However, some venom components are species-specific. In this study we have produced species-specific antivenoms against some members of the genus Bothrops. Monospecific rabbit antivenoms (IgG) were absorbed on venom affinity adsorbents. The species-specificity was tested by ELISA assays and immunoblots. The results of both assays showed complete species-specificity in some cases and highly increased species-specificity in others. These reagents can be used to determine the envenomating species in snake bite patients as an aid to improved serotherapy.

Antivenins↗

Purging in auto- and allografts: monoclonal antibodies which use human complement and other natural effector mechanisms.

CAMPATH-1M is a rat IgM monoclonal antibody which binds to an antigen on all human lymphocytes and monocytes, but which is not present on marrow stem cells (Hale et al., 1983). Lymphocytes can be efficiently killed in bone marrow buffy coat preparations using the antibody and donor human serum as a means to avoid graft versus host disease (GVHD) (Waldmann et al., 1984). An analysis of 520 matched sibling bone marrow transplants (BMT) for leukaemia demonstrates that T-cell depletion using CAMPATH-1M markedly reduces the incidence and severity of GVHD, but there is an increased risk of graft rejection. In the case of CGL in chronic phase, there is also an associated extra risk of relapse, particularly in patients where engraftment may have been compromised (Hale et al., 1988a). A rat IgG2b antibody of the same specificity as CAMPATH-1 (CAMPATH-1G) was developed which is able to both fix human complement and opsonize lymphocytes in vivo (Dyer et al., 1989). Initial studies for the prophylaxis of bone marrow rejection in 55 mismatched and matched unrelated donor (MUD) BMTs suggest that CAMPATH-1G treatment of the recipient may reduce, but not eliminate, marrow graft rejection. The broad CAMPATH-1 specificity means that it is also ideal for purging a range of lymphoid malignancies prior to autologous BMT, or even for direct serotherapy of leukaemic patients. However, there may be limitations of monoclonal antibody purging using complement or other natural effector mechanisms either in vivo or in vitro; in particular, antigenic modulation and an antiglobulin response. Phase 1 studies of "in vivo purging" with a monovalent CD3 antibody (Clark et al., 1989), and also with a genetically engineered humanized IgG1 (CAMPATH-1H) (Hale et al., 1988b) suggest that these limitations can be overcome.

Antibodies, Monoclonal↗

Aspects of immunobiology and immunotherapy and uses of monoclonal antibodies and biologic immune modifiers in human gliomas.

Recent progress in brain tumor biology research has helped us to understand the causes of our failure to improve patient survival with current therapeutic approaches. Present combination regimens of surgery, radiotherapy, and chemotherapy fail to address adequately two inherent biologic properties of brain tumors: tumor-induced host immunosuppression and tumor cell heterogeneity. Future success in immunotherapy will depend on our ability to dissect the mechanisms involved in tumor-host interactions. Also, therapies may have to be individualized. The potential for MAs in research and clinical application is great owing to their unlimited discriminative power for molecular and functional characterization. Differential diagnosis of difficult cases, such as parenchymatous tumors or neoplastic cells in CSF, with panels of MAs will be available in the near future. The use of MAs to direct localization and therapy of brain tumors is also promising, as evidenced by the preliminary data from our laboratory and from those of other workers. Other applications of MAs, such as prevention of invasion and metastasis by targeting cell surface molecules involved in cell-matrix attachment function, are also under study. Future refinement in MA-specificity and in enhancement of MA-delivery to tumor sites will significantly complement new therapeutic approaches. As brain tumors evade immunosurveillance through active participation in inducing tumor-specific immunosuppression, successful immunotherapy, either passive serotherapy or active immunization, will be best achieved in patients with a slight or moderate immunosuppressive state. Alteration of immune status with various biologic response modifiers to boost host reactivity against tumors will be an important adjunct in our arsenal against brain tumors. IFNs, with their direct tumoricidal activity, and lymphokines (such as interleukin-2) may be such reagents with a promising future.

Antibodies, Monoclonal↗

[Evaluation of 30-year-activity of the Virology Laboratory of the Pasteur Institute in Madagascar (1958-1987)].

The authors studied the different activities of Pasteur Institute virology laboratory since it was created. In general virology laboratory, 1.685 viral strains were isolated from 9.533 studied samples (17.6% of positivity). Enterovirus represented 90% of the viral strains. From 2.417 taking of rhino-pharynx, 133 myxovirus were isolated: A/H3N2 represented 76% of them. 10.776 patients, from 36.169 antirabic department consultants, were vaccinated and 600 had an antirabic serotherapy. 2.828 suspect samples were analysed for the rabies diagnostic: 1.438 were positive (51%). The Institute produced 3.410 liters of Fermi human vaccine type.

Enterovirus↗