High frequency of non-B subtypes in newly diagnosed HIV-1 infections in Switzerland.

HIV-1 subtypes were determined in newly diagnosed residents of Switzerland. Blood was anonymously collected from patients with a first confirmed positive HIV-1 test result. Viral DNA from the env V3-V5 region was amplified by nested polymerase chain reaction (PCR) and screened for subtype B by heteroduplex mobility assay. All amplicons not identified as B were sequenced. From November 1996 to February 1998, 206 samples were analyzed. Main transmission risks were unprotected heterosexual (55.7%) or homosexual (27.1%) sexual contact or intravenous drug use (12.9%). Subtype B dominated in patients of Swiss, other European, American, or Asian citizenship; particularly high frequencies were found in homosexuals (97%) and drug users (94%). Non-B subtypes including A, C, D, E, F, G, H, a possible B/F recombinant, and a sequence related to J were present in 28.2% (95% confidence interval [CI], 22.9%-35.0%). Non-B were frequent in African citizens (95%), heterosexually infected individuals (44%), and women (43%). Heterosexually infected Swiss males harbored non-B strains in 18% and females in 33%. The results document a change in the epidemiology of newly diagnosed HIV-1 infections in Switzerland: predominance of heterosexual transmission and a high frequency of non-B subtypes.

Assessment of needs for plasma for fractionation in Europe.

In the early 1990s, a series of outbreaks of hepatitis C (HCV) infections clustering among recipients of certain lots of plasma-derived medicinal products (PDMP) alarmed regulatory authorities, manufacturers and the public alike. Also, a few episodes of Hepatitis A (HAV) infections occurred in haemophiliacs receiving solvent-detergent-treated factor VIII concentrates. Thus, several measures were brought into effect to reestablish the safety of the incriminated products and to further increase the margin of safety of PDMP in general. Therefore, intramuscular immunoglobulins had to be free of HCV RNA as shown by nucleic acid amplification technology (NAT) in the final products. Furthermore, the manufacturing process of PDMP had to be validated for both viral inactivation and elimination. Finally, HCV-NAT was to be standardised and implemented as a validated test of plasma pool samples. In 1994, a joint meeting of EPFA, EAPPI and Regulatory Authorities was held in Brussels to outline the state of the art and to delineate the actions to be taken. Five years later, in 1999, the incidence rates of HIV, HBV and HCV in unpaid blood donors have been minimized, especially in European countries. With probabilities for window period donations as low as 0.6 in 1 million for both HIV and HCV and 2.1 in 1 million for HBV in Switzerland, labile blood products have reached extreme, but not absolute safety. The introduction of HCV-NAT roughly doubles this safety resulting in a 1 in 3 million probability of a window donation.Concomittantly, extensive viral validation studies document effective inactivation and removal of viruses in PDMP. The demonstrated margins of safety, expressed as logarithmical reduction factors (LRF), range from 4 to over 20 log(10), depending on product, virus, and inactivation procedure used. Further progress to even safer PDMP shall be acomplished by consolidating the GMP processes, abandoning of obsolete requirements and harmonising national regulations within Europe. Before introducing new measures for additional agents such as HAV or Parvovirus B 19, gains and risks and even potential new threats have to be carefully assessed. Alternative efforts for the safeguard of patients, e.g. vaccination for HAV, need to be balanced against the risks of changing established and validated manufacturing procedures of PDMP with long-lasting safety records.

Prevention of hepatitis C infection in haemodialysis units. A prospective study.

A prospective study was begun in our haemodialysis unit after four previously negative patients were found to be anti-HCV positive. A dedicated area and dedicated dialysis equipment (but not a separate room) were assigned to anti-HCV-positive patients and testing for HCV antibodies was performed every 3 months. A total of 131 patients were treated during the study period of 18 months. Of these, 50 patients were dialysed during the entire 18 months, and 21 were available to be tested six or more months after having left the centre. During the first 6 weeks after implementing the precautions two more anti-HCV-positive patients were detected. However, during the rest of the study period no further newly infected patients were found. It is concluded that the spread of HCV infection in a haemodialysis environment can be prevented by limited isolation procedures.

[Seroprevalence of hepatitis C virus in hemophiliacs in Switzerland]. / Hepatitis-C-Virus-Serostatus der Hämophilen in der Schweiz.

The sera of patients with hemophilia and von Willebrand factor deficiency, collected during clinical trials with virus-inactivated coagulation factor preparations, were retrospectively screened for the presence of antibodies against hepatitis C virus (HCV). Using the anti-HCV c100-3 assay, 10 out of 35 study patients had no HCV antibodies when entering the studies. The samples originally negative for anti-HCV were retested with a second-generation assay: all negative samples except two were positive on retesting. We conclude that the HCV seroprevalence in Swiss hemophiliacs must be of the order of > 90%. These results confirm that the first-generation assay for HCV antibodies is not sensitive enough; to obtain more accurate information on the seroprevalence of hemophiliacs, second-generation tests should be used.

Human serum induced opsonization of immunoglobulin G-coated polystyrene microspheres with complement components C3 and C4 as measured by flow cytometry.

Human IgG-coated polystyrene microspheres (IgG-ms) were incubated with human serum followed by biotinylated monoclonal anti-C3d or anti-C4d antibody, and phycoerythrin-streptavidin. The intensity of fluorescence was measured by flow cytometry and corresponds to the amount of deposited C3 and C4. Binding of C3 and C4 was dependent on the activation of the classical pathway of complement and on the amount of IgG adsorbed to the particles. No deposition was observed on control particles coated with bovine serum albumin or ovalbumin. Incubation of constant amounts of IgG-ms with increasing amounts of normal human serum (NHS) resulted in a dose-dependent increase in C3 deposition. The same result was found for C4 deposition at moderate NHS dilutions, but less C4 was detectable using a higher input of NHS. Half-maximum C3 and C4 deposition was observed at a mean serum dilution of 1/114 and 1/520, respectively (n = 26). No correlation was found between C4 or C3 deposition and either total C4 and C3 serum concentrations as measured by nephelometry or complement-mediated lysis of antibody-coated sheep red blood cells. Reduced or absent C4 or C3 deposition was found in the sera of patients with low amounts or deficiencies of components involved early in classical complement pathway activation whereas essentially normal C4 or C3 deposition was obtained with the sera of patients with deficiencies in components of the membrane attack complex. With this simple and specific functional assay using stable reagents an altered function of early components of the classical pathway of complement may be quickly and reliably detected in routine diagnostic laboratories. Moreover, such opsonized and well characterized particles may be useful in assays of phagocytic cell function.

[No HCV seroconversion in hemophilia following substitution with virus-inactivated coagulation factor VIII and IX concentrates]. / Keine HCV-Serokonversion bei Hämophilen nach Substitution mit Viren-inaktivierten Gerinnungsfaktor VIII- und IX-Konzentraten.

Since 1986 the factor VIII and IX concentrates of the Central Laboratory, Swiss Red Cross Blood Transfusion Service have been virus inactivated with tri-(n-butyl) phosphate and Tween 80. Clinical studies had shown that both preparations were well tolerated and hemostatically effective; no HIV infection was transmitted. However, safety from transmission of non-A/non-B hepatitis could not be shown since the study included no previously untreated patients. In the meantime, a laboratory test has become available which allows retrospective testing for anti-hepatitis C antibodies in frozen sera of the study patients. 5 of the 26 patients, observed during a 2-year follow-up study, had no HCV antibodies before entering the long-term trial. During this trial, each of these 5 patients substituted an average quantity of 40,200 coagulation factor units (7500-69,000) from 45 production lots. None of these 5 patients developed anti-HCV antibodies, nor did any of them show clinical signs of infection with hepatitis. This suggests that virus inactivation using solvent/detergent treatment reduces the risk of transmission of HCV.

Laboratory workshop on the characterization of anti-platelet antibodies in immune thrombocytopenic purpura.

The aim of this laboratory workshop was to evaluate the state of knowledge concerning the demonstration of membrane glycoprotein specific anti-platelet antibodies. The main interest lay in investigating whether specific antibody detection offers possibilities to distinguish the chronic from the acute form of ITP. In five laboratories four different methods were applied to demonstrate such antibodies. These methods are briefly described and compared. In all, except two, of the 45 ITP samples anti-platelet antibodies could be detected by at least one participating laboratory, in 85% of the samples antibodies were found by two or more laboratories. For seven out of eight control samples no positive results were reported. The comparison of glycoprotein specific anti-platelet antibodies shows partly considerable differences which may be due to the different methods as well as the different antibodies used (monoclonal antibody against membrane glycoprotein and antihuman globulin sera). This laboratory workshop leads to the conclusion that by exchange of reagents and patient samples the different methods may be compared and evaluated. The results obtained allowed no further characterization of ITP. All participants agreed on the usefulness of further similar laboratory workshops.

Immunoglobulin G subclass distribution in three human intravenous immunoglobulin preparations.

In immunodeficiency patients the lack of immunoglobulins (Ig) can be total or partial with a specific IgG subclass imbalance masked by normal values for total IgG. In the latter case therapy with intravenous IgG preparations (IVIG) is generally beneficial, provided the IVIG preparations used originate from large pools of normal blood donors and exhibit a normal IgG subclass distribution. We have analyzed the subclass distribution of three IVIG products: Sandoglobulin (SAGL), GamimuneN (GI), Gammagard (GG), 6-10 lots each, in four different laboratories. The competitive enzyme immunoassays and radial immunodiffusion methods used different monoclonal and polyclonal antibodies specific for IgG1, IgG2, IgG3, and IgG4, respectively. Despite minor interlaboratory differences, the results show that the slightly lower IgG1 content of SAGL versus GI and GG was quantitatively compensated by a higher proportion of IgG2, that no differences existed in IgG3 levels, but that one preparation (SAGL) contained 2-3% of IgG4 compared to 0.5-1.5% in GI and below 0.5% in GG. This difference was significant, the two latter preparations being at or below the lower limit of what are considered to be normal values found in human adults. Such differences may have important clinical consequences.

Antibody determination in an ongoing hepatitis B vaccination program.

In an interim analysis of our ongoing immunization program against hepatitis B (HB), started in early 1982, we tested 283 serum samples from 77 female and 110 male vaccinees for antibody to HB surface antigen (anti-HBs). We compared two methods, Anti-HBs EIA (ROCHE) (method 1), which is a neutralization test, and AUSABR EIA (method 2), which is a double-antigen-sandwich test. The nonresponder rate (after the 12-month booster dose of Hevac B Pasteur) was 4% in females with both methods, in males 15% measured with method 1 and 11% measured with method 2. Five healthy HBsAg carriers were detected only by method 1. When the samples were grouped according to their anti-HBs titers, method 1 measured higher in samples taken after three vaccine doses and method 2 did so in samples collected after the 12-month booster dose. This tendency was confirmed with samples from slow responders who received a 4th vaccine dose soon after the initial three doses. We therefore confirm the efficacy of the plasma-derived HBsAg vaccine and validate the assay systems used to measure anti-HBs, one parameter of immunity to HB virus infection.

Human blood monocytes and platelets share a cell surface component.

We describe a surface determinant shared by human monocytes and cells of the megakaryocytic axis that has been identified using a mouse monoclonal antibody. This monocyte-platelet antigen (MPA) is expressed on all (greater than 99%) of peripheral blood monocytes, platelets, and megakaryocytes. It is also expressed weakly on the monocytic cell line U937 and the promyelocytic line HL60 and is present on cells from 3 of 4 AML patients examined. It is absent from polymorphonuclear leukocytes, T and B lymphocytes, erythrocytes, and a panel of hematopoietic cell lines. MPA is stripped from monocyte membranes with pronase and is reexpressed overnight. The determinant is carried on a noncovalently linked biomolecular complex with molecular weights of 93,000 and 135,000.

Cell-mediated cytotoxicity against rat fibroblasts induced by Actinomyces viscosus.

Cell-mediated cytotoxicity against syngeneic fetal rat fibroblasts that require in vitro exposure of effector cells to Actinomyces viscosus Ny1 fractions was investigated by measuring the uptake of radioactivity by fibroblasts during a 2-h pulse with [14C]aminoisobutyric acid after 1 to 3 days of coculture with splenic effector cells. By using splenocytes from inbred RIC-Sprague-Dawley rats as effector cells and syngeneic embryonic rat fibroblasts as target cells, strong cell-mediated cytotoxicity dependent on the in vitro exposure to an A. viscosus Ny1 fraction was observed, but only within a small range of effector-to-target cell ratios (3:1 to 10:1). Concanavalin A and lipopolysaccharide from Escherichia coli induced a comparable cytotoxicity, indicating that the effect might be connected with the mitogenic activity of the A. viscosus NY1 fraction. Splenocytes from rats immunized with A. viscosus Ny1 and from control rats induced similar levels of cytotoxicity in 72-h cytotoxicity assays. In shorter assays (24 h), however, splenocytes from immune animals induced low cytotoxicity, which was, however, significantly higher than that induced by splenocytes from control animals. We conclude that both antigen- and mitogen-dependent cell mediated effector mechanisms are operative in this system and that the two normally overlapping effects can be experimentally separated. This new system describes a fibroblast impairment in the presence of splenocytes and bacterial components and may provide a useful model for studying pathogenic mechanisms operative in periodontal disease.

Radiographic measurements of alveolar bone loss in the rat.

A new method to evaluate alveolar bone loss in rodents is described. The palatal and lingual halves of maxillae and mandibles were radiographed. On enlarged positive prints, 5 vertical distances were drawn at defined sites from the cemento-enamel junction to points revealing fully intact bone structure. These were either located on the alveolar crest or at the depth of intrabony defects. These distances were recorded with a trace-reading pen coupled to a computer. Results were expressed in mm for each site separately and totals (left plus right values) for either maxillae or mandibles were calculated. This technique was compared to other methods for evaluating alveolar bone loss, using the jaws of rats subjected to a gnotobiotic regime in which the degree of bone loss was low. It was demonstrated that the measurement of vertical distances based on radiography by which also intrabony defects were defined was accurate, reproducible and more sensitive than other means of evaluating bone loss.

Alveolar bone loss in rats after immunization with Actinomyces viscosus.

We investigated a possible cause-and-effect relationship between sensitization against Actinomyces viscosus Nyl and destructive periodontal disease in RIC-Sprague-Dawley rats. Germfree rats (66) were either immunized with A. viscosus Nyl (day 20) or orally infected with A. viscosus Nyl (days 38 and 39) or both. We measured alveolar bone loss in maxillary and mandibular molars, in vitro T-lymphocyte responsiveness, and serum antibody titers. In immunized and monoassociated rats bone loss in both jaws progressed rapidly between days 37 and 72, whereas the rate of further resorption decreased until day 100. In monoassociated rats, development of bone loss was much slower, and the maximum resorption measured was, at best, half of the bone loss compared with the former group. However, no amplification of bone loss by immunization was observed in a second experiment using 63 conventional rats kept in relative gnotobiosis. Antibody titers to A. viscosus Nyl in gnotobiotic monoassociated rats were higher in immunized animals, whereas no difference was found in the respective groups of the relative gnotobiotic experiment. The fact that immunization more than doubled alveolar bone loss in gnotobiotic monoassociated rats confirms the allergic nature of the disease. The lack of such an effect under conventional conditions points to suppressor mechanisms whose decrease might convert stable periodontal lesions into progressive ones.

Cyclosporin A: in vivo and in vitro suppression of rat T-lymphocyte function.

The immunosuppressive effect of cyclosporin A (CS-A) was investigated in RIC-Sprague-Dawley rats. In vivo, CS-A totally abolished the formation of antibodies to the hapten dinitrophenyl (DNP) in rats immunized with DNP-keyhole limpet haemocyanin. In vitro, the effect of CS-A was investigated in spleen cell cultures stimulated by concanavalin A, phytohaemagglutinin or lipopolysaccharide. The suppression due to CS-A was more pronounced in cultures set up with cells from rats fed the drug than in spleen cell cultures from control animals supplemented with serum containing CS-A. Purified by filtration through Degalan-rat Ig-anti IgG columns, T lymphocytes from CS-A treated rats were no longer suppressed by CS-A serum in contrast to purified T cells obtained from control rats. Thus, CS-A seems to interfere with the mitogenic triggering of a subpopulation of T lymphocytes resulting in a functional clonal deletion.