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Direct gram stain and urease test to detect Helicobacter pylori.

Antral biopsies were obtained by gastrointestinal endoscopy on 143 adult patients with dyspeptic symptoms of gastritis or peptic ulcer disease. A direct Gram stain and a direct urease test were performed on each biopsy in addition to culture. Forty-three biopsies (30%) were considered positive for Helicobacter pylori based on culture or histologic examination, or both. Thirty-one biopsies (72% sensitivity) were positive for both direct tests, whereas 95 of 100 negative cultures were negative for both tests. Thirty-eight of the 43 positive biopsies were Gram stain positive (sensitivity, 88%; specificity, 100%). The direct urease test alone was positive at 4 hr for 29 biopsies (sensitivity, 67%; specificity, 100%) and at 24 hr for 38 biopsies (sensitivity, 74%; specificity, 95%). Rapid presumptive diagnosis of H. pylori in antral biopsies was obtained when at least one direct test, Gram stain or urease, was positive.

Adult↗

Covalent binding of urease on ammonium-selective potentiometric membranes.

As part of the development of disposable urea bioselective probes, the covalent binding of urease on ammonium-selective potentiometric membranes has been assessed. Nonactin/bis(1-butylpentyl)adipate/poly(vinylchloride) (PVC) membranes, directly applied to an internal solid contact (conductive epoxy-graphite composite), has been used as a support for covalent immobilization of urease. Two types of all-solid-state construction process have been assayed: thin layers of cellulose acetate (CA) were coated on the PVC ammonium-selective membranes (type 1) and blends of PVC and CA at various ratios were used as ammonium-selective membrane matrices (type 2). Urease was covalently attached to CA via aldehyde groups. These groups were created on the polysaccharide with sodium periodate to which the enzyme was immobilized through a spacer (hexamethylenediamine). The viability of both types of probe for the determination of ammonium ions was assessed after each step of the activation process. Results indicated that type 2 potentiometric probes are altered after the treatment with sodium periodate. Good results were obtained with type 1 probes. Their dynamic concentration range of response to urea was from 2 x 10(-5) to 0.01 M with a sensibility of 50 mV/decade.

Ammonia↗

Alpha-hydroxyketones as inhibitors of urease.

A variety of alpha-hydroxyketones (1-13) and alpha-diketones (14-20) were evaluated for their effect on the jack bean urease. Of 13 alpha-hydroxyketones (1-13) tested, 2,2'-thenoin (10) (IC(50)=0.18 mM), furoin (9) (IC(50)=0.36 mM), 2-hydroxy-1-phenylethanone (5) (IC(50)=0.47 mM) and acetol (1) (IC(50)=2.9 mM) showed potent inhibitory activity against the enzyme, comparable with hydroxyurea (IC(50)=0.1 mM). The inhibitory effects were completely blocked by 2-mercaptoethanol or dithiothreitol. A nickel ion influenced the inhibitory effects of 5 and 9 in a dose-dependent manner, but not of 1 and 10. On the other hand, the corresponding alpha-diketones such as 2,2'-thenil (20), furil (19) and PhCOCHO (14) exhibited little or no ability to inhibit the urease. We have demonstrated for the first time that some alpha-hydroxyketone derivatives show urease inhibitory activity, possibly by binding to cysteinyl residues in the active site.

Binding Sites↗

Biscoumarin: new class of urease inhibitors; economical synthesis and activity.

A variety of biscoumarins (1-21) with variable substituents at C-11 were synthesized with an improved method and evaluated as urease inhibitors. The synthesized compounds showed varying degree of urease inhibitory activity ranging from 15.06-91.35 microM. The size and electron donating or withdrawing effects of substituents influenced the activity, which lead to the urease inhibitors.

Coumarins↗

Prevalence, structure and expression of urease genes in Shiga toxin-producing Escherichia coli from humans and the environment.

A component of the ure gene cluster in E. coli, ureC, encodes a subunit of urease. We have investigated the distribution of ureC in 202 Shiga toxin-producing E. coli (STEC) strains from Austria belonging to 61 different serotypes. These strains were of human (n=150), animal (n=38), and food (n=14) origin. ureC was present in all 72 E. coli O157:H7 and O157:NM (non-motile) strains, as well as in all 29 strains of serotypes O26:H11/NM, O111:H8/NM and O145:NM. In contrast, none of eight sorbitol-fermenting E. coli O157:NM were ureC-positive. ureC occurred significantly more frequently among STEC that carry eae (113 of 132; 85.6%) than among eae-negative STEC strains (four of 70; 5.7%; p<0.0001). However, only 4 (2%) of the 202 strains (3.4% of ureC positive strains) expressed urease activity. There was no significant association (p=0.56) between urease expression and the source of the isolates (humans vs. animals). Nucleotide sequence analysis of PCR amplicons derived from all seven genes of the ure cluster in STEC of 10 different serotypes demonstrated a high degree of homology (>or=99%), indicating a recent acquisition of not necessarily expressed ure genes.

Adhesins, Bacterial↗

Human polymeric IgA is superior to IgG and single-chain Fv of the same monoclonal specificity to inhibit urease activity associated with Helicobacter pylori.

Helicobacter-induced gastritis is considered nowadays an epidemic, the prevalence of which is one of the highest world-wide (70%), with as much as 40% of the population in industrialized countries. Helicobacter pylori (H. pylori) antigens (Ag) capable to elicit a protective immune response in animal models have been identified, but these antigens have not been shown to be strongly immunogenic when administered to humans. Due to their stability in the gastric environment and avidity, passive administration of secretory immunoglobulin A (SIgA) antibodies (Ab) targeting protective Ag might be particularly relevant as a substitute or complement to current therapies. To this aim, we have designed expression vectors to convert a scFv polypeptide specific for H. pylori urease subunit A into human IgG, polymeric IgA (IgAp/d) and SIgA. Purified proteins show proper binding characteristics toward both the native and denatured forms of H. pylori urease. The direct comparison between different isotype and molecular forms, but of unique specificity, demonstrates that SIgA and IgAp/d are more efficient in blocking free and H. pylori-associated urease than IgG and scFv. We conclude that the expression system reported herein will represent a valuable tool to produce human SIgA Ab of multiple specificities against H. pylori antigens involved in colonization and persistence.

Animals↗

Impact of vector-priming on the immunogenicity of a live recombinant Salmonella enterica serovar typhi Ty21a vaccine expressing urease A and B from Helicobacter pylori in human volunteers.

Orally administered recombinant Salmonella vaccines represent an attractive option for mass vaccination programmes against various infectious diseases. Therefore, it is crucial to gather knowledge about the possible impact of preexisiting immunity to carrier antigens on the immunogenicity of recombinant vaccines. Thirteen volunteers were preimmunized with Salmonella typhi Ty21a in order to evaluate the effects of prior immunization with the carrier strain. Then, they received three doses of 1-2 x 10(10) viable organisms of either the vaccine strain S. typhi Ty21a (pDB1) expressing subunits A and B of recombinant Helicobacter pylori urease (n = 9), or placebo strain S. typhi Ty21a (n = 4). Four volunteers were preimmunized and boosted with the vaccine strain S. typhi Ty21a (pDB1). No serious adverse effects were observed in any of the volunteers. Whereas none of the volunteers primed and boosted with the vaccine strain responded to the recombinant antigen, five of the nine volunteers preimmunized with the carrier strain showed cellular immune responses to H. pylori urease (56%). This supports the results of a previous study in non-preimmunized volunteers where 56% (five of nine) of the volunteers showed a cellular immune response to urease after immunisation with S. typhi Ty21a (pDB1).

Adult↗

Poliovirus replicons encoding the B subunit of Helicobacter pylori urease protect mice against H. pylori infection.

We developed a novel vaccine for Helicobacter pylori based on a poliovirus vector in which capsid genes were replaced with the gene for the B subunit of H. pylori urease (UreB). Mice were vaccinated with UreB or control (L1) replicon and challenged with H. pylori. Twenty percent of mice vaccinated prophylactically with UreB, but 80% vaccinated with L1, and then challenged with H. pylori became infected (P = 0.003). Seventy-three percent of mice with established H. pylori infection vaccinated therapeutically with UreB replicon cleared their infection compared to 33% vaccinated with L1 (P = 0.067). In therapeutically vaccinated mice with residual infection, UreB-vaccinated animals had fewer H. pylori than L1-vaccinated mice (P < 0.05). Anti-urease antibody titres in prophylactically, but not therapeutically, vaccinated mice were markedly higher in animals that received UreB versus L1 replicon (P = 0.01). Vaccination with poliovirus vector containing the gene for the B subunit of H. pylori urease provides significant prophylactic and strong therapeutic protection against H. pylori in mice.

Animals↗

Human immune response towards recombinant Helicobacter pylori urease and cellular fractions.

Vaccination against Helicobacter pylori is of particular clinical interest. Recombinant urease, the major protein in H. pylori, has been used for mucosal vaccination trials in different animal models, but was found to be ineffective in humans. The current study therefore investigated the human immune response towards recombinant H. pylori urease A and B (rUreA/B) expressed in E. coli compared to different cellular fractions of H. pylori (cytosol, total, inner and outer membrane). Monocyte-derived dendritic cells (Mo-DC) were generated from monocytes isolated by magnetic antigen cell separation (MACS) from healthy volunteers and cultured in the presence of hrIL-4 and hrGM-CSF. Mo-DC were stimulated for 48h with the recombinant proteins (1 microg/ml) or cellular fractions (1-10 microg/ml) and cytokine release was determined in the culture supernatant by ELISA. rUreA and rUreB were effective in inducing IL-12 secretion (6-10 fold) and, to a much lesser extent (2 fold), IL-10 secretion from Mo-DC. Total and outer membrane preparations from H. pylori stimulated IL-12 secretion significantly, and were even more potent than intact bacteria. Mo-DCs pulsed with rUreA activated allogenic CD56+ NK-cells, as determined by TNF-alpha and IFN-gamma secretion, but not allogenic CD4+/CD45RA+ naïve T-cells. In contrast, Mo-DCs pulsed with H. pylori total membrane or outer membrane preparations activated allogenic naive T-cells in co-culture systems, as determined by increased TNF-alpha secretion. It appears that outer membrane preparations of H. pylori, but not recombinant urease are more effective in inducing a Th1 polarized response in humans in vitro.

Bacterial Vaccines↗

Shear deformation effects in enzyme catalysis. Metal ion effect in the shear inactivation of urease.

The mechanism of the inactivation of the enzyme urease produced by subjecting its dilute solutions to hydrodynamic shear stresses in the range 0.5-2.5 Pa has been determined. By studying the kinetics of urease-catalyzed urea hydrolysis during application of hydrodynamic shear under varying chemical environments, we demonstrate that micromolar quantities of metal ions, in this case adventitious Fe, can accelerate the oxidation of thiol groups on urease and thus inactivate it when the protein is subjected to a shearing stress of order 1.0 Pa. In the absence of metal ion this stress level is ineffectual. It is proposed that this type of synergy between deformation and chemical environment may be crucial in many situations where biological macromolecules are subjected to mechanical stress.

Iron↗

A prospective comparison of locally made rapid urease test and histology for the diagnosis of Helicobacter pylori infection.

BACKGROUND: A number of noncommercial preparations of urease test have been described. The present prospective study evaluated the accuracy of one such preparation for the diagnosis of Helicobacter pylori infection. METHODS: From February 1996 to November 1996, all patients undergoing elective upper endoscopy in a single endoscopy facility were included. Three antral biopsy specimens were taken. Two specimens were subjected to histologic examination, and one specimen was placed into a "locally made rapid urease test" (LRUT). Results of histologic examinations were taken as standards for comparison. The final result of LRUT was obtained on scrutiny of color changes at 4 hours after the start of the test. RESULTS: Two thousand three hundred sixteen patients (male/female = 1.5:1) with a mean age of 56.7 +/- 0.4 years were included. Five hundred sixty-two patients (24.3%) had a history of eradication treatment for H. pylori. Nine hundred fifty-three patients (41.1%) were found to be positive for H. pylori on histologic examination. In patients in whom a history of eradication therapy was absent, the sensitivity, specificity, and positive and negative predictive values of the LRUT were 92.8%, 97.6%, 97.5%, and 93.0%, respectively. In patients with a history of eradication treatment, the corresponding figures were 76.1%, 99.6%, 96.2%, and 96.9%. CONCLUSIONS: The locally made rapid urease test provides a simple, safe, rapid, inexpensive, and accurate test for the diagnosis of H. pylori infection.

Biopsy↗

Endoscopic urease sensor system for detecting Helicobacter pylori on gastric mucosa.

BACKGROUND: It is now accepted that the curing of Helicobacter pylori infection will result in healing of chronic active gastritis and will change the natural history of gastroduodenal ulcer disease. Both endoscopic observation and evaluation of H. pylori status of the stomach are necessary for diagnosis and treatment of such patients. We carried out a clinical evaluation of an endoscopic tube type urease sensor system for the detection of H. pylori on the gastric mucosa. The differential output of two pH-sensitive field effect transistors at the tip of the endoscopic tube reflects the pH change in a urea solution depending on the existence of urease. METHODS: In vitro experiments and clinical evaluation of the system were performed. Fifty-one patients who were suspected to have a gastroduodenal disorder were examined for H. pylori infection with this system, using the combination of histologic and bacteriologic examinations and rapid urease test as the references. RESULTS: Clinical sensitivity and specificity of this system were 26 of 28 (92.9%) and 22 of 23 (95.7%), respectively. A measurement at 1 site is completed in about 1 minute. Repetition of the procedure provides multi-site measurements. CONCLUSIONS: The present system makes possible quick on-site detection of H. pylori under endoscopic observation, with satisfactory sensitivity and specificity.

Adult↗

Long-term studies of urease-induced crystallization in human urine.

Urine samples were inoculated with viable Proteus mirabilis or purified Jack bean urease. The subsequent pH increase and crystallization were followed for 2 weeks. Particle formation was detected much earlier and at a lower pH in urines inoculated with Proteus, in which a higher end pH was also reached. The crystal configuration in bacteria and urease inoculated samples was different. Crystal aggregation was also much more pronounced in the Proteus mirabilis inoculated samples. The total precipitation was markedly increased in the Proteus mirabilis inoculated samples. The presence of live Proteus mirabilis thus has a profound influence on urease-induced crystallization in human urine. Despite the formation of rather large crystal aggregates in the Proteus-inoculated urines, no firm aggregates of a "prestone" type were observed.

Crystallization↗

The inhibitory effect of human urine on urease-induced crystallization in vitro.

To study whether human urine contains inhibitors against urease-induced crystallization, Jackbean urease and human urine, in amounts small enough (0.5 to 10 per cent) not to influence the ion concentration, buffering capacity or pH, were added to synthetic urine. The ammonia production and alkalinization that followed were independent of the amounts of human urine added. The addition of human urine gave a dose-related decrease in the amount of calcium phosphate and struvite precipitated on glass rods immersed in the synthetic urine, however. Addition of only 0.5 per cent human urine gave a reproducible decrease and when 10 per cent human urine was added to the synthetic urine the precipitation of calcium phosphate was reduced by 50 per cent and that of struvite by 75 per cent. The results thus indicate that human urine contains components with the ability to reduce the urease-induced crystallization.

Adult↗

Urease-induced crystallization in synthetic urine.

The urease-induced crystallization of magnesium ammonium phosphate and calcium phosphate was studied at different alkalinization degrees by incubating synthetic urine with increasing Jack Bean urease concentrations. The crystallization was studied as precipitation on glass rods immersed in synthetic urine. The calcium phosphate precipitation on the glass rods occurred when the pH reached 6.8. Magnesium ammonium phosphate precipitation occurred when the pH reached 7.0. The maximal crystallization occurred at a pH between 7.5 and 8.0; at higher pHs the precipitation was considerably lower. The possible mechanisms and clinical implications behind this narrow pH optimum for urease-induced crystallization, which also have important implications for future experimental studies, are discussed.

Calcium Phosphates↗

Rapid urease screening of Yersinia on CIN agar plates.

Yersinia enterocolitica is an important foodborne pathogen, but isolation of virulent Yersinia from food sources is still time consuming and requires skills. In this article, we describe a rapid urease screening on cefsulodin-irgasan-novobiocin (CIN) agar plates with an agar overlay assay. This test is simple to perform, all colonies on a plate can be checked simultaneously, it only takes minutes for detection of urease-positive colonies and the colonies survive for transfer, further characterisation, and storage. Additionally, this method is useful to isolate virulent (urease-positive and pYV harbouring) Y. enterocolitica from foodstuffs.

Agar↗

Purification, characterization, and application of an acid urease from Arthrobacter mobilis.

It has been shown that urea in fermented beverages and foods can serve as a precursor of ethylcarbamate, a potential carcinogen, and acid urease is an effective agent for removing urea in such products. We describe herein the purification and characterization of a novel acid urease from Arthrobacter mobilis SAM 0752 and show its unique application for the removal of urea from fermented beverages using the Japanese rice wine, sake, as an example. The purified acid urease showed an optimum pH for activity at pH 4.2. The enzyme exhibited an apparent K(m) for urea of 3.0 mM and a Vmax of 2370 mumol of urea per mg and min at 37 degrees C and pH 4.2. Gel permeation chromatographic and sodium dodecyl sulfate gel electrophoretic analyses showed that the enzyme has an apparent native molecular weight (M(r)) of 290,000 and consisted of three types of subunit proteins (M(r), 67,000, 16,600, 14,100) denoted by alpha, beta, and gamma. The most probable stoichiometry of the subunits was estimated to be alpha: beta: gamma = 1:1:1, suggesting the enzyme subunit structure of (alpha beta gamma)3. The enzyme also existed as an aggregated form with an M(r) of 580,000. The purified enzyme contained 2 g-atom of nickel per alpha beta gamma unit of the enzyme. Enzyme activity was inhibited by acetohydroxamic acid, HgCl2, and CuCl2. The isoelectric point of the native enzyme was estimated by gel electrofocusing to be 6.8. Urea (50 ppm), which was exogenously added to sake (pH 4.4, 17 +/- 1% (v/v) ethanol), was completely decomposed by incubation with the enzyme (0.09 U ml-1) at 15 degrees C for 13 days. The enzyme was unstable at temperatures higher than 65 degrees C and pHs lower than 4, and was completely inactivated under the conditions of a pasteurization step involved in the traditional sake-making processes. These results indicate that the enzyme is applicable to the elimination of urea in fermented beverages with minimal modification to the conventional process.

Alcoholic Beverages↗

Safety and immunogenicity of live recombinant Salmonella enterica serovar Typhi Ty21a expressing urease A and B from Helicobacter pylori in human volunteers.

Helicobacter pylori urease was expressed in the common live typhoid vaccine Ty21a yielding Ty21a(pDB1). Nine volunteers received Ty21a(pDB1) and three control volunteers received Ty21a. No serious adverse effects were observed in any of the volunteers. Ten out of 12 volunteers developed humoral immune responses to the Salmonella carrier as detected by antigen-specific antibody-secreting cells but only two volunteers seroconverted. A total of five volunteers showed responses in one or two out of three assays for cellular responses to the carrier (proliferation, IFN-gamma-secretion, IFN-gamma-ELISPOT). Three of the volunteers that had received Ty21a(pDB1) showed a weak but significant T-cell response to Helicobacter urease, while no volunteer had detectable humoral responses to urease. Ty21a(pDB1) is a suitable prototype to optimize Salmonella-based vaccination for efficient cellular responses that could mediate protective immunity against Helicobacter.

Adolescent↗