Vaginal bacterial load in the second trimester is associated with early preterm birth recurrence: a nested case-control study.

OBJECTIVE: To assess the association between vaginal microbiome (VMB) composition and recurrent early spontaneous preterm birth (sPTB)/preterm prelabour rupture of membranes (PPROM). DESIGN: Nested case-control study. SETTING: UK tertiary referral hospital. SAMPLE: High-risk women with previous sPTB/PPROM <34+0 weeks' gestation who had a recurrence (n = 22) or delivered at ≥37+0 weeks without PPROM (n = 87). METHODS: Vaginal swabs collected between 15 and 22 weeks' gestation were analysed by 16S rRNA gene sequencing and 16S quantitative PCR. MAIN OUTCOME MEASURE: Recurrent early sPTB/PPROM. RESULTS: Of the 109 high-risk women, 28 had anaerobic vaginal dysbiosis, with the remainder dominated by lactobacilli (Lactobacillus iners 36/109, Lactobacillus crispatus 23/109, or other 22/109). VMB type and diversity were not associated with recurrence. Women with a recurrence, compared to those without, had a higher median vaginal bacterial load (8.64 versus 7.89 log10 cells/mcl, adjusted odds ratio [aOR] 1.90, 95% CI 1.01-3.56, P = 0.047) and estimated Lactobacillus concentration (8.59 versus 7.48 log10 cells/mcl, aOR 2.35, (95% CI 1.20-4.61, P = 0.013). A higher recurrence risk was associated with higher median bacterial loads for each VMB type after stratification, although statistical significance was reached only for L. iners domination (aOR 3.44, 95% CI 1.06-11.15, P = 0.040). Women with anaerobic dysbiosis or L. iners domination had a higher median vaginal bacterial load than women with a VMB dominated by L. crispatus or other lactobacilli (8.54, 7.96, 7.63, and 7.53 log10 cells/mcl, respectively). CONCLUSIONS: Vaginal bacterial load is associated with early sPTB/PPROM recurrence. Domination by lactobacilli other than L. iners may protect women from developing high bacterial loads. Future PTB studies should quantify vaginal bacteria and yeasts. TWEETABLE ABSTRACT: Increased vaginal bacterial load in the second trimester may be associated with recurrent early spontaneous preterm birth.

The crystal structure of the globular domain of sheep prion protein.

The prion protein PrP is a naturally occurring polypeptide that becomes transformed from a normal conformation to that of an aggregated form, characteristic of pathological states in fatal transmissible spongiform conditions such as Creutzfeld-Jacob Disease and Bovine Spongiform Encephalopathy. We report the crystal structure, at 2 A resolution, of residues 123-230 of the C-terminal globular domain of the ARQ allele of sheep prion protein (PrP). The asymmetric unit contains a single molecule whose secondary structure and overall organisation correspond to those structures of PrPs from various mammalian species determined by NMR. The globular domain shows a close association of helix-1, the C-terminal portion of helix-2 and the N-terminal portion of helix-3, bounded by the intramolecular disulphide bond, 179-214. The loop 164-177, between beta2 and helix-2 is relatively well structured compared to the human PrP NMR structure. Analysis of the sheep PrP structure identifies two possible loci for the initiation of beta-sheet mediated polymerisation. One of these comprises the beta-strand, residues 129-131 that forms an intra-molecular beta-sheet with residues 161-163. This strand is involved in lattice contacts about a crystal dyad to generate a four-stranded intermolecular beta-sheet between neighbouring molecules. The second locus involves the region 188-204, which modelling suggests is able to undergo a partial alpha-->beta switch within the monomer. These loci provide sites within the PrPc monomer that could readily give rise to early intermediate species on the pathway to the formation of aggregated PrPSc containing additional intermolecular beta-structure.

Strabismus in infants of opiate-dependent mothers.

AIM: At a follow-up clinic for infants of opiate-dependent mothers it was noted that more infants than expected developed strabismus. This study aimed to assess the prevalence of strabismus and the need for active strabismus surveillance in this population. METHODS: Consecutive infants of opiate-dependent mothers born over an 18 mo period were recalled for ophthalmological assessment by an ophthalmologist and orthoptist. Those unable to attend were surveyed by telephone using a questionnaire. RESULTS: 49 (69%) of the 71 eligible infants were recalled at a mean age of 21 mo (range 6-39); 29 had a full ophthalmological examination and the remaining 20 completed the questionnaire only. Seven (14%) of the 49 recalled infants had strabismus on examination; 4 needed glasses or patching. A further seven (14%) had a history of intermittent strabismus but declined formal examination. Another child had significant hypermetropia without strabismus. The mean age at which strabismus was observed was 8.3 mo (range birth to 19 mo). The presence of strabismus was not significantly influenced by conditions at birth, maternal drug doses, family history or need for or duration of abstinence treatment. CONCLUSION: The rate of strabismus in infants of opiate-dependent mothers was at least 10 times that in the general population. As attendance at follow-up is often poor, paediatricians should be aware of the association to encourage opportunistic assessment and ophthalmological surveillance of this population.

Domains of invasion organelle proteins from apicomplexan parasites are homologous with the Apple domains of blood coagulation factor XI and plasma pre-kallikrein and are members of the PAN module superfamily.

Micronemes are specialised organelles, found in all apicomplexan parasites, which secrete molecules that are essential for parasite attachment to and invasion of host cells. Regions of several microneme proteins have sequence similarity to the Apple domains (A-domains) of blood coagulation factor XI (FXI) and plasma pre-kallikrein (PK). We have used mass spectrometry on a recombinant-expressed, putative A-domain from the microneme protein EtMIC5 from Eimeria tenella, to demonstrate that three intramolecular disulphide bridges are formed. These bridges are analogous to those that stabilise A-domains in FXI and PK. The data confirm that the apicomplexan domains are structural homologues of A-domains and are therefore novel members of the PAN module superfamily, which also includes the N-terminal domains of members of the plasminogen/hepatocyte growth factor family. The role of A-domains/PAN modules in apicomplexan parasites is not known, but their presence in the microneme suggests that they may be important for mediating protein-protein or protein-carbohydrate interactions during parasite attachment and host cell invasion.

Post-translational hydroxylation at the N-terminus of the prion protein reveals presence of PPII structure in vivo.

The transmissible spongiform encephalopathies are characterized by conversion of a host protein, PrP(C) (cellular prion protein), to a protease-resistant isoform, PrP(Sc) (prion protein scrapie isoform). The importance of the highly flexible, N-terminal region of PrP has recently become more widely appreciated, particularly the biological activities associated with its metal ion-binding domain and its potential to form a poly(L-proline) II (PPII) helix. Circular dichroism spectroscopy of an N-terminal peptide, PrP(37-53), showed that the PPII helix is formed in aqueous buffer; as it also contains an Xaa-Pro-Gly consensus sequence, it may act as a substrate for the collagen-modifying enzyme prolyl 4-hydroxylase. Direct evidence for this modification was obtained by mass spectrometry and Edman sequencing in recombinant mouse PrP secreted from stably transfected Chinese hamster ovary cells. Almost complete conversion of proline to 4-hydroxyproline occurs specifically at residue Pro44 of this murine protein; the same hydroxylated residue was detected, at lower levels, in PrP(Sc) from the brains of scrapie-infected mice. Cation binding and/or post-translational hydroxylation of this region of PrP may regulate its role in the physiology and pathobiology of the cell.

A multifaceted approach to improving motor vehicle restraint complicance.

OBJECTIVES: To increase proper use of seat belts and car seats, thereby reducing morbidity and mortality from motor vehicle collisions. SETTING: The Vehicle Injury Prevention program community intervention was implemented in Houston, Texas. Effectiveness data are limited to "target area one", an impoverished neighborhood in northeast Harris County. METHODS: This multifaceted public health education campaign brought together six segments of the community: education, health, government, law enforcement, private industry, and the media, to improve restraint use. It was evaluated by observation of proper restraint use before and nine months after implementation. Trained, independent observers made observations of occupants in the target area and at two comparison sites. Pre-post differences in restraint compliance were calculated by a standard binomial proportion test. RESULTS: Motorists in target area one significantly improved their restraint use by 15% (p<0.05) from 39% pre-intervention to 54% post-intervention, whereas use in the comparison neighborhoods remained unchanged. CONCLUSIONS: Implementation of a public health education program, combined with economic incentives to increase vehicle restraint use, can be successful with multifaceted community support.

Characterization and polyanion-binding properties of purified recombinant prion protein.

Certain polysulphated polyanions have been shown to have prophylactic effects on the progression of transmissible spongiform encephalopathy disease, presumably because they bind to prion protein (PrP). Until now, the difficulty of obtaining large quantities of native PrP has precluded detailed studies of these interactions. We have over-expressed murine recombinant PrP (recPrP), lacking its glycophosphoinositol membrane anchor, in modified mammalian cells. Milligram quantities of secreted, soluble and partially glycosylated protein were purified under non-denaturing conditions and the identities of mature-length aglycosyl recPrP and two cleavage fragments were determined by electrospray MS. Binding was assessed by surface plasmon resonance techniques using both direct and competitive ligand-binding approaches. recPrP binding to immobilized polyanions was enhanced by divalent metal ions. Polyanion binding was strong and showed complex association and dissociation kinetics that were consistent with ligand-directed recPrP aggregation. The differences in the binding strengths of recPrP to pentosan polysulphate and to other sulphated polyanions were found to parallel their in vivo anti-scrapie and in vitro anti-scrapie-specific PrP formation potencies. When recPrP was immobilized by capture on metal-ion chelates it was found, contrary to expectation, that the addition of polyanions promoted the dissociation of the protein.

Isolation and characterization of RNA from the intracellular parasite Theileria parva.

Using a rapid procedure to isolate schizonts of the intracellular parasite Theileria parva from infected bovine lymphocytes, we have prepared parasite RNA that is more than 90% pure. Characterization of this schizont RNA has revealed the presence of two ribosomal RNA species of 3.3 kb and 1.8 kb and a third non-adenylated abundant RNA species of 1.9 kb. In vitro translation of the isolated schizont mRNA has identified about 200 parasite specific polypeptides, only a few of which could be detected by translation of mRNA from infected host cells. By analysing the kinetics of liquid hybridization of schizont mRNA with its homologous complementary DNA the nucleotide sequence complexity of the abundant class of the parasite mRNA has been estimated to be 1.7 x 10(3) kb. Assuming a number average size of 2 kb per mRNA molecule this would represent 4000 transcripts for all abundance classes of the schizont mRNA. Using the same technique we estimate that approximately 10% of the mRNA isolated from infected lymphocytes were transcripts from the parasite genome. We conclude that the low number of parasite specific translation products in the mRNA from infected lymphocytes and the low number of parasite proteins detected in isolated schizonts reported previously is due to the low abundance of the parasite transcripts rather than a low number of expressed parasite genes.

Failure of a recombinant Babesia bovis antigen to protect cattle against heterologous strain challenge.

Groups of cattle were inoculated subcutaneously with (i) a recombinant DNA-derived Babesia bovis protein (KaBbl-GZ) fused to beta-galactosidase and combined with adjuvants, or (ii) native beta-galactosidase (GZ) plus adjuvant, or (iii) adjuvant only or (iv) a live, attenuated B bovis vaccine. KaBbl-GZ was produced in the lambda gt11-amp3 system as a 5-10 kD babesial polypeptide linked to GZ. KaBbl has previously been shown to be an immunodominant antigen of B bovis, localised at the apex of the parasite, and present in a range of B bovis strains. High levels of GZ antibodies were observed in KaBbl-GZ and GZ inoculated cattle, but specific KaBbl antibodies could not be detected by ELISA. Five months after primary inoculation, all cattle were blood challenged with a virulent heterologous B bovis strain. Despite four inoculations with KaBbl-GZ, significant protection against the challenge was not observed.

Babesia bovis: molecular and biological characteristics of cloned parasite lines.

An in vivo limiting dilution technique was used to produce several Babesia bovis cloned lines with which to study the basis of virulence and immunogenicity in this parasite. DNA hybridization using a cloned DNA fragment from the BabR locus demonstrated that the cloned lines were a more restricted genetic population than the parent strain. Biosynthetic labeling and immunoprecipitation studies indicated that the cloned lines differed from each other and from the parentals in the expression of a small number of polypeptides and antigens. Animal trials with three of the lines demonstrated that the parental line contains both virulent and avirulent parasite populations, at least three of which are not tick transmissible, and that while the lines do provide significant protection against heterologous challenge, they may not give as effective protection as the parental line. These experiments demonstrated the existence of subpopulations with distinctive molecular and biological properties, providing evidence that the attenuation process is based on the selection of preexisting parasite subpopulations combined with the ability of these parasites to vary genetically.

The DNA sequences of cloned complex satellite DNAs from Hawaiian Drosophila and their bearing on satellite DNA sequence conservation.

A class of restriction endonuclease fragments near 185 bp in length and comprising approximately 20% of the genomes of 3 species of Hawaiian Drosophila has been cloned using bacteriophage M13. The nucleotide sequences of 14 clones have been determined and the variation between clones has been found to be due to deletions and base changes. Analyses of uncloned material show that the cloning system itself does not introduce the variation. The variation of the basic repeat within and between species is high; 15% due to deletions and 10% due to base changes. The Drosophila data are similar in many respects to both the 23 bp calf satellite results (Pech et al., 1979 b) and those from sequence analyses of the 170 bp primate restriction fragments (Rubin et al., 1979; Donehower et al., 1980, Wu and Manuelidis, 1980). The intraspecies level of base changes and deletions in the calf satellite approaches 25% as does that in the human/African green monkey/baboon comparisons. The between species variation in the primate group is near 35%. Direct sequencing methods thus reveal a widespread sequence heterogeneity in both invertebrate and mammalian satellite systems of long or short repeat length. This heterogeneity does not support the strict sequence conservation implied by the "library" hypothesis, which claims a functional role in speciation for the rigid conservation of satellite DNA sequences (Fry and Salser, 1977). Furthermore the Drosophila and primate data reveal that satellite DNAs can change rapidly, though nonrandomly, at the nucleotide sequence level in a relatively closely knit group such as the Hawaiian species, as well as in more distantly related species from amongst the primates. We draw two major conclusions. There is no universal attribute of satellite DNA sequence per se, the only biological variable to date being the amount of satellite DNA and its effect in the germ line. Many aspects of satellite DNA evolution conform to Kimura's (1979) concepts of neutrality.