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BACKGROUND. Intravenous Ig (IVIg), plasma exchange, and immunoadsorption are frequently used in the management of severe autoimmune diseases mediated by pathogenic IgG autoantibodies. These approaches modulating IgG levels can, however, be associated with some severe adverse reactions and a substantial burden to patients. Targeting the neonatal Fc receptor (FcRn) presents an innovative and potentially more effective, safer, and more convenient alternative for clearing pathogenic IgGs. METHODS. A randomized, double-blind, placebo-controlled first-in-human study was conducted in 62 healthy volunteers to explore single and multiple ascending intravenous doses of the FcRn antagonist efgartigimod. The study objectives were to assess safety, tolerability, pharmacokinetics, pharmacodynamics, and immunogenicity. The findings of this study were compared with the pharmacodynamics profile elicited by efgartigimod in cynomolgus monkeys. RESULTS. Efgartigimod treatment resulted in a rapid and specific clearance of serum IgG levels in both cynomolgus monkeys and healthy volunteers. In humans, single administration of efgartigimod reduced IgG levels up to 50%, while multiple dosing further lowered IgGs on average by 75% of baseline levels. Approximately 8 weeks following the last administration, IgG levels returned to baseline. Efgartigimod did not alter the homeostasis of albumin or Igs other than IgG, and no serious adverse events related to efgartigimod infusion were observed. CONCLUSION. Antagonizing FcRn using efgartigimod is safe and results in a specific, profound, and sustained reduction of serum IgG levels. These results warrant further evaluation of this therapeutic approach in IgG-driven autoimmune diseases. TRIAL REGISTRATION. Clinicaltrials.gov {"type":"clinical-trial","attrs":{"text":"NCT03457649","term_id":"NCT03457649"}}NCT03457649. FUNDING. argenx BVBA.

Intestinal infections with the protozoan parasite Cryptosporidium parvum are prevalent in both immunocompetent and immunocompromised hosts. Although C parvum is an important cause of outbreaks and opportunistic infections worldwide, little is known about protective mucosal immune responses. This is in part because animal models of infection are limited to those with genetic or induced immunodeficiencies.In this report, we isolated immune (primed) or nonimmune (unprimed) intraepithelial lymphocytes (IEL) from BALB/cJ mouse intestines, adoptively transferred them into C parvum-infected severe combined immunodeficient (SCID) mice, and evaluated infection and cell phenotype responses.Control SCID mice that received no IEL shed large numbers of oocysts throughout the experimental period (day 18 to day 72). Transfer of primed IEL significantly reduced fecal oocyst shedding in recipient SCID mice compared with SCID mice that received unprimed IEL or no IEL. SCID mice transferred with unprimed IEL shed variable numbers of fecal oocysts that increased and decreased in bursts until day 57 after infection. SCID mice transferred with primed IEL exhibited significantly higher proportions of T-cell receptor (TCR) alphabeta+, CD8+, and CD8alphabeta+ EL compared with inoculated SCID mice that received unprimed or no IEL.We conclude that primed IEL from immunocompetent mice may influence protective mucosal response against cryptosporidiosis when transferred into SCID mice. In addition, the increased percentage of TCR alphabeta+, CD8+, CD8alphabeta+ IEL in recipient SCID mice may reflect mucosal cell populations involved in these responses during chronic C parvum infection.

The lack of immunocompetent laboratory animal models has limited our understanding of functional immune responses to Cryptosporidium parvum infection, but such responses have been studied in susceptible laboratory rodents with genetic, acquired, or induced immunodeficiencies. We previously observed that athymic C57BL/6J nude mice inoculated with C. parvum oocysts had lower or absent fecal oocyst excretion when compared to inoculated athymic BALB/cJ nude mice. This discrepancy prompted us to explore potential differences in intestinal immune responses in both strains. Prior to and after C. parvum challenge, BALB/cJ nude and C57BL/6J nude mice did not differ in either spleen cell numbers or in parasite-specific proliferation. However, both strains of mice exhibited a significant increase in intra-epithelial lymphocyte (IEL) numbers prior to and following C. parvum inoculation when compared to uninoculated controls (P0.05). Prior to challenge, C57BL/6J nude mice had a higher percentage of both CD8+ and CD8+ gammadelta+ IEL than BALB/cJ nude mice. Following challenge, resistant C57BL/6J nude mice had a higher percentage of gammadelta+, CD4+, and CD8+ gammadelta+ IEL than uninoculated C57BL/6J nude mice and than susceptible BALB/cJ nude mice (P0.05). Conversely, inoculated C57BL/6J nude mice had a significantly lower percentage of alphabeta+ IEL than inoculated BALB/cJ nude mice (P0.05). We conclude that gammadelta+, CD4+, and/or CD8+ gammadelta+ IEL may influence responses to cryptosporidiosis in athymic murine models, and that the increased percentage of alphabeta+ IEL in susceptible BALB/cJ nude mice could reflect a preferential expression during chronic C. parvum infection and/or might downregulate local protective responses.

Encephalitozoon intestinalis (Septata intestinalis) is the second most prevalent microsporidian species infecting humans, but it has not been described in other animal species. This investigation examined 10 domestic animal stool samples (8 mammalian, 2 avian) containing spores detected by anti-Encephalitozoon monoclonal antibody immunofluorescence (FA). The presence of E. intestinalis but not Encephalitozoon hellem or Encephalitozoon cuniculi was confirmed in 6 of 8 mammalian stool samples by species-specific FA and polymerase chain reaction. Clusters of spores inside epithelial cells were observed in feces of five mammals (donkey, dog, pig, cow, and goat) using "quick-hot" Gram-chromotrope stain. None of the 10 samples reacted with anti-E. hellem or anti-E. cuniculi sera, nor were they amplified with species-specific primers for E. hellem and E. cuniculi. To our knowledge, this is the first identification of E. intestinalis in animals other than humans. The data shown herein suggest the possibility that E. intestinalis infection may be zoonotic in origin.

The term microsporidia is used to describe several species of opportunistic protozoan parasites. Encephalitozoon intestinalis and Enterocytozoon bieneusi have been found in stools of more than 40% of AIDS patients with diarrhea. Diagnosis of infection with these small protozoans has been difficult, and until recently their occurrence has not been well documented. Formalin is widely used to preserve clinical specimens, but due to the nature of the fixation process, subsequent analysis, especially analysis by the PCR, is difficult. This study evaluated methods used to prepare formalin-fixed fecal specimens for PCR amplification of microsporidial DNA. Two methods were devised to allow PCR detection and subsequent identification of microsporidia in formalin-fixed fecal specimens to the species level. One method involved immunomagnetic separation to concentrate microsporidial spores from fecal specimens. In the second method Chelex resin (Bio-Rad, Hercules, Calif.) was used to remove inhibitory substances, followed by a DNA concentration step. Both methods resulted in reproducible, confirmed detection of microsporidia in formalinized fecal specimens and subsequent species determination by PCR sequencing. The detection sensitivity was two in vitro culture-derived spores ( Encephalitozoon intestinalis ) for the direct PCR. The reproducible detection sensitivity for DNA amplification from formalin-fixed fecal samples was 200 spores for either the Chelex method or the immunomagnetic bead separation method. Thus, we developed two methods for rapid, inexpensive detection of microsporidial spores in formalin-fixed fecal specimens.

Using an indirect immunofluorescence assay on stool samples, we found a 6.4% prevalence of cryptosporidiosis among 403 children less than five years of age with acute diarrhea in Mexico City over a one-year period. The prevalence was highest (11.4%) during the rainy summer months. Most Cryptosporidium parvum cases occurred in infants less than one year of age. Cryptosporidium parvum was more common in malnourished children (P < 0.05) and in nonbreast-fed infants less than six months of age (P < 0.01). Neither dwelling characteristics nor the presence of domestic animals at home were associated with C. parvum infection. Enteropathogenic bacteria were found in 26.8% of the children; Escherichia coli, Salmonella, and Shigella being the most frequently identified. None of 100 serum samples tested showed antibodies against human immunodeficiency virus. When compared with immunofluorescence, the acid-fast technique showed a sensitivity of 76.9% and a specificity of 98.9%, with a predictive positive value of 83.3%. It was concluded that 1) monoclonal antibody-based immunofluorescence is a better diagnostic tool than the acid-fast technique, 2) the prevalence of cryptosporidiosis in this population was similar to that of other developing countries, 3) clinical manifestations were nonspecific, and 4) C. parvum was more common in malnourished children and in nonbreast-fed infants.

We have developed an enzyme-linked immunosorbent assay (ELISA) for detection of whitefly antigen in the guts of predaceous arthropods based on a monoclonal antibody (MAb) produced in response to Bemisia tabaci (Gennadius) (Homoptera: Aleyrodidae) egg antigen. We observed positive antigen-antibody reactions with the egg and the adult female stages of certain whitefly species and not with others. This MAb did not cross-react with any of the whitefly nymphs or adult males we tested. Moreover, this MAb did not cross-react with the various life stages of other insect species we examined. This immunologically-based technique to identify whitefly egg facilitates examinations of predator gut contents in the field. Such a specific and sensitive whitefly egg immunoassay will expedite the characterization of the B. tabaci predator complex in the southwestern United States.

Whole-body macerates of field-collected insects were examined to identify qualitatively hemipteran predators of Lygus hesperus Knight eggs and adult females using an enzyme-linked immunosorbent assay (ELISA). A L. hesperus species- and egg-specific monoclonal antibody (MAB) was used to detect the presence of L. hesperus egg antigen in these predators. The majority of the polyphagous predators assayed did not have L. hesperus egg antigen in their systems, indicating that they had not preyed on L. hesperus eggs or adult (gravid) females. Additionally, we tested the sensitivity of this MAB and the ELISA assay to L. hesperus eggs of variable ages in the laboratory. Younger eggs were more responsive to the MAB than older eggs.

This study examines the feasibility of marking Lygus hesperus Knight adults externally by submersion in rabbit immunoglobulin G(IgG) solution. Rabbit IgG retention time was measured in the laboratory on insects submerged in an IgG solution. We marked insects with rabbit IgG and ran an enzyme-linked immunosorbent assay (ELISA) with its complementary antibody (antirabbit IgG). We concurrently ran an ELISA assay using the same samples against an egg-specific L. hesperus monoclonal antibody (MAb)to measure the presence of L. hesperus egg antigen in the insect. A previously developed egg-specific MAb to L. hesperus enabled us to assay simultaneously adult females (which possess the egg antigen) and adult males for the presence of L. hesperus egg antigen. This combination of techniques will enable us to examine the gut contents of potential predators of L. hesperus eggs or adult females using whole body macerates while simultaneously evaluating the efficiency of lab-reared predators for augmentative biological control.

Development of murine monoclonal antibodies to weakly immunogenic antigens was accomplished by combining both in vivo and in vitro immunizations. Following immunization of mice with Treponema hyodysenteriae outer membrane antigens, Manduca sexta apolipoproteins, and Drosophila melanogaster DNA polymerase, respectively, a significant increase in percentage of antibody-producing hybrids were identified when immune spleens were subjected to an in vitro immunization prior to fusion with SP2/0 myeloma cells. The hybrids developed, produced Abs to a T. hyodysenteriae 14 Kd carbohydrate, M. sexta apolipoproteins I, II, and III, and D. melanogaster DNA polymerase. The use of both in vivo and in vitro immunizations may increase the likelihood of generating monoclonal antibodies to weakly immunogenic antigens.

A species- and stage-specific monoclonal antibody (MAb) for a Lygus hesperus Knight egg antigen was developed. Positive antigen-antibody reactions were associated only with L. hesperus eggs and adult females. There was no cross-reactivity with any of the other L. hesperus life stages nor with any stage of L. lineolaris (Palisot de Beauvois). Furthermore, this MAb did not cross-react with the eggs of 10 other insect species examined. Electrophoretic and Western blot analyses indicated that the egg antigen had four polypeptides that bound to this MAb with molecular weights estimated at 64,000, 123,250, 140,300, and 150,300 Da. The use of this MAb as a diagnostic probe for gut content analysis of potential natural predators of L. hesperus eggs is discussed.

Infections with Encephalitozoon (phylum Microspora) protozoa in immunodeficient patients have emerged worldwide. The prevalence of infections due to Encephalitozoon species in nonclinical populations remains unclear. We conducted a cross-sectional survey of two rural highland villages in Mexico by using monoclonal antibody 3B6 to Encephalitozoon in immunofluorescence to assess the prevalence of Encephalitozoon spores in human stools. We found that 20 (7.84%) of the 255 subjects were positive and that 15 (21.4%) of the 70 households had at least one member who was positive. These results suggest that Encephalitozoon species, most likely Encephalitozoon intestinalis, may be commonly present in community settings.

Cryptosporidium parvum is an important diarrhea-causing protozoan parasite of immunocompetent and immunocompromised hosts. Immunoglobulin A (IgA) has been implicated in resistance to mucosal infections with bacteria, viruses, and parasites, but little is known about the role of IgA in the control of C. parvum infection. We assessed the role of IgA during C. parvum infection in neonatal mice. IgA-secreting hybridomas were developed by using Peyer’s patch lymphocytes from BALB/c mice which had been orally inoculated with viable C. parvum oocysts. Six monoclonal antibodies (MAbs) were selected for further study based on indirect immunofluorescence assay reactivity with sporozoite and merozoite pellicles and the antigen (Ag) deposited on glass substrate by gliding sporozoites. Each MAb was secreted in dimeric form and recognized a 23-kDa sporozoite Ag in Western immunoblots. The Ag recognized comigrated in sodium dodecyl sulfate-polyacrylamide gel electrophoresis with P23, a previously defined neutralization-sensitive zoite pellicle Ag. MAbs were evaluated for prophylactic or therapeutic efficacy against C. parvum , singly and in combinations, in neonatal BALB/c mice. A combination of two MAbs given prophylactically prior to and 12 h following oocyst challenge reduced the number of intestinal parasites scored histologically by 21.1% compared to the numbers in mice given an isotype-matched control MAb ( P < 0.01). Individual MAbs given therapeutically in nine doses over a 96-h period following oocyst challenge increased efficacy against C. parvum infection. Four MAbs given therapeutically each reduced intestinal infection 34.4 to 42.2% compared to isotype-matched control MAb-treated mice ( P < 0.05). One MAb reduced infection 63.3 and 72.7% in replicate experiments compared to isotype-matched control MAb-treated mice ( P < 0.0001). We conclude that IgA MAbs directed to neutralization-sensitive P23 epitopes may have utility in passive immunization against murine C. parvum infection.

The influence of Simulium vittatum Zetterstedt salivary gland extract on several immunological mechanisms was investigated in murine model hosts (laboratory mice). These mechanisms included the expression of major histocompatibility complex class II cell surface molecules, the in vitro mitogen responsiveness of lymphoid cells, and the antibody responses to heterologous foreign antigens (sheep erythrocytes). Experiments were designed to determine the influence of salivary gland extract following in vivo inoculation or in vitro inclusion in cell culture. In vivo inoculation of salivary gland extract reduced the percentage of Ia+ cells in spleen cell populations, although this difference was ameliorated by a 2 d in vitro culture period, regardless of whether salivary gland extract was included in culture. Salivary gland extract had no effect on Ia expression by cells derived from regional lymph nodes or the skin (epidermis). In vivo inoculation with salivary gland extract did not affect the responsiveness of splenic lymphocytes to mitogens, whereas in vitro exposure to salivary gland extract reduced both T and B cell mitogenesis. Finally, antibody responses to sheep erythrocytes were enhanced if salivary gland extract was included as a coinoculant, although this was expressed only at the systemic level regardless of the route of antigen delivery. In light of these results, immunomodulatory functions of black fly saliva are postulated; they are operative at different levels on different subcompartments of the immune system, possibly via cytokine modulation.

The humoral antibody responses to salivary antigens of Simulium vittatum Zetterstedt were investigated in a BALB/c mouse laboratory model. Production of antisera was stimulated by intraperitoneal immunization with salivary gland extract or by feeding flies directly on depilated mice. Antibody responses in these two groups of mice were compared by western blotting, thus characterizing “true” salivary immunogens present in salivary gland extract. Immunized mice developed IgG, IgM, and IgE antibodies which recognized several salivary gland components, ranging in molecular weight between 26 and 67 kDa. Sera from bitten mice recognized fewer antigens, indicating that some components of the salivary gland extract were poorly immunogenic or absent from the saliva secreted during blood feeding. Antisera raised against S. vittatum also were used to identify cross-reactive immunogens and allergens in salivary gland extracts from other New World simuliids ( Simulium argus Williston, S. metallicum Bellardi, and S. ochraceum Walker). SDS—PAGE protein profiles indicated a high degree of similarity between salivary gland extract of S. vittatum and S. argus, and several cross-reacting antigens were identified by western blotting. In contrast, protein profiles of S. ochraceum and S. metallicum differed from the former species, both qualitatively and quantitatively. Antisera demonstrated a low degree of cross-reactivity against salivary gland extract of S. ochraceum, whereas no cross-reactivity was detected against S. metallicum. These observations were confirmed using a monoclonal antibody raised against S. vittatum salivary gland extract (designated SVSG.1.F10), which showed cross-reactivity against S. argus but failed to recognize salivary gland components of either S. ochraceum or S. metallicum.