[Femoral neck fractures in patients over 50 years old]. / Les fractures du col du fémur après 50 ans.

INTRODUCTION: Despite many papers and instructional course lectures, therapeutic guidelines are not clearly defined about treatment of femoral neck fractures. The aim of this multicentric French symposium was to prospectively study the results of current therapeutic options in order to propose scientifically proven options. MATERIAL AND METHODS: Three prospective studies were carried out in order to answer to these questions: (1) is it possible with anatomical reduction and stable fixation to lower the non union and osteonecrosis rate? (2) is functional treatment of Garden 1 fractures successful in more than 65 years patients? (3) what criteria are useful to choose the kind of arthroplasty for more than 65 years patients? RESULTS: For the 64 patients between 50 and 65 years old included in the first study, 44 ORIF and 17 prostheses were performed. No open reduction was performed in this series despite a 34% malreduction rate. The risk for displacement after functional treatment of Garden 1 fractures is 31%. For patients over 65 years old, almost fractures are treated in this series by an arthroplasty. The one-year mortality rate after displaced femoral neck fracture was 17%. Functional results were better in total hip prosthesis group than in bipolar or unipolar group. Non cemented stems were not safer than cemented ones in frail patients. DISCUSSION AND CONCLUSIONS: For young patients, ORIF should be the treatment of choice: the initial displacement and its effects on the femoral head vascularisation, the quality of reduction and fixation are the two most significant factors for good outcome. For Garden 1, fractures in patients 65 years old or more, it is proposed to performed an internal fixation despite in two thirds of the cases, it should be unnecessary because non identification of predictive factors of failure. For patients over 65 years old, the type of arthroplasty to perform in displaced fractures is to be chosen according to the preoperative mobility and comorbidities. Because of acetabular erosion with long-term follow-up, it is clearly indicated to perform total hip replacement for patients with life expectancy of 10 years or more. For frail patients, unipolar arthroplasty is the best option. The place for bipolar or uncemented implants is not yet well-defined and more prospective trials are needed. In this multicentric study, results appear quite different in terms of mortality, or functional status. These differences seem to be related to technical choice, geriatric care, nutritional consideration or surgical organisation, all factors that may be of major importance for prognostic.

[Thrombosis of the posterior tibial artery complicating closed injury of the ankle]. / Thrombose de l'artère tibiale postérieure: une complication rare d'un traumatisme fermé de la cheville.

Closed ankle injury without fracture is a common finding in the emergency room. Outcome is generally spontaneously favorable, the injury having no long-term clinical impact. Exceptionally, these injuries can be associated with arterial damage. We report a case of an apparently benign closed ankle injury which was found to be associated with serious arterial damage. Forced dorsal flexion of the ankle joint during a traffic accident caused an arterial lesion without any apparent damage to the bone and joints. The posterior tibial artery was interrupted leading to subacute ischemia of the foot. The diagnosis was established 17 days after trauma. Revascularization could not be achieved and leg amputation was necessary. This case illustrates the difficulties encountered in this type of vascular injury. Most cases in the literature have also involved late diagnosis with often serious clinical impact. Clinicians should be aware of this rare complication of apparently benign ankle injury because of the risk of major loss of function.

Structural study of the lipomannans from Mycobacterium bovis BCG: characterisation of multiacylated forms of the phosphatidyl-myo-inositol anchor.

A biosynthetic filiation is postulated between the mycobacterial phosphatidyl-myo-inositol mannosides (PIMs), the lipomannans (LMs) and the lipoarabinomannans (LAMs), the major antigens of the envelopes. Moreover, as the PI anchor is thought to play a role in the biological functions of the LAMs, we characterized the lipid moiety of the PI anchor from Mycobacterium bovis BCG cellular LMs. Their structure was investigated along with that of a purified tetra-acylated form of PIM2 (Ac4PIM2). A two-dimensional 1H-31P heteronuclear multiple quantum correlation homonuclear Hartmann-Hahn spectroscopy study of Ac4PIM2 unambiguously localised a fourth fatty acid on the C3 of the myo-Ins beside the fatty acids already described on the C1 and C2 position of the glycerol and on the C6 position of the mannose. This analytical strategy was extended to the structural study of the cellular LM anchor. Using an appropriate solvent system, the one dimensional 31P NMR spectrum exhibited four major resonances typifying the LM populations. These populations differed in number and location of the fatty acids. For one of these populations, we established the presence of an extra fatty acid on the C3 of the myo-Ins of the LM anchor. The fact that both types of molecules have an elaborated anchor in common, indicates that cellular LMs are multimannosylated forms of PIMs. In addition, the LM mannan core structure was analysed by two-dimensional NMR, pointing to a high level of branching by single alpha1-->2 Manp side-chains.

[Ambulatory surgery in traumatic orthopedics]. / La chirurgie ambulatoire en orthopédie traumatologie.

The use of ambulatory surgery for orthopedic injuries over a 6-year period is reported. The hand was involved in 54% of cases but it is logical to extend these techniques to cover other fields, as shown by this report. The various local and regional types of anesthesia are discussed and emphasis placed on important pre-and post-operative modalities. No major anesthetic or surgical complication was observed. The method possesses advantages with respect to Health Care costs but inconveniences within the overall budget framework.

Analysis of the chromosome X exome in patients with autism spectrum disorders identified novel candidate genes, including TMLHE.

The striking excess of affected males in autism spectrum disorders (ASD) suggests that genes located on chromosome X contribute to the etiology of these disorders. To identify new X-linked genes associated with ASD, we analyzed the entire chromosome X exome by next-generation sequencing in 12 unrelated families with two affected males. Thirty-six possibly deleterious variants in 33 candidate genes were found, including PHF8 and HUWE1, previously implicated in intellectual disability (ID). A nonsense mutation in TMLHE, which encodes the ɛ-N-trimethyllysine hydroxylase catalyzing the first step of carnitine biosynthesis, was identified in two brothers with autism and ID. By screening the TMLHE coding sequence in 501 male patients with ASD, we identified two additional missense substitutions not found in controls and not reported in databases. Functional analyses confirmed that the mutations were associated with a loss-of-function and led to an increase in trimethyllysine, the precursor of carnitine biosynthesis, in the plasma of patients. This study supports the hypothesis that rare variants on the X chromosome are involved in the etiology of ASD and contribute to the sex-ratio disequilibrium.

Mini-invasive nail versus DHS to fix pertrochanteric fractures: a case-control study.

BACKGROUND: Fixation devices to treat trochanteric fractures belong to two general categories: dynamic hip screw (DHS) type and intramedullary type implants. In spite of possible pitfalls, both are considered valid options. Comparing a sliding screw-plate system (DHS) along a mini-invasive nailing device (BCM nail) with primary insertion of the cephalic screw, sheds light on the debated management of trochanteric fractures. HYPOTHESIS: Due to its design, the BCM nailing system allows a stable internal fixation and promotes enhanced postoperative functional recovery. OBJECTIVES: To test this hypothesis in a comparative prospective case-control study using the DHS screw-plate as a reference. MATERIALS AND METHODS: Two groups of 30 patients, older than 60 years old, with trochanteric fractures were included in this study. The screw-plates were placed according to the standard method. Regarding the nailing system, the cephalic screw was positioned first, then the nail was inserted through the screw via a mini-invasive approach and locked distally using a bicortical screw. Comparison between the two groups was based on (1) operative data: operating time, intra- and postoperative blood loss; (2) immediate postoperative course: complications, length of hospital stay, delay to sitting in a wheelchair; (3) the postdischarge evolution: weightbearing, readmission to hospital; (4) functional outcomes: recovery and mobility; (5) anatomical outcomes: restitution and bone healing. RESULTS: The operating time (54+/-8.8 min vs 59+/-13.8 min) and intraoperative (1.37+/-0.98 vs 1.90+/-1.43) and at Day 3 (1.25+/-1.05 vs 1.82+/-1.5) blood loss (haemoglobin loss), were favourable to the screw-plate subgroup (p<0.05). The delay to sitting in a wheelchair (4.76+/-1.53 d vs 4+/-1.44 d) was favourable to the nail subgroup (p<0.05). There was a higher incidence of secondary displacements in the screw-plate subgroup (3/26 [11.5%] vs 0/25 [0%]) (p<0.05). The screw-plate subgroup demonstrated a poorer healing rate at 3 months (88% vs 100%) (p<0.05). Regarding functional recovery, a lesser decrease in the Parker score was observed in the nail subgroup at 3 postoperative months (2.42+/-2.3 vs 1.52+/-1.44) (p<0.05). CONCLUSION: This study has shown the benefits of the BCM nail in terms of stability. But the potential advantages of this mini-invasive technique were limited by ancillary-related difficulties which need to be rectified. These preliminary results are in favour of a further development of this innovating device.

Lipooligosaccharidic antigens from Mycobacterium kansasii and Mycobacterium gastri.

A set of Lipooligosaccharides (LOSs) has previously been characterized in M. gastri W471. The structure of the highly antigenic LOS (LOS-III) was elucidated and this molecule can unambiguously distinguish M. gastri from the opportunistic pathogen M. kansasii. In the present study, the structures of three other M. gastri W471 LOSs were determined by one-dimensional 1H-NMR spectroscopy and gas liquid chromatography. They differ by the number of Xylp units and by the structure of the distal monosaccharide. The two dimensional (2D) NMR approach was successfully applied to the LOS antigen of M. kansasii to locate the acetyl and acyl substituents and to determine the anomeric configuration of the alpha-D-Fucp unit. The molecular specificity of anti-LOS-III antibodies was investigated and the LOS-III epitope was defined as the distal disaccharide: 3,6-dideoxy-4-C-(1,3-dimethoxy-4,5,6,7-tetrahydroxy- heptyl)-alpha-xylohexp-(1-->3)-beta-L-Xylp.

Lipo-oligosaccharidic antigen from Mycobacterium gastri. Complete structure of a novel C4-branched 3,6-dideoxy-alpha-xylo-hexopyranose.

The following incomplete structure, alpha-X-(1-->3)-[beta-L-Xylp-(1-->4)]6-3-O-Me-alpha-Rhap-(1- ->3)- beta-D-Galp-(1-->3)-beta-D-Glcp-(1-->4)-2-O-acyl-alpha-D-Glcp-(1<-->1)-4 ,6-di-O-acyl-alpha-D-Glcp, was previously established for the antigenic lipo-oligosaccharide typifying Mycobacterium gastri, namely, LOS-III. The partial structure of the distal monosaccharide (X) was assigned as 3,6-dideoxy-4-C-(1,3-di-O-methylpropyl)-alpha-hexopyranose, which corresponds to a new-found monosaccharide in nature [Gilleron M., Vercauteren J., & Puzo G. (1993) J. Biol. Chem. 268, 3168-3179]. This article reports the complete structure of X, which was determined from the FAB-MS and 2D NMR analysis of the peracetylated LOS-III. The comparative analyses of the native and per-O-acetylated LOS-III FAB-MS spectra revealed, for the monosaccharide X, a molecular mass of 370 Da and five hydroxyl groups that could be acetylated. Additionally, the 1D 1H NMR spectrum of the per-O-acetylated LOS-III showed a dramatically increased dispersion of the protons, which resonated between 3 and 4 ppm in the spectrum of the underivatized LOS-III. Thus, thanks to 2D NMR sequences (COSY, HOHAHA, HMQC, HMQC-HOHAHA, and HMBC), the complete assignment of the 1H and 13C signals was achieved. Starting from the quaternary C4 resonance, the spin system of the C-alkyl chain was assigned, allowing us to propose the following structure, 3,6-dideoxy-4-C-(1,3-dimethoxy-4,5,6,7-tetrahydroxyheptyl)-alpha-x ylo- hexopyranose. The xylo configuration was established from the ROESY spectrum.

Lipooligosaccharidic antigen containing a novel C4-branched 3,6-dideoxy-alpha-hexopyranose typifies Mycobacterium gastri.

Lipooligosaccharides (LOSs) have recently been proposed as markers of mycobacterial avirulence. They have been characterized in Mycobacterium kansasii cell wall and were investigated in Mycobacterium gastri since the distinction between the two mycobacterial species remains in some question. A set of unknown LOSs was isolated from M. gastri W471. The highly antigenic lipooligosaccharide, LOS-III, was purified and appeared in all the M. gastri strains investigated regardless of their morphology. Moreover, by enzyme-linked immunosorbent assay and chromatographic approaches, it was found that LOS-III unambiguously distinguished M. gastri from the opportunistic pathogen M. kansasii. The LOS-III structure was established from its native form using NMR spectroscopy. This strategy revealed the presence of a supplementary monosaccharide (X) which was not characterized by routine carbohydrate analysis. Its core structure, 3,6-dideoxy-alpha-hexopyranose, was established from the complete assignment of the 1H and 13C spectra by two-dimensional homonuclear (COSY, HOHAHA) and heteronuclear 1H-13C heteronuclear multiple quantum correlation spectroscopy (HMQC) and HMQC-HOHAHA spectroscopy. Due to the absence of a proton at C4, the key data of the C4 side chain structure came from the heteronuclear multiple bond correlation spectroscopy (HMBC) spectrum. It was revealed to be a C-alkyl chain of partial structure 1,3-dimethoxypropyl. From the HMBC spectrum, this novel C-branched monosaccharide was located at the nonreducing end of the LOS, while the putative reducing end was found to consist of a 2',4,6-triacylated alpha-alpha-trehalose. The following structure, based on the evidence presented in this paper, is proposed for LOS-III: Xp alpha(1-->3)[L-Xylp beta(1-->4)](6)3-O-Me-Rhap alpha(1-->3)D- Galp beta(1-->3)-D-Glcp beta(1-->4)2-O-acyl-D-Glcp-alpha(1<==>1)alpha 4,6-di-O- acyl-D-Glcp.

Lipoarabinomannans: characterization of the multiacylated forms of the phosphatidyl-myo-inositol anchor by NMR spectroscopy.

Lipoarabinomannans, which exhibit a large spectrum of immunological activities, emerge as the major antigens of mycobacterial envelopes. The lipoarabinomannan structure is based on a phosphatidyl-myo-inositol anchor whose integrity has been shown to be crucial for lipoarabinomannan biological activity and particularly for presentation to CD4/CD8 double-negative alphabetaT cells by CD1 molecules. In this report, an analytical approach was developed for high-resolution 31P-NMR analysis of native, i.e. multiacylated, lipoarabinomannans. The one-dimensional 31P spectrum of cellular lipoarabinomannans, from Mycobacterium bovis Bacillus Calmette-Guérin, exhibited four 31P resonances typifying four types of lipoarabinomannans. Two-dimensional 1H-31P heteronuclear multiple-quantum-correlation/homonuclear Hartmann-Hahn analysis of the native molecules showed that these four types of lipoarabinomannan differed in the number and localization of fatty acids (from 1 to 4) esterifying the anchor. Besides the three acylation sites previously described, i.e. positions 1 and 2 of glycerol and 6 of the mannosyl unit linked to the C-2 of myo-inositol, we demonstrate the existence of a fourth acylation position at the C-3 of myo-inositol. We report here the first structural study of native multiacylated lipoarabinomannans, establishing the structure of the intact phosphatidyl-myo-inositol anchor. Our findings would help gain more understanding of the molecular basis of lipoarabinomannan discrimination in the binding process to CD1 molecules.

Mycobacterium tuberculosis H37Rv parietal and cellular lipoarabinomannans. Characterization of the acyl- and glyco-forms.

Mannosylated lipoarabinomannans are multifaceted molecules. They have been shown to exert an immunosuppressive role in the immunopathogenesis of tuberculosis. They are also described as antigens of host double negative alphabeta T-cells. Delimitation of ManLAMs epitopes require knowledge of the precise structure of these molecules. The two major functional domains (the cap motifs and the phosphatidylinositol anchor) of the parietal and cellular ManLAMs of Mycobacterium tuberculosis H37Rv were investigated here. Using capillary electrophoresis, we established that parietal and cellular ManLAMs share the same capping motifs, mono-, di-, and trimannosyl units with the same relative abundance. By (31)P NMR analysis of the native LAMs in Me(2)SO-d(6), the major acyl-form of both parietal and cellular H37Rv ManLAM anchors, typified by the P3 phosphorus resonance, comprised a diacylglycerol unit. Three other acyl-forms were characterized in the cellular ManLAMs. Comparative analysis of the cellular Mycobacterium bovis BCG and M. tuberculosis ManLAM acyl-forms revealed the presence of the same populations, but with different relative abundance. The biological importance of the H37Rv ManLAM acyl-form characterization is discussed, particularly concerning the molecular mechanisms of binding of ManLAMs to the CD1 proteins involved in the presentation of ManLAMs to T-cell receptors.

Carbohydrate epitope structural elucidation by 1H-NMR spectroscopy of a new Mycobacterium kansasii phenolic glycolipid antigen.

The complete primary structure of the carbohydrate moiety of a new phenolic glycolipid antigen namely PheGl K-IV from Mycobacterium kansasii was successfully established from only one- and two-dimensional 1H-NMR data. Among the scalar two-dimensional techniques, correlated spectroscopy with a 45 degree mixing pulse and phase-sensitive double-quantum-filtered correlated spectroscopy were selected, combined with two-dimensional dipolar techniques (nuclear Overhauser effect). These techniques using milligram of quantities native PheGl K-IV allowed the following monoacetylated tetrasaccharide to be proposed for its carbohydrate part: 4-O-Me-alpha-Manp-(1----3)-4-O-Ac-2-O-Me-alpha-Fucp-(1----3) -2-O-Me-alpha-Rhap- (1----3)-2,4-di-O-Me-alpha-Rhap. The PheGl K-IV shares, with the other phenolic glycolipids isolated from M. kansasii (K-I, K-II), a common core assigned to the lipid aglycone glycosylated by the monoacetylated trisaccharide part. It differs in the structure of the distal monosaccharide residue.

Mycobacterium smegmatis phosphoinositols-glyceroarabinomannans. Structure and localization of alkali-labile and alkali-stable phosphoinositides.

Lipoarabinomannans from fast growing Mycobacterium sp., namely AraLAMs, stimulate the early events of macrophage activation. The immunological activities of all of these AraLAMs drastically decrease with the loss of the mild alkali groups, which were believed to be restricted to the fatty acid residues from the phosphatidyl-myo-inositol anchor. This report reveals the presence and the structure of mild alkali-labile phosphoinositide units linked via the phosphate to the C-5 of the beta-D-Araf in the AraLAMs of Mycobacterium smegmatis, a fast growing mycobacterial species. Their structure was unambiguously established with a strategy based on both one-dimensional 31P and two-dimensional 1H-31P heteronuclear multiple quantum correlation spectroscopy (HMQC) and HMQC-homonuclear Hartmann-Hahn spectroscopy NMR experiments applied to native AraLAMs and to AraLAMs treated in mild alkali conditions. Next to these alkali-labile phosphoinositides estimated at three per molecule, two other mild alkali-stable phosphoinositide units were identified: the expected (myo-inositol-1)-phosphate-(3-glycerol) unit typifying the well known glycosylphosphatidylinositol anchor of the mannan core and, more surprisingly, one (myo-inositol-1)-phosphate-(5-beta-D-Araf) unit having the same structure as the alkali-labile ones. Moreover, these four phosphoinositide units were found capping the arabinan side chains. Thus, their different behavior toward mild alkaline hydrolysis was explained according to their accessibility to the alkali reagent. This novel class of LAMs, namely phosphoinositols-glyceroarabinomannans (PI-GAMs), are characterized by their phosphoinositide units but also by the absence of fatty acid residues. These PI-GAMs were found to elicit the secretion of tumor necrosis factor-alpha, suggesting that phosphoinositides are the major PI-GAM epitope involved in this process.

Comparative structural study of the mannosylated-lipoarabinomannans from Mycobacterium bovis BCG vaccine strains: characterization and localization of succinates.

In order to investigate the molecular basis of the differences observed in the immunogenicity of various BCG vaccines, which may play a major role in BCG vaccination efficiency, the presence and the partial structure of the lipoarabinomannans (LAMs) were investigated in four different BCG strains (Pasteur, Glaxo, Copenhagen, and Japanese strains). According to their cell-wall extraction mode, the LAMs were subdivided into two classes, namely, parietal LAMs and cellular LAMs. From a structural point of view, the cellular LAMs and parietal LAMs both belong to the ManLAM class since the relevant structural features, described for ManLAMs, that is, the phosphatidyl-myo-Ins anchor and the manno-oligosaccharide caps were characterized. In addition, thanks to NMR experiments realized on the native ManLAMs, we prove the existence of succinyl groups and we determine their location on the C-2 of the 3,5-di-O-alpha-D-Araf units. The average number of succinyl groups was estimated at one and four per ManLAMs molecule for Glaxo and Japanese vaccines, respectively, and two for Pasteur and Copenhagen strains.

Acylation state of the phosphatidylinositol mannosides from Mycobacterium bovis bacillus Calmette Guérin and ability to induce granuloma and recruit natural killer T cells.

Previous studies have found that, when injected into mice, glycolipidic fractions of mycobacterial cell walls containing phosphatidylinositol mannosides (PIM) induced a granuloma and recruitment of Natural Killer T cells in the lesions. The dimannoside (PIM(2)) and the hexamannoside (PIM(6)) PIM were isolated from Mycobacterium bovis bacillus Calmette Guérin and shown to act alike, but the activity was found to be dependent on the presence of the lipidic part. The chemical structure of PIM was then re-evaluated, focusing on the characterization of their lipidic part, defining mono- to tetra-acylated PIM(2). The structure of these acyl forms was elucidated using a sophisticated combination of chemical degradations and analytical tools including electrospray ionization/mass spectrometry, electrospray ionization/mass spectrometry/mass spectrometry, and two-dimensional NMR. Finally, the acyl forms were purified by hydrophobic interaction chromatography and tested for their capacity to induce the granuloma and Natural Killer T cell recruitment. We found that there is an absolute requirement for the molecules to possess at least one fatty acyl chain, but the number, location, and size of the acyl chains was without effect. Moreover, increasing the complexity of the carbohydrate moiety did not lead to significant differences in the biological responses.

Mannosylated lipoarabinomannans inhibit IL-12 production by human dendritic cells: evidence for a negative signal delivered through the mannose receptor.

IL-12 is a key cytokine in directing the development of type 1 Th cells, which are critical to eradicate intracellular pathogens such as Mycobacterium tuberculosis. Here, we report that mannose-capped lipoarabinomannans (ManLAMs) from Mycobacterium bovis bacillus Calmette-Guérin and Mycobacterium tuberculosis inhibited, in a dose-dependent manner, the LPS-induced IL-12 production by human dendritic cells. The inhibitory activity was abolished by the loss of the mannose caps or the GPI acyl residues. Mannan, which is a ligand for the mannose receptor (MR) as well as an mAb specific for the MR, also inhibited the LPS-induced IL-12 production by dendritic cells. Our results indicate that ManLAMs may act as virulence factors that contribute to the persistence of M. bovis bacillus Calmette-Guérin and M. tuberculosis within phagocytic cells by suppressing IL-12 responses. Our data also suggest that engagement of the MR by ManLAMs delivers a negative signal that interferes with the LPS-induced positive signals delivered by the Toll-like receptors.

Structural features of lipoarabinomannan from Mycobacterium bovis BCG. Determination of molecular mass by laser desorption mass spectrometry.

It was recently shown that mycobacterial lipoarabinomannan (LAM) can be classified into two types (Chatterjee, D., Lowell, K., Rivoire B., McNeil M. R., and Brennan, P. J. (1992) J. Biol. Chem. 267, 6234-6239) according to the presence or absence of mannosyl residues (Manp) located at the nonreducing end of the oligoarabinosyl side chains. These two types of LAM were found in a pathogenic Mycobacterium tuberculosis strain and in an avirulent M. tuberculosis strain, respectively, suggesting that LAM with Manp characterizes virulent and "disease-inducing strains." We now report the structure of the LAM from Mycobacterium bovis Bacille Calmette-Guérin (BCG) strain Pasteur, largely used throughout the world as vaccine against tuberculosis. Using an up-to-date analytical approach, we found that the LAM of M. bovis BCG belongs to the class of LAMs capped with Manp. By means of two-dimensional homonuclear and heteronuclear scalar coupling NMR analysis and methylation data, the sugar spin system assignments were partially established, revealing that the LAM contained two types of terminal Manp and 2-O-linked Manp. From the following four-step process: (i) partial hydrolysis of deacylated LAM (dLAM), (ii) oligosaccharide derivatization with aminobenzoic ethyl ester, (iii) HPLC purification, (iv) FAB/MS-MS analysis; it was shown that the dimannosyl unit alpha-D-Manp-(1-->2)-alpha-D-Manp is the major residue capping the termini of the arabinan of the LAM. In this report, LAM molecular mass determination was established using matrix-assisted UV-laser desorption/ionization mass spectrometry which reveals that the LAM molecular mass is around 17.4 kDa. The similarity of the LAM structures between M. bovis BCG and M. tuberculosis H37Rv is discussed in regard to their function in the immunopathology of mycobacterial infection.

Structural definition of arabinomannans from Mycobacterium bovis BCG.

The structures of the hydrophilic parietal and cellular arabinomannans isolated from Mycobacterium bovis BCG cell wall [Nigou et al. (1997) J Biol Chem 272: 23094-103] were investigated. Their molecular mass as determined by MALDI-TOF mass spectrometry was around 16 kDa. Concerning cap structure, capillary electrophoresis analysis demonstrated that dimannoside (Manpalpha1-->2Manp) was the most abundant motif (65-75%). Using two-dimensional 1H-13C NMR spectroscopy, the mannan core was unambiguously demonstrated to be composed of -->6Manpalpha1--> backbone substituted at some O-2 by a single Manp unit. The branching degree was determined as 84%. Finally, arabinomannans were found to be devoid of the phosphatidyl-myo-inositol anchor and, by aminonaphthalene disulfonate tagging, the mannan core was shown to contain a reducing end. This constitutes the main difference between arabinomannans and lipoarabinomannans from Mycobacterium bovis BCG.

Structural and immunological properties of the phenolic glycolipids from Mycobacterium gastri and Mycobacterium kansasii.

Mycobacterial species-specific antigens belong to the three following classes: phenolic glycolipids (Phe Gl), acyltrehalose-containing lipooligosaccharides and polar glycopeptidolipids. These antigens have been chemically defined and alkali-labile epitopes were found to characterize the lipooligosaccharide antigen type. In the present study the major Mycobacterium kansasii phenolic glycolipid epitope namely Phe Gl K-I was delineated as the distal monoacetylated disaccharidic residue: 2,6-dideoxy-4-O-methyl-alpha-D-arabino-hexopyranosyl-(1----3)-2-O-methyl -4-O- acetyl-alpha-L-fucopyranose. This acetoxy group is required for K-I epitope recognition demonstrating that alkali-labile epitopes also occur in the phenolic glycolipid antigen class. Using immunoelectron microscopy, the Phe Gl K-I epitope was localized around the electron-transparent layer on the M. kansasii cell-wall surface. Furthermore, two new phenolic glycolipids namely Phe Gl K-III and Phe Gl K-IV were discovered in minute amounts. They were purified and characterized by their retention time in direct-phase column HPLC. These molecules are also M. kansasii antigens, whose epitopes differ from that of Phe Gl K-I. The complete family of phenolic glycolipids Phe Gl K-I, K-II, K-III and K-IV was found in both rough and smooth variants of both M. kansasii and Mycobacterium gastri species.

A novel nucleotide-containing antigen for human blood gamma delta T lymphocytes.

The stimulation of human gamma delta T cells by mycobacteria occurs through recognition of four distinct nonpeptide phosphorylated antigens termed TUBag1-4. Among these latter, TUBag4 has already been biochemically characterized as a gamma-X derivative of 5'-deoxythymidine triphosphate (Constant, P., Davodeau, F., Peyrat, M. A., Poquet, Y., Puzo, G., Bonneville, M. and Fournié, J.-J., Science 1994. 264: 267). However, despite chemical synthesis of weakly stimulatory nucleotide-containing analogs, these mycobacterial compounds remained the sole nucleotide-containing antigens actually isolated from natural sources. Here, we present the complete isolation of the TUBag3 antigen from Mycobacterium fortuitum and demonstrate that this nonpeptide molecule contains a 5'-UTP nucleotide moiety. On selected V gamma 9/V delta 2 clones, T cell responses can be triggered with nanomolar concentrations of TUBag3. Like crude mycobacterial extracts, this purified nucleotide conjugate elicits a strong polyclonal response of gamma delta PBL from healthy donors. Furthermore, we present evidence that this compound is distinct from the recently synthesized gamma-isopentenyl 5'-UTP, a nucleotide conjugate of isopentenyl pyrophosphate that was found to be stimulatory for human gamma delta T cells (Tanaka, Y., Morita, C.T., Tanaka, Y., Nieves, E., Brenner, M. B. and Bloom, B. R., Nature 1995. 375: 155). Since it appears that both mycobacterial nucleotide antigens are molecules structurally related to peculiar precursors of nucleic acid synthesis, we propose that TUBag-reactive T cells might be specifically devoted to surveillance of proliferating cells.