Clonal hematopoiesis related TET2 loss-of-function impedes IL1ß-mediated epigenetic reprogramming in hematopoietic stem and progenitor cells.

Clonal hematopoiesis (CH) is defined as a single hematopoietic stem/progenitor cell (HSPC) gaining selective advantage over a broader range of HSPCs. When linked to somatic mutations in myeloid malignancy-associated genes, such as TET2-mediated clonal hematopoiesis of indeterminate potential or CHIP, it represents increased risk for hematological malignancies and cardiovascular disease. IL1ß is elevated in patients with CHIP, however, its effect is not well understood. Here we show that IL1ß promotes expansion of pro-inflammatory monocytes/macrophages, coinciding with a failure in the demethylation of lymphoid and erythroid lineage associated enhancers and transcription factor binding sites, in a mouse model of CHIP with hematopoietic-cell-specific deletion of Tet2. DNA-methylation is significantly lost in wild type HSPCs upon IL1ß administration, which is resisted by Tet2-deficient HSPCs, and thus IL1ß enhances the self-renewing ability of Tet2-deficient HSPCs by upregulating genes associated with self-renewal and by resisting demethylation of transcription factor binding sites related to terminal differentiation. Using aged mouse models and human progenitors, we demonstrate that targeting IL1 signaling could represent an early intervention strategy in preleukemic disorders. In summary, our results show that Tet2 is an important mediator of an IL1ß-promoted epigenetic program to maintain the fine balance between self-renewal and lineage differentiation during hematopoiesis.

Clinical and epidemiological importance of typing of Mycobacterium avium complex isolates.

The results of the application of a range of typing procedures to the identification and classification of 6,264 cultures of nontuberculous mycobacteria from human sources and the environment are reported. Seroagglutination, an enzyme-linked immunosorbent assay applied to whole bacteria or the glycolipid typing antigens and based on serovar-specific polyclonal or monoclonal antibodies, thin-layer chromatography of these antigens, and gas chromatography of their specific sugar determinants were used to arrive at identifications. As a result of this comprehensive approach, 4,452 (71%) of all cultures and 88% of those of samples from patients with AIDS proved to be typeable. The rank order of frequency of occurrence of individual organisms within the entire group of isolates was Mycobacterium avium complex serovar 4 greater than serovar 8 greater than serovar 1 greater than serovar 9 greater than serovar 6 greater than serovar 14 greater than serovar 2 greater than M. fortuitum greater than M. kansasii greater than M. xenopi greater than an apparent mixture of serovar 4 and M. xenopi greater than a mixture of serovar 4 and serovar 8. These results were similar but not identical to the pattern observed for isolates obtained from patients with AIDS; the order was M. avium complex serovar 4 greater than serovar 8 greater than serovar 1 greater than a mixture of serovar 4 and M. xenopi, a mixture of serovar 4 and serovar 8 greater than serovar 9 greater than serovar 2 greater than serovar 6. Serotyping was also used to demonstrate the possible clinical significance of nontuberculous mycobacteria recovered from different body sites. Other information on the distribution of M. avium serovars in patients from different geographical environments is provided.

Definition of the surface antigens of Mycobacterium malmoense and use in studying the etiology of a form of mycobacteriosis.

Mycobacterium malmoense is the latest of a roster of atypical mycobacteria implicated in pulmonary infections. Yet it lacks recognizable phenotypic features to allow its ready identification. Some 23 clinical isolates of M. malmoense were examined for homologous seroagglutination reactions and characteristic surface antigens. One group showed concordant agglutination interreactions and an identical spectrum of glycolipids and are regarded as M. malmoense sensu stricto. The glycolipids are of the newly found, trehalose-containing lipooligosaccharide class. De-O-acylation followed by high-pressure liquid chromatography revealed one major and several minor oligosaccharides. Partial acidic cleavage to release glycosidically linked trehalose, alpha-mannosidase digestion to demonstrate the presence of a non-reducing-end mannobiose, perdeuteriomethylation, partial acid hydrolysis, reduction, and O ethylation, combined with 1H nuclear magnetic resonance and electron impact and fast-atom bombardment mass spectrometry revealed the structure of the major oligosaccharide as alpha-D-Manp-(1----3) -alpha-D-Manp-(1----[2-alpha-L-Rhap-(1--]4--3)-alpha-L-Rh ap- (1----3)-alpha-D-Glcp-(1----1)-alpha-D-Glcp, in which two of the 2-alpha-L-Rhap residues are O methylated at C-3. (Man, mannose; Rha, rhamnose; Glc, glucose; p, pyranosyl). The structures of the minor oligosaccharides were also determined; they differ at the distal nonreducing end. The dominant oligosaccharide was acylated by octanoate, 2-methyleicosanoate, and 2,4-dimethylpentacosanoate to yield the major species-specific surface antigen of M. malmoense, which we regard as the most characteristic feature of the pathogen.

Rapid and sensitive identification of Mycobacterium tuberculosis.

The fatty acid constituents of 14 species of Mycobacterium (14 isolates) and one isolate each of Corynebacterium xerosis, Nocardia asteroides, and Streptomyces albus were examined with the purpose of distinguishing Mycobacterium tuberculosis from other acid-fast bacilli. Combined thin-layer chromatography (TLC) of methyl mycolates and gas-liquid chromatography (GLC) of shorter-chain fatty acid esters provided an unequivocal identification of M. tuberculosis in a matter of 2 to 3 days. The methodology included rapid and simplified procedures for methanolysis and extraction of bacterial lipids with equally facilitated GLC and TLC analyses. These studies were performed with 0.5 to 1.0 mg of dry bacterial cells (approximately 2.5 X 10(7) CFU). When applied to 100 unknown cultures, the methodology with combined TLC-GLC correctly identified all 49 of the M. tuberculosis-Mycobacterium bovis cultures and a variety of other mycobacterium taxa. It was also interesting to note that 28 of 39 (72%) of the nontuberculous mycobacteria were correctly identified. An additional five species were tentatively identified as belonging to either of two species (Mycobacterium malmoense, Mycobacterium terrae), but in all cases, the two species belonged to the same Runyon group. All six nonmycobacterial species were differentiated from the mycobacteria studied.

Enzyme-linked immunosorbent assay of glycolipid antigens for identification of mycobacteria.

Enzyme-linked immunosorbent assays which are based on species- or type-specific glycolipids antigens and in which rabbit antisera are prepared with homologous strains are capable of distinguishing among serological variants of the Mycobacterium avium-Mycobacterium intracellulare-Mycobacterium scrofulaceum complex, Mycobacterium chelonei subspecies chelonei and abscessus, Mycobacterium simiae I and II, Mycobacterium kansasii, Mycobacterium szulgai, Mycobacterium xenopi, and Mycobacterium fortuitum biovariant peregrinum. The immunoreactive glycolipids can be divided into two classes. Those resistant to alkali, the C-mycoside glycopeptidolipids, are present in the M. avium-M. intracellulare-M. scrofulaceum, the M. chelonei subspecies chelonei and abscessus, and the M. simiae I and II complexes and in M. fortuitum biovariant peregrinum. The alkali-labile glycolipid antigens, the lipooligosaccharides, are present in M. kansasii, M. szulgai, and M. xenopi. In one study, the combination of enzyme-linked immunosorbent assay and alkaline susceptibility was compared with seroagglutination in the identification of 60 clinical isolates of nontuberculous mycobacteria: 45 showed perfect concordance, 9 could be narrowed to one, two, or three possibilities, and the rest did not correspond. In a second study involving 43 clinical isolates that were untypable by seroagglutination or were autoagglutinable, the results of enzyme-linked immunosorbent assay and thin-layer chromatography of glycolipid antigens were compared: 21 showed clear concordance. The results demonstrate that enzyme-linked immunosorbent assay is particularly useful in assessing the antigenicity of lipids, and sensitivity, ease, and rapidity recommend it as an adjunct to seroagglutination and thin-layer chromatography for the identification of nontuberculous mycobacteria.

Infections caused by Mycobacterium avium complex in immunocompromised patients: diagnosis by blood culture and fecal examination, antimicrobial susceptibility tests, and morphological and seroagglutination characteristics.

The Mycobacterium avium complex, only rarely described as an invasive pathogen in humans, has recently been reported to frequently cause disseminated disease in patients with the acquired immune deficiency syndrome. Between February 1981 and February 1984 at Memorial Sloan-Kettering Cancer Center, 30 patients with acquired immune deficiency syndrome, 3 patients with leukemia, and 2 patients with congenital severe combined immunodeficiency syndrome developed disseminated M. avium complex infection. Mycobacteria were often found in multiple sites both antemortem and postmortem. Blood cultures were a reliable method for detecting disseminated infection, and the new lysis blood culture systems provided an efficient technique for determining the number of organisms per milliliter of blood. Acid-fast stains and cultures of fecal specimens were also helpful in diagnosing infection. Most of the mycobacteria were serovar 4 (77%), and most (86%) produced a deep yellow pigment. All isolates were susceptible to standard concentrations of clofazimine, cycloserine, and ansamycin, but tended to be resistant to isoniazid, streptomycin, ethambutol, ethionamide, and rifampin.

Niacin, nitrate and pyrazinamide studies using Middlebrook 7H10 Broth.

An innovative and rapid method for testing mycobacteria was developed using Middlebrook 7H10 Tween Broth in place of conventional media. Niacin production, nitrate reduction and the breakdown of pyrazinamidase were determined in 198 mycobacteria isolates. Less than nine days were required to obtain positive test results, and the correlation of tween broth with conventional test methods exceeded 98%.

Immunological evaluation of a component isolated from Mycobacterium bovis BCG with a monoclonal antibody to M. bovis BCG.

A component of Mycobacterium bovis BCG referred to as BCG-a was isolated through the combined use of monoclonal antibody directed to BCG and affinity chromatography. Analysis of BCG-a by sodium dodecyl sulfate-polyacrylamide gel electrophoresis revealed a single prominent band with a molecular weight of ca. 10,000. Structural characterization of BCG-a consisting of amino acid composition and amino-terminal sequence determination was carried out. The intact BCG-a antigen was bound by neither the lectin from common lentils nor concanavalin A, implying that BCG-a does not carry any asparagine-linked oligosaccharides. Immunoprecipitation of 125I-labeled BCG-a with polyclonal and monoclonal antibodies directed against BCG resulted in bands having the same mobility on sodium dodecyl sulfate-polyacrylamide gel electrophoresis as did free 125I-BCG-a. In radioimmunoassays 125I-BCG-a was bound by the monoclonal antibody and by polyclonal antibodies from rabbits that had been immunized to BCG and to Mycobacterium tuberculosis H37Rv. Antibodies to nontuberculous and to nonacid-fast bacteria bound BCG-a poorly or not at all. The binding of 125I-BCG-a by the monoclonal antibody was readily inhibited by extracts of BCG and H37Rv, but it was not as readily inhibited by extracts of nontuberculous mycobacteria and was not at all inhibited by extracts of nonacid-fast bacteria. Considerable inhibition was similarly observed by surface antigens of nonviable, intact BCG organisms. Delayed cutaneous hypersensitivity reactions to small concentrations of BCG-a were elicited in guinea pigs that had been immunized with BCG or H37Rv antigens, but such reactions were not elicited in unimmunized animals.

Evaluation of the BACTEC radiometric method for recovery of mycobacteria and drug susceptibility testing of Mycobacterium tuberculosis from acid-fast smear-positive specimens.

A total of 463 respiratory specimens, all smear positive for acid-fast bacteria, were inoculated onto routine solid media and into BACTEC 7H12 Middlebrook medium for detection of mycobacterial growth. Conventional drug susceptibility testing (1% proportion method) was performed on Middlebrook 7H10/7H11 medium, and radiometric susceptibility testing was performed on BACTEC 7H12 medium. The average detection times for BACTEC-positive cultures were 8.3 days for Mycobacterium tuberculosis and 5.2 days for mycobacteria other than tuberculosis; by conventional methods, they were 19.4 and 17.8 days, respectively. These detection times do not include time required for identification, which was done by the conventional method only. There was an excellent correlation in the recovery rates of mycobacteria by the two methods. Drug susceptibility test results of M. tuberculosis isolates by the two methods showed 95.1 to 100% overall agreement. The average reporting time for drug susceptibility results ranged from 4.2 to 6.9 days for the BACTEC method and 13.7 to 21 days for the conventional methods. An average of 18 days was required by the BACTEC method for complete recovery and drug susceptibility testing of M. tuberculosis, as compared with 38.5 days for the conventional methods.

Detection of mycobacteria by radiometric and standard plate procedures.

A group of 89 smear-positive sputum specimens were evaluated by radiometric and standard plate procedures to determine the methodology which would provide the earliest detection of mycobacteria and maximum test sensitivity. Digested non-decontaminated specimens were concentrated and inoculated into modified selective BACTEC radiometric 7H12 broth and Mitchison selective 7H10 agar. Sodium hydroxide (1.5% final concentration) was then used to decontaminate these specimens. They were then concentrated and inoculated into both selective and nonselective 7H12 radiometric broths and into selective 7H10 and nonselective Middlebrook 7H11 agar media. The specimen processing and media combinations providing the earliest detection were non-decontaminated specimens with modified selective 7H12 BACTEC broth and decontaminated specimens with 7H12 BACTEC broths. Maximum sensitivity (percent positive) was obtained by using non-decontaminated specimens on Mitchison selective 7H10 Agar (98%) or decontaminated specimens in 7H12 BACTEC broth (95%). The decontamination process was found to reduce significantly the number of mycobacteria in clinical specimens, particularly the mycobacteria other than Mycobacterium tuberculosis. The specimen processing-media combinations providing the earliest detection and maximum recovery of mycobacteria (100%) were non-decontaminated specimens with modified selective 7H12 BACTEC broth or Mitchison selective agar and decontaminated specimens with 7H12 BACTEC broth or 7H11 agar.

Urease testing of mycobacteria with BACTEC radiometric instrumentation.

A total of 140 mycobacterial isolates from patients treated at Fitzsimons Army Medical Center or the National Jewish Hospital and Research Center and from animal specimens submitted to the National Veterinary Services Laboratory were tested by using a urease procedure modified for use with a BACTEC model 301. Mycobacterial suspensions were prepared by using Middlebrook 7H10 Tween broth. Of the 98 mycobacteria isolates which were urease positive utilizing standard methodology, all were positive using the radiometric procedures. Similarly, all 42 urease-negative isolates were also negative employing the new methodology. Although maximum radiometric readings were observed at 48 h, all positive strains were readily identified 24 h after inoculation without sacrificing either test sensitivity or specificity. Thus, urease testing of mycobacteria, using the modified BACTEC radiometric methodology, was as sensitive, as specific, and more rapid than conventional methods.

Use of pyrazinamidase activity on Mycobacterium tuberculosis as a rapid method for determination of pyrazinamide susceptibility.

Pyrazinamidase activity in clinical isolates of Mycobacterium tuberculosis has been previously found to correlate with susceptibility to the antituberculosis drug pyrazinamide. The Wayne method for determining pyrazinamidase activity, a technique also utilized as an aid in identification of mycobacteria, and thin-layer chromatography method were found to be useful screening methods for susceptibility testing, since resistant strains are pyrazinamidase negative. These simple methods overcome the difficulty in growing M. tuberculosis at pH 5.5, as is required in the conventional method of susceptibility testing.

The seroagglutination test in the study of nontuberculous mycobacteria.

The Schaefer seroagglutination test is useful in epidemiologic studies of nontuberculous mycobacteria, especially the Mycobacterium avium-intracellulare-scrofulaceum complex. Serovars 8, 16, 4, 19, 9, 42, and 1 were isolated most frequently from patients in the United States in the period 1976 to mid-1978. Several so-called double serovars were found serologically. It appears that this is an artifact due to cross-reacting antigens, because only one antigen is seen using chromatographic analyses. Further development of this system and its use in conjunction with other methods offer a valuable method for the study of nontuberculous mycobacteria.

Immunotherapy of the guinea pig line 10 hepatocarcinoma with a variety of nonviable bacteria.

A variety of heat-killed bacteria were tested for their capacity to induce regressions of established line 10 hepatocarcinomas in syngeneic guinea pigs. Multiple intralesional injections of heat-killed Escherichia coli, Streptococcus mutans, Listeria monocytogenes, and Propionibacterium acnes resulted in complete regression of the tumor in a majority of guinea pigs. Repeated injections of heat-killed Mycobacterium bovis strain Bacillus Calmette-Guérin caused no regressions. Surviving animals were immune to subsequent challenge with line 10 cells but not L2C cells, another syngeneic tumor.

Identification of atypical mycobacteria by thin-layer chromatography of their surface antigens.

The knowledge that the surface (Schaefer) antigens of certain smooth-colony atypical mycobacteria are multiglycosylated C-mycosidic peptidoglycolipids was used to devise a sensitive thin-layer chromatographic (TLC) procedure for the identification of Mycobacterium avium/M. intracellulare/M. scrofulaceum serotypes. TLC maps of the type-specific peptidoglycolipids from 17 of the 31 serotypes are presented. The primary use of the technique is to corroborate results obtained by seroagglutination. Without the aid of seroagglutination, the TLC procedure almost invariably requires the availability of reference strains or the specific peptidoglycolipids derived therefrom.

Immunological method to differentiate between antigens of tubercle bacilli, other mycobacterial species, and non-acid-fast bacteria.

Sera from rabbits immunized with sonicates of Mycobacterium bovis BCG were passed through an immunoadsorbent made of a soluble BCG extract to make partially purified antibodies to BCG. These antibodies were in turn used to prepare an immunoadsorbent through which the BCG extract was passed. The partially purified antigenic material was radiolabeled and subjected to electrophoresis in acrylamide gels. One of the radiolabeled fractions isolated (BCG-C) was found to bind to antibodies to BCG and H37Rv, but not to antibodies in sera from rabbits immunized with other mycobacterial species or Nocardia asteroides. The reaction between BCG-C and the partially purified antibodies to BCG was inhibited by small amounts of different BCG antigens. Cultures obtained from 25 patients with tuberculous diseases, other bacterial cultures, and various bacterial extracts were tested for their capacity to inhibit this reaction. Each of 13 mycobacteria identified as M. tuberculosis inhibited this reaction. Equivalent numbers of 12 strains of mycobacteria other than M. tuberculosis and high concentrations of other bacterial extracts did not inhibit, indicating that determinants of BCG present in M. tuberculosis were not detected in the other mycobacteria or in non-acid-fast bacteria. The use of sequential purification procedures could be of potential clinical value in quickly differentiating between M. tuberculosis and a variety of other mycobacteria.

Suppression and immunotherapy of the guinea pig line-10 hepatocarcinoma mediated by nonviable Staphylococcus aureus.

Suppression of growth of the line-10 guinea pig hepatocarcinoma was achieved after the simultaneous injection of line-10 cells and heat-killed Staphylococcus aureus. Growth of tumor was also suppressed when line-10 cells were injected alone, contralaterally, at the same time as the vaccine mixture. Immunity developed to subsequent line-10 cell challenges but not to other syngeneic tumors. Similar results were obtained with the use of protein A-rich or -deficient strains of S. aureus. Multiple intratumor injections of heat-killed S. aureus were therapeutically effective against 6-day tumors. The antitumor effects of nonviable S. aureus were similar in many ways to those of living BCG or bacterial products suspended in oil droplets.

Antimycobacterial activity of some potential chemotherapeutic compounds.

Fourteen compounds were tested in vitro for activity against Mycobacterium intracellulare and other pathogenic mycobacteria. Only clofazimine and chaulmoogric acid showed significant activity against M. intracellulare. In view of known minimal side effects of clofazimine further studies are warranted for this drug in chemotherapy of M. intracellulare infections.

Precipitation of radiolabeled antigen-antibody complexes with protein A-containing Staphylococcus aureus.

The feasibility of using protein A-containing Staphylococcus aureus to measure antibodies in sera from several mammalian species was studied. A variety of unrelated radiolabeled antigens were tested, including components of bovine serum, DNA, and bacterial and tumor-associated extracts. The use of S. aureus was found to be a reliable way to detect and measure the primary interactions between many of the antigens and antibodies tested. Results were equivalent under many circumstances to those obtained with the ammonium sulfate and heterologous anti-immunoglobulin methoods. However, some of the limitations noted were that certain antigens bound directly to S. aureus and that all classes of human immunoglobulins tested, in particular IgG3 and IgA1, were not precipitated by S. aureus. If these limitations are taken into consideration, the use of S. aureus can be of value in studying immunochemical reactions with other antigens.

Cross-resistance in M. tuberculosis to kanamycin, capreomycin and viomycin.

Drug resistant mutants to streptomycin, kanamycin, viomycin, capreomycin, and rifampicin were isolated from four strains of Mycobacterium tuberculosis. The mutants isolated from each parent were then tested for evidence of development of cross-resistance to other drugs. There was no cross-resistance between either streptomycin or rifampicin and any of the other drugs. Complete cross-resistance between viomycin and capreomycin was found. Cross-resistance between kanamycin and capreomycin, and kanamycin and viomycin was variable. A review of the medical histories of 27 patients with kanamycin-resistant tubercle bacilli indicated that cross-resistance with capreomycin and viomycin occurs, but is unpredictable. Because of this variability in cross-resistance and the fact that kanamycin is a more toxic drug than capreomycin, it is suggested that capreomycin be used in the first retreatment regimen for tuberculosis when streptomycin resistance has been demonstrated.