Staphylococcus aureus bacteremia in patients with acute leukemia.

The natural history and outcome of Staphylococcus aureus bacteremia in patients with acute leukemia were studied over a 10 year period at the Baltimore Cancer Research Program. There were 370 patients at risk; 32 (9 percent) had 37 episodes. Granulocytopenia (less than 1,000/microliters) was present in 95 percent of the episodes. The sites of origin of bacteremia were identified in 32 episodes and were usually the skin and lower respiratory tract. Initially, broad-spectrum antimicrobials were used empirically in 30 episodes and specific antistaphylococcal therapy was used in the remaining seven episodes. The median duration of therapy was 14 days of intravenous therapy and seven days of oral therapy, a total of 21 days. There was improvement during therapy in 31 of the 37 episodes (83 percent) although, among the subgroup of six patients with shock, only one improved (p less than 0.001). There was no clinical or postmortem evidence of endocarditis in any patient. Since endocarditis complicating Staph. aureus bacteremia appears to be rare in patients with acute leukemia, a shorter course of therapy than that usually recommended for endocarditis may be justified.

The problem of emesis during oral glucose-electrolytes therapy given from the onset of severe cholera.

In an attempt to obviate the need for intravenous fluids by preventing dehydration, 57 adult volunteers who experienced induced clinical cholera during a vaccine development programme were treated from the onset of diarrhoea with oral glucose-electrolytes therapy. 44 individuals with mild to moderately profuse diarrhoea (less than 8 L. total volume) were maintained in normal water and electrolyte balance with oral therapy alone. 13 individuals with severe diarrhoea (greater than 8 L. total volume) could not be maintained in balance with oral therapy alone, due chiefly to emesis during the first day of illness. Emesis occurred in the absence of significant dehydration or acidosis. Since emesis precludes effective early oral therapy in severe cases, domiciliary oral therapy is unlikely to eliminate cholera mortality. Rural diarrhoea treatment centres using oral therapy with limited amounts of intravenous fluids when needed, could reduce case fatality from cholera and related diarrhoeas virtually to zero with least expense.

The chemical composition of bovine vitreous-humour collagen fibres.

The insoluble protein fraction was prepared from the central and posterior peripheral fraction of bovine vitreous humour. The collagen present in this fraction was solubilized by pepsin and fractionated by gel chromatography. Analysis of the solubilized collagen fractions showed that the alpha-chain component had an amino acid composition and yielded a series of CNBr-cleavage peptides that showed it was very similar to type II collagen obtained from articular cartilage. Bovine vitreous-humour collagen alpha-chains differed, however, from those of cartilage collagen in that they had a lower alanine content and differed in their susceptibility to cleavage by CNBr. Satisfactory cleavage was obtained after two CNBr treatments involving reduction and alkylation. In addition, significant quantities of other peptides constituents were present in the vitreous-humour collagen fractions, and the galactose and glucose content of the alpha-chain fraction was more than double that of the same fraction obtained from articular cartilage. Although the origin of the additional peptide constituents in the vitreous-humour collagen preparations is not known, the results obtained indicate that they are probably not derived from a distinct type of alpha-chain component but may be terminal peptides covalently linked to the alpha 1 type-II helical portions of the collagen. The differences in the chemical composition of the vitreous-humour collagen indicate that vitreous-humour fibres are composed of a special type-II collagen.

The isolation and partial characterization of the major glycoprotein (LGP-I) from the articular lubricating fraction from bovine synovial fluid.

The articular lubricating fraction from bovine synovial fluid was prepared by repeated fractionation in three consecutive CsCl density gradients to remove completely traces of hyaluronic acid. The major glycoprotein consituent (LGP-I) was then isolated by repeated gel-permeation chromatography. The yield of the LGP-I component was about 20 mg/litre of synovial fluid. Sedimentation-equilibrium measurements showed that this glycoprotein was homogeneous and the mol.wt. was calculated to be 227500. Amino acids represented 43% (w/w) and carbohydrate constituents 44% (w/w) of the molecule. Threonine, glutamic acid, proline and lysine (224, 127, 242 and 128 residues/1000 residues respectively) were the major amino acids. Galactosamine, galactose and N-acetylneuraminic acid (202, 162 and 114 residues/molecule of LGP-I component respectively) accounted for 98% of the total carbohydrate residues present. Small amounts of mannose and glucosamine (1 and 9mol respectively/mol of LGP-I component) were also present. After treatment of LGP-I component with alkali and NaB3H4 radioactivity was incorporated into alpha-aminobutyric acid and alanine in a molar ratio of 4:1, and radioactive galactosaminitol was isolated by ion-exchange chromatography from a cleaved oligosaccharide fraction. These data demonstrate the presence of threonine and serine -O-GalNAc linkages, but only 25% of the theoretical likages involving threonine were cleaved by a beta-elimination reaction. Digestion of LGP-I component with Pronase followed by chromatography on DEAE-cellulose yielded glycopeptide fractions with a similar amino acid and carbohydrate composition to the intact molecule. Treatment of desialylated and intact LGP-I component with galactose oxidase followed by reduction with NaB3H4 revealed the presence of 52mol of terminal galactose in the intact molecule and 153mol of galactose/mol of LGP-I component after treatment with neuraminidase. The data indicate the LGP-I component is composed of a single polypeptide chain containg more than 150 oligaosaccharide side chains composed of O-GaINAc-Gal distributed over the length of the peptide chain and that terminal sialic acid residues are linked to galactose in two-thirds of these side chains.

Isolation and partial characterization of low density proteoglycans from bovine articular cartilage.

Low density proteoglycans (PG-III) were isolated from bovine articular cartilage by extraction with 4 M guanidinium chloride followed by sedimentation in a dissociative CsCl density gradient and fractionation by chromatography on DEAE-cellulose and Sepharose CL-6B columns. The PG fractions obtained were analyzed to determine the amino acid composition, the content of sulfate and carbohydrate constituents, the molecular weight, and sedimentation properties under associative and dissociative conditions and the types of glycosaminoglycan components. The results show that the major type of low density PG in adult bovine metacarpophalangeal cartilage is a proteochondroitin sulfate with a Mr approximately 44,000. A single glycosaminoglycan component was detected following alkaline borohydride cleavage that was completely digested by chondroitinase ABC treatment. The disaccharide composition of this glycosaminoglycan was 4% O-sulfate, 22% 6-sulfate, and 74% 4-sulfate. Variations were observed in the content of chondroitin sulfate and the other carbohydrate constituents, indicating that the low density PG in this tissue probably occurs as a family of molecules with a variable composition. Sedimentation velocity analysis showed that under associative conditions PG-III formed high molecular weight complexes by self-association.

Measurements of reducing end groups on bovine vitreous-humour hyaluronic acid by reaction with [14C]cyanide.

Bovine vitreous-humour sodium hyaluronate was purified by precipitation with cetylpyridinium chloride, CsCl-density-gradient sedimentation and gel-permeation chromatography. The number of reducing end groups in two similarly prepared hyaluronate samples was determined by reaction with K14CN, and measurements of intrinsic viscosity were performed to determine whether this reaction caused degradation of the hyaluronate. The intrinsic viscosity of one hyaluronate sample was 192ml/g, compared with a value of 187ml/g after reaction with [14C]cyanide, which indicates that the labelling reaction did not cause depolymerization of the hyaluronate. The Mr calculated from these viscosity values is approx. 60000. Fractionation of the [14C]cyanide-labelled hyaluronate by gel chromatography showed that it was composed of a polydisperse population of molecules with calculated chain lengths, based on the ratio of [14C]cyanide to uronic acid, ranging in molecular weight from 9000 to 264000, with an average Mr of 63200. On the basis of these measurements it is concluded that reaction with [14C]cyanide does not cause degradation of bovine vitreous-humour hyaluronate polysaccharide chains and that reaction with [14C]cyanide can be used to determine the molecular weight of this hyaluronate.

The formation of a stable complex between dissociated proteoglycan and hyaluronic acid in the absence of a link protein.

A proteoglycan fraction prepared from bovine articular cartilage under dissociative conditions was shown to interact with three purified hyaluronic acid preparations to form stable complexes in the analytical ultracentrifuge. It is concluded from these experiments that, although link proteins are associated with hyaluronic acid and proteoglycans in complexes between these macromolecular constituents.

The lubricating activity of synovial fluid glycoproteins.

Friction measurements were performed on fractions prepared from bovine synovial fluid by using a cartilage on glass apparatus. A fraction containing lubricating glycoprotein-I (LGP-I) as the only detectable component at concentrations of 30-50 microgram/ml was able to lubricate in an identical manner to whole synovial fluid. These data indicate that LGP-I is th molecule responsible for the lubricating ability of synovial fluid. 125Iodine-labeled LGP-I also lubricated in a manner similar to synovial fluid, whereas when this sample was reduced and alkylated or treated with neuraminidase, the lubricating activity was greatly decreased. In tests to measure binding of 125I LGP-I to cartilage, an initial linear increase in binding was observed, followed by a decrease in binding at higher concentrations. In contrast, both the reduced and alkylated and the neuraminidase treated samples did not show the same concentration-dependent binding to the cartilage. It is suggested, therefore, that at least part of the lubricating ability of LGP-I is dependent upon its ability to bind to articular cartilage.

Isolation and partial characterization of dermatan sulfate proteoglycans from human post-burn scar tissues.

Dermatan sulfate (DS) proteoglycans (PGs) were extracted from human post-burn scar (Sc) tissues with 4M guanidinium chloride and isolated from the extracts by DEAE-cellulose chromatography and by differential ethanol precipitation. The DS.PGs were further purified by Sepharose CL-6B column chromatography. The average molecular weight (Mr) of hypertrophic scar (HSc) tissue DS.PGs was 39,000 based on sedimentation equilibrium measurements. Alkaline borohydride treatment of DS.PGs liberated glycosaminoglycan (GAG) chains and the presence of xylitol indicated that these chains were attached to protein core by xylosyl residues. The average Mr of the DS.GAG chain from HSc and normal scar (NSc) samples were 23,500 and 20,000 respectively. After digestion of the HSc and NSc, DS.PGs with chondroitinase ABC in the presence of proteinase inhibitors, two peptide components with Mr values of 21,500 and 17,000 were detected by SDS-polyacrylamide gel electrophoresis using reducing conditions. Analysis of the protein core fractions derived from NSc and HSc DS.PGs by Sepharose CL-6B column chromatography showed the presence of a single NH2-terminal amino acid (aspartic acid) and also that the fractions with different KAV values had an identical NH2-terminal sequence (A1-A5). The A1-A23 sequence of NSc DS.PG (major fraction, C): NH2Asp-Glu-Ala-O-Gly-Ile-Gly-Pro-Glu-Val-Pro-Asp-Asp-Arg-Asp-Phe-G lu-Pro- Ser-Leu-Gly-Pro-Val was the same as reported for a DS.PG isolated from human fetal membrane (HFM) tissue (Brennan et al., 1984). ELISA inhibition assay using monoclonal antibodies raised in rabbit against the NH2-terminal peptide (containing 15 amino acids) of human fetal membrane tissue were found to cross-react with HSc and NSc DS.PGs. Monoclonal antibodies to bovine skin DS.PGs protein core (Pearson et al., 1983) did not show any cross-reactivity with scar DS.PGs. These results show that the scar DS.PGs described here are different from normal bovine skin DS.PGs in the size and type of the protein core, and that in all the samples, the peptide components have the same NH2-terminal amino acid sequence.

Genetic susceptibility to cholera.

In the course of studies of immunity to experimental cholera in man, 10(5) or 10(6) Vibrio cholerae were given to 66 college students and other community volunteers under quarantine in an isolation ward. HLA antigen and blood group determinations were carried out to test the hypothesis that severity of clinical cholera is dependent in part upon genetically-determined host susceptibility. Fifty-five volunteers developed diarrhoea; 38 had mild illness and 17 had severe cholera (stool volume greater than or equal to 5.0 litres). HLA antigens were found in similar frequency in volunteers with severe, mild or no diarrhoea; antigen A1, A2, A3 and B7 were most common. Blood group O, however, was found in 64% of persons with severe cholera versus 36-38% of volunteers with mild or absent illness. Thus, while no correlation was found between HLA type and severity of cholera, these results do support the claims of other investigators that blood group O is found more frequently in patients with severe cholera than in the normal population.

Escherichia coli strains that cause diarrhoea but do not produce heat-labile or heat-stable enterotoxins and are non-invasive.

Three enteropathogenic Escherichia coli (E.P.E.C.) strains (O127:K63:H6, O128:K67:H2, and O142:K86:H6) isolated from outbreaks of infantile diarrhoea and one strain from the "normal" colonic flora (E. coli HS) of a healthy adult were fed in doses of 10(6), 10(8), and 10(10) organisms in NaHCO3 to adult volunteers. The strains, which had been stored for 7--9 years, gave negative results in sensitive tests for heat-labile (L.T.) enterotoxin (Y-1 adrenal-cell test), heat-stable (S.T.) enterotoxin (infant mouse assay), invasiveness (guineapig eye test), and gross fluid accumulation (infant rabbit assay). Two strains (O142 and O127) caused diarrhoea. L.T. or S.T. enterotoxins were not found in E. coli stool isolates from individuals with diarrhoea and no one had a rise in L.T. antitoxin titre; the findings suggest that L.T. and S.T. enterotoxins were not involved in pathogenesis of the diarrhoea. Non-invasive E.P.E.C. strains probably induce diarrhoea by a mechanism (presumably an enterotoxin) distinct from L.T. or S.T. enterotoxins.

Live Victoria/75-ts-1[E] influenza A virus vaccines in adult volunteers: role of hemagglutinin immunity in protection against illness and infection caused by influenza A virus.

To explore the relationship between neuraminidase immunity and the degree of attenuatíon of live influenza A virus vaccines, a comparative evaluation of three Victoria/75-ts-1[E] (Vic/75-ts-1[E]) recombinant viruses in serum hemagglutination-inhibiting-negative (titer,

Evaluation of influenza A/Hong Kong/123/77 (H1N1) ts-1A2 and cold-adapted recombinant viruses in seronegative adult volunteers.

Two attenuated influenza A donor viruses, the A/Udorn/72 ts-1A2 and the A/Ann Arbor/6/60 cold-adapted (ca) viruses, are being evaluated for their ability to reproducibly attenuate each new variant of influenza A virus to a specific and desired level by the transfer of one or more attenuating genes. Each of these donor viruses has been able to attenuate influenza A viruses belonging to the H3N2 subtype by the transfer of one or more attenuating genes. To determine whether these two donor viruses could attenuate a wild-type virus that belonged to a different influenza A subtype, ts-1A2 and ca recombinants of a wild-type virus representative of the A/USSR/77 (H1N1) Russian influenza strain were prepared and evaluated in adult doubly seronegative volunteers at several doses. The recombinants derived from both donor viruses were attenuated for the doubly seronegative adults. Less than 5% of infected vaccinees developed a febrile or systemic reaction, whereas five of six recipients of wild-type virus developed such a response. The 50% human infectious dose (HID(50)) for each recombinant was approximately 10(5.0) 50% tissue culture infective doses. The virus shed by the ts-1A2 and ca vaccinees retained the ts or ca phenotype, or both. This occurred despite replication of the recombinant viruses for up to 9 days. No evidence for transmission of the ca or ts-1A2 recombinant virus to controls was observed. A serum hemagglutination inhibition response was detected in less than 50% of the infected vaccinees. However, with the more sensitive enzyme-linked immunosorbent assay, a serological response was detected in 100% of the ca vaccinees given 300 HID(50) and approximately 70% of ca or ts vaccinees who received 10 to 32 HID(50) of virus. These results indicate that the recombinants derived from both donor viruses were satisfactorily attenuated and were stable genetically after replication in doubly seronegative adults although they induced a lower serum hemagglutination inhibition response than that found previously for H3N2 ts and ca recombinants.