Comparative infectious serology testing of pre- and post-mortem blood samples from cornea donors

Defined serological blood tests of deceased cornea donors are required to minimize the risk of viral infections of a transplant recipient as much as possible. Haemolysis, autolysis and bacterial contamination, may produce significant changes of post-mortem blood samples, which may lead to false serological test results. Pre- and post-mortem findings from the same cornea donors of the University Tissue Bank of the Charité in the years 2004-2009 (n?=?487) were retrospectively analyzed and compared. The test results from pre-mortem blood samples were defined as the reference for the post-mortem blood test. Of 487 cornea donors, there were a total of 21 cases (4.3?%) with discrepancies between serological test results from pre- and post-mortem blood samples. Of these, 7 values referred to the HBsAg-testing, 3 to the anti-HBs-, 1 to the anti-HBcIgG?+?IgM-, 1 to the anti-HCV-, 4 to the anti-HIV 1/2- and 5 to the TPLA-findings. False negative results within post-mortem serology occurred in 4 of 487 cases (0.8?%). False positive results within the post-mortem blood samples occurred at a much more frequent rate, with 17 of 487 cases (3.5?%). Discrepancies between serological pre- and post-mortem blood tests occur mainly due to the use of non-validated test systems. Therefore, it seems reasonable to test pre- and post-mortem blood samples serologically, whenever possible, at the same time, regardless of the sample age. Positive results, regardless of the sample type, should always be retested with validated confirmation tests (e.g. NAT), in order to differentiate between false and true positive results.     

PCR diagnostics underestimate the prevalence of avian malaria (Plasmodium relictum) in experimentally-infected passerines

Several polymerase chain reaction (PCR)-based methods have recently been developed for diagnosing malarial infections in both birds and reptiles, but a critical evaluation of their sensitivity in experimentally-infected hosts has not been done. This study compares the sensitivity of several PCR-based methods for diagnosing avian malaria (Plasmodium relictum) in captive Hawaiian honeycreepers using microscopy and a recently developed immunoblotting technique. Sequential blood samples were collected over periods of up to 4.4 yr after experimental infection and rechallenge to determine both the duration and detectability of chronic infections. Two new nested PCR approaches for detecting circulating parasites based on P. relictum 18S rRNA genes and the thrombospondin-related anonymous protein (TRAP) gene are described. The blood smear and the PCR tests were less sensitive than serological methods for detecting chronic malarial infections. Individually, none of the diagnostic methods was 100% accurate in detecting subpatent infections, although serological methods were significantly more sensitive (97%) than either nested PCR (61-84%) or microscopy (27%). Circulating parasites in chronically infected birds either disappear completely from circulation or to drop to intensities below detectability by nested PCR. Thus, the use of PCR as a sole means of detection of circulating parasites may significantly underestimate true prevalence.     

Malaria seroprevalence in blood bank donors from endemic and non-endemic areas of Venezuela

In Venezuela, a total of 363,466 malaria cases were reported between 1999-2009. Several states are experiencing malaria epidemics, increasing the risk of vector and possibly transfusion transmission. We investigated the risk of transfusion transmission in blood banks from endemic and non-endemic areas of Venezuela by examining blood donations for evidence of malaria infection. For this, commercial kits were used to detect both malaria-specific antibodies (all species) and malaria antigen (Plasmodium falciparum only) in samples from Venezuelan blood donors (n = 762). All samples were further studied by microscopy and polymerase chain reaction (PCR). The antibody results showed that P. falciparum-infected patients had a lower sample/cut-off ratio than Plasmodium vivax-infected patients. Conversely, a higher ratio for antigen was observed among all P. falciparum-infected individuals. Sensitivity and specificity were higher for malarial antigens (100 and 99.8%) than for antibodies (82.2 and 97.4%). Antibody-positive donors were observed in Caracas, Ciudad Bolívar, Puerto Ayacucho and Cumaná, with prevalences of 1.02, 1.60, 3.23 and 3.63%, respectively. No PCR-positive samples were observed among the donors. However, our results show significant levels of seropositivity in blood donors, suggesting that more effective measures are required to ensure that transfusion transmission does not occur.     

Effective serological and molecular screening of deceased tissue donors

A comprehensive and effective screening programme is essential to support the banking of tissues from deceased donors. However, the overall quality of the samples obtained from deceased donors, quantity and condition, is often not ideal, and this may lead to problems in achieving accurate and reliable results. Additionally a significant percentage of referrals are still rejected upon receipt as unsuitable for screening. We are actively involved in improving the overall quality of deceased donor screening outcomes, and have specifically evaluated and validated both serological and molecular assays for this purpose, as well as developing a specific screening strategy to minimise the specificity issues associated with serological screening. Here we review the nature and effectiveness of the deceased donor screening programme implemented by National Health Service Blood and Transplant (NHSBT), the organisation with overall responsibility for the supply of tissue products within England. Deceased donor screening data, serological and molecular, from August 2007 until May 2012 have been collated and analysed. Of 10,225 samples referred for serology screening, 5.5 % were reported as reactive; of 2,862 samples referred for molecular screening, 0.1 % were reported as reactive/inhibitory. Overall 20 % of the serological and 100 % of the molecular screen reactivity was confirmed as reflecting true infection. The use of a sequential serology screening algorithm has resulted in a marked reduction of tissues lost unnecessarily due to non-specific screen reactivity. The approach taken by NHSBT has resulted in the development of an effective and specific approach to the screening of deceased tissue donors.     

Malaria diagnosis by enzyme-linked immunosorbent assays.

Enzyme-linked immunosorbent assays (ELISA) for detecting malarial parasites in blood were tested on uninfected monkeys and in monkeys infected with Plasmodium falciparum. A double antibody sandwich ELISA detected one malarial cell per 10(3) uninfected cells, and an inhibition ELISA detected on infected cell per 10(4) uninfected erythrocytes. These methods are not yet as sensitive as conventional blood-film examinations, in which a well-trained microscopist might be expected to detect one malarial cell per 10(6) erythrocytes. Nevertheless, ELISA offers an objective means of detecting malaria and is particularly advantageous since up to 100 samples may be processed simultaneously.     

Determining Toxoplasma high-risk autologous and allogeneic hematopoietic stem cell transplantation patients by systematic pre-transplant PCR screening of stem cell originated buffy coat

The diagnosis of Toxoplasma infection or disease in hematopoietic stem cell transplantation (HSCT) patients is achieved mainly by PCR screening; however screening did not find wide field of use in practice due to costly expenditures of PCR. This study aimed to determine patients at high risk of Toxoplasma infection or disease before transplantation by stem cell originated buffy coat PCR and subsequently to screen them. Buffy coats collected from 12 autologous and 18 allogeneic HSCT patients' donors were investigated by PCR before transplantation. After transplantation, blood and sera collected at fixed time intervals were screened by two PCR methods and serological assays. Screening results first time assessed a toxoplasmosis incidence level as 25% in autologous HSCT patients and increased incidence level in allogeneic HSCT patients to 22%. Importantly, buffy coat PCR was first time performed before transplantation, to determine the risk of toxoplasmosis. Buffy coat PCR results showed that four patients were at high risk of toxoplasmosis before transplantation. After transplantation, these patients experienced toxoplasmosis. In conclusion, for the determination of patients at risk of toxoplasmosis, clinicians should consider buffy coat PCR in combination with serology before transplantation. After transplantation, PCR screening can be initiated in high risk patients upon clinical suspicion.     

Saurian malaria in Kenya: epidemiological features of malarial infections in lizard populations of the West Pokot District

During investigations into the prevalence of malarial parasites among lizards in the West Pokot District in Kenya, 179 lizards comprising eight species were caught. Examination of the Giemsa-stained smears made from their blood showed that 34 lizards were infected with Plasmodium species. Fifteen lizards were infected with a single species of Plasmodium and 19 carried multiple infections, the maximum, in four lizards, was four species. There were 19 combinations of parasite infections. Seventeen Plasmodium species were identified, the commonest being P. icipeensis. Only two of the eight lizard species were infected: the skink Mabuya striata and the agamid Agama agama. Eight of the Plasmodium species infected both; another eight species infected M. striata only but three of these have been described from different lizard families elsewhere in Africa. P. robinsoni infected A. agama only, although it was first described from another lizard family in another part of Africa. The epidemiological significance of these results is discussed.     

Mechanisms of resistance of Plasmodium falciparum to antimalarial drugs

Chemotherapy and chemoprophylaxis are the principal means of combating malaria parasite infections in the human host. In the last 75 years, since the introduction of synthetic antimalarials, only a small number of compounds have been found suitable for clinical usage, and this limited armoury is now greatly compromised by the spread of drug-resistant parasite strains. Our current knowledge of the molecular mechanisms underlying resistance in the lethal species Plasmodium falciparum is reviewed here.     

Humoral and cellular CMV responses in healthy donors; identification of a frequent population of CMV-specific, CD4+ T cells in seronegative donors

CMV status is an important risk factor in immune compromised patients. In hematopoeitic cell transplantations (HCT), both donor and recipient are tested routinely for CMV status by serological assays; however, one might argue that it might also be of relevance to examine CMV status by cellular (i.e., T lymphocyte) assays. Here, we have analyzed the CMV status of 100 healthy blood bank donors using both serology and cellular assays. About half (56%) were found to be CMV seropositive, and they all mounted strong CD8+ and/or moderate CD4+ T cell responses ex vivo against the immunodominant CMV protein, pp65. Of the 44 seronegative donors, only five (11%) mounted ex vivo T cell responses; surprisingly, 33 (75%) mounted strong CD4+ T cell responses after a brief in vitro peptide stimulation culture. This may have significant implications for the analysis and selection of HCT donors.     

Lipid rafts and malaria parasite infection of erythrocytes

Infection of human erythrocytes by the malarial parasite, Plasmodium falciparum, results in complex membrane sorting and signaling events in the mature erythrocyte. These events appear to rely heavily on proteins resident in erythrocyte lipid rafts. Over the past five years, we and others have undertaken a comprehensive characterization of major proteins present in erythrocyte detergent-resistant membrane lipid rafts and determined which of these proteins traffic to the host-derived membrane that bounds the intraerythrocytic parasite. The data suggest that raft association is necessary but not sufficient for vacuolar recruitment, and that there is likely a mechanism of active uptake of a subset of erythrocyte detergent-resistant membrane proteins. Of the ten internalized proteins, few have been evaluated for a role in malarial entry. The beta(2)-adrenergic receptor and heterotrimeric G protein G(s) signaling pathway proteins regulate invasion. The implications of these differences are discussed. In addition, the latter finding indicates that erythrocytes possess important signaling pathways. These signaling cascades may have important influences on in vivo malarial infection, as well as on erythrocyte membrane flexibility and adhesiveness in sickle cell anemia. With respect to malarial infection, host signaling components alone are not sufficient to induce formation of the malarial vacuole. Parasite proteins are likely to have a major role in making the intraerythrocytic environment conducive for vacuole formation. Such interactions should be the focus of future efforts to understand malarial infection of erythrocytes since host- and parasite-targeted interventions are urgently needed to combat this terrible disease.     

Plasmodium berghei XAT: protective 155/160 kDa antigens are located in parasitophorous vacuoles of schizont-stage parasite

Effective blood-stage malaria vaccine candidates have been mainly developed from the proteins in exposed locations on the parasite such as the surface of free merozoites or infected red blood cells. In the present study, we identified and localized novel protective antigens derived from the blood-stage of Plasmodium berghei XAT after establishment of hybridomas producing protective monoclonal antibodies (mAbs) against the parasites. The protective antigens were expressed in schizonts but not in trophozoites, and located in the parasitophorous vacuoles in the infected erythrocyte cytoplasm. The antigens, with molecular weight of 155/160 kDa, were not identical to any merozoite/schizont antigens that have been reported as target molecules recognized by mAbs developed to rodent malaria parasites. The characterization of new malarial antigenic targets of potentially protective antibody responses following infection would give us new insights for the selection of candidate antigens for malaria vaccine.     

Effect of xanthurenic acid on infectivity of Plasmodium falciparum to Anopheles stephensi.

Terminally differentiated malarial gametocytes remain in the vertebrate circulation in a developmentally arrested state until they are taken up by the mosquito. The gametocytes then undergo gametogenesis in the mosquito mid-gut within minutes after ingestion of the infected blood meal. The male gametogenesis (exflagellation) can be triggered by the combination of a decrease in temperature of at least 5 degrees C and a simultaneous increase in pH between 8.0 and 8.3. Xanthurenic acid, which is present in mosquito mid-gut as well as in mosquito head, had been shown to induce exflagellation in vitro at a non-permissible pH. Here we report for the first time that with the increasing concentration of exogenous xanthurenic acid, there is a gradual increase in the number of oocysts in the mid-gut of infected mosquitoes. The concentration of xanthurenic acid for optimum infection in the membrane feeding assay was determined to be 100 microM. Three different strains of Plasmodium falciparum, viz. 3D7, 7G8 and W2 were tested in different experiments and similar findings hold true for all of them. These results demonstrate that xanthurenic acid not only induces exflagellation of male gametocytes but also promotes infectivity of Plasmodium falciparum to mosquito vectors.     

Plasmodium yoelii: a differential fluorescent technique using Acridine Orange to identify infected erythrocytes and reticulocytes in Duffy knockout mouse

Both human malarial parasite Plasmodium vivax and mouse malaria parasite Plasmodium yoelii use Duffy protein as the receptor for invasion and they preferentially invade reticulocytes. Recently, it has been shown that P. yoelii invades mouse reticulocytes by a Duffy independent pathway. Parasite invasion is generally visualized by time consuming staining procedures with dyes like Giemsa or Wright-Giemsa. Fluorochromatic dye like Acridine Orange has been used for instantaneous detection of parasites in RBCs. Acridine Orange binds to both DNA and RNA but with different emission spectra; and the binding can be distinguished with a fluorescent microscope using a green or a red filter, respectively. We have used this differential emission of Acridine Orange to determine P. yoelii invasion into erythrocytes and reticulocytes of Duffy positive and Duffy knockout mice. Moreover, we show that this method can be used to determine the maturity of reticulocytes in the peripheral blood of anemic mice.     

Preservation of Borrelia kansas and Plasmodium berghei

Borrelia kansas and Plasmodium berghei have been stored after slow freezing in thioglycollate-glycerol medium for a 6-month period. During this time, 75% or more of the Borrelia remained motile, many intracellular malarial parasites exhibited amoeboid movement, and the growth pattern of both organisms in mice remained unchanged.     

Serological responses and immunity to superinfection with avian malaria in experimentally-infected Hawaii amakihi

Six of seven Hawaii Amakihi (Hemignathus virens) with chronic malarial infections had no increases in peripheral parasitemia, declines in food consumption, or loss of body weight when rechallenged with the homologous isolate of Plasmodium relictum 61 to 62 days after initial infection. Five uninfected control amakihi exposed at the same time to infective mosquito bites developed acute infections with high parasitemias. Reductions in food consumption and loss of body weight occurred in all control birds and three of these individuals eventually died. When surviving birds were rechallenged >2 yr later with either the same parasite isolate or an isolate of P. relictum collected on the island of Kauai, all individuals were immune to superinfection. Chronically infected birds developed antibodies to a common suite of malarial antigens ranging in size from 22 to 170 kDa that were detectable as early as 8 days post infection on immunoblots of SDS-polyacrylamide gels. Antibodies to this suite of malarial antigens persisted as long as 1,248 days after initial infection and were consistently detectable at times when parasites were not easily found by microscopy on Giemsa-stained blood smears. The immunoblotting method that is described here appears to be an effective technique for identifying birds with chronic, low-intensity malarial infections when circulating parasites are not easily detectable by microscopy. Hawaiian honeycreepers that are capable of recovering from acute infections develop concomitant immunity to superinfection, making them functionally immune in areas where malaria transmission has become endemic.     

Are heart valves from donors over 65 years of age morphologically suitable for transplantation?

Since there is no upper age limit for general organ donation, unlike heart valve donation, and since a quarter of all organ donors are 65 years and older, we examined whether the heart valves from these donors are suitable as allografts. In the period 1999–2004 the aortic valve and pulmonary valve of 100 organ donors above 65 years of age were examined to establish whether they would have been suitable as valve grafts. To compare the valve grafts above and below the age limit of 65 years, we used data on the aortic and pulmonary valves of 380 organ donors below the age limit in the same time period. Examination of the 200 heart valves showed that – just like valves from donors below the age limit – 100 of them would have met the medical quality standards for transplantation, which discriminate among optimal, suitable and unsuitable tissue morphology. The morphological suitability of the aortic valves decreases rapidly during the 4th decade of life and near to the age limit only 6% of them are accepted as grafts. The rate of potentially acceptable aortic valve grafts from organ donors aged over 65 years of 15% is also small. By contrast, the pulmonary valves are not affected by age-related tissue changes that might reduce their transplantability. The predominant majority (85%) of potential pulmonary valve grafts from organ donors over 65 years of age fulfilled the acceptance criteria, half of them (48%) even showing good tissue quality. In light of these results the age limit was raised to 70 years in 2005.     

Plasmodium berghei: gluconeogenesis in the infected mouse liver studied by 13C nuclear magnetic resonance

Using 13C nuclear magnetic resonance, we have compared the gluconeogenic activity of perfused livers isolated from normal starved mice and mice highly parasitized with Plasmodium berghei, using [2-13C]pyruvate as substrate. In both types of livers, 13C labeling of glucose carbons occurred in positions 1, 2, 5, and 6. The equal proportions of [1,6-13C]- and [2,5-13C]glucose in livers from malarial and normal mice suggests that pyruvate enters the gluconeogenic pathway directly and, to an equal extent, via the tricarboxylic acid cycle. The normalized signal heights indicated that at a given time after the addition of [2-13C]pyruvate the degree of 13C labeling in glucose carbons was reduced in livers from malarial animals, when compared to livers from normal animals. During the course of the perfusion experiment, the [2-13C]lactate resonance signal was always more intense from livers of malarial animals than from normal animals. A reduced activity of hepatic gluconeogenesis in malarial animals was further confirmed by a separate set of perfusion experiments which showed a 56% reduction of the measured rate of glucose production in livers from malarial animals, with respect to that of normal animals. A lowered NAD/NADH ratio in livers from malarial animals would explain the increased proportion of lactate observed in the spectra and be related to a decreased gluconeogenic rate. A more reduced oxidoreduction level in the hepatocytes of a malarial animal would result from a defect in the oxidative phosphorylation activity of mitochondria.     

Hemodilution – An Overview of Current Canadian Practices

Background. Transplant teams evaluate potential organ and tissue donors to exclude donation of tissues at risk for disease transmission. Standards dictate that serological tests be performed on every donor to assess the presence of transmissible diseases including: Human Immunodeficiency Virus 1 & 2, Human T Lymphotropic Virus 1 & 2, Hepatitis C, Hepatitis B surface Antigen, Hepatitis B core Antibody and Syphilis. A limitation of serological testing is the risk of false negative results due to the dilution of the serum. Hemodilution results from the transfusion of fluids (blood products, colloids and/or crystalloid). Confidence in the accuracy and sensitivity of donor serology testing is of utmost importance to ensure the provision of safe organs and tissues for transplantation. Methods. In order to determine the preferred and validated methodology for determining hemodilution, if any; and to determine the level of hemodilution that jeopardizes serologic test results, we reviewed the literature and current testing practices. Tissue banks throughout Canada as well as accrediting bodies were contacted regarding the hemodilution algorithm they utilize. Results. In the absence of a pretransfusion sample, hemodilution calculations are the prevalent methodology for assessing sensitivity of serology testing. A literature search and personal communications provided no documentation on the validation of any hemodilution algorithm or evidence that 50% hemodilution is an acceptable level for accurate serology testing. Conclusion. A validation of hemodilution algorithms and the acceptable or unacceptable rate of hemodilution is required. The utilization of a validated algorithm should be mandated in standards to ensure continuity of practice by all transplantation centres. If validation cannot be obtained, alternative methodologies for serology testing should be investigated.