Immunotherapeutic strategies to combat staphylococcal infections.

Antibiotic-resistant staphylococci are the leading cause of nosocomial infections in many hospitals around the world. Meanwhile, methicillin-resistant Staphylococcus aureus (MRSA) spread also in the community where highly virulent strains infect healthy adults that have no predisposing risk factors. Although a few novel antibiotics have been recently introduced into clinical practice, the search for alternative strategies to efficiently combat staphylococcal infections is urgently demanded to decrease the enormous burden caused by pathogenic staphylococci. In particular, immunological strategies based on vaccine development or therapeutic antibodies may significantly enhance the efficiency of anti-staphylococcal therapy. Most approaches are directed against surface components of staphylococci such as cell wall-linked adhesins, teichoic acids, capsule, the biofilm component PIA/PNAG, or soluble virulence determinants such as alpha-toxin, Panton-Valentine leukocidin, or superantigenic enterotoxins. Although 2 recent clinical trials have failed, several novel promising vaccines and therapeutic antibodies are currently in preclinical and clinical development.

Development of StaphVAX, a polysaccharide conjugate vaccine against S. aureus infection: from the lab bench to phase III clinical trials.

Staphylococcus aureus is the most common nosocomial pathogen and is responsible for approximately one-third of hospital-acquired bacteremias. The emergence of strains with multidrug resistance, including resistance to vancomycin, the antibiotic of last resort, presents the medical community with a major public health problem. Alternative therapies, including immunotherapy, have been in development for several decades. The discovery of S. aureus capsular polysaccharides from clinical isolates, and their importance to pathogenicity via antiphagocytic activity, opened a new window of opportunity for development of vaccines and immunotherapy against this pathogen. A conjugate vaccine, StaphVAX that includes the two most prevalent capsular polysaccharides, types 5 and 8, coupled to a carrier protein efficient in promoting a Th2 response, was developed. In a recent phase III clinical study in hemodialysis patients, StaphVAX was shown to prevent S. aureus bacteremia for up to 10 months following a single immunization. The history, epidemiology, serology, and development of StaphVAX, including preclinical and clinical studies demonstrating efficacy are described in this review.

[Effect of antibiotic therapy and vaccine therapy on the phagocytic reaction in mice infected with Staphylococcus]. / Vliianie antibiotikoterapii i vaktsinoterapii na fagotsitarnuiu reaktsiiu u myshei, infitsirovannykh stafilokokkom.

The time course of changes in the activity, intensity and completeness of phagocytosis with leukocytes of the peritoneal exudate was studied on mice with experimental staphylococcal infection treated with rifampicin, lincomycin and inactivated staphylococcal vaccine used alone or in combination. It was shown that immunization of the animals with inactivated staphylococcal vaccine promoted stimulation of the phagocytic defense. Rifampicin and lincomycin applied therapeutically induced a decrease in the activity, intensity and completeness of phagocytosis. It should be noted that rifampicin had a less pronounced inhibitory effect than lincomycin. The combined use of vaccine and antibiotics with therapeutic purposes promoted an increase in phagocytosis as compared to the use of the antibiotics alone. The combined therapy sometimes resulted in completeness of phagocytosis making it reach the control values (the 10th and 15th days, rifampicin and vaccine). It should be noted that a more pronounced stimulation of the activity, intensity and completeness of the phagocytosis was observed with the use of the combination of rifampicin and the vaccine.

[Effect of antibiotic and vaccine therapies on the succinate dehydrogenase and phosphatase activity of liver cells of mice infected with Staphylococcus]. / Vliianie antibiotikoterapii i vaktsinoterapii na aktivnost' suktsinatdegidrogenazy i fosfatazy v kletkakh pecheni u myshei, infitsirovannykh stafilokokkom.

Changes in the activity of succinate dehydrogenase (SDH), total and acid phosphatase (TP and AP) were studied in treatment of laboratory animals with rifampicin, lincomycin and with inactivated staphylococcal vaccine used alone or in combinations. It was shown that immunization of the animals with inactivated staphylococcal vaccine under conditions of experimental staphylococcal infection promoted stimulation of the enzyme activity. Rifampicin and lincomycin used for the treatment of such animals lowered the activity of the enzymes. The suppressing effect of the antibiotics increased with an increase in the period of their use. It should be noted that the inhibitory effect of rifampicin on the activity of SDH, TP and AP was less pronounced than that of lincomycin. The combined use of the vaccine and antibiotics for the treatment of the animals promoted an increase in the enzyme activity as compared to the use of the antibiotics alone. Sometimes the activity of SDH, TP and AP reached the control levels in such animals or the levels observed in the animals treated with the vaccine alone. Stimulation of the enzyme activity was more pronounced when the vaccine was used in combination with rifampicin.

[Possibilities of influencing experimental pneumoconiosis and experimental etching of respiratory organs by means of aerosol-inhalations (author's transl)]. / Möglichkeiten einer Beeinflussung experimenteller Pneumokoniosen und experimenteller Verätzung der Atemorgane mittels Aerosolinhalationen.

The author presented the results of 7 experiments in which he followed with his co-workers the effect of preventively applied aerosol inhalations with rats and rabbits, dusted with quartz or coal dust. Aerosol inhalations of alkaline mineral water "Vincentka" and of salt mixtures, especially of calcium salts affected in some experiments favourably the development of lung dust changes, in other cases on the contrary they did not. The best effect was proved by polyvinylpyridin-N-oxide (PNO). The author described further his experience with aerosoltherapy in persons affected by inhalation of etching substances. Here the inhalation of 10% CaCl2 or Ca gluconicum and of 1% natrium bicarbonicum proved to be the best.

Nonspecific enhancers of resistance in man.

Nonspecific enhancers of resistance may include (1) viral interference, (2) interferon, (3) interferon inducers, (4) bacterial interference, (5) bacterial products such as Coley's "toxins," endotoxins, or staphylococcal, BCG, and Corynebacterium parvum vaccines, (6) transfer factor, and (7) well-defined chemicals such as dinitrochlorbenzene, levamisole, and vitamin C. These are discussed only as they have been applied to man to learn whether or not they have enhanced his ability to resist infections and growth of tumors. Preliminary studies suggest that a variety of relatively safe and effective nonspecific enhancers may soon be available for clinical use.