A comparative analysis of heterogeneity in commercially available recombinant factor VIII products.

INTRODUCTION: Advances in analytical technologies enable investigation of possible correlations between molecular structure, aggregation and subvisible particle content. Regulatory agencies place increasing attention on potential risks associated with protein aggregates in the micron range in biological therapeutics. AIM: Assess the heterogeneity, high-molecular-weight protein (HMWP) species, subvisible particle content and posttranslational modifications in six commercially available recombinant FVIII (rFVIII) products. METHODS: Three B-domain-deleted (BDD) or B-domain truncated rFVIII products (turoctocog alfa, simoctocog alfa and moroctocog alfa) and three full-length rFVIII products (octocog alfa FS and two octocog alfa) were analysed. HMWP content, amount of micron range subvisible particles, tyrosine-1680 sulphation and N-glycan analysis were investigated. RESULTS: The B-domain-modified products had more protein size homogeneity vs the full-length products. Size exclusion-high-performance liquid chromatography data indicated no association between B-domain structure and aggregate content or size of the products tested. The rFVIII products showed large variation in subvisible particle concentration, with turoctocog alfa and simoctocog alfa having the lowest numbers (1000-1600 and 1800-2400 particles/100 IU, respectively). Turoctocog alfa and simoctocog alfa displayed the most complete tyrosine sulphation (>99.5%). CONCLUSION: Overall, there was no association between molecular structure (full-length B-domain, BDD or truncated) and subvisible particle or HMWP content. Dissimilarities may be related to production and product handling differences. In this study, turoctocog alfa, such as simoctocog alfa, had one of the lowest levels of subvisible particles and HMWP content, and high protein size homogeneity.

A 12-month randomised pilot trial of the Alzheimer's and music therapy study: a feasibility assessment of music therapy and physical activity in patients with mild-to-moderate Alzheimer's disease.

BACKGROUND: The Alzheimer's and Music Therapy (ALMUTH) study is the first randomised controlled trial (RCT) design with 12 months of active non-pharmacological therapy (NPT) implementing music therapy (MT) and physical activity (PA) for participants with Alzheimer's disease (AD). The aim of the present article is to retrospectively examine the inclusion of mild-to-moderate Alzheimer's Disease patients into the main ALMUTH study protocol and to determine if continued inclusion of AD patients is warranted. METHODS: The randomised pilot trial was conducted as a parallel three-arm RCT, reflecting the experimental design of the ALMUTH study. The trial was conducted in Bergen, Norway, and randomisation (1:1:1) was performed by an external researcher. The study was open label and the experimental design features two active NPTs: MT and PA, and a passive control (no intervention, CON) in Norwegian speaking patients with AD who still live at home and could provide informed consent. Sessions were offered once per week (up to 90 min) up to 40 sessions over 12 months. Baseline and follow-up tests included a full neuropsychological test battery and three magnetic resonance imaging (MRI) measurements (structural, functional, and diffusion weighted imaging). Feasibility outcomes were assessed and were determined as feasible if they met the target criteria. RESULTS: Eighteen participants with a diagnosis of mild-to-moderate AD were screened, randomised, and tested once at baseline and once after 12-months. Participants were divided into three groups: MT (n = 6), PA (n = 6), and CON (n = 6). Results of the study revealed that the ALMUTH protocol in patients with AD was not feasible. The adherence to the study protocol was poor (50% attended sessions), with attrition and retention rates at 50%. The recruitment was costly and there were difficulties acquiring participants who met the inclusion criteria. Issues with study fidelity and problems raised by staff were taken into consideration for the updated study protocol. No adverse events were reported by the patients or their caregivers. CONCLUSIONS: The pilot trial was not deemed feasible in patients with mild-to-moderate AD. To mitigate this, the ALMUTH study has expanded the recruitment criteria to include participants with milder forms of memory impairment (pre-AD) in addition to expanding the neuropsychological test battery. The ALMUTH study is currently ongoing through 2023. TRIAL REGISTRATION: Norsk Forskningsråd (NFR) funded. Regional Committees for Medical and Health Research Ethics (REC-WEST: reference number 2018/206). CLINICALTRIALS: gov: NCT03444181 (registered retrospectively 23 February 2018, https://clinicaltrials.gov/ct2/show/NCT03444181 ).

Author Correction: Inhibition of casein kinase 1δ/εimproves cognitive-affective behavior and reduces amyloid load in the APP-PS1 mouse model of Alzheimer's disease.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Inhibition of casein kinase 1δ/εimproves cognitive-affective behavior and reduces amyloid load in the APP-PS1 mouse model of Alzheimer's disease.

Circadian rhythm disruption is one of the earliest biomarkers of Alzheimer's disease (AD), and there exists a bidirectional relationship by which dysfunctions in the circadian clock drive AD pathology and AD pathology drives circadian dysfunction. Casein kinase 1 (CK1) isoforms ε and δ, key circadian regulators, are significantly upregulated in AD and may contribute to AD pathogenesis. In the current studies, we have examined how inhibition of CK1ε/δ with PF-670462 (at 10 mg/kg, δ isoform selective, or 30 mg/kg, δ and ε selective) impacts regional Aß and circadian gene expression in 10-13 month old APP-PS1 mice and nontransgenic controls. We have also assessed circadian, cognitive, and affective behavioral correlates of these neural changes. At baseline, APP-PS1 mice showed a short period, as well as impaired cognitive performance in both prefrontal cortex and hippocampus-dependent tasks. Both doses of PF-670462 lengthened the period and improved affect, whereas only the higher dose improved cognition. Further, PF-670462 treatment produced a dose-dependent reduction in amyloid burden - overall Aß signal decreased in all three areas; in the prefrontal cortex and hippocampus, PF-670462 also reduced plaque size. Together, these findings support chronotherapy as a potential tool to improve behavior in AD.

Epidemiological differences between the UK and Ireland versus France in Staphylococcus aureus isolates resistant to fusidic acid from community-acquired skin and soft tissue infections.

OBJECTIVES: To characterize the epidemiology of Staphylococcus aureus isolates resistant to fusidic acid isolated from patients with skin and soft tissue infections (SSTIs) in France, the UK and Ireland. METHODS: One hundred and thirty-six S. aureus isolates with an MIC of fusidic acid above 1 mg/L were isolated during the EPISA study from patients more than 2 years old attending their general practitioners for SSTIs. All isolates were related to clonal complex by a combination of PFGE, spa typing and multilocus sequence typing. The presence of toxin genes and of the fusB determinant was monitored to characterize each represented clonal complex. RESULTS: Eight different clonal complexes were identified. CC121 constituted the majority of the isolates from Ireland and the UK but was not represented in France. Among the other clonal complexes, CC8 and CC5 were the most common in the three countries, although the number of French isolates was limited. CC121 was the only clonal complex significantly associated with a skin infection, namely impetigo (P < 0.05). Toxin genes were present in CC121 and CC80. The fusB determinant was also detected in the same clonal complexes. Enterotoxins were found in four clonal complexes (CC1, CC5, CC8 and CC22). CONCLUSIONS: The impetigo clone (CC121: ST123) was present in the majority of S. aureus isolates from the UK and Ireland but was not detected in France. This strain was associated with impetigo, exfoliative toxins and the fusB determinant. No other clonal complex appeared to be dominant in other types of skin infections.

The EPISA study: antimicrobial susceptibility of Staphylococcus aureus causing primary or secondary skin and soft tissue infections in the community in France, the UK and Ireland.

OBJECTIVES: To provide information on the susceptibility of Staphylococcus aureus causing skin and soft tissue infections (SSTIs) in France, Ireland and the UK. PATIENTS AND METHODS: One thousand three hundred and ninety patients attending their general practitioners for skin infections were recruited. Susceptibility to 11 antimicrobials using CLSI (formerly NCCLS) broth microdilution was determined for 646 S. aureus isolates detected in the evaluable patient population. RESULTS: Susceptibility results were similar in the UK and Ireland, but differed in France. The largest difference between countries was observed for erythromycin and fusidic acid. In France, 67.8% of isolates were susceptible to erythromycin when compared with 88.6% in Ireland and 92.8% in the UK. However, 93.7% of French isolates were susceptible to fusidic acid, compared with 68.6% in Ireland and 75.6% in the UK. A diagnosis of impetigo was associated with reduced fusidic acid susceptibility. CONCLUSIONS: Differences in the prevalence of certain diagnoses, particularly impetigo, rather than differences in antibiotic consumption may explain some of the observed differences in susceptibility seen between these countries.

[Antibiotic susceptibility of Staphylococcus aureus strains responsible for community-acquired skin infections]. / Sensibilité aux antibiotiques des souches de Staphylococcus aureus responsables d'infections cutanées communautaires.

BACKGROUND: The appearance and worldwide spread of community-acquired methicillin-resistant Staphylococcus aureus (MRSA) skin infections warrant new studies of antibiotic resistance among strains of S. aureus responsible for cutaneous infections seen in general practice. PATIENTS AND METHODS: A prospective, multicentre study was performed from December 2003 to August 2004 in outpatients of both sexes presenting with a common bacterial skin infection presumed due to S. aureus (primary or secondary impetigo, ecthyma, paronychia, folliculitis, furunculosis). The investigators (n=50) were GPs from seven French regions. Clinical data (history, previous hospitalisation, type of infection, site, previous treatment, etc.) were collected using a standard questionnaire. A bacteriological sample was taken in attempt to isolate S. aureus after which antibiograms were prepared and minimal inhibiting concentrations determined (11 antibiotics). RESULTS: Four hundred and eighty patients of mean age 42 years (range: 2-94 years) were included. S. aureus was isolated from cultures in 205 of 477 samples, i.e. in 197 patients (eight had two strains of S. aureus). Patients with S. aureus had a primary skin infection in 104/197 cases (53%) (24 impetigo, 20 paronychia, 45 folliculitis or furunculosis) and a secondary infection in 93/197 cases (47%), with 4.9% patients being hospitalized within the preceding six months (median: 10 days). Percentages of resistant S. aureus strains were as follows: penicillin: 86%, erythromycin: 32%, ciprofloxacin: 9.3%, tetracycline: 5.8%, oxacillin: 5.8% (representing MRSA strains), fusidic acid: 4.4%, clindamycin: 3.4%, mupirocin: 1% and gentamicin: 0.5%. All S. aureus strains were sensitive to vancomycin and rifampicin. Except for one strain also resistant to tetracycline and fusidic acid, all MRSA strains were also resistant to ciprofloxacin. DISCUSSION: Multiresistant bacterial strains could become a concern in the community in France in the near future. In our study, only 14/197 (6.8%) S. aureus strains were sensitive to all tested antibiotics, whereas 21/197 (10.7%) were resistant to at least three of them. Compared to a French study performed in private practice in 2000, the level of MRSA is growing only slowly (5.8% versus 3.9%), whereas the percentage of strains of Peni-R/Oxa-S S. aureus are stable (80.5%). CONCLUSION: Common bacterial infections of the skin due to MRSA or to multiresistant S. aureus are not rare in France and have tended to increase slowly in recent years.

The occurrence of Enterococcus faecium and faecalis Is significantly associated With anastomotic leakage After pancreaticoduodenectomy.

BACKGROUND AND AIMS: Enterococcus has emerged as a virulent species; Enterococcus faecium especially has arisen as a source of nosocomial infections. Furthermore, specific Enterococcus faecalis species are significantly associated with anastomotic leakage in rodent studies. The objective of this study was to investigate whether the occurrence of Enterococci ( E. faecium and E. faecalis) obtained from drain samples was associated with leakage in humans undergoing pancreaticoduodenectomy. MATERIALS AND METHODS: All patients undergoing pancreaticoduodenectomy had a peritoneal drain sample sent for culturing between postoperative days 3 and 10. Postoperative pancreatic fistulas were defined and classified according to the International Study Group of Pancreatic Fistula. Bile leakage was radiologically verified. Postoperative complications were classified according to the Dindo-Clavien classification. RESULTS: A total of 70 patients were eligible and enrolled in this study. Anastomosis leakage was observed in 19 patients; 1 leakage corresponding to the hepaticojejunostomy and 18 pancreatic fistulas were identified. In total, 10 patients (53%) with leakage had Enterococci-positive drain samples versus 12 patients (24%) without leakage [odds ratio (OR) = 5.1, 95% confidence interval (CI) = 1.4-19.4, p = 0.02]. Preoperative biliary drainage with either endoscopic stenting or a percutaneous transhepatic cholangiography catheter was associated with the occurrence of Enterococci in drain samples (OR = 5.67, 95% CI = 1.8-12.9, p = 0.003), but preoperative biliary drainage was not associated with leakage (OR = 0.45, 95% CI = 0.1-1.7, p = 0.23). CONCLUSION: Enterococci in drain sample cultures in patients undergoing pancreaticoduodenectomy occurs significantly more among patients with anastomotic leakage compared to patients without leakage.

Pancreatic spasmolytic polypeptide: first three-dimensional structure of a member of the mammalian trefoil family of peptides.

BACKGROUND: The trefoil peptides are a rapidly growing family of peptides, mainly found in the gastrointestinal tract. There is circumstantial evidence that they stabilize the mucus layer, and may affect the rate of healing of the mucosal epithelium. RESULTS: We have determined the structure of porcine pancreatic spasmolytic polypeptide (PSP) to 2.5 A resolution. The polypeptide contains two trefoil domains. The domain structure is compact, and is composed of a central short antiparallel beta-sheet with one short helix above and one below it. This is a novel motif. The two domains are related by two-fold symmetry, and each domain contains a cleft. CONCLUSIONS: The cleft within each domain could accommodate a polysaccharide chain, and may therefore be responsible for binding mucin glycoproteins. We suggest that PSP may cross-link glycoproteins, explaining its ability to stabilize the mucus layer.

Person-task-context: a model for designing curriculum and in-training assessment in postgraduate education.

Structured curricula for senior house officers have often been lacking. The aim of this study was to trial a person-task-context model in designing a curriculum and in-training assessment (ITA) programme for SHOs in internal medicine. A working group designed the programme based on triangulation of information from interviews with trainees and programme directors, analysis of patient case mix and national quality assurance data. The interview data showed that the main difference currently between trainee levels was in expected degree of responsibility for patient management rather than in actual tasks. Key learning needs were how to take a structured approach to the tasks and get an overview of situations. SHOs expressed a need for explicit learning goals and standards of performance. SHOs requested formal teaching in non-medical aspects of competence such as communication, interpersonal skills and professionalism. This article points out how consideration of the type of trainees involved, the tasks they must do and learn, and the context in which they work are important in designing postgraduate curricula. The person-task-context model can be used to tailor curricula and ITA that support learning and may be especially beneficial in promoting learning in non-dominant areas of a specialty.

On the significance of the carbohydrate moieties of bovine prothrombin for clotting activity.

Purified bovine prothrombin has been treated with different mixtures of glycosidases. Upon incubation of the prothrombin for 30 h with a combination of neuraminidase, alpha- and beta-galactosidase and beta-N-acetylglucosaminidase in 4 mM diisopropylfluorophosphate at pH 5.3 and 30 degrees C, about 70% of the carbohydrates were removed without affecting the coagulation activity. All the sialic acid and about half of the mannose, galactose and glucosamine residues were removed by this treatment.

Crystallization and preliminary X-ray diffraction studies of a peroxidase from barley grain.

Crystals suitable for X-ray diffraction analysis of both glycosylated and non-glycosylated forms of a barley peroxidase have been grown. The crystals of the glycosylated peroxidase have been grown by the hanging drop vapour diffusion method using polyethylene glycol 4000 as the precipitant in the presence of n-propanol and potassium iodide at pH 8.5. The crystals are needles belonging to the orthorhombic spacegroup P2(1)2(1)2(1) with unit cell dimensions a = 62.95 A, b = 66.24 A and c = 70.78 A. There is one barley peroxidase molecule in the asymmetric unit. The crystals contain approximately 38% solvent and appear to be stable to lengthy X-ray exposure. They diffract to beyond 1.9 A.

A kinase inhibitor screen identifies Mcl-1 and Aurora kinase A as novel treatment targets in antiestrogen-resistant breast cancer cells.

Antiestrogen resistance is a major problem in breast cancer treatment. Therefore, the search for new therapeutic targets and biomarkers for antiestrogen resistance is crucial. In this study, we performed a kinase inhibitor screen on antiestrogen responsive MCF-7 cells and a panel of MCF-7-derived tamoxifen- and fulvestrant-resistant cell lines. Our focus was to identify common and distinct molecular mechanisms involved in tamoxifen- and fulvestrant-resistant cell growth. We identified 18 inhibitors, of which the majority was common for both tamoxifen- and fulvestrant-resistant cell lines. Two compounds, WP1130 and JNJ-7706621, exhibiting prominent preferential growth inhibition of antiestrogen-resistant cell lines, were selected for further studies. WP1130, a deubiquitinase inhibitor, induced caspase-mediated cell death in both tamoxifen- and fulvestrant-resistant cell lines by destabilization of the anti-apoptotic protein Mcl-1. Mcl-1 expression was found upregulated in the antiestrogen-resistant cell lines and depletion of Mcl-1 in resistant cells caused decreased viability. JNJ-7706621, a dual Aurora kinase and cyclin-dependent kinase inhibitor, specifically inhibited growth and caused G2 phase cell cycle arrest of the tamoxifen-resistant cell lines. Knockdown studies showed that Aurora kinase A is essential for growth of the tamoxifen-resistant cells and inhibition of Aurora kinase A resensitized tamoxifen-resistant cells to tamoxifen treatment. Preferential growth inhibition by WP1130 and JNJ-7706621 was also found in T47D-derived tamoxifen-resistant cell lines, pointing at Mcl-1 and Aurora kinase A as potential treatment targets. In addition, tumor samples from 244 estrogen receptor-positive breast cancer patients treated with adjuvant tamoxifen showed that higher expression level of Aurora kinase A was significantly associated with shorter disease-free and overall survival, demonstrating the potential of Aurora kinase A as a biomarker for tamoxifen resistance.

Structure of soybean seed coat peroxidase: a plant peroxidase with unusual stability and haem-apoprotein interactions.

Soybean seed coat peroxidase (SBP) is a peroxidase with extraordinary stability and catalytic properties. It belongs to the family of class III plant peroxidases that can oxidize a wide variety of organic and inorganic substrates using hydrogen peroxide. Because the plant enzyme is a heterogeneous glycoprotein, SBP was produced recombinant in Escherichia coli for the present crystallographic study. The three-dimensional structure of SBP shows a bound tris(hydroxymethyl)aminomethane molecule (TRIS). This TRIS molecule has hydrogen bonds to active site residues corresponding to the residues that interact with the small phenolic substrate ferulic acid in the horseradish peroxidase C (HRPC):ferulic acid complex. TRIS is positioned in what has been described as a secondary substrate-binding site in HRPC, and the structure of the SBP:TRIS complex indicates that this secondary substrate-binding site could be of functional importance. SBP has one of the most solvent accessible delta-meso haem edge (the site of electron transfer from reducing substrates to the enzymatic intermediates compound I and II) so far described for a plant peroxidase and structural alignment suggests that the volume of Ile74 is a factor that influences the solvent accessibility of this important site. A contact between haem C8 vinyl and the sulphur atom of Met37 is observed in the SBP structure. This interaction might affect the stability of the haem group by stabilisation/delocalisation of the porphyrin pi-cation of compound I.

Synthesis and conformational analysis of fusidic acid side chain derivatives in relation to antibacterial activity.

Novel fusidic acid type antibiotics having flexible side chains are described. Saturation of the double bond between C-17 and C-20 of fusidic acid produces four stereoisomers differing in the configuration at C-17 and C-20. The structure-activity relationship of the stereoisomers was studied using computer-assisted analyses of low-energy conformations and crystallographic data. Only one of the four stereoisomers showed potent antibiotic activity comparable with that of fusidic acid, whereas the other three stereoisomers retained little or no activity. The orientation of the side chain is crucial, and there is only a limited space for bioactive side chain conformations. This investigation demonstrates the essential role of the side chain conformations in relation to antibacterial activity and contradicts earlier assumptions that the Delta17(20) bond is an essential feature in the molecule.

Enhancement by a serum factor of the immunoaccessibility of an enterobacterial porin protein domain.

Monoclonal antibody (MAb) generated against the domain Po I on the outer membrane (OM) porin (Po) protein of an Escherichia coli 055 strain showed weak binding by the OM in ELISA. Human serum and sera from different animal species enhanced the MAb binding in ELISA when the antibody was incubated together with serum or the OM was pretreated with serum. Human serum also enhanced the MAb binding when coats were prepared by using OMs from various cross-reacting bacteria. The ability of human serum to amplify the MAb binding by OMs was similar to that of lysostaphin. Amplification by serum was not observed when MAbs against three other enterobacterial OM proteins were tested. The amplifying serum factor was destroyed by heating (100 degrees C) and by mercaptoethanol. It appeared in fractions which corresponded to an apparent molecular weight of 75,000-80,000 after gel permeation, and, after ion-exchange chromatography, in fractions which contained a protein of 60 kD when analysed by SDS-PAGE. These data support the notion that the serum-induced enhancement of the anti-Po I MAb binding was due to a previously described serum amidase (N-acetylmuramyl-L-alanine amidase) which has peptidoglycan-degrading activity. The effects of the amplifying serum factor may influence the antibody levels which are measured when OMs from Gram-negative bacteria are used as antigen in a serodiagnostic test.

Antibody response to defined domains on enterobacterial outer membrane proteins in healthy persons and patients with bacteraemia.

Monoclonal antibody (MAb)-based competitive enzyme immunoassays (cELISAs) were elaborated to measure antibodies against MAb-defined domains on three different enterobacterial outer membrane (OM) proteins in sera from healthy individuals (n = 30) and in paired serum samples from patients (n = 45) with bacteraemia caused by enterobacteria or by various nonenteric bacteria (n = 15). The MAb-defined domains were Hm I and Hm II on the heat-modifiable (Hm) protein, PALp I and PALp II on the peptidoglycan-associated lipoprotein (PALp), and BLp I on Braun's lipoprotein (BLp). All MAbs have shown broad cross-reactivity with and specificity for enterobacteria. Sera from healthy individuals and from patients with infections caused by nonenteric bacteria contained low levels of MAb-blocking antibodies. Bacteraemia caused by enterobacteria resulted in generation of antibodies against the MAb-defined domains in many of the patients. Thus, 40% and 69% showed a positive BLp I cELISA with the first and second serum samples, respectively. Of the second serum samples, 20-38% showed positive Hm and PALp cELISAs. The BLp I cELISA showed higher diagnostic sensitivity than the previously described indirect ELISA for IgG antibodies against E. coli 055 OM protein antigens. Assays using the MAbs as competitors showed that the patients bacteraemic with enterobacteria, also generated antibodies against other domains on the OM proteins. The cELISAs may be useful in the diagnosis and management of patients with serious infections caused by enterobacteria. In this regard, the BLp I cELISA showed the most promising results.

A conserved domain on enterobacterial porin protein analysed by monoclonal antibody.

Broadly cross-reactive monoclonal antibodies (MAbs) against enterobacterial outer membrane (OM) porin (Po) protein were isolated after immunization of BALB/c mice with whole cells of E. coli 055:B5. MAbs (n = 6) of the IgG class but of four different isotypes were studied. Based on a competition ELISA, all of the MAbs were directed against one and the same Po protein domain (Po I). The MAbs cross-reacted with 72 of 74 strains from 10 different genera of the Enterobacteriaceae. One Morganella and one Salmonella strain showed no cross-reactivity. Also, nine strains of various Neisseria spp. cross-reacted while 21 strains of various other nonenteric Gram-negative bacteria showed no cross-reactivity. The Po I sites were inaccessible in intact homologous bacteria but partially accessible in the OM. Digestion of OM with lysozyme or lysostaphin affected the accessibility of the Po I sites in OMs of various enterobacteria. Lysostaphin strongly enhanced the immunoaccessibility, whereas lysozyme had lesser effects. The enzymes also affected the binding by Neisseria OMs of the anti-Po I MAb. The Po I site was immunogenic both in humans and rabbits. The data indicate that Po I is an important Po protein domain, and that the effects of peptidoglycan-degrading enzymes must be considered in studies of Po protein domains.

Immunogenicity expressed in patients with bacteraemia of an epitope shared by enterobacterial and neisserial porin proteins.

A monoclonal antibody (MAb) against an epitope (Po I) on an Escherichia coli O55 porin protein has shown broad cross-reactivity with other Enterobacteriaceae and with both pathogenic and non-pathogenic Neisseriaceae. In this study, we have measured antibody levels against the Po I site in patients with bacteraemia in order to examine the immunogenicity of the Po I domain in humans. A MAb-based competition ELISA (cELISA) was used. Only 20% of healthy controls had detectable levels of anti-Po I antibodies in serum. Of patients bacteraemic with enterobacteria (n = 45), 11% and 58% showed elevated antibody levels compared to healthy controls with the first and second serum specimens, respectively, and 73% of these patients showed > or = 10% increase in the antibody levels. Of patients bacteraemic with N. meningitidis (n = 20), only 30% showed > or = 10% increase in the antibody levels when paired serum specimens were tested. Levels of competing antibodies were similar in the cELISA with N. meningitidis (B: 15: P1, 7, 16) OM coat or E. coli O55 OM coat. The results demonstrated that the highly conserved porin protein domain Po I expressed immunogenicity in humans when present in bacteria which caused bacteraemia. This finding represents a challenge in further investigations on the immunobiological role of the cross-reacting antibodies.

Monoclonal antibodies against three different enterobacterial outer membrane proteins. Characterization, cross-reactivity, and binding to bacteria.

BALB/c mice were immunized with whole-cells of Escherichia coli 055:B5 or Proteus mirabilis NCTC 60 to produce broadly cross-reacting monoclonal antibodies (MAbs) against outer membrane (OM) proteins. A total of 10 anti-OM MAbs of the IgG class were selected. These included 5 MAbs against the heat-modifiable (Hm) protein, 3 against the peptidoglycan-associated lipoprotein (PALp), and 2 against Braun's lipoprotein (BLp). Based on competition ELISA, the MAbs defined 2 Hm protein binding sites (Hm I and Hm II), 2 PALp sites (PALp I and PALp II), and one BLp site (BLp I). The MAbs showed broad cross-reactivity against 74 strains of 10 different genera of the Enterobacteriaceae. Non-cross-reacting enteric bacilli occurred only among bacteria of the genera Salmonella, Proteus, and Providentia. The results revealed that Proteus and Providentia strains differed from other enteric bacilli with regard to BLp synthesis or specificity. A panel of 30 non-enteric Gram-negative bacteria did not cross-react. Testing of MAb binding to bacteria showed that a part of the BLp I, PALp I, and PALp II sites was immunoaccessible in intact homologous bacteria, and that the Hm I and Hm II epitopes were inaccessible. The MAbs should facilitate studies of structure and immunobiological function of enterobacterial OM proteins and should have a potential as immunodiagnostic reagents.