Progress in vaccine development against Helicobacter pylori

Based on the very high prevalence of diseases caused by Helicobacter pylori, particularly in the developing world, and the rapid emergence of antibiotic resistance among clinical isolates, there is a strong rationale for an effective vaccine against H. pylori. In this review we describe recent promising candidate vaccines and prophylactic or therapeutic immunization strategies for use against H. pylori, as well as studies to identify immune responses that are related to protection in experimental animals. We also describe identification of different types of immune responses that may be related to protection against symptoms based on comparisons of H. pylori-infected patients with duodenal ulcers or gastric cancer and asymptomatic carriers. We conclude that there is still a strong need to clarify the main protective immune mechanisms against H. pylori as well as to identify a cocktail of strong protective antigens, or recombinant bacterial strains that express such antigens, that could be administered by a regimen that gives rise to effective immune responses in humans.     

Impact of rapid urbanization on the rates of infection by Vibrio cholerae O1 and enterotoxigenic Escherichia coli in Dhaka, Bangladesh

Background

In Bangladesh, increases in cholera epidemics are being documented with a greater incidence and severity. The aim of this prospective study was to identify the prevalence and importance of V. cholerae O1 and enterotoxigenic Escherichia coli (ETEC) as causal agents of severe diarrhea in a high diarrhea prone urban area in Dhaka city.

Methodology

Systematic surveillance was carried out on all diarrheal patients admitted from Mirpur between March 2008 to February 2010 at the ICDDR, B hospital. Stool or rectal swabs were collected from every third diarrheal patient for microbiological evaluation.

Principal Findings

Of diarrheal patients attending the hospital from Mirpur, 41% suffered from severe dehydration with 39% requiring intravenous rehydration therapy. More diarrheal patients were above five years of age (64%) than those below five years of age (36%). About 60% of the patients above five years of age had severe dehydration compared with only 9% of patients under five years of age. The most prevalent pathogen isolated was Vibrio cholerae O1 (23%) followed by ETEC (11%). About 8% of cholera infection was seen in infants with the youngest children being one month of age while in the case of ETEC the rate was 11%. Of the isolated ETEC strains, the enterotoxin type were almost equally distributed; ST accounted for 31% of strains; LT/ST for 38% and LT for 31%.

Conclusion

V. cholerae O1 is the major bacterial pathogen and a cause of severe cholera disease in 23% of patients from Mirpur. This represents a socioeconomic group that best reflects the major areas of high cholera burden in the country. Vaccines that can target such high risk groups in the country and the region will hopefully be able to reduce the disease morbidity and the transmission of pathogens that impact the life and health of people.     

Strategies to overexpress enterotoxigenic <Emphasis Type="Italic">Escherichia coli</Emphasis> (ETEC) colonization factors for the construction of oral whole-cell inactivated ETEC vaccine candidates

Enterotoxigenic Escherichia coli (ETEC) is an important cause of diarrheal disease and deaths among children in developing countries and the major cause of traveler's diarrhea (TD). Since surface protein colonization factors (CFs) of ETEC are important for pathogenicity and immune protection is mainly mediated by locally produced IgA antibodies in the gut, much effort has focused on the development of an oral CF-based vaccine. The most extensively studied ETEC candidate vaccine is the rCTB-CF ETEC vaccine, containing recombinantly produced cholera B subunit and the most commonly encountered ETEC CFs on the surface of whole inactivated bacteria. Initial clinical trials with this vaccine showed significant immune responses against the key antigens in different age groups in Bangladesh and Egypt and protection against more severe TD in Western travelers. However, when tested in a phase-III trial in Egyptian infants, the protective efficacy of the vaccine was found to be low, indicating the need to improve the immunogenicity of the vaccine, e.g., by increasing the levels of the protective antigens. This review describes different strategies for the construction of recombinant nontoxigenic E. coli and Vibrio cholerae candidate vaccine strains over-expressing higher amounts of ETEC CFs than clinical ETEC isolates selected to produce high levels of the respective CF, e.g., those ETEC strains which have been used in the rCTB-CF ETEC vaccine. Several different expression vectors containing the genes responsible for the expression and assembly of the examined CFs, all downstream of the powerful tac promoter, which could be maintained either with or without antibiotic selection, were constructed. Expression from the tac promoter was under the control of the lacI ^q repressor present on the plasmids. Following induction with isopropyl-β-d-thiogalactopyranoside, candidate vaccine strains over-expressing single CFs, unnatural combinations of two CFs, and also hybrid forms of ETEC CFs were produced. Specific monoclonal antibodies against the major subunits of the examined CF were used to quantify the amount of the surface-expressed CF by a dot-blot assay and inhibition ELISA. Oral immunization with formalin- or phenol-inactivated recombinant bacteria over-expressing the CFs was found to induce significantly higher antibody responses compared to immunization with the previously used vaccine strains. We therefore conclude that our constructs may be useful as candidate strains in an oral whole-cell inactivated CF ETEC vaccine.     

Pathogenesis and host response of Helicobacter pylori

The 5th International Workshop on Pathogenesis and Host Response in Helicobacter Infections was held in Elsinore, Denmark, 4–7 July, 2002.     

Assessing antigen specific HLA-DR+ antibody secreting cell (DR+ASC) responses in whole blood in enteric infections using an ELISPOT technique

Antibody secreting cells (ASCs) generate antibodies in an antigen-specific manner as part of the adaptive immune response to infections, and these cells increase their surface expression of HLA-DR. We have studied this parameter (HLA-DR+ ASC) in patients with recent diarrheal infection using immuno-magnetic cell sorting and an enzyme linked immunospot (ELISPOT) technique that requires only one milliliter of blood. We validated this approach in adult patients with cholera (n = 15) or ETEC diarrhea (n = 30) on days 2, 7 and 30 after showing clinical symptom at the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) hospital in Dhaka, and we compared responses to age-matched healthy controls (n = 7). We found that HLA-DR+ ASC (DR+ASC) responses specific both for T cell-dependent (cholera toxin B subunit), and T cell-independent (lipopolysaccharide) antigens were elevated at day 7 after showing clinical cholera symptom. Similarly, DR+ASCs were elevated against both heat-labile toxin and colonization factors following ETEC infection. We observed significant correlations between antigen-specific DR+ASC responses and antigen-specific, gut homing ASC and plasma antibody responses. This study demonstrates that a simple ELISPOT procedure allows determination of antigen-specific ASC responses using a small volume of whole blood following diarrhea. This technique may be particularly useful in studying DR+ASC responses in young children and infants, either following infection or vaccination.     

Enantioselective assay of β-receptor antagonists present in microdialysis and plasma samples of rats

The enantiomers of alprenolol, metoprolol, and propranolol have been separated on an enantioselective cellulase column and analysed using a fully automated HPLC system involving coupled column chromatography and fluorescence detection. The assays had sufficient selectivity and sensitivity to investigate the disposition of these β₂-receptor antagonists in blood and brain extracellular fluid of rats. A cellulase column was used as the first column to separate the enantiomers giving separation factors between 2.9 and 4.3. After the separation, the enantiomers were trapped on two small precolumns by the use of a switching valve and were then introduced on an achiral C₁₈ analytical column by eluting the small columns backward. The enantiomers in blood and brain tissue dialysates were analysed by direct injection of 8 μl samples. The limit of quantitation was 0.025–0.4 μg/ml of the different enantiomers. Plasma samples were analysed after a simple extraction procedure. The intraassay precision of the lowest quality control plasma samples (0.2–0.8 μg rac drug/ml) was 4–8% for the different enantiomers. © 1995 Wiley-Liss, Inc.     

Stability of the Encoding Plasmids and Surface Expression of CS6 Differs in Enterotoxigenic Escherichia coli (ETEC) Encoding Different Heat-Stable (ST) Enterotoxins (STh and STp)

Enterotoxigenic Escherichia coli (ETEC), one of the most common reasons of diarrhea among infants and children in developing countries, causes disease by expression of either or both of the enterotoxins heat-labile (LT) and heat-stable (ST; divided into human-type [STh] and porcine-type [STp] variants), and colonization factors (CFs) among which CS6 is one of the most prevalent ETEC CFs. In this study we show that ETEC isolates expressing CS6+STh have higher copy numbers of the cssABCD operon encoding CS6 than those expressing CS6+STp. Long term cultivation of up to ten over-night passages of ETEC isolates harboring CS6+STh (n = 10) or CS6+STp (n = 15) showed instability of phenotypic expression of CS6 in a majority of the CS6+STp isolates, whereas most of the CS6+STh isolates retained CS6 expression. The observed instability was a correlated with loss of genes cssA and cssD as examined by PCR. Mobilization of the CS6 plasmid from an unstable CS6+STp isolate into a laboratory E. coli strain resulted in loss of the plasmid after a single over-night passage whereas the plasmid from an CS6+STh strain was retained in the laboratory strain during 10 passages. A sequence comparison between the CS6 plasmids from a stable and an unstable ETEC isolate revealed that genes necessary for plasmid stabilization, for example pemI, pemK, stbA, stbB and parM, were not present in the unstable ETEC isolate. Our results indicate that stable retention of CS6 may in part be affected by the stability of the plasmid on which both CS6 and STp or STh are located.     

Diagnosing Depression in Chronic Pain Patients: DSM-IV Major Depressive Disorder vs. Beck Depression Inventory (BDI)

Background

Diagnosing depression in chronic pain is challenging due to overlapping somatic symptoms. In questionnaires, such as the Beck Depression Inventory (BDI), responses may be influenced more by pain than by the severity of depression. In addition, previous studies have suggested that symptoms of negative self-image, a key element in depression, are uncommon in chronic pain-related depression. The object of this study is to assess the relationship of the somatic and cognitive-emotional items of BDI with the diagnosis of depression, pain intensity, and disability.

Methods

One hundred consecutive chronic pain patients completed the Structured Clinical Interview for DSM Disorders (SCID) for the diagnosis of major depressive disorder (MDD) according to DSM-IV. Two subscales of BDI (negative view of self and somatic-physical function) were created according to the factor model presented by Morley.

Results

In the regression analysis, the somatic-physical function factor associated with MDD, while the negative view of self factor did not. Patients with MDD had higher scores in several of the BDI items when analysed separately. Insomnia and weight loss were not dependent on the depression diagnosis.

Limitations

The relatively small sample size and the selected patient sample limit the generalisability of the results.

Conclusions

Somatic symptoms of depression are also common in chronic pain and should not be excluded when diagnosing depression in pain patients. Regardless of the assessment method, diagnosing depression in chronic pain remains a challenge and requires careful interpretation of symptoms.     

The food-web of theCladophora-belt fauna

Summary 1. The species composition of the fauna in theCladophora glomerata belts of the Baltic sea has been studied quantitatively.2. Examples are presented to illustrate composition and density of the epiphytic diatom flora.3. The dry weight ofCladophora glomerata was determined with the aid of length measurements under a microscope. It amounts to 0.25 mg per 1000 mm length of alga filaments, and to 15.9 mg for a tuft with a total surface area of 1 dm².4. The productivity ofCladophora glomerata was calculated. It amounts to 3105 m alga filaments per dm² per month.5. The following biomasses per dm² rock surface have been estimated:Cladophora (dry weight): 0.78 g, diatoms (dry weight): 1.15 g, animals (number of individuals): 12 544.6. The fauna of theCladophora-belt has been subdivided according to feeding types.7. Some herbivores have been studied in laboratory experiments. The epiphytic diatoms are important for survival of the first postmarsupial stages of the isopodIdotea baltica as well as for maximum growth rates of the gastropodHydrobia ulvae and chironomid larvae.8. The daily consumption ofCladophora-filaments has been determined for juveniles of the isopodIdotea baltica and the amphipodGammarus oceanicus by microscope examinations of faecal pellets.9. The diatom diet of the rotiferProales reinhardti has been listed according to genera or species. Among the animals living in theCladophora-belt,P. reinhardti attains the highest numbers of individuals.10. Examples of food-chains within theCladophora community are presented.

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Die Nahrungskette der Fauna derCladophora-Zone

Kurzfassung In der Ostsee bildet die GrünalgeCladophora glomerata große, gürtelförmige bestände in Ufernähe. Diese Bestände und ihre Fauna sind für die ökologischen Verhältnisse in der Ostsee von großer Bedeutung. Es wurde daher das Artengefüge dieser Fauna analysiert und Trockengewichtsbestimmungen anC. glomerata durchgeführt. Die Produktivität dieser Alge beträgt 3105 m Algenfilamente pro Quadratdezimeter pro Monat (mittleres Trockengewicht eines 1000 mm langen Algenfilamentes: 0,25 mg). Pro Quadratdezimeter Felsenoberfläche ergeben sich folgende Werte für die Hauptorganismengruppen: Trockengewicht fürCladophora: 0,78 g, für Diatomeen: 1,25 g; Anzahl Tiere: 12 544 Individuen. In Laboratoriumsexperimenten konnte nachgewiesen werden, daß epiphytische Diatomeen derCladophora für die ersten postmarsupialen Stadien des IsopodenIdotea baltica lebensnotwendig und für den GastropodenHydrobia ulvae sowie für Chironomidenlarven zur Erzielung maximaler Wachstumsraten erforderlich sind. Der tägliche Konsum anCladophora-Filamenten wurde für jungeIdotea baltica undGammarus oceanicus an Hand der ausgeschiedenen Faeces ermittelt. Die Nahrungskette innerhalb der Fauna derCladophora-Zone wird an Hand von Beispielen illustriert.

     

Synthesis on nontoxic, antibody-binding Escherichia coli heat-stable enterotoxin (STa) peptides

Abstract Modified Escherichia coli heat-stable enterotoxin (ST_a) peptides have been synthesized to identify structures that retain the immunological properties of native ST_a but lack toxicity. Two synthetic peptides, corresponding to the 15 C-terminal amino acid residues of ST_a (ST_h) except for the replacement of one or two Cys residues by Ala, had ≥ 35 000-fold reduced toxicity in infant mice despite almost intact activity as compared to native ST_a to inhibit monoclonal anti-ST antibody binding to solid phase ST_a. Three shorter peptides of 6–8 amino acid residues also did not manifest any toxic activity and showed significant but much reduced reactivity with anti-ST_a antibodies.