Girish N. Vyas

Hemagglutination Assay for Antigen and Antibody Associated with Viral Hepatitis

Hemagglutination assays are described for measuring hepatitis-associated Australia antigen and antibody. Red cells coated with isolated antigen, with chromic chloride as a coupling agent, are used for detection of antibodies. Detection of the antigen in serums depends on inhibition of hemagglutination. The test has the sensitivity and rapidity of the best tests available, is simpler to perform, and lends itself to large-scale screening of blood donors.

Biology of hepatitis B virus

Immunochemical investigations of the viral antigens and molecular characterization of the viral DNA have elucidated the nature of the hepatitis B virus infection underlying acute, chronic, and oncogenic disorders of the liver in man. Cloning and sequencing of viral DNA have made possible studies on the structure of the genome and on certain aspects of the biology of the virus, hitherto constrained for a lack of tissue culture systems and laboratory animal models useful in its propagation.

EVALUATION OF SCREENED BLOOD DONATIONS FOR HUMAN IMMUNODEFICIENCY VIRUS TYPE 1 INFECTION BY CULTURE AND DNA AMPLIFICATION OF POOLED CELLS

BACKGROUND Reports of transmission of the human immunodeficiency virus type 1 (HIV-1) from transfusions of screened blood and reports of silent, antibody-negative HIV-1 infections in persons at high risk continue to foster concern about the safety of the blood supply. Previous estimates of the risk of HIV-1 range from 1 in 38,000 to 1 in 300,000 per unit of blood but are based on either epidemiologic models or the demonstration of seroconversion in recipients. METHODS We isolated peripheral-blood mononuclear cells from blood that was fully screened and found to be seronegative, combined them into pools of cells from 50 donors, and tested them for HIV-1 by viral culture and the polymerase chain reaction, using protocols specifically adapted for this analysis. RESULTS The 1530 pools of mononuclear cells were prepared from 76,500 blood donations made in San Francisco between November 1987 and December 1989. Of these pools, 1436 (representing 71,800 donations) were cultured successfully; 873 (43,650 donations) were evaluated by the polymerase chain reaction. Only one pool was confirmed as HIV-1--infected by both methods. After adjustment for sample-based estimates of the sensitivity of the detection systems using culture and the polymerase chain reaction, the probability that a screened donor will be positive for HIV-1 was estimated as 1 in 61,171 (95 percent upper confidence bound, 1 in 10,695). CONCLUSIONS Silent HIV-1 infections are exceedingly rare among screened blood donors, so the current risk of HIV-1 transmission from blood transfusions, even in high-prevalence metropolitan areas, is extremely low.

Adverse effects of plasma transfusion

Plasma utilization has increased over the past two decades, and there is a growing concern that many plasma transfusions are inappropriate. Plasma transfusion is not without risk, and certain complications are more likely with plasma than other blood components. Clinical and laboratory investigations of the patients suffering reactions after infusion of fresh‐frozen plasma (FFP) define the etiology and pathogenesis of the panoply of adverse effects. We review here the pathogenesis, diagnosis, and management of the risks associated with plasma transfusion. Risks commonly associated with FFP include: 1) transfusion‐related acute lung injury, 2) transfusion‐associated circulatory overload, and 3) allergic and/or anaphylactic reactions. Other less common risks include 1) transmission of infections, 2) febrile nonhemolytic transfusion reactions, 3) red blood cell alloimmunization, and 4) hemolytic transfusion reactions. The effects of pathogen inactivation or reduction methods on these risks are also discussed. Fortunately, a majority of the adverse effects are not lethal and are adequately treated in clinical practice.

Australia Antigen (Hepatitis B Antigen): A Conformational Antigen Dependent on Disulfide Bonds

Reduction and alkylation of purified hepatitis-associated Australia antigen (hepatitis B antigen) resulted in a total loss of serologic activity. The reduced and alkylated protein formed a single band with a sedimentation coefficient of 31S on analytical ultracentrifugation, and no subunits were detected by Sephadex gel filtration. Although this preparation induced a delayed hypersensitivity response when injected into guinea pigs, it failed to stimulate humoral antibody formation. The data suggest that hepatitis B antigen is a conformational antigen critically dependent upon the disulfide bonds of the protein moiety.

Molecular pathogenesis of hepatitis B virus infection: simultaneous detection of viral DNA and antigens in paraffin-embedded liver sections.

Hepatitis B virus (HBV) DNA and viral antigens were simultaneously identified by immunohistochemical staining of formalin-fixed, paraffin-embedded liver sections followed by in situ hybridisation. In the developed radioautographs, silver grains indicate the location of viral DNA in the cell and the immunohistochemical stain marks sites of accumulation of viral antigen. In liver from a patient with chronic active hepatitis serologically positive for hepatitis B surface antigen and e antigen (HBsAg/HBeAg) viral nucleotide sequences, representing actively replicating DNA species, were demonstrated predominantly in the cytoplasm. Viral core antigen (HBcAg) was expressed in the liver cell nuclei. HBcAg was not detectable in most hepatocytes with high levels of viral replication. Conversely, most liver cells in which HBcAg was found did not contain replicating HBV. HBcAg and replicating viral DNA species were not detectable in hepatocytes undergoing pathological changes, such as ground glass cells. Because no pathological changes could be identified either in hepatocytes with high levels of HBV replication or expression of nuclear HBcAg, the liver cell damage in this patient with chronic hepatitis B was presumably induced by other mechanisms. The simultaneous observation of viral DNA, antigens, and pathological changes at the single cell level and their correlation with clinical findings should contribute to the understanding of the molecular mechanisms underlying HBV-induced liver cell injury.

Asymmetric replication of hepatitis B virus DNA in human liver: Demonstration of cytoplasmic minus-strand DNA by blot analyses and in situ hybridization

In situ and blot hybridization techniques have been used with strand- and region-specific probes to characterize the forms of hepatitis B virus (HBV) DNA in the liver of a patient with chronic active hepatitis B. The hepatocytes contain a heterogeneous population of rapidly migrating DNA species in the 0.5-1.4 kb position that are localized predominantly in the cytoplasm and are of minus-strand polarity. The findings indicate that the replication is asymmetric, with separate pathways for plus- and minus-strand synthesis of HBV DNA; that viral DNA synthesis is initiated at a site near the nick in the minus strand of virion DNA; and that actively replicating forms of HBV DNA can be identified at the cellular level by in situ hybridization.

Polymerase chain reaction compared with concurrent viral cultures for rapid identification of human immunodeficiency virus infection among high-risk infants and children.

To determine the usefulness of DNA amplification by polymerase chain reaction for the early identification of human immunodeficiency virus type 1 (HIV-1) infection in infants and children, we compared the polymerase chain reaction and concurrent viral cultures of peripheral blood mononuclear cells from 25 high-risk subjects aged 5 weeks to 8 years. In two separate primer pairs, HIV-1 proviral DNA gag sequences were successfully identified in cell lysates from seven patients, including two infants with previously indeterminate HIV-1 status on the basis of serologic and culture results. In the remaining 18 patients the polymerase chain reaction was negative for HIV-1. Simultaneously grown HIV-1 cultures concurred with polymerase chain reaction results for all patients. In an 18-month-old infant who had had a single HIV-1 positive culture at 1 month of age with four subsequent negative cultures, both polymerase chain reaction and HIV-1 culture were negative. Our data demonstrate the clinical applicability of polymerase chain reaction on crude cell lysates for the rapid, early, definitive detection of HIV-1 infection in high-risk infants and children.

Reduction of human immunodeficiency virus- infected cells from donor blood by leukocyte filtration

Several filters for leukocyte removal were evaluated in terms of their ability to reduce the cell‐associated human immunodeficiency virus (HIV) load in units of blood either inoculated in vitro with lymphocytes from a chronically infected cell line or collected directly from seropositive donors. Filtration of the experimentally inoculated units of blood resulted in a 5.9 log10 mean reduction (95% confidence interval:7.4–4.5) of tissue culture infectious units (TCIU) as assayed by end‐point titration using the cocculture assay. Filtration of the units of blood from anti‐HIV positive donors lowered the infectivity by over 2 logs, as detected by the coculture and polymerase chain reaction (PCR) techniques. However, residual cell‐associated virus was detected in the majority of experiments. Clinical studies are warranted to determine if leukocyte filtration of blood will reduce the risk of transfusion transmitted viral infections.

Human antibodies to human IgA globulins

Abstract Human antibodies to IgA globulin have been demonstrated in human sera by a passive hemagglutination method using as antigens IgA myeloma proteins coupled to inert indicator red cells. The vast majority of sera containing such agglutinators occur in patients with little or no serum IgA and normal levels of IgG and/or IgM. Specificity of the antibodies was shown by inhibition of agglutination. The antibodies of different sera appear directed toward different antigenic sites in the alpha chains. Such sera may prove useful in demonstrating allotypic genetically determined antigens in IgA molecules analogous to the Gm factors of IgG molecules.