A QUANTITATIVE THEORY OF THE PRECIPITIN REACTION : III. THE REACTION BETWEEN CRYSTALLINE EGG ALBUMIN AND ITS HOMOLOGOUS ANTIBODY

Prozone phenomenon in pretransplant testing: An interesting conundrum involving solid-phase and cell-based assays

BACKGROUND

Human leukocyte antigen (HLA) is a major determinant in deciding upon solid organ histocompatibility. Donor-specific anti-HLA antibodies (Donor-specific anti-HLA antibodies (DSAs)) are always a contraindication for solid organ transplantation, and identification of DSA becomes very crucial before transplantation to provide long-term graft survival. For identification of DSA, usually, either cell-based or HLA bead-based assay is being used in laboratories. However, both cell-based and bead-based assays have certain limitations. One such common limitation is "prozone effect," which can give false-negative results. Here, we would like to present a small pilot study to analyze the effect of the prozone phenomenon in the cell-based and HLA bead-based assays and its utility in histocompatibility testing.

MATERIALS AND METHODS

In a series of four experiments, cell-based assay, flow cytometric cross-match (FCXM), and HLA bead-based flow cytometric panel reactive antibodies (PRAs) were performed. Single-antigen bead (SAB) testing was conducted as a first experiment on four known positives samples for anti-HLA antibody-antibodies. In the second experiment, these four samples were pooled together (called pooled sera in the text) and tested for FCXM and PRA. In the third experiment, known commercially available positive control sera were mixed with pooled positive sera (positive control sera + pooled sera) to prepare, what we have called "positive concoction" in the text. In the fourth experiment, the positive concoction was diluted serially (1:2, 1:4, 1:8, and 1:16) and FCXM and PRA were performed again to analyze and compare the prozone effect.

RESULTS

Pooled sera did not have the expected median fluorescence intensity (MFI) values in FCXM assay, whereas the PRA was showing >90% positivity. In positive concoction, the MFI of FCXM assay was observed to be declining; however, PRA values remained almost constant. Dilutions of the pooled sera showed that MFI values of FCXM assays were increased suddenly after dilution. The highest MFI values were observed in 1:4 dilution of the sera, and then, it declined gradually, but the PRA values remained almost constant even after serial dilutions.

CONCLUSION

In our experimental findings, it was clear that cell-based assay (FCXM) was more severely affected by the prozone, whereas solid-phase (flow PRA) assay remained resistant to prozone.

Basophil Activation Test With Aspergillus Molecules: The Case for ABPA

Background

Allergic bronchopulmonary aspergillosis (ABPA) is an underestimated allergic disease due to Aspergillus fumigatus (AF). The main diagnostic criteria for ABPA rely on the evaluation of immunoglobulin (Ig) E and IgG responses to AF extracts, although these cannot discriminate AF-sensitization from ABPA.

Objectives

To evaluate the performance of cellular functional assays with extract and molecular AF allergens in ABPA.

Methods

A prospective cohort of 67 patients (6 ABPA) was investigated with basophil activation test (BAT) with AF extract. Twelve patients were further investigated for BAT responses to molecular AF components: Asp f 1, Asp f 2, Asp f 3, Asp f 4, and Asp f 6.

Results

BAT with AF extract with an optimized cutoff displayed 100% sensitivity and 77.6% specificity for ABPA diagnosis. Among patients with positive BAT to AF, BAT with Asp f 4 was significantly higher in ABPA patients at 10 ng/mL (mean basophil stimulation index 10.56 in ABPA vs. 1.24 in non-ABPA patients, p = 0.0002).

Conclusion

BAT with AF is a promising diagnostic biomarker in the context of suspected ABPA, which can be further improved with AF molecular allergens, especially Asp f 4.

Why current quantitative serology is not quantitative and how systems immunology could provide solutions

Determination of the presence of antibodies against infectious agents, self-antigens, allogeneic antigens and environmental antigens is the goal of medical serology. Along with the standardization of these tests the community also started to use the expression “quantitative serology,” referring to the fact that arbitrary units are used for the expression of results. In this review I will argue against the use of the term quantitative serology for current tests. Because each test and each antibody isotype determination uses its own references, the term semiquantitative better describes these methods. The introduction of really quantitative serology could both benefit from and drive forward systems immunological approach to immunity.

Empty mast cell syndrome: fallacy or fact?

Post-anaphylaxis mast cell anergy (PAMA), commonly referred to as 'empty mast cell (MC) syndrome', is a state of temporary loss of cutaneous MC reactivity in the immediate aftermath of anaphylaxis. Data relating to this condition are sparse and the incidence rate is currently unknown. PAMA has been described only in a few published case reports in the context of hymenoptera venom allergy and perioperative anaphylaxis. Best practice guidelines regarding optimal timing for performing skin tests postanaphylaxis are largely based on expert opinion, and allergy work-up has been recommended after 4-6 weeks postanaphylaxis to avoid false-negative results.This article provides a review of clinical literature surrounding PAMA, critically evaluates intracellular events in MCs from in vitro data and hypothesises regarding plausible immune mechanisms. There are no published data to directly explain molecular mechanisms underlying this phenomenon. Although not evidence based, PAMA has been attributed to depletion of MC granules following anaphylaxis. It is also plausible that exposure to high allergen concentrations in anaphylaxis can induce a temporary shift in MCs towards dominance of inhibitory signalling pathways, thus contributing to a state of transient hyporesponsiveness observed in some patients. Other potential contributory factors for reduced MC reactivity include downregulation of FcεRI expression, cross-linking of FcεRI to the inhibitory, low-affinity IgG receptors and administration of pharmacotherapeutic agents for anaphylaxis treatment. It is likely that this interesting phenomenon can be explained by a combination of these proposed mechanisms in addition to other genetic/host factors that have not yet been identified.

Kinetic Approach Extends the Analytical Measurement Range and Corrects Antigen Excess in Homogeneous Turbidimetric Immunoassays

BACKGROUND

Homogeneous turbidimetric immunoassays are widely used in the clinical laboratory and offer short assay times, reduced reagent costs, and the potential for full automation. However, these assays have a limited analytical measurement range (AMR) above which antigen excess leads to falsely low estimates of the analyte concentration (i.e., the hook effect). Traditional methods for correction of antigen excess require sample dilution, compromising time and cost-efficiency. Therefore, novel methods that extend the AMR are needed.

METHODS

A kinetic model of a generic homogeneous turbidimetric immunoassay was built and then parameterized using a genetic algorithm. Kinetic features that could be used to extend the AMR were identified and subsequently validated with clinical data from consecutive measurements of 2 homogeneous turbidimetric immunoassays: κ serum free light chain and rheumatoid factor.

RESULTS

A novel kinetic parameter, the area under the curvature (AUCU), was derived that increases in proportion to the analyte concentration in a range beyond the AMR of conventional end point methods. When applied to clinical data, the AUCU method provided a log-linear calibration curve in the zone of antigen excess extending the AMR by >10-fold for 2 different immunoassays.

CONCLUSIONS

The AUCU method detects and corrects antigen excess, extending the AMR in homogeneous turbidimetric immunoassays. The advantage of this method over conventional methods would be a reduction in the number of repeated samples, resulting in significant time and cost savings.

Inhibiting phosphatase SHIP-1 enhances suboptimal IgE-mediated activation of human blood basophils but inhibits IgE-mediated activation of cultured human mast cells

IgE-mediated activation of basophil granulocytes and mast cells follows a bell-shaped dose-response curve. The decreased activation at supraoptimal allergen stimulation is thought to be associated with SH2-containing inositol-5'-phosphatase 1 (SHIP-1). SHIP-1 phosphorylation is inversely related to IgE-mediated releasability of basophils. This study sought to clarify the regulatory role of SHIP-1 in degranulation of basophil granulocytes and mast cells by selective inhibition of the phosphatase function of SHIP-1with 3-α-aminocholestane (3-α-AC). Six grass pollen allergic patients, six non-responder patients and six cultured human primary mast cell lines were included. The effect of 3-α-AC (1-60 μM, 30 min, 37 °C) was analyzed at individual suboptimal, optimal and supra-optimal allergen concentrations. The activity, upregulation of CD63, measured at different conditions was compared to evaluate the maximal effect of selective SHIP-1 inhibition. Basophils of five non-responder patients were treated with 3-α-AC (10 μM, 30 min, 37 °C). At high concentrations (>60 μM) of 3-α-AC, cells appeared to enter apoptosis. The median reactivity increased from 27.1% to 44.9% CD63⁺ basophils at 10 μM of 3-α-AC and suboptimal allergen stimulation (p = 0.0153). There was no effect on blood basophils of 3-α-AC at optimal or supra-optimal allergen concentrations. In contrast, treatment with more than 6 μM 3-α-AC significantly inhibited mast cell reactivity. 10 μM 3-α-AC reduced median reactivity from 32.85% to 16.5% CD63+ mast cells (p = 0.0465). Treatment with 3-α-AC did not increase response of basophils of non-responder patients. Modulating blood basophils with 3-α-AC enhanced reactivity only at suboptimal allergen concentration, and basophils from non-responders did not regain responsiveness to IgE stimulation. 3-α-AC inhibited the IgE response of mast cells in a dose dependent manner.

Simultaneous Quantification of Plasmodium Antigens and Host Factor C-Reactive Protein in Asymptomatic Individuals with Confirmed Malaria by Use of a Novel Multiplex Immunoassay

Malaria rapid diagnostic tests (RDTs) primarily detect Plasmodium falciparum antigen histidine-rich protein 2 (HRP2) and the malaria-conserved antigen lactate dehydrogenase (LDH) for P. vivax and other malaria species. The performance of RDTs and their utility is dependent on circulating antigen concentration distributions in infected individuals in a population in which malaria is endemic and on the limit of detection of the RDT for the antigens.

Malaria rapid diagnostic tests (RDTs) primarily detect Plasmodium falciparum antigen histidine-rich protein 2 (HRP2) and the malaria-conserved antigen lactate dehydrogenase (LDH) for P. vivax and other malaria species. The performance of RDTs and their utility is dependent on circulating antigen concentration distributions in infected individuals in a population in which malaria is endemic and on the limit of detection of the RDT for the antigens. A multiplexed immunoassay for the quantification of HRP2, P. vivax LDH, and all-malaria LDH (pan LDH) was developed to accurately measure circulating antigen concentration and antigen distribution in a population with endemic malaria. The assay also measures C-reactive protein (CRP) levels as an indicator of inflammation. Validation was conducted with clinical specimens from 397 asymptomatic donors from Myanmar and Uganda, confirmed by PCR for infection, and from participants in induced blood-stage malaria challenge studies. The assay lower limits of detection for HRP2, pan LDH, P. vivax LDH, and CRP were 0.2 pg/ml, 9.3 pg/ml, 1.5 pg/ml, and 26.6 ng/ml, respectively. At thresholds for HRP2, pan LDH, and P. vivax LDH of 2.3 pg/ml, 47.8 pg/ml, and 75.1 pg/ml, respectively, and a specificity ≥98.5%, the sensitivities for ultrasensitive PCR-confirmed infections were 93.4%, 84.9%, and 48.9%, respectively. Plasmodium LDH (pLDH) concentration, in contrast to that of HRP2, correlated closely with parasite density. CRP levels were moderately higher in P. falciparum infections with confirmed antigenemia versus those in clinical specimens with no antigen. The 4-plex array is a sensitive tool for quantifying diagnostic antigens in malaria infections and supporting the evaluation of new ultrasensitive RDTs.

Large molecule specific assay operation: recommendation for best practices and harmonization from the global bioanalysis consortium harmonization team

The L2 Global Harmonization Team on large molecule specific assay operation for protein bioanalysis in support of pharmacokinetics focused on the following topics: setting up a balanced validation design, specificity testing, selectivity testing, dilutional linearity, hook effect, parallelism, and testing of robustness and ruggedness. The team additionally considered the impact of lipemia, hemolysis, and the presence of endogenous analyte on selectivity assessments as well as the occurrence of hook effect in study samples when no hook effect had been observed during pre-study validation.

Activation/Inhibition of mast cells by supra-optimal antigen concentrations

Mast cells (MCs) are tissue resident cells of hemopoietic origin and are critically involved in allergic diseases. MCs bind IgE by means of their high-affinity receptor for IgE (FcεRI). The FcεRI belongs to a family of multi-chain immune recognition receptors and is activated by cross-linking in response to multivalent antigens (Ags)/allergens. Activation of the FcεRI results in immediate release of preformed granular substances (e.g. histamine, heparin, and proteases), generation of arachidonic acid metabolites, and production of pro-inflammatory cytokines. The FcεRI shows a remarkable, bell-shaped dose-response behavior with weak induction of effector responses at both low and high (so-called supra-optimal) Ag concentrations. This is significantly different from many other receptors, which reach a plateau phase in response to high ligand concentrations. To explain this unusual dose-response behavior of the FcεRI, scientists in the past have drawn parallels to so-called precipitin curves resulting from titration of Ag against a fixed concentration of antibody (Ab) in solution (a.k.a. Heidelberger curves). Thus, for high, supra-optimal Ag concentrations one could assume that every IgE-bound FcεRI formed a monovalent complex with “its own Ag”, thus resulting in marginal induction of effector functions due to absence of receptor cross-linking. However, this was never proven to be the case. More recently, careful studies of FcεRI activation and signaling events in MCs in response to supra-optimal Ag concentrations have suggested a molecular explanation for the descending part of this bell-shaped curve. It is obvious now that extensive FcεRI/IgE/Ag clusters are formed and inhibitory molecules and signalosomes are engaged in response to supra-optimal cross-linking (amongst them the Src family kinase Lyn and the inositol-5′-phosphatase SHIP1) and they actively down-regulate MC effector responses. Thus, the analysis of MC signaling triggered by supra-optimal crosslinking holds great potential for identifying novel targets for pharmacologic therapeutic intervention to benefit patients with acute and chronic allergic diseases.

FcγRIIb on liver sinusoidal endothelium clears small immune complexes

It has long been known that the ITIM-bearing IgG Fc receptor (FcγRIIb, RIIb) is expressed on liver sinusoidal endothelial cells (LSEC) and that the liver is the major site of small immune complex (SIC) clearance. Thus, we proposed that RIIb of LSEC eliminates blood-borne SIC, thereby controlling immune complex-mediated autoimmune disease. Testing this hypothesis, we found most RIIb of the mouse, fully three-quarters, to be expressed in liver. Moreover, most (90%) liver RIIb was expressed in LSEC, the remainder in Kupffer cells. An absent FcRγ in LSEC implied that RIIb is the sole FcγR expressed. Testing the capacity of liver RIIb to clear blood-borne SIC, we infused mice intravenously with radio-iodinated SIC made of OVA and rabbit IgG anti-OVA. Tracking decay of SIC from the blood, we found the RIIb knockout strain to be severely deficient in eliminating SIC compared with the wild-type strain, terminal half-lives being 6 and 1.5 h, respectively. RIIb on LSEC, a major scavenger, keeps SIC blood concentrations low and minimizes pathologic deposition of inflammatory immune complex.

Continuous-flow biomolecule concentration and detection in a slanted nanofilter array

We demonstrate continuous-flow biomolecule concentration and detection in a microfabricated slanted sieving structure, which we term a herringbone nanofilter array (HNA). The HNA structure consists of periodically-patterned deep and shallow nanoslits meeting at right angles. In addition to concentration, we can discriminate different sized analytes by mixing a fluorescent probe with the sample and measuring the extent of the concentrating effect. Using this principle, we interrogate biomolecular interactions, including protein-DNA binding, protein-protein interaction and antibody-antigen binding. The final example demonstrates a novel method to perform a homogeneous immunoassay for detecting a disease marker, human C-reactive protein (CRP), using fluorescent-labeled antibodies at clinically relevant concentrations. The signal amplification potential and continuous flow operation provide a significant advantage over other microfluidic batch separation techniques for the easy integration of this device into a common point-of-care diagnostic platform.

Fast protein detection using absorption properties of gold nanoparticles

In this study we describe the use of gold nanoparticles as a fast detection system for the sensitive analysis of proteins. The immunological method allows for protein analysis at the nanogram level, as required for clinical diagnosis. Initially a test protein is used for the development of the assay. The system is subsequently adopted for alpha-fetoprotein, which is a relevant tumor marker. This work demonstrates that antibody functionalized gold nanoparticles can be used for the detection of proteins by forming gold nanoparticle aggregates. The influence of the size of the gold nanoparticles on the sensitivity of the assay is investigated in the range from 20-60 nm particles; the larger particles show here the highest relative changes. The formation of antigen-gold nanoparticle aggregates is detected by an increase in hydrodynamic diameter by dynamic light scattering (DLS). UV/Vis spectroscopy also allows assay monitoring by quantifying the red shift of the plasmon resonance wavelength. Alpha-fetoprotein can be analysed in the concentration range of 0.1-0.4 μg ml(-1). The influence of pH, ionic strength and ratio of sample to Au-NP solution is studied. With this method, the protein AFP can be rapidly detected as demanded for clinical diagnosis.

Barriers of the Human Organism and Their Achilles’ Heels

The human body is covered by barriers separating it from the external and internal surroundings. The “milieu enterieur” has to be stabilised in spite of the variable external and internal conditions of toxic, osmotic, microbial and climatic environmental circumstances. This first line of barriers is composed of skin and mucous membranes of complicated structures.

A second line of barrier system is present in our organisms. Certain organs have to be separated from the immune system and other parts of the body because of evolutionary reasons (eye-bulb and testicles) because of unique proteins “unknown” for the acquired immune system. The blood-brain barrier (BBB) is providing enhanced safety circumstances for the central nervous system. The second line of barriers is represented by the special properties of the capillary endothelial system.

The maternal-fetal barrier is the most complex. At the maternal fetal interface two individuals of two different haplotypes has to be live 9 months separated by a very complicated dynamic barrier.

The placenta is the organ, which is separating the maternal and fetal tissues. Similar to others the bidirectional transport of gasses, metabolites, cells, proteins, regulatory substances, are transported by active or passive transcellular and intercellular mechanisms.

The fetal immune system develops immunotolerance to all maternal cells and antigens transferred transplacentally. The problem is to mitigate the maternal immune system to tolerate the paternal haplotype of the fetus. In the case of normal pregnancy a complex series of physiological modifications can solve the problem without harmful consequences to the mother and fetus.

The outermost contact cells of trophoblasts express instead of HLA-class Ia and class II antigens non-variable HLA-C, HLA-E, HLA-F and HLA-G antigens. The first consequence of this is reduction of the activity of maternal natural killer cells and maternal dendritic cells;

Progesteron, micro-RNA and mediators influence the development of T effector-cells. The production of soluble HLA-G(5 and 6) and IL-10 supports the differentiation of Th-2 CD4⁺ helper cells, reducing the ability of maternal cells to kill fetal cells.

Series of receptors and costimulators are expressed by the different lines of semi-allogenic trophoblast cells to bind HLA-G and mitigate maternal immune response;

The maternal immunotolerance is further facilitated by the activation of CD4⁺CD25^brightFoxp3⁺ regulatory T (T_REG) cells.

Infections have to be prevented during pregnancy. The cells of placenta express 10 Toll-like receptors a group of pattern recognition receptors responsible for innate immunity. The interferon level is also higher in the placental tissues than in the somatic fetal or maternal cells.

The complement system is also adapted to the requirements of the pregnancy and fetal damage is inhibited by the production of “assymmetric IgG antibodies” under hormonal and placental-regulation. These modifications prevent the activation of complement, cytotoxic activity, opsonising ability, antigen clearance and precipitating activity of the molecules.

The Achilles’ heels of the different barriers are regularly found by virus infections. Lamina cribrosa of the blood-brain barrier, optical nerve of the eyes, etc. the risk factors of the maternal-fetal barrier has been summarised in Table 1.1.

Specific antibodies to soluble alpha-synuclein conformations in intravenous immunoglobulin preparations

Alpha-synuclein is the major protein in Lewy bodies, the hallmark pathological finding in Parkinson's disease (PD) and dementia with Lewy bodies (DLB). Although normally intracellular, it also can be secreted, so extracellular alpha-synuclein may contribute to neuronal injury. Serum antibodies to alpha-synuclein could exert protective effects by increasing alpha-synuclein's movement out of the brain and, if they cross the blood-brain barrier, by inhibiting its neurotoxic effects. The objective of this study was to measure antibody concentrations to alpha-synuclein monomer and soluble oligomers in three intravenous immunoglobulin (IVIG) preparations, Gamunex (Talecris Biotherapeutics), Gammagard (Baxter Healthcare) and Flebogamma (Grifols Biologicals). Antibodies were measured in native IVIG preparations and after antibody-antigen complex dissociation. IVIG's non-specific binding was subtracted from its total binding to alpha-synuclein to calculate specific anti-alpha-synuclein antibody concentrations. Specific antibodies to alpha-synuclein monomer and/or soluble oligomers were detected in all IVIG products. In native IVIG preparations, the highest anti-monomer concentrations were in Gammagard and the highest anti-oligomer concentrations were in Gamunex; the extent to which lot-to-lot variation may have contributed to these differences was not determined. Antibody-antigen complex dissociation had variable effects on these antibody levels. The IVIG preparations did not inhibit alpha-synuclein oligomer formation, although they changed the distribution and intensity of some oligomer bands on Western blots. The presence of antibodies to soluble alpha-synuclein conformations in IVIG preparations suggests that their effects should be studied in animal models of synucleinopathies, as a first step to determine their feasibility as a possible treatment for PD and other synucleinopathies.

ON CROSS REACTIONS OF EGG ALBUMIN SERA

Experiments are presented on the cross reactions of hen egg albumin immune sera with egg albumins of other species by means of exhaustion with heterologous proteins and by inhibition tests. From the results it can be concluded that the sera contain multiple, qualitatively distinct antibodies. For this, two not mutually exclusive explanations come into consideration: the presence in proteins of a number of different, perhaps similar, complex determinants, and the fact, established by previous results, that one antigenic grouping can call forth the formation of diverse antibodies. It is inferred that cross reactions between proteins of kindred species are ascribable, in general, to similarity in determinant structures, and not to the distribution of identical determinant groups among the related proteins.

THE IMMUNOLOGICAL PROPERTIES OF THE HETEROPHILE ANTIGEN AND SOMATIC POLYSACCHARIDE OF PNEUMOCOCCUS

1. The lipocarbohydrate or F polysaccharide derived from a rough variant of Type I pneumococcus (I R) is antigenic in rabbits and gives rise to precipitins and sheep cell hemolysins. The somatic or C carbohydrate on the other hand is not antigenic. 2. Antisera for the rough variant of Type 1 pneumococcus contain also bacterial agglutinins immunologically unrelated to the C and F precipitins and the heterophile antibody. 3. A study has been made of the quantitative precipitin reaction of the C and F polysaccharides in the serum of rabbits immunized with the IR pneumococcus clarifying certain of these relationships.

QUANTITATIVE STUDIES ON THE PRECIPITIN REACTION : EFFECT OF SALTS ON THE REACTION

1. A quantitative study has been made of the effect on the precipitin reaction between the specific polysaccharide of Type III pneumococcus and the homologous antibody of salt concentrations ranging from O.1 M to 1.79 M, including the effect of ions of higher valence. 2. Within these limits, observed decreases in precipitated antibody with increasing salt concentration appear to be due to a decrease in the amount of antibody combined with the S III, rather than to an increase in solubility of the S III-antibody compounds. 3. The egg albumin-antibody reaction is far less sensitive to changes in salt concentration than is the S III-antibody reaction.

QUANTITATIVE CHEMICAL STUDIES ON COMPLEMENT OR ALEXIN : I. A METHOD

1. A quantitative micro method, conforming to the criteria of analytical chemistry, is proposed for the estimation of complement, or its combining component or components, in milligrams per milliliter instead of in the customary relative and variable volume units. 2. Data are given showing the range of accuracy and reproducibility of the new method.

ON CROSS REACTIONS OF IMMUNE SERA TO AZOPROTEINS

The phenomena observed on absorption of immune sera to azoproteins with heterologous azoantigens lead to the conclusion that in general the sera do not contain a single antibody but antibody fractions somewhat different in their reactivity for heterologous antigens. From the constitution of the azocomponent it follows that these fractions cannot be specific for distinct chemical groups in the molecule. In fact, inhibition experiments showed that in the cases examined the various antibodies are all specifically directed towards the whole molecule of the homologous hapten.

THE COMPOSITION OF SPECIFIC PRECIPITATES IN THE REGION OF ANTIGEN EXCESS

Data are given, for seven different antisera, for the composition of the specific precipitate as a function of the relative proportions of antiserum and antigen used. In the region of antigen excess, a linear relation is found between the ratio of antibody to antigen in the precipitate and the amount of antiserum used. The significance of these results, particularly in their bearing on theories of the precipitin reaction, is discussed.

QUANTITATIVE CHEMICAL STUDIES ON COMPLEMENT OR ALEXIN : II. THE INTERRELATION OF COMPLEMENT WITH ANTIGEN-ANTIBODY COMPOUNDS AND WITH SENSITIZED RED CELLS

1. The molecular quantities of hemolysin and complement combining component or components (C'1) involved in hemolysis have been calculated on the basis of new, quantitative, absolute methods of analysis. 2. Molecular combining ratios between antigen, antibody, and C'1 have been established. 3. The data are shown to be in accord with the theory of combination of multivalent antigen with multivalent antibody. 4. The fixation of complement by antigen-antibody combination is qualitatively and quantitatively accounted for on this basis.

ON CROSS REACTIONS OF IMMUNE SERA TO AZOPROTEINS : II. ANTIGENS WITH AZOCOMPONENTS CONTAINING TWO DETERMINANT GROUPS

Azoproteins have been prepared with azocomponents possessing two serologically active groups. On immunization with such antigens immune sera were obtained containing two separate, unrelated antibodies, each specific for one of the two groups and separable by absorption. In other cases one of the two structures was dominant, in that antibodies were formed only towards this and not towards the other grouping. The specificity of the antibodies was in general found to be influenced to some extent by the presence of a second group in the antigen. The relevancy of these observations for antibodies directed against natural antigens has been noted.

A QUANTITATIVE THEORY OF THE PRECIPITIN REACTION : IV. THE REACTION OF PNEUMOCOCCUS SPECIFIC POLYSACCHARIDES WITH HOMOLOGOUS RABBIT ANTISERA

1. The reaction between the specific polysaccharide of Type III pneumococcus and homologous antibody in rabbit sera is quantitatively accounted for by expressions similar to those derived from the mass law for the corresponding horse sera. Preliminary data are also given for the Type I reaction. 2. Differences and similarities of the reaction with antibodies produced by the two animals are discussed. 3. Calculations are made of the equivalent composition of the specific precipitate at various reference points in the reaction range. 4. Certain theoretical and practical implications of the findings are pointed out.

THE INFLUENCE OF THE MOLECULAR WEIGHT OF ANTIGEN ON THE PROPORTION OF ANTIBODY TO ANTIGEN IN PRECIPITATES : II. A STATISTICAL EXAMINATION OF AVAILABLE DATA, INCLUDING SOME PREVIOUSLY UNPUBLISHED

A statistical examination of the available data on the ratio of antibody to antigen in specific precipitates made at or near the optimum shows a definite correlation between the ratio and the molecular weight of antigen (regression coefficient = -0.529 (+/-0.014)). The authors' assumption that at this point the antigen molecules are just about covered by a layer of antibody behaving as contiguous spherical ("Svedberg") units of weight 35,200 leads to predicted ratios that in general agree well with those found, though individual experimental determinations may deviate considerably.

CHEMICAL STUDIES ON BACTERIAL AGGLUTINATION : III. A REACTION MECHANISM AND A QUANTITATIVE THEORY

1. By the application of an absolute, quantitative microchemical method for the estimation of agglutinins, precise data have been obtained on the course of the agglutination of Type I pneumococcus by homologous anticarbohydrate. 2. Within the limitations imposed by the necessity for the agglutination reaction to take place at the bacterial surface, the reaction is shown to be analogous to the precipitin reaction and subject to the same laws. 3. The entire process of a typical instance of specific bacterial agglutination has been quantitatively accounted for on a purely chemical basis and expressed in the form of equations derived from the law of mass action. 4. Experimental verification of predictions based on the theory has shown a fundamental difference between this instance of specific bacterial agglutination and the commonly adduced analogies, and necessitated a revision of current conceptions regarding the rôle of electrolytes and of physical forces in the reaction.

QUANTITATIVE CHEMICAL STUDIES ON COMPLEMENT OR ALEXIN : III. UPTAKE OF COMPLEMENT NITROGEN UNDER VARYING EXPERIMENTAL CONDITIONS

1. Quantitative data are given on the effect of variations in the time of contact and the proportions of the reactants on the quantity of complement combining component nitrogen (C'1 N) found in active guinea pig serum. 2. C'1 N was the same when determined with precipitates containing excess antibody or excess antigen. 3. Finely divided specific precipitates took up the complement combining component (C'1) from subsequently added guinea pig serum almost as well as specific precipitates formed in the presence of complement.

QUANTITATIVE CHEMICAL STUDIES ON COMPLEMENT OR ALEXIN : IV. ADDITION OF HUMAN COMPLEMENT TO SPECIFIC PRECIPITATES

1. A modified method is given for the titration of human complement so that C'1 titers are measured, as in guinea pig serum, instead of the C'2 titers yielded by the usual titration. 2. The measurement of complement combining component or components in weight units, instead of relative terms, is carried out as in guinea pig serum and leads to similar values, 0.03 to 0.05 mg. of C' N per ml. of human serum. 3. Other similarities in human and guinea pig complements are noted and discussed.

STUDIES ON THE MOLECULAR WEIGHT OF DIPHTHERIA TOXIN, ANTITOXIN, AND THEIR REACTION PRODUCTS

Purified diphtheria antitoxic horse pseudoglobulin has been prepared which is homogeneous by sedimentation, diffusion, and electrophoresis. Immunologically, however, the preparation contains only 43.5 per cent antitoxin specifically precipitable by toxin. The inactive pseudoglobulin remaining after specific precipitation was found to have the same physical and chemical properties as the original antitoxic pseudoglobulin. Although the molecular weight of antitoxin is the same as that of the normal horse serum globulins, the electrophoretic mobility does differ from those normally present. The molecular weight of diphtheria toxin is 70,000 and of antitoxin is 150,000. From ultracentrifuge studies on the two reactants and on mixtures of toxin and antitoxin in the soluble inhibition zones, the average molecular composition of the specific floccules at certain reference points throughout the equivalence zone and the maximum "valence" of toxin and antitoxin with respect to each other have been calculated. The significance of the results has been discussed in relation to antigen-antibody reactions in general and a possible explanation for the exceptional behavior of the toxin-antitoxin reaction in the region of excess antitoxin has been suggested.

QUANTITATIVE STUDIES ON ANTIBODY PURIFICATION : I. THE DISSOCIATION OF PRECIPITATES FORMED BY PNEUMOCOCCUS SPECIFIC POLYSACCHARIDES AND HOMOLOGOUS ANTIBODIES

1. Quantitative data are given on the effect of changes in hydrogen ion concentration and of salt solutions of high concentration on certain immune precipitates obtained at lower salt concentration. 2. Advantage is taken of the shift in reaction equilibrium brought about by the salt in the case of pneumococcus carbohydrate-anti-carbohydrate precipitates to enable the preparation, in a single step from unconcentrated serum, of antibody solutions in which up to 93 per cent of the total nitrogen is immune nitrogen. The method permits successive absorptions of a serum to be made with the same specific precipitate. 3. A modification of Felton's alkaline earth hydroxide dissociation procedure is proposed which yields highly purified antibody with precipitates which have been subjected to several successive salt dissociations.

ANTI-EGG ALBUMIN ANTIBODY IN THE HORSE

The reaction between three times recrystallized egg albumin and its antibody in the horse has been studied. The reaction exhibits a behavior typical of the Ramon diphtheria flocculation reaction.

THE REACTION BETWEEN THE ENZYME TYROSINASE AND ITS SPECIFIC ANTIBODY

1. Antibodies to the enzyme tyrosinase, obtained from the mushroom Psalliota campestris, have been produced in rabbits and human beings. 2. These antibody preparations, though precipitating the enzyme from solution, do not affect its catalytic activity.

QUANTITATIVE STUDIES ON ANTIBODY PURIFICATION : II. THE DISSOCIATION OF ANTIBODY FROM PNEUMOCOCCUS SPECIFIC PRECIPITATES AND SPECIFICALLY AGGLUTINATED PNEUMOCOCCI

1. The salt dissociation and barium hydroxide-barium chloride methods are extended to the preparation of highly purified antibody solutions from specific precipitates derived from Type III and Type VIII antipneumococcus horse sera and a low grade polyvalent bovine serum. Analytically pure precipitin (agglutinin) was obtained from the last, and Types I, II, and III antibodies were separated. 2. Difficulties connected with the application of the methods to Type I antipneumococcus rabbit sera are described, as is also the purification of antibody from low grade pig and sheep sera. 3. The dissociation of antibody by both methods from Type I pneumococci agglutinated in antisera produced in the horse, rabbit, pig, and sheep, is described and its advantages discussed. 4. Certain theoretical aspects of the work are also discussed.

A QUANTITATIVE THEORY OF THE PRECIPITIN REACTION : V. THE REACTION BETWEEN CRYSTALLINE HORSE SERUM ALBUMIN AND ANTIBODY FORMED IN THE RABBIT

1. The reaction between crystalline horse serum albumin and homologous antibody in rabbit sera is quantitatively accounted for by expressions similar to those derived from the law of mass action for other immune precipitating systems. 2. The reaction of an azo dye prepared from crystalline serum albumin by coupling with diazotized R-salt-azo benzidine was also studied with homologous antibody and anti-serum albumin. 3. Quantitative data obtained on cross reactions with the two antigens differ markedly from data on the corresponding reactions in the egg albumin system and indicate that tyrosine and perhaps histidine, while important in determining the serological specificity of egg albumin, have little connection with the specificity of serum albumin. 4. Calculations are made of the equivalent composition of the specific precipitate at various reference points in the reaction range.

ANTIPROTEINS IN HORSE SERA : III. ANTIBODIES TO RABBIT SERUM ALBUMIN AND THEIR REACTION WITH ANTIGEN

1. Two horses were injected subcutaneously with alum-precipitated rabbit serum albumin. 2. The resulting antibody resembled diphtheria antitoxin and anti-egg albumin in the horse in giving a sharp zone of flocculation with antigen, in being water-soluble, in reactivity toward an anti-antibody rabbit serum, and in its electrophoretic properties. 3. The effect of continued immunization, and of variation in volume and temperature on the reactivity of the antibody are discussed. 4. Intravenous injection of the same antigen into horses did not give rise to detectable amounts of antibody of the same type.

STUDIES ON PHOTO-OXIDATION OF ANTIGEN AND ANTIBODIES

1. Quantitative precipitin studies indicate that progressive photo-oxidation progressively destroys the antigenic function of egg albumin. 2. Quantitative precipitin reactions of antisera (anti-egg albumin rabbit serum and antipneumococcus Type I horse serum) demonstrate that progressive photo-oxidation causes progressive lowering of the potency of the sera. 3. Quantitative precipitin reactions of the photo-oxidized globulin gamma fraction of anti-egg albumin rabbit serum and of Felton solution of antipneumococcus Type I horse serum show that these specific antibody fractions behave similarly to antibodies in whole sera. 4. Egg albumin whose precipitin reaction is destroyed by photo-oxidation no longer causes anaphylaxis in guinea pigs and does not produce precipitins in rabbits. 5. Chemical studies of progressively photo-oxidized egg albumin show a progressive destruction of tryptophane and histidine while tyrosine remains intact and cystine is reversibly oxidized. Sulfhydryl groups can no longer be demonstrated in photo-oxidized egg albumin whose antigenic characteristics are greatly weakened. 6. Similar studies on the globulin gamma fraction of anti-egg albumin rabbit serum and on Felton solution show no diminution of these amino acids in photo-oxidized material whose antigenic properties are destroyed. 7. The non-coagulable nitrogen and the amino nitrogen of egg albumin, antisera, and their specific antibody fractions show but an insignificant increase during photo-oxidation, indicating that the loss of the precipitin reaction is not due to splitting of the respective protein molecules. 8. Electrophoretic studies of egg albumin, antisera, and their specific antibody fractions show that photo-oxidation causes a marked alteration of the pattern of these substrates. 9. Photo-oxidation of proteins causes the formation of aggregates, indicating denaturation. 10. Hematoporphyrin migrates with the albumin fraction of unaltered as well as the photo-oxidized anti-egg albumin rabbit serum and pneumococcus Type I horse serum; in isolated proteins such as egg albumin, globulin gamma, or Felton solution, etc., the dye moves independently of the protein; after progressive photo-oxidation Hp becomes progressively fixed to the protein. Eosin behaves similarly to hematoporphyrin.

THE EFFECT OF SALICYLATES ON THE PRECIPITATION OF ANTIGEN WITH ANTIBODY

1. Sodium salicylate modifies the precipitation of normal rabbit serum protein by sodium tungstate, and partially inhibits the precipitation of horse serum euglobulin by rabbit antiserum. Sodium salicylate added to a system containing crystalline egg albumin and its antibody partly prevents the formation of precipitate, the degree of inhibition being related to the concentration of salicylate. 2. Precipitation in the equivalence zone is more readily prevented by salicylate than precipitation in the region of antibody excess, the immune system becoming progressively less sensitive to the action of salicylate as the excess of antibody becomes larger. 3. Formed precipitates were partly dissolved following resuspension in the presence of salicylate. 4. The salicylate effect on immune precipitation is reversible, and appears to be due to inactivation of antibody. 5. Salicylate was more effective in preventing specific precipitation than other anions of a lyotropic series tested.

QUANTITATIVE EXPERIMENTS WITH ANTIBODIES TO A SPECIFIC PRECIPITATE. I

1. Rabbits were injected with the washed specific precipitate from Type II antipneumococcus horse serum. Antibody in the resulting antiserum was determined by the quantitative agglutinin method using various specific precipitates as antigens. 2. Suspensions of Types I and II antipneumococcus horse specific precipitates, as well as the specific precipitates derived from Type VIII Pn (anti-C portion), and H. influenzae horse antisera were found to remove the same amount of antibody from the immune rabbit serum. 3. Purified antibody solutions prepared by dissociation methods from Types I and II antipneumococcus horse sera were found to remove the same quantity of antibody as did the homologous specific precipitates. 4. Specific precipitates from anti-crystalline egg albumin and anti-diphtheria horse sera were found to remove only a fraction of the antibody. The reasons for this are discussed. 5. A specific precipitate prepared from pepsin-digested Type I anti-pneumococcus horse serum removed all of the antibody to the homologous antigen from the rabbit anti-precipitate serum, but followed a different quantitative course. 6. From the quantitative course of these reactions and from experiments with specific precipitates from anti-Pn rabbit and pig sera it is concluded that the only antigenic specificity demonstrable for the antibodies investigated was that due to their common origin, and that the groupings responsible for their antibody function constitute either a small part of the total protein molecule or else are non-antigenic.

QUANTITATIVE EXPERIMENTS WITH ANTIBODIES TO A SPECIFIC PRECIPITATE : III. ANTIGENIC PROPERTIES OF HORSE SERUM FRACTIONS ISOLATED BY ELECTROPHORESIS AND BY ULTRACENTRIFUGATION

1. Rabbit antisera to a Type II pneumococcus specific precipitate from horse serum were tested with fractions prepared by ultracentrifugation and electrophoresis of normal and immune horse serum. 2. In one instance a rapidly sedimenting protein from normal horse serum had nearly the same quantitative antigenic properties toward the anti-antibody rabbit serum as did the purified pneumococcus antibody solutions previously reported. In another instance a comparable fraction removed only a part of the rabbit antibody. 3. Electrophoretic γ-globulin from an immune horse serum had quantitatively the same antigenic properties as did antibody solutions prepared by salt-dissociation of specific precipitates. 4. Electrophoretic γ-globulin from normal horse serum differed in its antigenic behavior from γ-globulin containing antibody. The data are compared with the antigenic properties of acid and alkali treated pneumococcus specific polysaccharides toward antipneumococcus horse sera. An interpretation in terms of polymers is suggested. 5. The cross-reaction of goat serum γ-globulin against the anti-antibody serum is reported and the extent of the reaction compared with those of goat and horse serum albumins against a rabbit antiserum to the latter.

A FURTHER STUDY OF THE CROSS REACTION BETWEEN THE SPECIFIC POLYSACCHARIDES OF TYPES III AND VIII PNEUMOCOCCI IN HORSE ANTISERA

1. The cross reaction of the specific polysaccharide of Type VIII pneumococcus with Type III antipneumococcus horse serum has been studied quantitatively and found similar to the S III-anti-S VIII reaction. 2. Contrasted with the general similarity of the two-segment reaction curves were distinct qualitative and quantitative differences in the course and character of the reciprocal reactions with respect to each segment. 3. These differences could be interpreted in terms of the known chemical differences between the specific polysaccharides of the two types. A minimum molecular weight of 62,000 was calculated for S III and 140,000 for S VIII. 4. It was also found possible to fractionate the Type VIII antibody into portions characteristic of each segment of the cross reaction curve. At least three different kinds of Type III and Type VIII anticarbohydrates were identified.

ANTIPROTEINS IN HORSE SERA : IV. ANTIBODIES TO RABBIT SERUM GLOBULIN AND THEIR INTERACTION WITH ANTIGEN

1. The intravenous injection of two horses with alum-precipitated rabbit serum globulin resulted in the production of antibody which gave a typical precipitin reaction without a prezone in the region of antibody excess. 2. The chemical, physical, and serological properties of this antibody are comparable to those of the more familiar anticarbohydrate antibodies. 3. The subcutaneous injection of horses with the globulin antigen gave rise to low grade "univalent" antibody which did not precipitate with soluble antigen. 4. The low grade antibody could be removed from solution by attachment to preformed specific precipitates, or by coprecipitation in the presence of "multivalent" precipitating antibody. 5. It is concluded that the familiar antitoxin type of antibody is not the only form of antiprotein response in horses but that precipitating and low grade non-precipitating antibodies may also be formed. 6. The nature of the antigen and the route of injection are demonstrated to be important factors in determining the characteristics of the antibody formed.

A QUANTITATIVE THEORY OF THE PRECIPITIN REACTION : VI. THE REACTION BETWEEN MAMMALIAN THYROGLOBULINS AND ANTIBODIES TO HOMOLOGOUS AND HETEROLOGOUS PREPARATIONS

1. Quantitative data for both homologous and heterologous precipitin reactions of human, hog, beef, and sheep thyroglobulins show that these reactions have the same mechanism as other instances of the precipitin reaction and may be expressed quantitatively by the same equations derived from the law of mass action. 2. It is shown that all of the added antigen is precipitated in the region of antibody excess and in the equivalence zone, so that in these portions of the reaction range the composition of the specific precipitate may be calculated from the nitrogen precipitated and the amount of antigen nitrogen added. 3. The thyroglobulin-antibody reaction is characterized by low antibody N to antigen N ratios, as would be expected with an antigen of high molecular weight. Molecular ratios varying from 60:1 to 1:1 were calculated for the extremes of the reaction range, indicating a very large number of immunologically reactive groupings on the thyroglobulin molecule. 4. Failure of thyroxine or diiodotyrosine to inhibit specific precipitation was confirmed, but it is shown that this need not mean that these substances do not occur in thyroglobulin, as has been claimed.

Assessment of the prozone effect in malaria rapid diagnostic tests

Background

The prozone effect (or high doses-hook phenomenon) consists of false-negative or false-low results in immunological tests, due to an excess of either antigens or antibodies. Although frequently cited as a cause of false-negative results in malaria rapid diagnostic tests (RDTs), especially at high parasite densities of Plasmodium falciparum, it has been poorly documented. In this study, a panel of malaria RDTs was challenged with clinical samples with P. falciparum hyperparasitaemia (> 5% infected red blood cells).

Methods

Twenty-two RDT brands were tested with seven samples, both undiluted and upon 10 ×, 50 × and 100 × dilutions in NaCl 0.9%. The P. falciparum targets included histidine-rich protein-2 (HRP-2, n = 17) and P. falciparum-specific parasite lactate dehydrogenase (Pf-pLDH, n = 5). Test lines intensities were recorded in the following categories: negative, faint, weak, medium or strong. The prozone effect was defined as an increase in test line intensity of at least one category after dilution, if observed upon duplicate testing and by two readers.

Results

Sixteen of the 17 HRP-2 based RDTs were affected by prozone: the prozone effect was observed in at least one RDT sample/brand combination for 16/17 HRP-2 based RDTs in 6/7 samples, but not for any of the Pf-pLDH tests. The HRP-2 line intensities of the undiluted sample/brand combinations with prozone effect (n = 51) included a single negative (1.9%) and 29 faint and weak readings (56.9%). The other target lens (P. vivax-pLDH, pan-specific pLDH and aldolase) did not show a prozone effect.

Conclusion

This study confirms the prozone effect as a cause of false-negative HRP-2 RDTs in samples with hyperparasitaemia.