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The Modified Surface Killing Assay Distinguishes between Protective and Nonprotective Antibodies to PspA. mSphere 2019; 4:4/6/e00589-19. [PMID: 31826968 PMCID: PMC6908419 DOI: 10.1128/msphere.00589-19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The most important finding of this study is that the MSKA can be used as an in vitro functional assay. Such an assay will be critical for the development of PspA-containing vaccines. The other important findings relate to the locations and nature of the protection-eliciting epitopes of PspA. There are limited prior data on the locations of protection-eliciting PspA epitopes, but those data along with the data presented here make it clear that there is not a single epitope or domain of PspA that can elicit protective antibody and there exists at least one region of the αHD which seldom elicits protective antibody. Moreover, these data, in concert with prior data, strongly make the case that protective epitopes in the αHD are highly conformational (≥100-amino-acid fragments of the αHD are required), whereas at least some protection-eliciting epitopes in the proline-rich domain are encoded by ≤15-amino-acid sequences. Pneumococcal surface protein A (PspA) elicits antibody protective against lethal challenge by Streptococcus pneumoniae and is a candidate noncapsular antigen for inclusion in vaccines. Evaluation of immunity to PspA in human trials would be greatly facilitated by an in vitro functional assay able to distinguish protective from nonprotective antibodies to PspA. Mouse monoclonal antibodies (MAbs) to PspA can mediate killing by human granulocytes in the modified surface killing assay (MSKA). To determine if the MSKA can distinguish between protective and nonprotective MAbs, we examined seven MAbs to PspA. All bound recombinant PspA, as detected by enzyme-linked immunosorbent assay and Western blotting; four gave strong passive protection against fatal challenge, two were nonprotective, and the seventh one only delayed death. The four that were able to provide strong passive protection were also most able to enhance killing in the MSKA, the two that were not protective in mice were not effective in the MSKA, and the MAb that was only weakly protective in mice was weakly effective in the MSKA (P < 0.001). One of the four most protective MAbs tested reacted to the proline-rich domain of PspA. Two of the other most protective MAbs and the weakly protective MAb reacted with a fragment from PspA’s α-helical domain (αHD), containing amino acids (aa) 148 to 247 from the N terminus of PspA. The fourth highly protective MAb recognized none of the overlapping 81- or 100-aa fragments of PspA. The two nonprotective MAbs recognized a more N-terminal αHD fragment (aa 48 to 147). IMPORTANCE The most important finding of this study is that the MSKA can be used as an in vitro functional assay. Such an assay will be critical for the development of PspA-containing vaccines. The other important findings relate to the locations and nature of the protection-eliciting epitopes of PspA. There are limited prior data on the locations of protection-eliciting PspA epitopes, but those data along with the data presented here make it clear that there is not a single epitope or domain of PspA that can elicit protective antibody and there exists at least one region of the αHD which seldom elicits protective antibody. Moreover, these data, in concert with prior data, strongly make the case that protective epitopes in the αHD are highly conformational (≥100-amino-acid fragments of the αHD are required), whereas at least some protection-eliciting epitopes in the proline-rich domain are encoded by ≤15-amino-acid sequences.
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Khan N, Jan AT. Towards Identifying Protective B-Cell Epitopes: The PspA Story. Front Microbiol 2017; 8:742. [PMID: 28512452 PMCID: PMC5411445 DOI: 10.3389/fmicb.2017.00742] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 04/10/2017] [Indexed: 01/15/2023] Open
Abstract
Pneumococcal surface protein A (PspA) is one of the most abundant cell surface protein of Streptococcus pneumoniae (S. pneumoniae). PspA variants are structurally and serologically diverse and help evade complement-mediated phagocytosis of S. pneumoniae, which is essential for its survival in the host. PspA is currently been screened for employment in the generation of more effective (serotype independent) vaccine to overcome the limitations of polysaccharide based vaccines, providing serotype specific immune responses. The cross-protection eliciting regions of PspA localize to the α-helical and proline rich regions. Recent data indicate significant variation in the ability of antibodies induced against the recombinant PspA variants to recognize distinct S. pneumoniae strains. Hence, screening for the identification of the topographical repertoire of B-cell epitopes that elicit cross-protective immune response seems essential in the engineering of a superior PspA-based vaccine. Herein, we revisit epitope identification in PspA and the utility of hybridoma technology in directing the identification of protective epitope regions of PspA that can be used in vaccine research.
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Affiliation(s)
- Naeem Khan
- Glycobiology Group, Max Planck Institute of Colloids and Interfaces (MPG)Potsdam, Germany
| | - Arif T Jan
- Department of Medical Biotechnology, Yeungnam UniversityGyeongsan, South Korea
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Kolberg J, Aase A, Naess LM, Aaberge IS, Caugant DA. Human antibody responses to pneumococcal surface protein A and capsular polysaccharides during acute and convalescent stages of invasive disease in adult patients. Pathog Dis 2013; 70:40-50. [DOI: 10.1111/2049-632x.12106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Revised: 09/13/2013] [Accepted: 09/23/2013] [Indexed: 11/30/2022] Open
Affiliation(s)
- Jan Kolberg
- Department of Bacteriology and Immunology; Norwegian Institute of Public Health; Oslo Norway
| | - Audun Aase
- Department of Bacteriology and Immunology; Norwegian Institute of Public Health; Oslo Norway
| | - Lisbeth M. Naess
- Department of Bacteriology and Immunology; Norwegian Institute of Public Health; Oslo Norway
| | - Ingeborg S. Aaberge
- Department of Bacteriology and Immunology; Norwegian Institute of Public Health; Oslo Norway
| | - Dominique A. Caugant
- Department of Bacteriology and Immunology; Norwegian Institute of Public Health; Oslo Norway
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Nguyen CT, Kim SY, Kim MS, Lee SE, Rhee JH. Intranasal immunization with recombinant PspA fused with a flagellin enhances cross-protective immunity against Streptococcus pneumoniae infection in mice. Vaccine 2011; 29:5731-9. [PMID: 21696869 DOI: 10.1016/j.vaccine.2011.05.095] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2010] [Revised: 05/25/2011] [Accepted: 05/28/2011] [Indexed: 10/18/2022]
Abstract
Streptococcus pneumoniae is a major respiratory pathogen that causes high levels of mortality and morbidity in infants and the elderly. Despite the use of antibiotics and vaccines, fatal pneumococcal disease remains prevalent. Pneumococcal surface protein A (PspA), a highly immunogenic surface protein produced by all strains of S. pneumoniae, can elicit protective immunity against fatal pneumococcal infection. We have previously demonstrated that the Vibrio vulnificus FlaB, a bacterial flagellin protein and agonist of TLR5, has strong mucosal adjuvant activity and induces protective immunity upon co-administration with tetanus toxoid. In this study, we have tested whether intranasal immunization with recombinant fusion proteins consisted of PspA and FlaB (PspA-FlaB and FlaB-PspA) is able to elicit more efficient protective mucosal immune responses against pneumococcal infection than immunization with PspA alone or with a stoichiometric mixture of PspA and FlaB. When mice were intranasally immunized with fusion proteins, significantly higher levels of anti-PspA IgG and IgA were induced in serum and mucosal secretions. The mice immunized intranasally with the FlaB-PspA fusion protein were the most protected from a lethal challenge with live S. pneumoniae, as compared to the mice immunized with PspA only, a mixture of PspA and FlaB, or the PspA-FlaB fusion protein. FlaB-PspA also induced a cross protection against heterologous capsular types. These results suggest that a FlaB-PspA fusion protein alone could be used as an anti-pneumococcal mucosal vaccine or as an effective partner protein for multivalent capsular polysaccharide conjugate vaccines.
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Affiliation(s)
- Chung Truong Nguyen
- Clinical Vaccine R&D Center, Chonnam National University Hwasun Hospital, 160 Ilsimri, Hwasun-gun, Jeonnam 519-809, South Korea
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Rohatgi S, Dutta D, Tahir S, Sehgal D. Molecular Dissection of Antibody Responses against Pneumococcal Surface Protein A: Evidence for Diverse DH-Less Heavy Chain Gene Usage and Avidity Maturation. THE JOURNAL OF IMMUNOLOGY 2009; 182:5570-85. [PMID: 19380805 DOI: 10.4049/jimmunol.0803254] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
MESH Headings
- Amino Acid Sequence
- Animals
- Antibodies, Bacterial/biosynthesis
- Antibodies, Bacterial/genetics
- Antibodies, Bacterial/metabolism
- Antibodies, Monoclonal/biosynthesis
- Antibodies, Monoclonal/genetics
- Antibodies, Monoclonal/metabolism
- Antibody Affinity/genetics
- Antibody Diversity/genetics
- Bacterial Proteins/immunology
- Base Sequence
- Epitopes, B-Lymphocyte/metabolism
- Female
- Gene Deletion
- Gene Rearrangement, B-Lymphocyte, Heavy Chain/genetics
- Hybridomas
- Immunoglobulin Heavy Chains/genetics
- Immunoglobulin Heavy Chains/metabolism
- Immunoglobulin Variable Region/genetics
- Immunoglobulin Variable Region/metabolism
- Membrane Proteins/immunology
- Mice
- Mice, Inbred BALB C
- Mice, Inbred CBA
- Molecular Sequence Data
- Multigene Family/immunology
- Streptococcus pneumoniae/immunology
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Affiliation(s)
- Soma Rohatgi
- National Institute of Immunology, Aruna Asaf Ali Marg, New Delhi, India
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Kolberg J, Hammerschmidt S, Frank R, Jonák J, Šanderová H, Aase A. The surface-associated elongation factor Tu is concealed for antibody binding on viable pneumococci and meningococci. ACTA ACUST UNITED AC 2008; 53:222-30. [DOI: 10.1111/j.1574-695x.2008.00419.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Darrieux M, Moreno AT, Ferreira DM, Pimenta FC, de Andrade ALSS, Lopes APY, Leite LCC, Miyaji EN. Recognition of pneumococcal isolates by antisera raised against PspA fragments from different clades. J Med Microbiol 2008; 57:273-278. [DOI: 10.1099/jmm.0.47661-0] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Pneumococcal surface protein A (PspA) is an important vaccine candidate against pneumococcal infections, capable of inducing protection in different animal models. Based on its structural diversity, it has been suggested that a PspA-based vaccine should contain at least one fragment from each of the two major families (family 1, comprising clades 1 and 2, and family 2, comprising clades 3, 4 and 5) in order to elicit broad protection. This study analysed the recognition of a panel of 35 pneumococcal isolates bearing different PspAs by antisera raised against the N-terminal regions of PspA clades 1 to 5. The antiserum to PspA clade 4 was found to show the broadest cross-reactivity, being able to recognize pneumococcal strains containing PspAs of all clades in both families. The cross-reactivity of antibodies elicited against a PspA hybrid including the N-terminal region of clade 1 fused to a shorter and more divergent fragment (clade-defining region, or CDR) of clade 4 (PspA1–4) was also tested, and revealed a strong recognition of isolates containing clades 1, 4 and 5, and weaker reactions with clades 2 and 3. The analysis of serum reactivity against different PspA regions further revealed that the complete N-terminal region rather than just the CDR should be included in an anti-pneumococcal vaccine. A PspA-based vaccine is thus proposed to be composed of the whole N-terminal region of clades 1 and 4, which could also be expressed as a hybrid protein.
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Affiliation(s)
- Michelle Darrieux
- Centro de Biotecnologia, Instituto Butantan, Av. Vital Brasil, 1500, 05509-900, São Paulo, SP, Brazil
| | - Adriana T. Moreno
- Centro de Biotecnologia, Instituto Butantan, Av. Vital Brasil, 1500, 05509-900, São Paulo, SP, Brazil
| | - Daniela M. Ferreira
- Centro de Biotecnologia, Instituto Butantan, Av. Vital Brasil, 1500, 05509-900, São Paulo, SP, Brazil
| | - Fabiana C. Pimenta
- Instituto de Patologia Tropical e Saude Publica, Universidade Federal de Goias, Goiania, Brazil
| | | | - Alexandre P. Y. Lopes
- Centro de Biotecnologia, Instituto Butantan, Av. Vital Brasil, 1500, 05509-900, São Paulo, SP, Brazil
| | - Luciana C. C. Leite
- Centro de Biotecnologia, Instituto Butantan, Av. Vital Brasil, 1500, 05509-900, São Paulo, SP, Brazil
| | - Eliane N. Miyaji
- Centro de Biotecnologia, Instituto Butantan, Av. Vital Brasil, 1500, 05509-900, São Paulo, SP, Brazil
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Fusion proteins containing family 1 and family 2 PspA fragments elicit protection against Streptococcus pneumoniae that correlates with antibody-mediated enhancement of complement deposition. Infect Immun 2007; 75:5930-8. [PMID: 17923518 DOI: 10.1128/iai.00940-07] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
PspA is an important pneumococcal vaccine candidate that is capable of inducing protection in different animal models. Because of its structural diversity, a PspA-based vaccine should contain at least one fragment from each of the two major families (1 and 2) in order to elicit broader protection. In the present work, we have tested the potential of PspA hybrids containing fused portions of family 1 and 2 (PspA1ABC-4B and PspA1ABC-3AB) PspA fragments to induce protection against pneumococci bearing distinct PspA fragments. Sera from mice immunized with these hybrid PspA fragments were able to increase C3 deposition on pneumococci bearing PspA fragments from both families, in contrast with sera made against the PspA family 1 (PspA1ABC) and PspA family 2 (PspA3ABC) fragments, which were effective only within the same family. Although PspA hybrids were able to extend protection against pneumococcal infection with strains bearing diverse PspA fragments, the immunity elicited by family 2 was clade dependent, suggesting that PspA fragments from family 2 clades 3 and 4 should both be included in a comprehensive PspA vaccine. These results indicate that PspA fusion proteins constitute an efficient immunization strategy for future PspA-based antipneumococcal vaccines since they are able to extend protection provided by a protein derived from a single transcript.
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Kolberg J, Aase A, Bergmann S, Herstad TK, Rødal G, Frank R, Rohde M, Hammerschmidt S. Streptococcus pneumoniae enolase is important for plasminogen binding despite low abundance of enolase protein on the bacterial cell surface. Microbiology (Reading) 2006; 152:1307-1317. [PMID: 16622048 DOI: 10.1099/mic.0.28747-0] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Enolase represents one of the anchorless surface proteins of Streptococcus pneumoniae and has previously been identified as a plasminogen-binding protein, endowing this pathogen with host proteolytic activity. In this study the mAb 245,C-6 (IgG1) was produced in a BALB/c mouse after immunizing with a protein fraction from S. pneumoniae. The mAb reacted with recombinant pneumococcal enolase both under non-denaturing and denaturing conditions. The epitope for the mAb was mapped to residues 55DKSRYGGLG63 of pneumococcal enolase using a peptide array. By applying the previously reported structure of enolase, this epitope was localized in a surface-exposed loop in each of the monomers of the octameric enolase. Previous immunoelectron microscopic studies, using polyclonal rabbit antibodies against enolase, depicted enolase on the cell surface but did not quantify the amount of surface-exposed enolase on viable pneumococci. Here, flow cytometry revealed no binding of mAb 245,C-6 to viable pneumococci, including TIGR4 and its non-encapsulated isogenic mutant, and only a minor increase of fluorescence intensity was measured when the polyclonal anti-enolase antibodies were used. In contrast, control antibodies recognizing the choline-binding proteins (CBPs) PspA and PspC showed high reactivities. The non-encapsulated TIGR4 did not show increased levels of antibody binding for mAb 245,C-6 or polyclonal anti-enolase antibodies, but revealed increased binding of polyclonal antibodies reacting with PspA or PspC. These results suggest that, compared to other surface-exposed proteins such as CBPs, the amount of enolase under the selected conditions is low. Flow cytometry, however, with FITC-labelled plasminogen demonstrated that the amount of surface-exposed enolase is important for plasminogen binding and, therefore, is also important for pneumococcal pathogenesis.
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Affiliation(s)
- Jan Kolberg
- Department of Bacteriology and Immunology, Norwegian Institute of Public Health, Box 4404 Nydalen, NO-0403 Oslo, Norway
| | - Audun Aase
- Department of Bacteriology and Immunology, Norwegian Institute of Public Health, Box 4404 Nydalen, NO-0403 Oslo, Norway
| | - Simone Bergmann
- Research Center for Infectious Diseases, University of Würzburg, Roentgenring 11, D-97070 Würzburg, Germany
| | - Tove K Herstad
- Department of Bacteriology and Immunology, Norwegian Institute of Public Health, Box 4404 Nydalen, NO-0403 Oslo, Norway
| | - Gunnhild Rødal
- Department of Bacteriology and Immunology, Norwegian Institute of Public Health, Box 4404 Nydalen, NO-0403 Oslo, Norway
| | - Ronald Frank
- Department of Chemical Biology, German Research Centre for Biotechnology, Mascheroder Weg 1, D-38124 Braunschweig, Germany
| | - Manfred Rohde
- Department of Microbial Pathogenesis, German Research Centre for Biotechnology, Mascheroder Weg 1, D-38124 Braunschweig, Germany
| | - Sven Hammerschmidt
- Research Center for Infectious Diseases, University of Würzburg, Roentgenring 11, D-97070 Würzburg, Germany
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Jedrzejas MJ. Unveiling molecular mechanisms of pneumococcal surface protein A interactions with antibodies and lactoferrin. Clin Chim Acta 2006; 367:1-10. [PMID: 16513101 DOI: 10.1016/j.cca.2005.09.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2005] [Revised: 09/27/2005] [Accepted: 09/29/2005] [Indexed: 11/16/2022]
Abstract
BACKGROUND Streptococcus pneumoniae is a Gram-positive bacterium and a major human pathogen. The organism displays on its surface a variety of molecules that are involved in many essential processes including interactions with the tissues and molecules of its human host. A number of such surface molecules are essential virulence factors in disease processes and pathogenesis during all stages of bacterial life. FOCUS Here we introduce one such surface protein, pneumococcal surface protein A (PspA), and show its molecular and structural aspects, and underlying mechanism of function at the atomic level as currently understood. The basis of its anti-complementary properties and functional interactions with its ligand, lactoferrin, is discussed. The PspA antigen binding to lactoferrin prevents the bactericidal effect of this human molecule of many functions. This review is focused on new function characterization studies performed during this century (year 2001 and later). Earlier studies on PspA were reviewed by this author in 2001 and 2004 [Jedrzejas MJ. Pneumococcal virulence factors: structure and function. Microbiol Mol Biol Rev, 2001;65:187-207; Jedrzejas MJ. Extracellular virulence factors of Streptococcus pneumoniae. Front Biosci 2004;9:891-914]. CONCLUSIONS The discovery and understanding of the molecular mechanisms of individual virulence factors, including PspA, are essential to the appreciation of S. pneumoniae function and mechanisms responsible for colonization and invasion of human tissues by this organism. The utilization of a microscopic view at the atomic level provided by structural biology is essential to this process of discovery. The development of new and better cures for the disease might follow as a result of such awareness.
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Affiliation(s)
- Mark J Jedrzejas
- Children's Hospital Oakland Research Institute, 5700 Martin Luther King, Jr. Way, Oakland, CA 94609, USA.
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Bogaert D, Hermans PWM, Adrian PV, Rümke HC, de Groot R. Pneumococcal vaccines: an update on current strategies. Vaccine 2005; 22:2209-20. [PMID: 15149779 DOI: 10.1016/j.vaccine.2003.11.038] [Citation(s) in RCA: 139] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2003] [Revised: 11/06/2003] [Accepted: 11/20/2003] [Indexed: 11/28/2022]
Abstract
Streptococcus pneumoniae is a major cause of morbidity and mortality in infants, children and the elderly. Despite the availability of excellent antimicrobial therapy and adequate health care systems, respiratory diseases and invasive infections caused by pneumococci still comprise a major health problem. The emerging resistance to penicillin and other commonly used antibiotics underscores the importance of the development of novel vaccine strategies to combat pneumococcal disease. Although the 23-valent polysaccharide (PS) vaccine is immunogenic and protective in most adults and children over 5 years of age, they fail to protect children under 2 years of age. Fortunately, the recent conjugate vaccines have shown to be highly efficacious in preventing invasive diseases in this risk group. Moreover, promising results regarding prevention of pneumonia and acute otitis media have been published. Unfortunately, protection is raised against a limited number of pneumococcal serotypes, and serotype replacement and subsequent vaccine failure have become a serious concern. Currently, several pneumococcal surface proteins are considered as alternative vaccine candidates because of their serotype-independence. Thus far, pneumococcal surface adhesin A (PsaA) has proven to be highly protective against colonization in animal models. Moreover, pneumococcal surface protein A (PspA) and pneumolysin have shown to elicit protection against invasive diseases. Future research will elucidate their true potential in protecting humans. In this paper we discuss the present knowledge on pneumococcal vaccines and the current status of novel vaccine strategies.
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Affiliation(s)
- D Bogaert
- Department of Pediatrics, Erasmus MC-Sophia, Dr. Molewaterplein 60, 3015 GJ Rotterdam, The Netherlands
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Kolberg J, Aase A, Rødal G, Littlejohn JE, Jedrzejas MJ. Epitope mapping of pneumococcal surface protein A of strain Rx1 using monoclonal antibodies and molecular structure modelling. ACTA ACUST UNITED AC 2003; 39:265-73. [PMID: 14642312 DOI: 10.1016/s0928-8244(03)00255-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Pneumococcal surface protein A (PspA) is an antigenic variable vaccine candidate of Streptococcus pneumoniae. Epitope similarities between PspA from the American vaccine candidate strain Rx1 and Norwegian clinical isolates were studied using PspA specific monoclonal antibodies (mAbs) made against clinical Norwegian strains. Using recombinant PspA/Rx1 fragments and immunoblotting the epitopes for mAbs were mapped to two regions of amino acids, 1-67 and 67-236. The discovered epitopes were visualized by modelling of the PspA:Fab part of mAb in three dimensions. Flow cytometric analysis showed that the epitopes for majority of mAbs were accessible for antibody binding on live pneumococci. Also, the epitopes for majority of the mAbs are widely expressed among clinical Norwegian isolates.
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Affiliation(s)
- Jan Kolberg
- Department of Airborne Infections, Norwegian Institute of Public Health, P.O. Box 4404, Nydalen, 0403 Oslo, Norway.
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