The serum and conjunctival antibody response to trachoma in Gambian children

Genome-wide profiling of humoral immunity and pathogen genes under selection identifies immune evasion tactics of Chlamydia trachomatis during ocular infection

The frequency and duration of Chlamydia trachomatis (Ct) ocular infections decrease with age, suggesting development of partial immunity. However, there is a lack of clear correlates of immunity to Ct infection in humans. We screened sera from a cohort of Gambian children followed for six-months against a Ct-proteome microarray. At genome sequence level, we detected signatures of selection from a population of ocular Ct isolates from Guinea-Bissau. Together these approaches allowed us to highlight the focus of humoral responses and hypothesise new modes of pathogen immune evasion. Children who were susceptible to frequent and/or prolonged Ct infection had a less focussed antibody response, including preferential recognition of forty-two antigens. There was evidence of positive and purifying selection across the genome, but little balancing selection. In contrast, most antigens that were associated with susceptibility were under neutral selection. These data suggest an evasion strategy in which Ct presents a large panel of irrelevant antigens to the immune system to block or misdirect protective responses. Development of a focused immune response, possibly induced through vaccination, may be an effective strategy to promote protection to Ct infection.

Immunohistochemical Analysis of Scarring Trachoma Indicates Infiltration by Natural Killer and Undefined CD45 Negative Cells

INTRODUCTION

The phenotype and function of immune cells infiltrating the conjunctiva in scarring trachoma have yet to be fully characterized. We assessed tissue morphology and immunophenotype of cellular infiltrates found in trachomatous scarring compared to control participants.

METHODOLOGY

Clinical assessments and conjunctival biopsy samples were obtained from 34 individuals with trachomatous scarring undergoing trichiasis surgery and 33 control subjects undergoing cataract or retinal detachment surgery. Biopsy samples were fixed in buffered formalin and embedded in paraffin wax. Hematoxylin and eosin (H&E) staining was performed for assessment of the inflammatory cell infiltrate. Immunohistochemical staining of single markers on individual sections was performed to identify cells expressing CD3 (T-cells), CD4 (helper T-cells), CD8 (suppressor/cytotoxic T-cells and Natural Killer, NK, cells), NCR1 (NK cells), CD20 (B-cells), CD45 (nucleated hematopoietic cells), CD56 (NK and T-cells), CD68 (macrophages/monocytes) and CD83 (mature dendritic cells). The degree of scarring was assessed histologically using cross-polarized light to visualize collagen fibres.

PRINCIPLE FINDINGS

Scarring, regardless of clinical inflammation, was associated with increased inflammatory cell infiltrates on H&E and CD45 staining. Scarring was also associated with increased CD8+ and CD56+ cells, but not CD3+ cells, suggestive of a NK cell infiltrate. This was supported by the presence of NCR1+ cells. There was some increase in CD20+ cells, but no evidence for increased CD4+, CD68+ or CD83+ cells. Numerous CD45 negative cells were also seen in the population of infiltrating inflammatory cells in scarred conjunctiva. Disorganization of the normal collagen architecture was strongly associated with clinical scarring.

CONCLUSIONS/SIGNIFICANCE

These data point to the infiltration of immune cells with a phenotype suggestive of NK cells in conjunctival trachomatous scarring. A large proportion of CD45 negative inflammatory cells were also present. Future work should seek to understand the stimuli leading to the recruitment of these cells and their role in progressive scarring.

[Chlamydia infection impact among native Indian groups of the Brazilian Amazon region]

Knowledge is limited on the spread of bacteria from genus Chlamydia in Brazil. This study included a sero-epidemiological survey of 2,086 samples from native Indian populations of the Brazilian Amazon region. Sera were screened using indirect immunofluorescence assay for detection of antibodies to C. trachomatis serotype L2, followed by microimmunofluorescence assay using fifteen C. trachomatis and C. pneumoniae serotypes as antigen substrates. Antibody prevalence was 48.6%, but there was a large prevalence range among the groups, including those that had never been challenged with the bacteria, as well as those in which almost all individuals had been infected. Titration of IgG antibodies and detection of specific IgM in high-titer samples showed the persistence of Chlamydia in 6.1% of the reactive individuals, who probably play an important role as reservoirs for dissemination of the bacteria. Specific seroreactivity to C. trachomatis showed the presence of serotypes A, B, Ba, D, E, G, H, I, and L1 in the geographic area surveyed. Furthermore, the survey showed that C. pneumoniae was also infecting these individuals. Both species may be involved in a significant human disease burden that merits further clarification.

The influence of local antichlamydial antibody on the acquisition and persistence of human ocular chlamydial infection: IgG antibodies are not protective

In order to study the effect of antichlamydial antibodies in ocular secretions on resistance to ocular chlamydial infection and clearance of this infection, we have performed linked longitudinal studies in a Gambian village in which trachoma is endemic. We have measured IgG and IgA antibody levels to a local serotype B isolate of Chlamydia trachomatis by amplified enzyme immunoassay, and chlamydial antigen levels in conjunctival swabs using a commercially available immunoassay which detects chlamydial glycolipid. Having previously demonstrated that sharing a bedroom with a case of active trachoma is a risk factor for acquisition of the disease, we have analyzed the effect of IgG and IgA antibody on the acquisition and persistence of clinical trachoma after controlling for age, sex, exposure to infection and for the presence of chlamydial antigen using a Poisson regression model. We have found that the presence of antichlamydial IgG in ocular secretions of disease-free subjects is associated with an increased incidence of trachoma. IgA antibody shows an opposite trend, but this is not statistically significant. One possible explanation of these findings is that antichlamydial IgG antibodies enhance the infectivity of C. trachomatis for the human eye; this could have major implications for the development of a chlamydial vaccine.

Comparison of serological tests for the diagnosis of Chlamydia psittaci infection of sheep

An enzyme-linked immunosorbent assay (ELISA) was developed and compared with the complement fixation test (CFT) and the indirect immunofluorescence antibody test (IIFAT) for the detection of antibodies to C. psittaci in sheep. Field sera and experimental sera from aborting ewes, subclinically infected sheep and vaccinated sheep were used. The ELISA and IIFAT were much more sensitive than the CFT. Agreement between the CFT and ELISA varied between 50% and 98%, while agreement between the IIFAT and ELISA varied between 70.5% and 94.3%. The specificity of IIFAT and ELISA with regard to the identification of animals which may be a source of ovine abortion strains of C. psittaci was critically assessed, using antigen preparations derived from an abortion isolate and from a non-abortion isolate of C. psittaci. Indirect immunofluorescence was shown to be the more discerning test.

Seroepidemiology of Chlamydia trachomatis infection in infertile women in Melbourne

A serological study was undertaken to determine the prevalence of antibody to Chlamydia trachomatis in women and to investigate any possible role of the organism in infertility and pelvic inflammatory disease. Thirty-seven per cent of pregnant women were found to have antibodies to Chl. trachomatis, as were 69% of women with pelvic inflammatory disease. Eighty-five per cent of women who were infertile due to inflammatory tubal damage and 78% who were infertile secondary to ectopic pregnancy had antibody as compared with 56% of women who were infertile for other reasons. Sperm bank donors and children showed low prevalences (16% and 3%, respectively). Exposure to Chl. trachomatis is widespread in sexually active women and appears to have a role in pelvic inflammatory disease and infertility that is due to inflammatory tubal disease.

Comparison of two immunofluorescence tests for detecting antibodies to C. trachomatis

Two immunofluorescence tests were compared for detecting antibodies to chlamydiae. The inclusion antigen test was more sensitive, detecting antibodies in more sera and at higher titres. The micro-IF test was more specific, differentiating between antibodies to C. trachomatis and those to C.IOL 207. Antibodies to this non-genital chlamydial type accounted for half the positive results. These antibodies can cause the prevalence of C. trachomatis infections to be over estimated when genus-specific serology tests are used.

Fluorescent antibody studies in chlamydial infections

Irradiated McCoy cells infected with genital strains of Chlamydia trachomatis were grown in wells on slides coated with polytetrafluoroethylene. The inclusions produced in this system formed the antigen in an indirect immunofluorescence test, which detected group-specific chlamydial antibodies in sera from patients attending veneral disease clinics. Chlamydial antibodies were found more frequently and in higher titer in sera from women attending veneral disease clinics then in sera from a less promiscuous population attending a Family Planning Association clinic. Paired sera from 13 patients with nongonococcal urethritis from whom chylamydiae had been isolated were tested against the homologous isolates; seroconversion was demonstrated in only one instance, and antibody was present in the first serum specimens of all the other patients. Chlamydia-specific immunoglobulin M was found in four of eight patients with psittacosis and in a proportion of sera from patients attending veneral disease and Family Planning Association clinics. The antigen for this immunofluorescence test can easily be prepared in laboratories with cell culture facilities for the isolation of C. trachomatis, and the test should be useful for laboratories which cannot undertake the micro-immunofluorescence test.

Serotypes of trachoma agent isolated in the Gambia: with an observation on the relation between serotype and morphology

Of 60 TRIC agents isolated from Gambian children with trachoma, 25 were serotype 1 and the remainder type 2. There was a pronounced difference in the proportions of these types in the two villages studied. In the village with a predominance of type 2 strains, TRIC agents remained confined to 2 adjacent compounds over a 14 month observation period. All 19 type 1 strains examined were characterized by the appearance in yolk sac smears of compact aggregates of elementary bodies; such aggregates were seen in only 2 of 35 type 2 strains, and may reflect a chemical difference in the surface of the elementary bodies or in a substance elaborated during their replication.