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Signal transduction in Pneumocystis carinii: characterization of the genes (pcg1) encoding the alpha subunit of the G protein (PCG1) of Pneumocystis carinii carinii and Pneumocystis carinii ratti.

Pneumocystis carinii is a eukaryotic organism that causes pneumonia in immunocompromised hosts. The cell biology and life cycle of the organism are poorly understood primarily because of the lack of a continuous in vitro cultivation system. These limitations have prevented investigation of the organism's infectious cycle and hindered the rational development of new antimicrobial therapies and implementation of measures to prevent exposure to the organism or transmission. The interaction of P. carinii with its host and its environment may be critical determinants of pathogenicity and life cycle. Signal transduction pathways are likely to be critical in regulating these processes. G proteins are highly conserved members of the pathways important in many cellular events, including cell proliferation and environmental sensing. To characterize signal transduction pathways in P. carinii, we cloned a G-protein alpha subunit (G-alpha) of P. carinii carinii and P. carinii ratti by PCR amplification and hybridization screening. The gene encoding the G-alpha was present in single copy on a 450-kb chromosome of P.c. ratti. The 1,062-bp G-alpha open reading frame is interrupted by nine introns. The predicted polypeptide showed 29 to 53% identity with known fungal G-alpha proteins with greatest homology to Neurospora crassa Gna-2. Northern (RNA) blot analysis and immunoprecipitation demonstrated expression of the G-alpha mRNA and protein P. carinii isolated from heavily infected animals. Some alteration in the level of transcription was noted in short-term maintenance in starvation or rich medium. Characterization of signal transduction in P. carinii will permit a better understanding of the reproductive capacity and other cellular processes in this family or organisms that cannot be cultured continuously.

Amino Acid Sequence

Pneumocystis pneumonia: importance of gallium scan for early diagnosis and description of a new immunoperoxidase technique to demonstrate Pneumocystis carinii.

Pneumocystis pneumonia presented in a homosexual with fever, a normal chest radiograph, and pulmonary gallium uptake. Bronchial washings yielded Mycobaterium tuberculosis, but despite antituberculosis therapy he remained febrile, and gallium uptake in the lung increased. Subsequently, silver stain of transbronchial lung biopsy obtained 2 months earlier at the time that tuberculosis was diagnosed showed many Pneumocystis cysts in alveolar spaces. In contrast to Pneumocystis cysts in infected lung tissue from other humans, our patient's Pneumocystis cysts reacted more avidly with antiserum to rat Pneumocystis than with antiserum to human pneumocystis, raising the possibility that organisms that infect humans may have varied surface antigenic properties.

Adult

Correlation of Pneumocystis carinii cyst density with mortality in patients with acquired immunodeficiency syndrome and pneumocystis pneumonia.

Fifteen percent to 20% of patients with the acquired immunodeficiency syndrome and pneumocystis pneumonia do poorly despite early intervention. It is not known what distinguishes those who die, despite early intervention and aggressive therapy, from those who readily respond to therapy. We used image analysis to determine the relative abundance of cysts within aggregates of Pneumocystis carinii found in induced sputa (21 patients) and bronchoalveolar lavage fluid (14 patients) from 35 patients with pneumocystis pneumonia. We calculated a cyst density (number of cysts per area of aggregate) for each aggregate and a mean cyst density for all of the aggregates on the smear. Six patients died within 2 weeks of diagnosis; four of these six patients who had autopsies all had residual P carinii. The mean cyst density for those who died was 9.7 +/- 3.9 (range, 5 to 15 x 10(-3)). The 29 patients who survived beyond 2 weeks had a mean cyst density of 18.4 +/- 8.7 (range, 5 to 35 x 10(-3); P = .01). Mean cyst density was not influenced by the number of aggregates present in the smear, the variation in cyst density among aggregates in a smear, or the episode of pneumocystis pneumonia. Cyst density determinations alone should not be used to predict outcome for individuals with P carinii pneumonia until further study is completed. Nevertheless, the current study suggests that a low cyst density specimen, which may indirectly indicate a greater proportion of trophozoites compared with a high cyst density specimen, may be associated with an unfavorable outcome in acquired immunodeficiency syndrome-associated pneumocystis pneumonia.

Acquired Immunodeficiency Syndrome

[Primary and secondary prevention of Pneumocystis carinii pneumonia with pentamidine aerosol. Effectiveness, side effects and incidence of extrapulmonary Pneumocystis carinii manifestations].

BACKGROUND: We report on a retrospective study in 544 HIV-positive patients, (42 women, 502 men, mean age 35 years) showing CD4 lymphocyte counts below 200 c/mcl or after their cure of Pneumocystis carinii pneumonia, who received 300 mg pentamidine aerosol as prophylaxis against Pneumocystis carinii pneumonia every four week. PATIENTS AND METHODS: 277 patients were asymptomatic, 120 in the AIDS related complex stage (ARC) and 147 in the full stage of AIDS. The mean follow-up was 14.4 months. RESULTS: A total of 25 cases of Pneumocystis carinii pneumonia was observed (3.83/year): in the primary prophylaxis group 18 (3.25%/year), in the secondary prophylaxis group seven (6.8%/year). By introducing the loading dose (one inhalation per day for five consecutive days for patients with CD4 cell counts below 150 c/mcl) we reduced the percentage of early manifestations within the first three months from 61% to 14%. No extrapulmonary Pneumocystis carinii manifestation was observed. CONCLUSION: This study supports the efficacy of pentamidine aerosol prophylaxis of primary and secondary Pneumocystis carinii pneumonia.

AIDS-Related Opportunistic Infections

[Laboratory and clinical study on Pneumocystis carinii. II. Immunoblot analysis for detection of anti-Pneumocystis carinii antibodies in the sera from healthy blood donors].

Rat Pneumocystis carinii cyst soluble antigen (CSA) was analysed by SDS-PAGE, and more than 20 polypeptide bands were found. The molecular weights of the major bands were > 100kDa, 85-94kDa, 67kDa, 52kDa and 34kDa, respectively. The specific IgG antibodies in the sera from healthy blood donors recognizing the 110kDa, 105kDa, 85kDa, 67kDa, 52kDa and 46kDa polypeptide antigens were identified by immunoblot analysis. The total positive rate of IgG specific antibodies was 56.7% (59/104). The 85kDa polypeptide antigen could also react with the monoclonal antibody derived from human Pneumocystis carinii. The positive rate of the specific anti-85kDa-IgG antibody was 37.5% (39/104), but the specific anti-Pneumocystis carinii IgM antibodies were not detected in all the sera examined. Three of 7 serum samples from the patients with Pneumocystis carinii pneumonia were positive for specific anti-85kDa-IgG antibody (Figs 1-4).

Animals

Pneumocystis carinii: improved models to study efficacy of drugs for treatment or prophylaxis of Pneumocystis pneumonia in the rat (Rattus spp.).

Rats which were immunosuppressed with adrenal corticosteroids then transtracheally inoculated with Pneumocystis carinii were evaluated as models for study of drug efficacy. Trimethoprim/sulfamethoxazole, known to be effective against Pneumocystis, was given in therapeutic and prophylactic regimens and its long-term effectiveness determined by a protocol to study relapse. Untreated animals uniformly developed severe infection with differences in numbers of organisms between untreated and treated animals being greater than two logs. Therapy of prophylaxis studies could be completed in 6 to 7 weeks. Animals given prophylaxis or therapy with trimethoprim/sulfamethoxazole had few organisms detected in lungs. Numbers of organisms did not increase during the 4 weeks when the animals were continued on immunosuppression after discontinuing treatment as long as reinfection was prevented. These models are useful for evaluating anti-Pneumocystis activity of antimicrobials. Relapse study data suggest that reinfection may have an important role in development of recurrent Pneumocystis pneumonia.

Animals

Detection of antibodies to Pneumocystis carinii in bronchoalveolar lavage fluid by immunoreactivity to Pneumocystis carinii within alveoli, granulomas, and disseminated sites.

Although Pneumocystis carinii pneumonia (PCP) is the most common major opportunistic infection in the acquired immunodeficiency syndrome (AIDS), its immunopathogenesis is not fully understood. It is known that anti-pneumocystis antibodies are present in the sera of individuals with and without PCP. In order to determine whether anti-pneumocystis antibodies are also present in bronchoalveolar lavage fluid (BAL), we looked for them, by immunoreactivity with tissue sections of intra-alveolar P. carinii, in the BAL of (a) HIV-seropositive patients with PCP (n = 18); (b) HIV-seropositive patients without PCP (n = 11); and (c) HIV-seronegative patients with nonpneumocystis lung disease (n = 5). BALs from 19 of 29 HIV-seropositive patients were deficient in at least one isotype (13 with PCP, six without PCP), while only one of five HIV-seronegative patients was deficient. Despite the considerable documentation of atypical presentations of disease caused by P. carinii, little is known concerning the mechanisms involved. To determine whether there is any relationship between BAL anti-pneumocystis antibodies and diverse host responses, we studied antibody binding to P. carinii in different settings. IgG antibodies in BAL bound P. carinii within spleen, liver, skin, and muscle, as well as within pulmonary alveoli and granulomas. However, IgA antibodies in BAL bound intraalveolar and disseminated P. carinii but did not bind to P. carinii within pulmonary granulomas.(ABSTRACT TRUNCATED AT 250 WORDS)

Antibodies, Fungal

Reduced concentrations of IgG antibodies to Pneumocystis carinii in HIV-infected patients during active Pneumocystis carinii infection and the possibility of passive immunisation.

The relationship between Pneumocystis carinii antibody concentrations and acute Pneumocystis infection was investigated by testing sequential samples of serum from HIV antibody-positive patients with respiratory symptoms and HIV-negative immunocompromised patients by means of an indirect immunofluorescence assay for specific IgG antibodies to P. carinii. Loss of circulating antibody at the time of active Pneumocystis infection was observed in five patients with proven infection. Three others showed recovery of antibody coinciding with treatment and clinical recovery from infection. Concentrations of specific IgG antibody against P. carinii were measured in 40 blood donors and in six different batches of an intravenous immunoglobulin (IV Ig) preparation. Titres greater than 128 were found in the IV Ig batches examined. The use of IV Ig, either alone or in conjunction with other therapeutic agents, should therefore be considered in patients suffering from acute infection with P. carinii.

Antibodies, Fungal

Identification and characterization of an endo/exonuclease in Pneumocystis carinii that is inhibited by dicationic diarylfurans with efficacy against Pneumocystis pneumonia.

Dicationic diarylfurans and dicationic carbazoles are under development as therapeutic agents against opportunistic infections. While their ability to bind to the minor groove of DNA has been established, the complete mechanism of action has not. We demonstrate here that an effective diarylfuran, 2,5-bis[4-(N-isopropylguanyl)phenyl]furan, inhibits an endo/exonuclease activity present in Pneumocystis carinii, Cryptococcus neoformans, Candida albicans, and Saccharomyces cerevisiae. This activity was purified from the particulate fraction of P. carinii. The enzyme requires Mg++ or Mn++, and shows preferences for single-over double stranded DNA and for AT-rich over GC-rich domains. A panel of 12 dicationic diarylfurans and eight dicationic carbazoles, previously synthesized, were evaluated for inhibition of the purified nuclease and for efficacy against Pneumocystis pneumonia in rats. Among the diarylfurans, potency of nuclease inhibition, in vivo antimicrobial activity, and DNA binding strength were all strongly correlated (p < 0.001). These findings suggest that one target for antimicrobial action of the diarylfurans may be a nucleolytic or other event requiring unpairing of DNA strands. Dicationic carbazoles which were strong nuclease inhibitors all displayed anti-Pneumocystis activity in vivo, but there were also noninhibitory carbazoles with in vivo efficacy.

Animals

Application of immunoblotting to detect soluble Pneumocystis carinii antigen(s) in bronchoalveolar lavage of patients with Pneumocystis pneumonia and AIDS.

The technique of immunoblotting for detecting soluble Pneumocystis carinii antigen(s) in bronchoalveolar lavage fluid specimens from patients with AIDS and Pneumocystis pneumonia was evaluated. A soluble 67 kilodalton polypeptide that was immunoreactive with an anti-P carinii monoclonal antibody (2G2) was found in the supernatants of 26 lavage samples from patients with pneumocystosis. Intact organisms in lavage sediments were detected by methenamine silver or immunofluorescence staining procedures. The diagnostic use of this technique was shown in four cases in which lavage sediments proved negative for intact Pneumocystis carinii organisms on first examination; 2G2 reactive soluble antigen, however, was identified in the immunoblots of the supernatants from the same samples. It is concluded that immunoblotting of bronchoalveolar lavage specimens using 2G2 monoclonal antibody as a detection probe may be a useful adjunct to the morphological demonstration of organisms by special staining procedures.

Acquired Immunodeficiency Syndrome

The value of Pneumocystis carinii antibody and antigen detection for diagnosis of Pneumocystis carinii pneumonia after marrow transplantation.

Thirty-three marrow transplant patients with Pneumocystis carinii pneumonia were studied to determine the usefulness of antibody and antigen detection in the diagnosis of pneumocystis infection. Antibody against P. carinii was present in one half of all patients tested, and changes in antibody titer were not helpful diagnostically. P. carinii antigen was detected by counterimmunoelectrophoresis in the serum of 22 of 28 patients tested. Fifteen of 28 patients had antigen detected before or within 72 h after diagnosis. However, antigen was also present in 35 of 52 marrow transplant patients with viral or idiopathic pneumonia, in 11 of 25 transplant patients with no pneumonia, and in 22 of 28 other patients with pulmonary infiltrates. Only 1 of 50 normal marrow donors had detectable antigenemia. Detection of this antigen does not appear to establish the diagnosis of P. carinii pneumonia in the absence of other clinical or histologic data. The data may suggest that subclinical infection with this agent is more common than was previously recognized.

Adolescent

Persistence of Pneumocystis carinii in lung tissue of acquired immunodeficiency syndrome patients treated for pneumocystis pneumonia.

Eleven patients with acquired immunodeficiency syndrome (AIDS) and Pneumocystis carinii pneumonia (PCP) were studied by repeat bronchoscopy during PCP treatment to assess histologic evidence of resolution of the pneumonia. Nine of 10 patients studied after 8 to 21 days of therapy demonstrated evidence of persistent PCP. Four of 6 patients studied after 22 to 35 days of therapy continued to demonstrate Pneumocystis carinii cysts on repeat examination, while only 1 of 4 patients studied after 35 days of therapy showed evidence of PCP pneumonia. The rate of resolution of PCP in patients with AIDS may be different from the rate of resolution of PCP in patients without AIDS. There was no apparent correlation between rate of clinical response and likelihood of histologic resolution on follow-up biopsy. The PCP in patients with AIDS may require more prolonged therapy for complete resolution of this pneumonic process.

Acquired Immunodeficiency Syndrome

Increased Pneumocystis carinii recovery from the upper lobes in Pneumocystis pneumonia. The effect of aerosol pentamidine prophylaxis.

STUDY OBJECTIVE: To determine the relative distribution of Pneumocystis carinii in the lungs of patients with P carinii pneumonia and to see the effect of aerosol pentamidine prophylaxis on this distribution. DESIGN: A prospective study of all human immunodeficiency virus-infected patients with pulmonary symptoms over a nine-month period. Patients were followed up for at least six weeks after bronchoscopy. SETTING: Inpatient and outpatient service at one referral center. PATIENTS: Human immunodeficiency virus-infected patients with pulmonary symptoms were referred for evaluation. Those patients subsequently found to have P carinii pneumonia were studied. INTERVENTION: Bronchoalveolar lavage was performed in the middle lobe (or lingula) and the apical segment of the same lung. MEASUREMENTS AND RESULTS: The aspirated fluids were kept separate and modified Wright-Giemsa-stained cytocentrifuge-prepared slides were made from each area, and the number of P carinii clusters per 500 nucleated cells was counted. Fifty patients were studied: 27 receiving pentamidine prophylaxis and 23 receiving no aerosol therapy. There was no significant difference in the amount of fluid retrieved by lavage from the middle or upper lobe for either group. Both groups had significantly lower numbers of P carinii clusters per 500 cells in the middle lobe (receiving pentamidine: 10 +/- 15.8 [SD]; not receiving pentamidine: 15 +/- 12.3) than in the upper lobe (receiving pentamidine: 22 +/- 19.8; not receiving pentamidine: 24 +/- 21.5; p < 0.02). In six patients, there were no P carinii organisms seen in the middle lobe lavage specimen. CONCLUSION: Pneumocystis carinii has a preference for the upper lobes which may be apparent even in patients not receiving aerosol pentamidine. In addition, yield for P carinii may be increased by performing lavage in the apical segment.

AIDS-Related Opportunistic Infections

Immunohistochemical detection of Pneumocystis carinii in transbronchial lung biopsy specimens: antigen difference between human and rat Pneumocystis carinii.

Transbronchial lung biopsy specimens, from three patients with non-AIDS-related Pneumocystis carinii pneumonia (PCP) and rat lung tissue in which PCP was induced by the administration of dexamethasone, were studied to determine the diagnostic usefulness of an immunohistochemical method using commercially available anti-Pneumocystis monoclonal antibody, 3F6, on formalin-fixed, paraffin-embedded tissue. PC was consistently stained a bright red color and unambiguously identified in all three human lung specimens, but not stained in lung tissues at autopsy from patients with various fungal pneumonias. In contrast, PC was weakly stained in PCP-induced rat lungs. The present study indicates human PC and rat PC to be antigenically different in terms of the existence of the 82 kilo-dalton (kD) antigen against which 3F6 is directed.

Adult

Antibodies to Pneumocystis carinii in Danish blood donors and AIDS patients with and without Pneumocystis carinii pneumonia.

Sera from 1) 8 AIDS patients with Pneumocystitis carinii pneumonia, 2) 13 HIV antibody-positive patients, 9 with AIDS and 4 with AIDS-related symptoms, all 13 without Pneumocystis carinii pneumonia, and 3) 36 healthy male blood donors, all HIV antibody negative, were examined for antibodies against Pneumocystis carinii using the indirect immunofluorescence antibody technique. Seven (87%) out of eight sera from group 1, 12 (92%) out of 13 sera from group 2, and 35 (97%) out of 36 sera from group 3 were positive. There was no significant difference between group 1 and 2, and group 2 and 3. The difference between group 1 and group 3 was significant (p = 0.03).

AIDS-Related Opportunistic Infections

Discrimination of rat-derived Pneumocystis carinii f. sp. Carinii and Pneumocystis carinii f. sp. Ratti using the polymerase chain reaction.

The rat model of Pneumocystis carinii infection is widely used for the study of this non-culturable pathogen. Two genetically divergent < > of the organism have been detected in infected rat lungs, P. carinii formae specialis carinii and P. carinii formae specialis ratti, in some cases as a co-infection. We have developed a simple and rapid method to analyse rat-derived P. carinii samples, based on DNA amplification of a portion of the gene encoding the mitochondrial large subunit ribosomal RNA. A pair of oligonucleotide primers were designed for each special form of rat-derived P. carinii, the RC primer pair amplifying a 137 bp fragment from P. carinii f. sp. carinii DNA and the RR primer pair amplifying a 251 bp fragment from P. carinii f. sp. ratti DNA. The specificity of the primers was confirmed by sequencing the amplification products. The polymerase chain reaction (PCR) technique was consistent with, and more sensitive than, the electrophoretic karyotype method. The application of the specific PCR technique has implications for future studies on epidemiology, drug sensitivity, immunology and molecular biology of rat-derived P. carinii.

Animals

The development of Pneumocystis carinii pneumonia in germ-free rats requires immunosuppression and exposure to the Pneumocystis carinii organism.

Adult germ-free rats treated with dexamethasone and exposed to a non-sterile environment did not harbor or develop Pneumocystis carinii cysts or trophozoites after 10 weeks of immunosuppression. Only when they were exposed to infected, conventional rats and treated with dexamethasone for 8 weeks or longer, did adult germ-free rats develop P. carinii infection.

Animals

Pneumocystis carinii pneumonia: the status of Pneumocystis biochemistry.

Pneumocystis carinii pneumonia remains a prevalent opportunistic disease among immunocompromised individuals. Although aggressive prophylaxis has decreased the number of acute P. carinii pneumonia cases, many patients cannot tolerate the available drugs, and experience recurrence of the infection, which can be fatal. It is now generally agreed that the organism should be placed with the fungi, but the identification of extant fungal species representing its closest kins, remains debated. Most recent data indicate that P. carinii represents a diverse group of organisms. Since the lack of methods for the continuous subcultivation of this organism hampered P. carinii research, molecular cloning and nucleotide sequencing approaches led the way for understanding the biochemical nature of this pathogen. However, within the last 5 years, the development of improved protocols for isolating and purifying viable organisms from infected mammalian host lungs has enabled direct biochemical and metabolism studies on the organism. The protein moiety of the major high mol. wt surface antigen, represented by numerous isoforms, is encoded by different genes. These proteins are post-transcriptionally modified by carbohydrates and lipids. The organism has the shikimic acid pathway that leads to the formation of compounds which mammals cannot synthesise (e.g., folic acid), hence drugs that inhibit these pathways are effective against the pathogen. Ornithine decarboxylase has now been detected; rapid and complete depletion of polyamines occurs in response to difluoromethylornithine (DFMO). Instead of ergosterol (the major sterol of higher fungi), P. carinii synthesises distinct delta7, C-24-alkylated sterols. An unusual C32 sterol, pneumocysterol, has been identified in human-derived P. carinii. Another signature lipid discovered is cis-9,10-epoxy stearic acid. CoQ10, identified as the major ubiquinone homologue, is synthesised de novo by P. carinii. Atovaquone and other hydroxynaphthoquinone drugs with anti-P. carinii activity probably inhibit pathogen respiration as CoQ analogues. Unlike its effects on Plasmodium, atovaquone does not inhibit the P. carinii dihydroorotate dehydrogenase and pyrimidine metabolism.

Animals