Neutralizing antibody to Pseudomonas aeruginosa exotoxin in human sera: evidence for in vivo toxin production during infection

Isolation and characterizations of a novel recombinant scFv antibody against exotoxin A of Pseudomonas aeruginosa

BACKGROUND

Pseudomonas aeruginosa is the leading cause of nosocomial infections, especially in people with a compromised immune system. Targeting virulence factors by neutralizing antibodies is a novel paradigm for the treatment of antibiotic-resistant pseudomonas infections. In this respect, exotoxin A is one of the most potent virulence factors in P. aeruginosa. The present study was carried out to identify a novel human scFv antibody against the P. aeruginosa exotoxin A domain I (ExoA-DI) from a human scFv phage library.

METHODS

The recombinant ExoA-DI of P. aeruginosa was expressed in E. coli, purified by Ni-NTA column, and used for screening of human antibody phage library. A novel screening procedure was conducted to prevent the elimination of rare specific clones. The phage clone with high reactivity was evaluated by ELISA and western blot.

RESULTS

Based on the results of polyclonal phage ELISA, the fifth round of biopanning leads to the isolation of several ExoA-DI reactive clones. One positive clone with high affinity was selected by monoclonal phage ELISA and used for antibody expression. The purified scFv showed high reactivity with the recombinant domain I and full-length native exotoxin A.

CONCLUSIONS

The purified anti-exotoxin A scFv displayed high specificity against exotoxin A. The human scFv identified in this study could be the groundwork for developing a novel therapeutic agent to control P. aeruginosa infections.

Fms-like tyrosine kinase-3 ligand alters antigen-specific responses to infections after severe burn injury

Burn patients are susceptible to opportunistic infections partly because of decreased immune functions, especially TH1-driven antigen-specific responses, which are regulated by dendritic cells. The dendritic cell growth factor, fms-like tyrosine kinase-3 ligand (FL), has been shown to increase resistance to Pseudomonas aeruginosa, in a dendritic cell-dependent manner, in a mouse model of burn wound infection. The specific mechanisms of protection are not known. This study tested the hypothesis that FL can enhance production of P. aeruginosa-specific antibodies after burn wound infection. Mice that had been previously exposed to P. aeruginosa were infected after burn injury by wound inoculation or challenged by intraperitoneal injection of heat-killed P. aeruginosa. In response to wound infection, FL treatments enhanced bacterial clearance and induced a shift from immunoglobulin (Ig) M toward IgG and IgA. However, serum levels of neither P. aeruginosa-specific antibodies nor interferon gamma (IFN-gamma) were significantly increased by FL, possibly because of decreased systemic exposure to bacteria. After challenge with heat-killed bacteria, which ensured equal exposures, FL-treated mice produced significantly greater levels of P. aeruginosa-specific IgG2a, which correlated with an increase in serum levels of interferon gamma and enhanced opsonization capacity. IL-12, IL-10, and transforming growth factor beta were significantly increased in FL-treated mice, regardless of the type of challenge. These findings indicate that FL treatments after burn injury enhance cytokine responses to recall antigens and increase bacterial clearance. In addition, through its ability to promote TH1-associated antigen-specific responses, FL may have potential as an immunotherapy to enhance adaptive immunity after severe burn injury.

Active immunization using exotoxin A confers protection against Pseudomonas aeruginosa infection in a mouse burn model

BACKGROUND

Pseudomonas aeruginosa is an important cause of nosocomial infection and may lead to septicemia and death. We evaluated the immunogenicity of semi-purified exotoxin A from the bacterium in a mouse burn model.

METHODS

The toxoid was prepared from exotoxin A taken from toxigenic strains of P. aeruginosa (PA 103). 50 mice were immunized with the toxoid, burned with hot metal and infected with 1 x 10(8) CFU of toxigenic strains of P. aeruginosa (experimental group); 25 non-immunized mice were also burned and infected (control group). The mortality rate and presence of any exotoxin and P. aeruginosa in the sera, liver and spleen were determined.

RESULTS

In the experimental group, 2 mice died before the burns were administered and were excluded from the study. The remainder (48 mice) were challenged with a lethal dose of P. aeruginosa and followed for 70 days. 3 of these mice died. Neither P. aeruginosa nor exotoxin A was not detected in the liver, spleen or sera of the surviving mice. The protective efficacy of toxoid vaccination was therefore 93.8%. In the control group, all mice died from bacteremia and septicemia, most (80%) within 6 days, and P. aeruginosa and exotoxin A were isolated from sera, spleen and liver.

CONCLUSION

Active immunization of mice using a semi-purified exotoxin A derived from P. aeruginosa was 93.8% effective at protecting mice from subsequent P. aeruginosa infections in a mouse burn model.

Effect of static growth and different levels of environmental oxygen on toxA and ptxR expression in the Pseudomonas aeruginosa strain PAO1

Within certain infection sites, such as the lung of cystic fibrosis patients, Pseudomonas aeruginosa grows statically under either decreased oxygen tension or anaerobic conditions, a situation that is likely to influence the production of virulence factors. The goal of this study was to determine the effect of static growth under microaerobic (decreased oxygen) and anaerobic conditions on the expression of the P. aeruginosa exotoxin A (ETA) gene toxA and its positive regulator ptxR. Using toxA-lacZ and ptxR-lacZ fusion plasmids, the level of toxA and ptxR expression was measured throughout the growth cycle of strain PAO1, which was grown in either iron-deficient or iron-sufficient medium under four different conditions: 20%-SH (aerobic, shaking), 20%-ST (aerobic, static), 10%-ST (microaerobic, static) and 0%-ST (anaerobic, static). In iron-deficient medium, toxA expression was higher under 20%-ST and 10%-ST than under 20%-SH. However, the highest level of toxA expression occurred under 0%-ST. Analysis of ETA protein using sandwich ELISA revealed that at time points between 8 and 24 h of the growth curve, PAO1 produced higher levels of ETA under 0%-ST than under 20%-SH. In iron-sufficient medium, toxA expression was significantly repressed under all conditions. Additional analyses using PAO1 strains that carry lacZ fusions with the toxA regulatory genes regA and pvdS revealed that the expression of regA and pvdS is reduced rather than increased at 0%-ST. ptxR expression under different conditions paralleled that of toxA expression, except that it was repressed by iron under 20 %-SH only. Between 6 and 24 h of growth, and under all conditions, the level of dissolved oxygen (DO) within the PAO1 cultures was sharply reduced. These results suggest that (1) the combined effect of static growth and anaerobic conditions produce a significant increase in toxA and ptxR expression in PAO1; (2) this effect appears to be unique to toxA and ptxR, since the level of regA and pvdS expression was reduced under the same conditions; (3) neither static growth nor anaerobic conditions interfere with the repression of toxA expression by iron, although static growth deregulates ptxR expression with respect to iron; and (4) the enhanced expression of toxA and ptxR is not related to the reduced levels of DO in PAO1 cultures.

Association between transcript levels of the Pseudomonas aeruginosa regA, regB, and toxA genes in sputa of cystic fibrosis patients

In this study, we examined the regulation of exotoxin A (ETA) production by Pseudomonas aeruginosa during chronic lung infections of cystic fibrosis (CF) patients. We used a recently developed technique termed population transcript accumulation in hybridization studies with RNA extracted from sputa. With this technique, we demonstrated that the structural gene for ETA, toxA, as well as two genes encoding positive regulators of ETA synthesis, regA and regB, were expressed in the lungs of CF patients infected with P. aeruginosa. These genes were always expressed together, never alone or in pairs, suggesting coincident expression and a possible regulatory role for regA and regB in this environment. Fluctuations in the levels of the three gene products were observed among samples, consistent with a regulatory phenomenon. The level of regB RNA detected never exceeded that of regA, although the ratio of regA RNA to regB RNA detected did change between samples. These observations are in agreement with in vitro observations which have shown that regB is located 3' to regA in an operon which is expressed from two independently regulated promoters located upstream of regA. The presence of high levels of toxA, regA, and regB RNAs in some sputum samples prompted us to look for hyperproducing-toxin strains in the sputa of CF patients. In vitro, one such strain, 4384, had a transcript accumulation pattern for toxA, regA, and regB similar to that of a laboratory hyperproducer of ETA, strain PA103. These observations suggest that regA and regB are involved in the regulation of ETA production in strains of P. aeruginosa infecting the lungs of CF patients and that some of these strains may regulate ETA production in a manner similar to that of the hyperproducing-ETA strain PA103.

Comparative in vitro exoenzyme-suppressing activities of azithromycin and other macrolide antibiotics against Pseudomonas aeruginosa

The inhibitory effects of azithromycin (AZM), a new 15-membered macrolide antibiotic, on the production of exotoxin A, total protease, elastase, and phospholipase C by Pseudomonas aeruginosa were determined, and the virulence-suppressing effects of AZM were compared with those of erythromycin (EM), roxithromycin (RXM), and rokitamycin (RKM). The effect of exposure of P. aeruginosa PA103 or B16 in cultures to sub-MICs of these macrolide antibiotics on the production of exoenzymes was determined. AZM suppressed the in vitro production of extracellular and intracellular exotoxin A by P. aeruginosa PA103 more than did EM, even at a concentration of only 2 micrograms/ml. At concentrations of between 4 and 32 micrograms/ml, AZM also inhibited total protease, elastase, and phospholipase C production by P. aeruginosa B16 more than did EM, RXM, and RKM. AZM was effective in suppressing exotoxin A and total protease production through 24 h of incubation in the presence of drug at sub-MICs, but it had no significant effect on either the growth of P. aeruginosa or its total protein production. Moreover, at a concentration of 4 micrograms/ml, AZM suppressed exoenzyme production by other strains of P. aeruginosa more than did EM. These findings indicate that AZM, EM, RXM, and RKM each has an inhibitory effect on exoenzyme production separate from the antimicrobial effect and that, of these macrolides, AZM has the strongest virulence-suppressing effect.

Laboratory and clinical evaluation of conjugate vaccines composed of Staphylococcus aureus type 5 and type 8 capsular polysaccharides bound to Pseudomonas aeruginosa recombinant exoprotein A

The synthesis, standardization, and immunogenicity in young outbred mice and clinical evaluation in adult volunteers of investigational vaccines designed to induce serum antibodies to the type 5 and type 8 capsular polysaccharides (CPs) of Staphylococcus aureus are described. Conjugates composed of the type 5 CP and a sonicated preparation of a high-molecular-weight type 8 CP bound to a nontoxic recombinant protein derived from Pseudomonas aeruginosa exotoxin A (rEPA) were synthesized. The conjugates were nontoxic and elicited serum CP antibodies after two subcutaneous injections into young outbred mice; a third injection elicited a booster response. The lower-molecular-weight type 8 CP was not immunogenic in the mice, and the high-molecular-weight type 8 CP elicited low levels of antibodies without a booster effect. In the volunteers, neither the conjugates nor the type 8 CP alone caused significant local reactions or fever. The conjugates elicited type-specific antibodies of both the immunoglobulin M (IgM) and IgG classes after the first injection; a second injection 6 weeks later did not stimulate a booster effect. The high-molecular-weight type 8 CP alone, injected once only, elicited levels of IgG and IgM type-specific antibodies similar to those of the conjugate. The vaccine-induced CP antibodies were mostly of the IgG1 and IgG2 subclasses and had opsonophagocytic activity. The conjugates elicited IgG antibodies to the native exotoxin A with neutralizing activity. In summary, the type 5 and type 8 conjugates were safe and elicited biologically active antibodies to both the CP and rEPA components.

Population transcript accumulation of Pseudomonas aeruginosa exotoxin A and elastase in sputa from patients with cystic fibrosis

The in vivo regulation of Pseudomonas aeruginosa virulence factors during the chronic lung infections associated with cystic fibrosis is poorly understood. We have developed an approach for the analysis of transcript accumulation of individual virulence factors from the P. aeruginosa populations found in the sputa of patients with cystic fibrosis. This method has been named population transcript accumulation, since we examine the transcript accumulation patterns in RNA extracted from the total bacterial population found in the sputum samples. DNA probes specific for P. aeruginosa elastase (lasB) and exotoxin A (toxA) were used to examine the population transcript accumulation of 21 sputum samples taken from 10 patients. We detected three patterns of population transcript accumulation: lasB and toxA, lasB alone, and neither lasB nor toxA. We also measured the relative levels of elastase and exotoxin A transcript accumulation in 19 of these samples. In the six samples containing both toxA and lasB transcripts, we found that the levels of lasB transcripts were consistently higher than those of toxA. Differences in the stability of the two mRNA species could not completely account for the higher level of lasB population transcript accumulation, since we showed that the mRNA half-life of lasB (11 min) was similar to that of toxA (10 min). Finally, we showed that elastase transcripts could be detected in some samples which contained only mucoid isolates. This finding suggests that both mucoid and nonmucoid populations may be transcribing lasB in the lungs of patients with cystic fibrosis.

Synthesis and immunologic properties in mice of vaccines composed of Staphylococcus aureus type 5 and type 8 capsular polysaccharides conjugated to Pseudomonas aeruginosa exotoxin A

Epidemiological, serological and in vitro phagocytosis experiments provide evidence that the newly discovered type 5 and type 8 capsular polysaccharides (CPs) are both virulence factors and protective antigens for bacteremia caused by Staphylococcus aureus. Neither type 5 nor type 8 CP elicited serum antibodies when injected into mice. These two CPs were bound to Pseudomonas aeruginosa exotoxin A (ETA) to form conjugates by using the synthetic scheme devised for the CP (Vi) of Salmonella typhi and of pneumococcus type 12F (A. Fattom, W. F. Vann, S. C. Szu, A. Sutton, X. Li, D. Bryla, G. Schiffman, J. B. Robbins, and R. Schneerson, Infect. Immun. 56:2292-2298, 1988; S. C. Szu, A. L. Stone, J. D. Robbins, R. Schneerson, and J. B. Robbins, J. Exp. Med. 166:1510-1524, 1987). Both S. aureus CP-ETA conjugates elicited a rise in CP antibodies. As components of conjugates, both S. aureus CPs acquired T-cell-dependent properties, as shown by their ability to respond to carrier priming and to stimulate booster responses. The conjugate-induced antibodies facilitated type-specific opsonization of S. aureus by human polymorphonuclear leukocytes. The conjugates also induced ETA antibodies which neutralized the native toxin in vitro. Clinical studies of these two conjugates for active or passive immunization of patients at risk for S. aureus bacteremia are planned.

Pseudomonas aeruginosa exotoxin A primes human monocyte oxidative burst response in vitro

Modulation of the oxidative burst responsiveness of human blood monocytes and neutrophils after incubation with purified exotoxin A from Pseudomonas aeruginosa was studied in a lucigenin- and luminol-enhanced chemiluminescence system. Exotoxin A alone caused a dose-dependent stimulation of monocyte chemiluminescence responses, whereas neutrophil responses were inconsistent. Preincubation of monocytes with exotoxin A primed the cells for a significantly higher oxidative burst response when N-f-methionyl-leucyl-phenylalanine (fMLP) was used as a secondary stimulus, especially in the lucigenin-enhanced system. Heat-treatment at 100 degrees C for 15 min completely abolished the priming activity of the exotoxin A preparation. These findings demonstrate that exotoxin A modulates monocyte responsiveness in the chemiluminescence assay and suggest that increased release of toxic oxygen radicals from mononuclear phagocytes may contribute to the tissue damage in lungs with chronic P. aeruginosa infections.

Functionally distinct monoclonal antibodies reactive with enzymatically active and binding domains of Pseudomonas aeruginosa toxin A

Monoclonal antibodies (MAbs) are described which react with two discrete structural domains of Pseudomonas aeruginosa toxin A and which have two distinct functional profiles. The MAbs designated T3-1C7 and T4-1F2 reacted with a 46,000-dalton peptide similar to the putative B or binding fragment of toxin A. These antibodies neutralized the cytotoxic and lethal properties of toxin but had no effect on its ADP-ribosyl transferase activity. T4-1F2 interfered with the binding of toxin A to membrane receptors on mouse fibroblasts (L cells), although the epitope for the antibody appears to be distinct from the actual receptor binding site. The MAb designated T2-1H2 reacted with intact toxin A and with a cloned, enzymatically active carboxy-terminal polypeptide similar to the toxin A fragment. This MAb neutralized the ADP-ribosyl transferase activity of activated holotoxin and of the cloned peptide, but inhibited neither binding of toxin to membrane receptors nor its cytotoxic and lethal actions. The complementary specificity and function of these MAbs confirm the functional specialization of discrete structural domains within the toxin A molecule. Our findings suggest the greater antitoxic potential of antibodies that block binding, compared with those which inhibit the enzymatic activity of toxin A.

Detection of anti-Vibrio vulnificus cytolysin antibodies in sera from mice and a human surviving V. vulnificus disease

An enzyme-linked immunosorbent assay and a cytolysin neutralization assay were used detect anti-Vibrio vulnificus cytolysin antibodies in sera from mice and a human that survived V. vulnificus disease. The detection of antibodies against the cytolysin indicated that the cytolysin is produced in vivo, and this observation is consistent with the hypothesis that the cytolysin is involved in the pathogenesis of V. vulnificus disease.

Gram-negative bacillary infections. Pathogenic and pathophysiologic correlates

Gram-negative bacillary infections continue to be extremely important. Escherichia coli is the single most frequently encountered pathogen, followed by organisms belonging to the tribe Klebsiella-Enterobacter-Serratia and Proteus-Providencia. Pseudomonas aeruginosa, although it receives considerable (perhaps excessive) attention, is found relatively less frequently, occurring principally in the hospitalized patient who is immunocompromised. Many factors, both host and microbial, are responsible for invasiveness, virulence, and pathogenicity of gram-negative bacilli, but their relative roles, importance, and the pathophysiologic reactions they trigger are yet to be precisely defined. Certain aspects of many (but certainly not all) of the pathogenic correlates considered important in gram-negative bacillary infections, such as microbial flora, local barriers, surface and serum antibodies, complement, cell-mediated immunity, slime production, capsules, pili, endotoxin, cell wall components, extracellular products, and inoculum size are discussed herein. Points at which preventive or therapeutic strategies might be developed are offered. The benefits of antibiotics in managing susceptible gram-negative bacillary infections appear to be plateauing. If further advances are to be made in the therapy of these infections, new approaches to rapidly identifying the responsible etiologic agent and a better understanding of the factors responsible for invasiveness, virulence, and pathogenicity are needed.

[Infections of the respiratory tract with Pseudomonas aeruginosa in cystic fibrosis]

The main cause of death in cystic fibrosis (CF) patients is progressive pulmonary insufficiency frequently associated with chronic infections of the respiratory tract by Pseudomonas aeruginosa. Bacteria of this species synthesize numerous extracellular products contributing to its pathogenicity. An alginate-like exopolysaccharide is characteristic for mucoid mutants predominating among P. aeruginosa isolates from CF patients. It interferes with immune defense mechanisms of the host and probably protects the bacteria against certain antibiotics. Furthermore, it is involved in the formation of bacterial microcolonies that resist mucociliary clearance, opsonisation, and phagocytosis. Exotoxin A and elastase are regarded as the most important among various extracellular enzymes involved in pulmonary injury in CF patients. Exotoxin A inhibits eukaryotic protein synthesis leading to necrosis; elastase, together with other Pseudomonas-proteases, induces hemorrhagic lesions and necrosis and seems to inactivate immunoglobulins and complement factors. Phospholipase C and glycolipid represent two hemolysins of P. aeruginosa that may contribute to cytopathogenic effects in infected lungs. No primary defect in the immunological defense mechanisms of CF patients has been described so far. Antibodies against various P. aeruginosa antigens including those mentioned above have been demonstrated, but a complete elimination of the bacteria from infected lungs has not been observed. Therapy of pulmonary P. aeruginosa infections in CF patients usually includes combinations of antibiotics of the beta-lactam and aminoglycoside type. Difficulties arise from an unusually high intrinsic resistance of P. aeruginosa as well as from poor penetration of many antibiotics into the sputum of CF patients. Therefore, future efforts to manage the Pseudomonas problem in CF will probably concentrate on prophylactic therapy, e.g. childhood vaccination of CF patients in order to prevent bacterial colonization of the respiratory tract.

Bacterial toxin vaccines

A rebirth of interest and activity in vaccine development has occurred in recent years which is probably due to the persistence of threat to health by infectious diseases, as well as technological advances which have made possible new approaches to solve old problems. Most work being done today with vaccine development against diseases caused entirely or in part by bacterial toxins falls into the categories of, attenuated organisms (whether by classical means or application of newly developed genetic technologies), and/or toxin subunits (derived by genetic manipulations, peptide synthesis, or chemical modification of toxins). This review discusses some of these new approaches in general as well as specific examples of their application to several bacterial diseases whose pathologies involve toxins.

Trafficking of Pseudomonas exotoxin A in mammalian cells

Experiments designed to elucidate cellular internalization of Pseudomonas aeruginosa exotoxin A are described. Inhibition of protein synthesis was used as an index of the biological activity of exotoxin A, and a biotinyl-toxin: avidin-gold system to follow its movement on the ultrastructural level. Addition of amantadine, methylamine and dansylcadaverine to cells enhanced the toxicity of exotoxin A at lower concentrations, while protecting cells at higher concentrations. In general, both sensitive and resistant cell lines responded similarly. Exposure of LM or Vero cells to an acidic extracellular pH did not overcome the protection afforded by ammonium chloride against exotoxin A cytotoxicity. This and other data suggest that sensitive and resistant cells may internalize exotoxin A in a similar manner, the toxin entering the cytosol from a prelysosomal acidic vacuole.

Effect of Pseudomonas aeruginosa exotoxin-A on the synthesis and secretion of proteins in isolated rat pancreatic acini

Exposure of isolated rat dispersed pancreatic acini to increasing concentrations (10 to 1000 ng/ml) of purified exotoxin-A from Pseudomonas aeruginosa resulted in a progressive inhibition of 3H-leucine incorporation into "cellular" (those remaining in the cells) and "secretory" (those released into the medium) proteins. With each concentration of exotoxin-A, magnitude of reduction was found to be greater for the "secretory" proteins than that observed for the "cellular" proteins. Thus, in the presence of 250 ng/ml of exotoxin-A, a dose that produced maximal inhibition in protein synthesis, 3H-leucine incorporation into "cellular" and "secretory" proteins was found to be decreased by about 19 and 50%, respectively, when compared with the corresponding basal controls. Release of trypsinogen, chymotrypsinogen and amylase from the isolated pancreatic acini was also inhibited by high doses of exotoxin-A. However, whereas the exotoxin concentration of 1000 ng/ml, caused a near complete inhibition of chymotrypsinogen release, trypsinogen and amylase secretion were decreased by 40 and 50%, respectively. It is concluded that in isolated pancreatic acini, exotoxin-A inhibits the synthesis and secretion of proteins.

Identification of the principal T lymphocyte-stimulating antigens of Pseudomonas aeruginosa

To aid in understanding the role of cellular immunity in limiting Pseudomonas aeruginosa infections, we have identified some of the principal antigens of the organism that are recognized by human T cells. Clones of T cells were selected in such a manner that they would provide information not only about the identity of Pseudomonas antigens, but also the T cell repertoires of immune donors. Most clones were found to be specific for Pseudomonas alkaline protease (AP). Such clones could be physically isolated by selecting with crude Pseudomonas antigens or purified AP. In either case, their fine specificities were the same when tested against a panel of Pseudomonas antigens. The conclusion that AP is the principal immunogen for many donors was confirmed by measuring the absolute frequencies of proliferating T cells committed to AP and all other Pseudomonas antigens. Frequencies of AP-specific clones (1.5-2.7 X 10(-5] were comparable to those from the same donors that were specific for all secreted Pseudomonas antigens (1.3-6.0 X 10(-5]. These results provide a model system for studying human T cell-mediated immunity to bacteria by identifying discrete antigens and measuring the repertoire diversities of cells responding to them.

Production and characterization of monoclonal antibodies to exotoxin A from Pseudomonas aeruginosa

Hybridomas secreting monoclonal antibodies specific for exotoxin A from Pseudomonas aeruginosa strain PA103 were derived from the fusion of spleen cells from mice immunized with: (i) purified exotoxin A, (ii) Formalin-treated exotoxin A, (iii) exotoxin A covalently coupled to Sepharose 4B, or (iv) P. aeruginosa-infected mice. All hybridomas were screened and selected by using an enzyme-linked immuno-adsorbent assay. All antibody isotypes were represented (immunoglobulins G, A, and M) as determined by enzyme-linked immunoadsorbent assay. The most productive fusions resulted from immunization with antigens coupled to an insoluble matrix, such as Sepharose 4B, or by infection of mice. Several hybridomas were selected and cloned by limiting dilution. The specificity of the monoclonal antibodies for exotoxin A was demonstrated by indirect immunoprecipitation of 125I-labeled exotoxin A followed by sodium dodecyl sulfate-polyacrylamide gel electrophoresis analysis and by the immunoblotting technique. The protective ability of certain monoclonal antibodies was demonstrated in vitro by toxin neutralization in tissue culture and in vivo by prolonged survival time in the burned mouse infection model, after passive immunization. One monoclonal antitoxin displayed specificity for PA103-derived exotoxin yet failed to react with exotoxin purified from PAO-PR1 or PAO1, suggesting that structural differences exist between these exotoxins.

Toxoids of Pseudomonas aeruginosa exotoxin-A: photoaffinity inactivation of purified toxin and purified toxin derivatives

For the preparation of greatly detoxified but highly immunogenic toxoids, two enzymatically active, low-toxicity derivatives of Pseudomonas aeruginosa exotoxin-A were further inactivated by photoaffinity labeling. These derivatives were formed during toxin purification, when a relatively crude toxin preparation was concentrated by ammonium sulfate precipitation and subsequently dialyzed. These derivatives, designated peak-1 protein (PK-1) and peak-2 protein (PK-2) were antigenically indistinguishable from native toxin, but had isoelectric points (5.00 and 4.90, respectively) that were different from that of the native toxin (4.95). Although the enzymatic activities and molecular weights of PK-1 and PK-2 were similar to those of native toxin, their toxicities were greatly reduced (ca. 500-fold). Photoaffinity labeling of fully active toxin-A, purified by a process which limits the formation of these derivatives, decreased its enzymatic activity (ca. 30-fold) and toxicity (ca. 100-fold). Likewise, photoaffinity labeling of purified PK-1 and PK-2 decreased their enzymatic activities and toxicities (ca. 30-fold and 100-fold, respectively) and, thus, yielded toxoids that were ca. 50,000-fold less toxic than unpurified native toxin. These toxoids were irreversibly detoxified and highly immunogenic during 9 months of storage at 4 degrees C.

Comparative analysis of serum antibody responses to Pseudomonas aeruginosa exotoxin A by cystic fibrosis and intensive care unit patients

Pulmonary infection with Pseudomonas aeruginosa is a major cause of morbidity and mortality in cystic fibrosis (CF) patients. P. aeruginosa toxin is one of several proposed virulence factors which may be responsible for chronic P. aeruginosa infections in these patients. With a highly specific, sensitive, and quantitative radioimmunoassay (RIA) and a cell culture assay, the humoral immune responses of CF patients in terms of total antitoxin, antitoxin immunoglobulins A and M, and neutralizing antitoxin were compared with those of P. aeruginosa-infected intensive care unit patients and controls. The P. aeruginosa-infected CF patients were divided into severe and moderate disease groups based on mortality observed over an 8-year period. The intensive care unit patients were divided by the site of infection and the controls were healthy children and uninfected CF patients. Antibodies to toxin were found in the sera of all subjects by radioimmunoassay. Neutralizing antibody was associated with current infection. Elevated titers of antitoxin immunoglobulin A were found only in subjects with pulmonary P. aeruginosa infections. No significant differences in any antibody class were observed between the severe and moderate disease groups. In addition, no differences were observed in the antitoxin immune response of chronically infected CF patients and intensive care unit patients with acute pulmonary infections.

Clinical significance of serum antibody responses to exotoxin A and type-specific lipopolysaccharides in patients with Pseudomonas aeruginosa infections

Serum antibodies to Pseudomonas aeruginosa exotoxin A and immunotype-specific lipopolysaccharides were evaluated as diagnostic and prognostic markers in patients with Pseudomonas disease. Hemagglutination titers to exotoxin A were 1:1,024 or higher and/or showed a fourfold acute-to-convalescent increase in 17 of 25 (68 percent) patients infected with Pseudomonas compared with only one of seven (15 percent) colonized (p = 0.01) and two of 24 (8 percent) culture-negative patients (p less than 0.001). By comparison, hemagglutination titers to the lipopolysaccharide of patients' Pseudomonas isolates were 1:1,024 or higher or showed a fourfold increase in only four of 17 (24 percent) infected patients and in none of six (0 percent) colonized patients (p = 0.96). Serial antibody titers to exotoxin A provided serologic confirmation of invasive disease, distinguished infection from colonization, and, in the case of decreasing titers, indicated successful therapy. It is concluded that serum antibodies to exotoxin A are useful serologic markers for the clinical assessment of Pseudomonas infections in man.

Locus of the Pseudomonas aeruginosa toxin A gene

The gene for Pseudomonas aeruginosa toxin A has been mapped in the late region of the chromosome of strain PAO. Strain PAO-PR1, which produces parental levels of toxin A antigen that is enzymatically inactive and nontoxic, was used as the donor for R68.45 plasmid-mediated genetic exchange. Strain PAO-PR1 (toxA1) was mated with toxin A-producing strains, and exconjugates for selected prototrophic markers were tested for the transfer of toxA1. The toxA1 gene was located between cnu-9001 and pur-67 at approximately 85 min on the PAO chromosome.

Protection against Pseudomonas aeruginosa infection in a murine burn wound sepsis model by passive transfer of antitoxin A, antielastase, and antilipopolysaccharide

The protective capacity of passively transferred immunoglobulin G (IgG) fractions from antitoxin (AT-IgG), antielastase (AE-IgG), and antilipopolysaccharide (ALPS-IgG) against Pseudomonas aeruginosa infection was evaluated in a murine burn wound sepsis model. Complete protection was afforded by homologous ALPS-IgG against intermediate challenge doses (10 50% lethal doses) of P. aeruginosa PA220, whereas AT-IgG and AE-IgG offered no significant protection (P less than 0.5). The simultaneous transfer of AT-IgG or AE-IgG with ALPS-IgG gave no additional protection above that seen with ALPS-IgG alone. The transfer of ALPS-IgG did not dramatically alter bacterial multiplication in the skin at the site of infection. However, bacteremia and infection of the liver were prevented. In parallel experiments, AT-IgG or AE-IgG did not significantly alter either the course of the infection or the number of bacteria seen in the blood, liver, or skin when compared with controls. ALPS-IgG administered 24 h before infection, at the time of infection, or 4 h postinfection provided complete protection. Even when ALPS-IgG was transferred at a time when the infection was well established locally in the skin (8 h postinfection), highly significant protection (P greater than 0.999) was obtained. Protection afforded by ALPS-IgG was serotype specific. These results indicate that antibody to lipopolysaccharide is of critical importance for protection against P. aeruginosa challenge in a relevant animal model.

Pseudomonas aeruginosa exotoxin A inhibits proliferation of human bone marrow progenitor cells in vitro

Pseudomonas aeruginosa exotoxin A, a potent inhibitor of eukaryotic protein synthesis, is produced in vivo during human infection. We tested the hypothesis that exotoxin A may be responsible for the leukopenia which sometimes accompanies pseudomonas disease by examining the in vitro toxicity of exotoxin A for human bone marrow granulocyte-macrophage progenitor cells (colony-forming units in culture [CFU-c] in the soft agar cloning system. Colony formation by freshly obtained marrow cells from five normal subjects was inhibited by exotoxin A in a concentration-dependent manner. The mean 50 and 100% inhibitory concentrations of toxin were 1.4 x 10(-10) and 1.4 x 10(-8) M, respectively, and significant inhibition was observed at a toxin concentration as low as 1.4 x 10(-13) M in two subjects. The inhibitory effect of exotoxin A on colony formation was specifically neutralized by antiserum to exotoxin A. Although mouse CFU-c were somewhat less sensitive to exotoxin A in vitro compared with human CFU-c, exotoxin A produced significant leukopenia in vivo in mice. These data suggest a possible mechanism for the leukopenia which sometimes occurs in human pseudomonas disease.

Contribution of toxin A and elastase to virulence of Pseudomonas aeruginosa in chronic lung infections of rats

A chronic pulmonary infection model in rats was employed to assess the role of individual Pseudomonas aeruginosa exoproducts in disease due to this organism. Groups of rats were inoculated transtracheally with agar beads in which were embedded approximately 10(4) colony-forming units of P. aerugijnosa PAO and the PAO derivatives PR1, T1, E64, and a mixture of T1 and E64 in equal numbers (10(4)). Eight animals from each group were sacrificed at 3, 9, and 30 days after challenge, and their lungs were examined for histopathological changes, bacterial numbers, and the presence of P. aeruginosa exoproducts. The Tox- mutant T1 and the PR1 mutant, which produces enzymatically inactive toxin A, were both found to be less virulent in the rat lung model than was the toxigenic parental strain PAO. Pathological changes seen in animals infected with these mutants were restricted to intra- and peribronchial inflammation, whereas the toxigenic parental strain caused parenchymal changes, including a dense mononuclear-cell infiltration in the alveolar spaces in addition to intra- and peribronchial inflammation. Additionally, mutant E64, which produces a temperature-sensitive elastase, was also found to be less virulent in the rat lung model than was the parental strain. These data demonstrate that both active toxin A and elastase are required for maximum virulence of P. aeruginosa in this model.

Antibody response to Pseudomonas aeruginosa exoproducts in cancer patients

We analyzed sera from 28 patients with various types of malignancies for the occurrence of antibodies against exotoxin A of Pseudomonas aeruginosa and two Pseudomonas proteases. A total of 27 of these individuals were colonized or infected with P. aeruginosa at one time or another during the study, whereas the remaining patient was colonized with four non-P. aeruginosa species of Pseudomonas. Sera were obtained from several of these patients before P. aeruginosa colonization or infection of these individuals was detected, which provided an opportunity to evaluate their responsiveness to pseudomonal exoproducts as they acquired the organism. Exotoxin A was purified from culture supernatant fluids of strain PA-103, and the two proteases were purified from an isolate of strain JR3, a highly proteolytic strain originally recovered from the sputum of a cystic fibrosis patient. Antibodies to the exotoxin A and the two proteases were detected in these sera, and sera which contained relatively high antibody levels to exotoxin A afforded mice complete protection against lethal challenges with this substance. Statistical analyses showed that patients infected with P. aeruginosa had consistently higher antibody levels (P less than 0.005) to the exoproducts than patients who were colonized with this organism. Also, patients colonized with P. aeruginosa possessed significantly higher antibody levels (P less than 0.003) to these three exoproducts than uninfected, hospitalized patients. Parke-Davis type 1 was the strain most commonly isolated from these patients (46%), but colonization or infection due to this organism usually resulted in the production of low levels of antibody to Pseudomonas exoproducts. However, infections with Parke-David type 7 organisms were always associated with intermediate- and high-responder sera to exotoxin A. These results indicated that potentially toxic products were elaborated during the course of cancer-related colonization and infection with P. aeruginosa.

Antibodies to cell envelope proteins of Pseudomonas aeruginosa in cystic fibrosis patients

Many vaccines containing somatic and secreted antigens of Pseudomonas aeruginosa have been reported. The vaccines containing lipopolysaccharide have been found to provide type-specific protection, but the endotoxin content of these vaccines does not make it feasible to use them in patients who are already debilitated. Outer membrane proteins could be effective as vaccines, as they can be purified free of lipopolysaccharide, and also because they are common to all serotypes of P. aeruginosa. To be effective as a vaccine, such proteins must be immunogenic and accessible from the outside of the intact bacterial cell. In this study, we showed that systemic antibodies were produced frequently to two cell envelope proteins with masses of 58,500 and 37,500 daltons and occasionally to 34,000-dalton protein of P. aeruginosa in cystic fibrosis patients with chronic lung infections. In rabbits immunized with whole, fixed cells of P. aeruginosa, antibodies were also produced against the 58,500-dalton proteins. Thus, the 58,500-dalton cell envelope protein of P. aeruginosa was the only immunogenic protein that was accessible to the immune system when whole, fixed cells were used for immunization. These serum antibodies did not protect the cystic fibrosis patients against further lung infection with P. aeruginosa.

Protection against experimental Pseudomonas aeruginosa infection in mice by active immunization with exotoxin A toxoids

The immunoprophylactic effect of chemically inactivated Pseudomonas aeruginosa exotoxin A in experimental pseudomonas infections was studied. Exotoxin A toxoids were prepared by Formalin (f-TXD) or glutaraldehyde (g-TXD) treatment. Immunization of mice with three or four doses (10 micrograms each) of f-TXD and the synthetic adjuvant N-acetylmuramyl-L-alanyl-D-isoglutamine (50 micrograms) induced high levels of antiexotoxin A antibodies as measured by passive hemagglutination assay and enzyme-linked immunosorbent assay. Immunization with toxoid alone did not elicit antitoxin. A significant increase in survival time and survival rate (P less than 0.01) was seen in immunized (f-TXD) and in burned and infected mice (50 to 85%) as compared with control mice immunized with formalinized bovine serum albumin (6 to 20%). Virtually 100% survival was obtained when preinfection immunization weas combined with single-dose gentamicin treatment within 24 h of infection. Immunization with g-TXD increased survival time (P less than 0.01) but did not consistently increase survival rate, and the results were not as satisfactory as those with formalinized exotoxin. The data presented indicate that active immunization with formalinized exotoxin A toxoid and adjuvant induced protective immunity to various degrees against infections in mice and could be potentially useful in prophylaxis of P. aeruginosa infections.

Effect of formalin toxoiding on Pseudomonas aeruginosa toxin A: biological, chemical, and immunochemical studies

We investigated the effect of Formalin toxoiding on the biological, chemical, and immunological activities of Pseudomonas aeruginosa toxin A. Formalin treatment alone resulted in a 1,000-fold decrease in toxin-induced cell cytotoxicity and altered the antigenicity of the toxin A molecule without adversely affecting enzymatic activity. Competitive blocking experiments indicated that Formalin-mediated detoxification proceeded via alterations in a region of the toxin molecule other than the active site of the enzyme. The addition of lysine to Formalin-toxin mixtures not only increased the rate and extent of detoxification and antigenic alteration, but also completely destroyed enzymatic activity. The immunogenicities of different toxoids varied substantially. Upon dialysis and storage, Formalin-derived toxoids underwent partial toxic reversion, whereas a Formalin-lysine-derived toxoid did not. The sodium dodecyl sulfate-polyacrylamide gel patterns of Formalin- and Formalin-lysine-treated toxins indicated that these treatments caused the formation of a heterogenous group of high-molecular-weight species and produced substantial changes in the electrophoretic mobility of toxin A.

Toxin A-deficient mutants of Pseudomonas aeruginosa PA103: isolation and characterization

An immunological assay utilizing double-diffusion principles was developed for identification of Pseudomonas aeruginosa mutants deficient in toxin A. Mutations were chemically induced, and mutants were isolated from P. aeruginosa strain PA103. Quantitative assays, both enzymatic and immunological, indicated that five mutants produced toxin A in vitro at levels of 0.3% or less of parental strain levels. Characterization indicated that the mutants fell into four classes and suggested that multiple genes are involved in the regulation of toxin A yields. Classes 1 to 3 produced less than 1% of parental levels of extracellular toxin A. Class 1 mutants are apparently specific for toxin A. Class 2 mutants are pleotropic and produced toxin A, protease, and other extracellular proteins at reduced yields. Class 3 mutants are pleotropic and in addition have relatively high levels of cell-bound toxin A. Class 4 mutants produce toxin A at levels greater than 1% of parental yields. Of 16 toxin A-deficient mutants examined, only 1 was a class 1 mutant. This mutant (PA103-29) was shown to be identical to the parental strain in all respects tested except for its marked deficiency in toxin A. The suitability of this class 1 mutant for use in virulence studies is discussed.

Production of exoenzyme S during Pseudomonas aeruginosa infections of burned mice

Antisera which distinguished between Pseudomonas aeruginosa exoenzyme S and toxin A neutralized the adenosine diphosphate ribosyl transferase activity of the homologous, but not the heterologous, enzyme. Skin extracts and sera from burned mice infected with the exoenzyme S-producing strain P. aeruginosa 388 contained adenosine diphosphate ribosyl transferase activity that was not found in skin extracts or sera from uninfected mice. On the basis of immunological reactivity and enzymatic properties, the adenosine diphosphate ribosyl transferase activity present in skin extracts and sera from P. aeruginosa 388-infected mice was identified as exoenzyme S. Active elongation factor 2 levels in tissues from strain 388-infected mice were normal at 24 h postinfection, indicating that strain 388 does not produce detectable amounts of toxin A in vivo. An unexpected finding in this investigation was the presence of exoenzyme S-inactivating activity in the sera from some nonimmunized animals.

Enzyme-linked immunosorbent assay for Pseudomonas aeruginosa exotoxin A

An enzyme-linked immunosorbent assay (ELISA) is described for Pseudomonas aeruginosa exotoxin A. A double antibody sandwich method was used, employing polyvinyl microtiter plates as the solid phase, a primary coat of monospecific rabbit antitoxin serum, an outer layer composed of a horseradish peroxidase-sheep antitoxin immunoglobulin G conjugate, and an ortho-phenylene-diamine substrate. Absorbance (optical density) of hydrolyzed end product was read spectrophotometrically at 492 nm. ELISA detected as little as 30 pg (0.3 ng/ml) of purified toxin, and absorbance was linear over a 20-fold or greater concentration range. Toxin was demonstrated in culture filtrates from 42 of 48 (88%) consecutive clinical P. aeruginosa isolates compared with 37 of 48 (77%) positive by hemagglutination inhibition. Results of the two assays correlated closely (r = 0.82, P less than 0.001). Specificity was confirmed by neutralizability of ELISA activity with monospecific antitoxin. ELISA was thus a sensitive, specific, and quantifiable technique for the assay of P. aeruginosa exotoxin A in both purified and crude culture materials.

Production of exotoxin A by Pseudomonas aeruginosa in a chemically defined medium

A defined medium was developed in which easily measured quantities of exotoxin A (PE) were produced by Pseudomonas aeruginosa PA-103. The medium contained three L-amino acids (arginine, aspartic acid, and alanine), basal and trace salts including 14 mM K2HPO4, 14 mM glucose, and 140 mM glycerol. The concentrations of amino acids which yielded most satisfactory results were 6 mM alanine, 13 mM aspartic acid, and 16 mM arginine. The identity of PE in the culture supernatant fluid was demonstrated by adenosine diphosphate-ribosyl transferase activity and by immunodiffusion with sheep antitoxin elicited with purified PE and with PE produced in Trypticase soy broth dialysate and pure PE as controls. PE production was also demonstrated by mouse lethality and passive hemagglutination. As compared to Trypticase soy broth dialysate, P. aeruginosa produced 25 to 50% PE in the defined medium. Different strains of P. aeruginosa produced PE in the defined medium in proportions relative to those in Trypticase soy broth dialysate.

Protective activity of antibodies to exotoxin A and lipopolysaccharide at the onset of Pseudomonas aeruginosa septicemia in man

Serum antibodies to exotoxin A and type-specific lipopolysaccharide were measured by passive hemagglutination in 52 patients with Pseudomonas aeruginosa septicemia. Their comparative protective activities were evaluated by relating the titers of each at the onset of bacteremia to subsequent outcome. High acute serum antitoxin and antilipopolysaccharide titers (log2 reciprocal mean titers greater than 5) were associated with survival (76% of 17 with high vs. 46% of 24 with low antitoxin titers, P = 0.05; 85% of 13 with high vs. 48% of 29 with low antilipopolysaccharide titers, P = 0.03). In contrast, neither antibody titer was significantly associated (P less than or equal to 0.05) with patients' age or sex, severity of underlying disease, presence of leukopenia, steroid or immunosuppressive therapy. Despite a correlation between acute titers of the two antibodies (r = 0.33, P = 0.06), they appeared to protect independently and additively. Whereas 75% of 8 patients with high antitoxin titers and only 38% of 16 with low titers survived with low antilipopolysaccharide titers (P = 0.10), 100% (6/6), 73% (8/11), and 38% (6/16) survived, respectively, when both, one, or neither antibody was present in high titer (P = 0.01). Furthermore, the association between high acute serum antitoxin titers and survival was more pronounced in patients with rapidly fatal underlying disease (P = 0.06) and leukopenia (P = 0.12) than in more favorable prognostic and immune categories. These data indicate that serum antibodies to exotoxin A and lipopolysaccharide are found in most patients with P. aeruginosa septicemia and both are protective. Both antibodies may have therapeutic or prophylactic potential, whereas serum antiexotoxin A antibodies may be particularly beneficial in compromised hosts.

Microscopic characterization of rabbit lung damage produced by Pseudomonas aeruginosa proteases

The intratracheal administration of highly purified Pseudomonas aeruginosa proteases (ca. 10 to 100 microgram) elicited extensive, grossly observable rabbit lung damage by 3 h postinjection. Light and electron microscopic characterization of the lesions revealed: (i) progressive injury and necrosis of type I epithelial cells and capillary endothelial cells from 3 h to 1 day postinjection, and progressively increasing accumulations of erythrocytes, plasma proteins, fibrin, and released type II epithelial cell lamellar bodies in alveolar lumina during that time period; (ii) progressively increasing accumulations of macrophages, but not of polymorphonuclear leukocytes, in alveolar lumina from 3 h to 6 days postinjection; (iii) progressive hyperplasia of type II epithelial cells from 12 h to 4 days postinjection; (iv) progressive infiltration of alveolar septa by mononuclear inflammatory cells (interstitial pneumonitis) from 2 to 6 days postinjection; (v) no loss of alveolar septal connective tissue and no damage to pulmonary arterioles and venules; and (vi) almost normal alveolar structure by ca. 8 days postinjection. The study revealed that the intra-alveolar hemorrhage, the injury and necrosis of alveolar septal cells, and the infiltration by mononuclear cells that have been reported to occur during human pseudomonas pneumonia can also be elicited by the experimental administration of pseudomonas proteases. Thus, the results support the idea that in vivo production and activity of P. aeruginosa proteases is important, at least in part, in eliciting the lung damage characteristic of pseudomonas pneumonia.

Role of exotoxin and protease as possible virulence factors in experimental infections with Pseudomonas aeruginosa

Evidence is presented which suggests that both the proteases and the exotoxin produced by Pseudomonas aeruginosa multiplying in situ in a burned mouse model are virulence factors. A 50% decrease in functional elongation factor 2 (EF-2) was seen 16 h postinfection in the liver of mice infected with the toxigenic, protease-producing P. aeruginosa strain M-2; at the time of death EF-2 was depleted by 80%. This correlates with a reduction in the level of protein synthesis in the liver of infected animals. Treatment with specific antitoxin extended the mean time to death and blocked depletion of EF-2. Administration of gentamicin 24 h after infection caused rapid clearance of bacteria and extended the mean time to death, but all animals treated with either antitoxin or gentamicin eventually died. In contrast, treatment with both antitoxin and gentamicin provided virtually complete protection. Infection of mice with P. aeruginosa WR5 (protease-producing, nontoxigenic) or with P. aeruginosa PA103 (toxigenic, slow protease producer) required several logs more bacteria and did not result in the same extensive depletion in EF-2 content. When challenge with PA103 was supplemented by injection of purified Pseudomonas protease, the mean time to death was shortened and significant reduction in liver EF-2 was observed. It is suggested that both toxin and proteases are required for the full expression of virulence in Pseudomonas infections.

Effect of iron on yields of exotoxin A in cultures of Pseudomonas aeruginosa PA-103

The yields of exotoxin A in Pseudomonas aeruginosa cultures were influenced by the concentration of iron in the culture media. When the iron concentration of the culture media was increased from 0.05 to 1.5 microgram/ml, there was at least a 90% decrease in exotoxin A (measured both by enzymatic activity and by mouse lethality) and a slight increase in the growth of the bacteria. The addition of iron as late as 13 h after initiation of growth repressed further measurable increases of exotoxin A within 3 h. Intracellular toxin levels were also reduced by increasing the iron concentrations of the culture media. The addition of 3.0 microgram of iron per ml did not significantly alter either the enzyme activity of preformed crude or purified exotoxin A or the mouse toxicity of the pure toxin. Thus it appears that either the rate of production or the rate of intracellular degradation of exotoxin A is regulated by the concentration of iron in the culture media.

Toxicity of Pseudomonas aeruginosa exotoxin A for human macrophages

Pseudomonas aeruginosa exotoxin A was toxi in vitro for human peripheral blood macrophages. Cytotoxicity, manifested by morphological evidence of cell death and inhibition of [3H]thymidine uptake, followed exposure to as little as 10 ng of exotoxin per ml for 1 h. In addition, phagocytosis of heat-killed Candida albicans by macrophages exposed to sublethal concentrations of exotoxin was impaired. This cytotoxicity was neutralizable with antiexotoxin serum.

Mechanism of action of Pseudomonas aeruginosa exotoxin A in experimental mouse infections: adenosine diphosphate ribosylation of elongation factor 2

The data presented indicate that one of the primary actions of Pseudomonas aeruginosa exotoxin during experimental infection is the inactivation of elongation factor 2 (EF-2) in various mouse organs. Organs from mice infected with the toxigenic P. aeruginosa strain PA103 contained considerably less EF-2 activity than did organs from uninfected controls. Whereas EF-2 activity was reduced in all organs examined from PA103-infected animals, the largest decrease was observed in the liver, where the active EF-2 levels were reduced by 70 to 90%. In addition, consistent inhibition of protein synthesis in livers but not in other organs was observed in mice infected with the toxigenic PA103 strain. Treatment of mice with antitoxin before infection with strain PA103 prevented inactivation of EF-2. When mice were infected with lethal doses of the nontoxigenic P. aeruginosa WR5 strain, tissue EF-2 levels were not markedly reduced below those derived from uninfected control animals.

Purification of Pseudomonas aeruginosa exotoxin by affinity chromatography

Pseudomonas aeruginosa exotoxin A was purified by affinity chromatography from culture supernatants by elution of toxin from antitoxin immunoglobulin G-Sepharose 4B with 3 M NaSCN. The purity, toxicity, and enzymatic activity of exotoxin obtained were comparable to those of toxin purified by previously reported multiple-step procedures.

Passive protection by antitoxin in experimental Pseudomonas aeruginosa burn infections

The protective effect of intravenously administered rabbit antitoxin serum was studied in lethal Pseudomonas aeruginosa burn infections in mice. Survival after infection with 2 median lethal doses of a toxigenic, low-protease-producing strain (PA103) was enhanced in antitoxin-treated mice, as compared with controls that had received anti-bovine serum albumin serum (P = 0.0004). Survival time was prolonged in other antitoxin-treated mice infected with toxigenic, high-protease-producing strains (PA86 and PA220, P = 0.0003 and P = 0.01, respectively). In contrast, antitoxin had no protective effect in mice challenged with a nontoxigenic strain (WR 5, P = 0.57). There were fewer viable bacteria in blood and liver of antitoxin-treated mice than in those of anti-bovine serum albumin-treated controls after infection with toxigenic organisms, whereas there were no significant differences between the two groups after challenge with the nontoxigenic strain. These data suggest that P. aeruginosa exotoxin A contributes to lethality in this burn infection model, and this effect is diminished by passive immunization with antitoxin.

Serum antibody to Pseudomonas aeruginosa exotoxin measured by a passive hemagglutination assay

A passive hemagglutination (PHA) assay for antibody to Pseudomonas aeruginosa exotoxin is described which utilizes chromic chloride-treated ovine erythrocytes coated with purified toxin. PHA antitoxin titers correlated well with those obtained by a cytotoxicity neutralization assay (r = 0.91, P less than 0.001), whereas the PHA assay was four to eight times as sensitive. The mean serum PHA titer of 16 patients convalescing from recent pseudomonas infections (log2 = 9.4 +/- 3.9) was significantly higher (P less than 0.001) than that of 17 healthy controls (2,7 +/- 2.6), and fourfold or greater rises were demonstrated in 5 of 7 patients examined sequentially. The lower levels of PHA antibody in sera from 11 of 17 controls suggested the acquisition of antitoxin secondary to asymptomatic infection.