Leslie Ann Mitchell

A NEW CATEGORIZATION OF HLA DR ALLELES ON A FUNCTIONAL BASIS

In this analysis, we introduce a new categorization of HLA DR alleles which are important members of HLA class II genes encoding cell surface glycoproteins that function to present antigenic peptides to T cells. We have grouped all HLA DR molecules into seven different functional categories on the basis of their ability to bind and present antigenic peptides to T cells and their association with susceptibility or resistance to disease. This novel categorization of DR alleles on the basis of function allows for the prediction of seven similar subregion structures (supertypes or supermotifs) within pocket 4 of HLA DR peptide binding groove as the molecular basis for grouping these alleles. The physicochemical characteristics of HLA DR supertype residues, charge in particular, may influence the selectivity for binding peptide, dominate promiscuous T-cell recognition of antigenic peptides, and affect HLA DR disease associations. To rationalize the functional categories of DR alleles, we have further combined the seven DR supertype patterns into three groups based on the charges of residues within the supertypes. Grouping HLA DR alleles into functional categories may assist in understanding the mechanistic basis of autoimmunity, resolving current paradoxes in HLA disease associations, and developing new immunotherapy strategies.

Randomised double-blind placebo-controlled study on adverse effects of rubella immunisation in seronegative women

BACKGROUND The objective of our study was to investigate the association of adverse clinical musculoskeletal and neurological events in healthy postpartum women with live attenuated (RA27/3 strain) rubella-virus vaccine, and to assess the frequency of acute and recurrent arthralgia and arthritis and associations with acute and recurrent muscle pain (myalgia) and neurological manifestations (paraesthesias). METHODS We used a randomised placebo-controlled, double-blind design in a community setting. 636 women were enrolled and, after 90 women dropped out, 546 healthy women aged 18-41 years, who were rubella seronegative on routine screening were immunised parenterally with either monovalent live attenuated (RA27/3 strain) rubella vaccine (n = 270) or saline placebo (n = 276) in the postpartum period. Outcome measures were the occurrence of acute and persistent or recurrent joint manifestations (arthralgia or arthritis) at 1, 3, 6, 9, and 12 months after immunisation. Occurrence of muscle pain (myalgia), and neurological symptoms (paraesthesia) was also assessed at the same times. FINDINGS 543 women completed 1-month follow-up. 456 women completed the 12-month assessment. There were no differences at the time of immunisation between rubella vaccine and placebo groups in distribution of age, ethnic origin, parity, time between delivery and immunisation, breastfeeding history, or histories of earlier rubella vaccination or joint complaints. Results indicated a significantly higher incidence (p = 0.006; odds ratio = 1.73 [95% CI = 1.17-2.57]) of acute joint manifestations in rubella-vaccine recipients (30%) than in placebo recipients (20%). Frequency of chronic (recurrent) arthralgia or arthritis was only marginally significant (p = 0.042; 1.58 [1.01-2.45]). INTERPRETATION RA27/3 rubella vaccine given to seronegative women during the postpartum period was significantly associated with development of acute arthralgia or arthritis. Although the numbers of women assessed and length of follow-up revealed only marginally significant differences in persistent or recurrent joint manifestations between rubella vaccine and placebo recipients, it is possible that susceptible women who are given rubella vaccination may experience this outcome.

HLA-DR Class II Associations with Rubella Vaccine-Induced Joint Manifestations

HLA class II (HLA-DR) frequencies were examined in relation to incidence of acute arthralgia or arthritis in 283 white women who had received RA27/3 rubella vaccine (n = 146) or placebo (n = 137) postpartum. Leukocyte DNA was molecularly typed for HLA-DRB1 gene expression. Univariate analysis revealed higher frequencies of DR2 (odds ratio [OR], 4.8; 95% confidence interval [CI], 1.2-18.8) and DR5 (OR, 7.5; 95% CI, 1.5-37.5) but lower frequencies of DR4 (OR, 2.3; 95% CI, 1.1-4.9) and DR6 (OR, 2.8; 95% CI, 1.4-5.8), in rubella vaccinees compared with placebo recipients with arthropathy. Logistic regression modelling of DR, treatment, age, time postpartum, and arthropathy revealed that the odds of developing arthropathy was 1.9 times greater (95% CI, 1.07-3.44) after rubella vaccine than placebo. Risk for arthropathy (regardless of rubella vaccination) was also influenced by DR interactions: odds were 8 times greater in individuals with both DR1 and DR4 (95% CI, 1.45-44.02) and 7.1 times greater with both DR4 and DR6 present (95% CI, 1.85-27.52), suggesting that coexpression of these specificities may predispose to postpartum arthropathy.

Lymphocyte recognition of human parvovirus B19 non-structural (NS1) protein: associations with occurrence of acute and chronic arthropathy?

Immune recognition of recombinant parvovirus B19 non-structural (rNS1) protein was studied by immunoblot and lymphoproliferative assays in blood from the following B19 seropositive groups: B19 infected (n = 14), B19 exposed but non-infected (n = 16), other illness with rash (n = 3), chronic arthropathy of unknown aetiology (n = 4) and healthy controls (n = 7). Sera from 11 B19 seronegative subjects were also studied. Sera collected at initial diagnosis or at the time of accidental B19 exposure in pregnancy were tested for NS1 antibody and evidence of B19 DNA by nested PCR. Follow-up specimens were obtained 3-12 months later for serological, PCR and proliferation studies. B19 DNA was detected sporadically in early specimens and in one follow-up specimen from a subject who developed chronic arthropathy after B19 infection. There was no correlation with development of arthropathy. NS1-specific IgG was detected in early sera from B19-infected and exposed subjects but to a lesser degree in follow-up specimens, and in only one healthy control serum. No correlation with the presence of NS1-specific antibodies was found with development of acute or chronic arthropathy. Although lymphocyte proliferation in response to stimulation with rNS1 in vitro occurred at a higher frequency in patients who developed acute and chronic joint manifestations after B19 infection, suggesting an association with this outcome, NS1-reactive lymphocytes were also found in three B19 seronegative patients, two of whom had recently been exposed to B19 but had no illness. Hence, immune recognition of NS1 may be more indicative of recent infection with, or exposure to, parvovirus B19 than associated with development of arthropathy as previously reported.

Identification of rubella virus T-cell epitopes recognized in anamnestic response to RA27/3 vaccine: associations with boost in neutralizing antibody titer.

Rubella virus (RV)-specific cell-mediated immunity (CMI) and antibodies were measured in healthy adolescents reimmunized with measles-mumps-rubella (MMR) vaccine. Lymphocyte proliferation to RV synthetic peptides was determined before and at 2, 4 and 10 weeks after, MMR. After MMR, increased CMI was observed with 16 peptides, including six containing antibody neutralization (NT) domains. Positive CMI (stimulation index > or =2.0) to E1(254-285) and C(1-29) before vaccination was significantly associated with a boost in NT titers, while positive CMI at weeks 2 or 4 to E1(254-285), E1(301-314), E1(389-408), E1(462-481), E2(134-150), E2(140-156), E2(168-179), C(1-29) and C(88-111) showed the same association.

Identification of immunoreactive regions of rubella virus E1 and E2 envelope proteins by using synthetic peptides

Relatively large (16-33 aa) synthetic peptides (SPs) representing defined sequences of rubella virus (RV) E1 and E2 envelope proteins were used in lymphocyte stimulation and enzyme immunoassays to map immunoreactive regions recognized by peripheral blood mononuclear cells (PBMNC) and serum antibodies from healthy RV-seropositive, RV-seronegative, and RV-vaccinated adults. Five distinct immunoreactive regions were identified in RV E1 protein, spanning residues (11-39), (154-179), (199-239), (226-277), and (389-412), which stimulated cellular responses in 29-83% of the subjects tested. Two SPs, E1(213-239) and E1(258-277) containing previously-identified virus neutralizing antibody domains, reacted with serum antibodies and also stimulated lymphoproliferation suggesting that these E1 sequences contain linked or overlapping B-and T-cell antigenic sites. The frequency and magnitude of cellular responses to E2 SPs were somewhat lower. SPs encompassing E2 residues (50-72), (140-199), and (244-263) stimulated lymphocyte responses in 28-64% of the subjects tested, while to a lesser degree, SPs within residues (1-36) were also stimulatory. E2 SPs within the regions (1-36), (151-170), and (244-263) also showed low levels of antibody reactivity with sera from RV-seropositive subjects. E2(244-263) which induced the highest level of response among the E2 SPs tested, was of interest due to previous reports of sequence homology of this RV region with human myelin and its potential immunopathogenic role in demyelinating autoimmune diseases. Identification of these potentially immunodominant regions of RV envelope proteins is an important first step in the rational design of new RV vaccines.

Reduction of rubella ELISA background using heat denatured sample buffer

During the analysis of rubella-specific antibodies in sera from adult vaccinees, it was observed that the inclusion of heat-denatured blocking proteins in the sample dilution buffer substantially reduced non-specific binding of serum IgG to microtitre plates. Results suggest that this modification to standard ELISA technique may reduce the incidence of false positive results in these assays.

Analysis of overlapping T- and B-Cell antigenic sites on rubella virus E1 envelope protein influence of HLA-DR4 polymorphism on T-cell clonal recognition

Abstract A CTL antigenic site located between residues 273 and 291 of the E1 envelope protein of RV was identified by 51Cr-release assays employing SPs. Two E1-specific CTL clones were examined for immune recognition of RV wild-type and attenuated vaccine strains and recombinant E1 protein. The exact sequence (273–284) recognized by both clones was delineated by using truncated and overlapping SPs covering these residues. The defined T-cell site overlapped almost completely with a virus neutralizing antibody-binding site previously identified with mouse monoclonal and human antibodies. A series of single aa-substituted SP analogues of E1(273–284) was used to define residues critical for T-cell recognition. Using EBV-Bl displaying different HLA-DR haplotypes and -DR4 subtypes as targets to determine MHC class II restriction elements, immune recognition by both T-cell clones was shown to be associated with HLA-DR4. Three HLA-DR4 subtypes (DR4Dw 13A, DR4Dw13B, and DR4KT2) sharing a common residue, glutamic acid at position 74 in their β 1 chains, were able to present SP E1(273–284) to the T-cell clones.

Sequential follow up observations of a patient with rubella associated persistent arthritis.

In 1985 a patient was described whose persistent polyarthritis was found to be aetiologically linked to rubella virus infection through the detection of repeated maximal synovial lymphocyte proliferative responses to rubella virus antigen and by isolation of rubella virus from her synovium. Follow up over the succeeding seven years has shown continuing chronic polyarthritis and persistent synovial lymphocyte responses to rubella virus antigen with the additional observation that she has a defective humoral immune response against rubella virus.

Rectal immunization of mice with hepatitis A vaccine induces stronger systemic and local immune responses than parenteral immunization.

Systemic (spleen cell (SPLC), serum antibodies) and intestinal mucosal (Peyers patch cells (PPC), lamina propria lymphocytes (LPLs), coproantibodies) immune responses were compared in mice immunized with varying doses (144, 72, 36, 18 ELISA units [EU]) of HAVRIX, an alum-adsorbed killed hepatitis A virus (HAV) vaccine, delivered either intrarectally (i.r.) or intraperitoneally (i.p.) in three doses at weekly intervals. HAV-specific IgG, IgM, and IgA antibody responses were evaluated by ELISPOT and EIA and HAV-responsive lymphocytes by lymphocyte stimulation assays. Systemic IgG responses were greater in mice immunized intraperitoneally with 144, 72, and 36EU of HAVRIX, while IgM and IgA responses were greater in PPC and LPL cell populations, serum and coproantibodies of rectally immunized mice, particularly at HAVRIX doses of 36 and 18EU. Rectal immunization at lower doses (36, 18EU) also elicited strong cellular responses in all cell populations while parenteral (i.p.) vaccination, did not. Results suggest that rectal immunization may be a highly effective way of inducing both local and systemic immunity to HAV.