Herpes simplex virus-specific serum immunoglobulin a: detection in patients with primary or recurrent herpes infections and in healthy adults

B cells, antibody-secreting cells, and virus-specific antibodies respond to herpes simplex virus 2 reactivation in skin

Tissue-based T cells are important effectors in the prevention and control of mucosal viral infections; less is known about tissue-based B cells. We demonstrate that B cells and antibody-secreting cells (ASCs) are present in inflammatory infiltrates in skin biopsy specimens from study participants during symptomatic herpes simplex virus 2 (HSV-2) reactivation and early healing. Both CD20+ B cells, most of which are antigen inexperienced based on their coexpression of IgD, and ASCs - characterized by dense IgG RNA expression in combination with CD138, IRF4, and Blimp-1 RNA - were found to colocalize with T cells. ASCs clustered with CD4+ T cells, suggesting the potential for crosstalk. HSV-2-specific antibodies to virus surface antigens were also present in tissue and increased in concentration during HSV-2 reactivation and healing, unlike in serum, where concentrations remained static over time. B cells, ASCs, and HSV-specific antibody were rarely detected in biopsies of unaffected skin. Evaluation of samples from serial biopsies demonstrated that B cells and ASCs followed a more migratory than resident pattern of infiltration in HSV-affected genital skin, in contrast to T cells. Together, these observations suggest the presence of distinct phenotypes of B cells in HSV-affected tissue; dissecting their role in reactivation may reveal new therapeutic avenues to control these infections.

Analysis of the Targets and Glycosylation of Monoclonal IgAs From MGUS and Myeloma Patients

Previous studies showed that monoclonal immunoglobulins G (IgGs) of “monoclonal gammopathy of undetermined significance” (MGUS) and myeloma were hyposialylated, thus presumably pro-inflammatory, and for about half of patients, the target of the monoclonal IgG was either a virus—Epstein–Barr virus (EBV), other herpes viruses, hepatitis C virus (HCV)—or a glucolipid, lysoglucosylceramide (LGL1), suggesting antigen-driven disease in these patients. In the present study, we show that monoclonal IgAs share these characteristics. We collected 35 sera of patients with a monoclonal IgA (6 MGUS, 29 myeloma), and we were able to purify 25 of the 35 monoclonal IgAs (6 MGUS, 19 myeloma). Monoclonal IgAs from MGUS and myeloma patients were significantly less sialylated than IgAs from healthy volunteers. When purified monoclonal IgAs were tested against infectious pathogens and LGL1, five myeloma patients had a monoclonal IgA that specifically recognized viral proteins: the core protein of HCV in one case, EBV nuclear antigen 1 (EBNA-1) in four cases (21.1% of IgA myeloma). Monoclonal IgAs from three myeloma patients reacted against LGL1. In summary, monoclonal IgAs are hyposialylated and as described for IgG myeloma, significant subsets (8/19, or 42%) of patients with IgA myeloma may have viral or self (LGL1) antigen-driven disease.

The Neonatal Fc Receptor and Complement Fixation Facilitate Prophylactic Vaccine-Mediated Humoral Protection against Viral Infection in the Ocular Mucosa

The capacity of licensed vaccines to protect the ocular surface against infection is limited. Common ocular pathogens, such as HSV-1, are increasingly recognized as major contributors to visual morbidity worldwide. Humoral immunity is an essential correlate of protection against HSV-1 pathogenesis and ocular pathology, yet the ability of Ab to protect against HSV-1 is deemed limited due to the slow IgG diffusion rate in the healthy cornea. We show that a live-attenuated HSV-1 vaccine elicits humoral immune responses that are unparalleled by a glycoprotein subunit vaccine vis-à-vis Ab persistence and host protection. The live-attenuated vaccine was used to assess the impact of the immunization route on vaccine efficacy. The hierarchical rankings of primary immunization route with respect to efficacy were s.c. ≥ mucosal > i.m. Prime-boost vaccination via sequential s.c. and i.m. administration yielded greater efficacy than any other primary immunization route alone. Moreover, our data support a role for complement in prophylactic protection, as evidenced by intracellular deposition of C3d in the corneal epithelium of vaccinated animals following challenge and delayed viral clearance in C3-deficient mice. We also identify that the neonatal Fc receptor (FcRn) is upregulated in the cornea following infection or injury concomitant with increased Ab perfusion. Lastly, selective small interfering RNA-mediated knockdown of FcRn in the cornea impeded protection against ocular HSV-1 challenge in vaccinated mice. Collectively, these findings establish a novel mechanism of humoral protection in the eye involving FcRn and may facilitate vaccine and therapeutic development for other ocular surface diseases.

Herpes simplex virus-specific IgM, IgA and IgG subclass antibody responses in primary and nonprimary genital herpes patients

To clarify the humoral immunity in herpes simplex virus (HSV) infection, HSV-specific IgM, IgA and IgG subclass antibody responses were studied in patients with genital herpes: 17 primary, 13 recurrent and 6 nonprimary first episode. A total of 181 serum samples serially collected from the patients, 5 per patient until 213 days after the onset of disease (on average), were analyzed by an enzyme-linked immunosorbent assay. IgG1, IgG3 and IgA were detected in all patients with primary and nonprimary infections, whereas IgG4 was detected in 74% of only those with nonprimary infections and IgG2 was detected in none. IgM was detected in 100% of the patients with primary infections, but also in 68% of those with nonprimary infections. IgA showed a peak similar to that of IgM in patients with primary infections. No significant difference was observed in the detection rate or pattern of antibody responses between the recurrent and nonprimary first episode infections, nor between the HSV-1 and HSV-2 infections. These findings may be useful to improve the diagnostic potential of HSV serology.

Detection of enterovirus-specific total and polymeric IgA antibodies in serum using a synthetic peptide or heated virion antigen in ELISA

The presence of enterovirus-specific total and polymeric IgA antibodies was assessed in serum from different groups of patients and healthy controls by indirect ELISA using heated virions and synthetic peptide, both enteroviral broad reactive antigens. Total IgA antibody response against a synthetic peptide, representing an enterovirus group-common epitope, was detected in 52% of the patients with an acute enterovirus infection and in 12% of the patients with other infections (P = 0.02). We also found a significant difference (P = 0.005) in the prevalence of peptide IgA antibodies between serum samples collected from blood donors during summer (20%), the prevalent season of enterovirus infections, and winter (6%). A polymeric IgA activity against the peptide was detected in only three patients with an enterovirus infection. In contrast, when a heated coxsackie B5 (coxB5) virus antigen was used, the prevalence of total serum IgA antibodies was not significantly different between patients with an acute enterovirus infection and patients with other infections (71% vs. 53% respectively; P = 0.3). Also no difference was found between the two groups of blood donors (47% in summer vs. 51% in winter; P = 0.7). However, the prevalence of serum polymeric IgA antibodies against coxsackie B5 antigen was significantly greater (P = 0.02) in patients with an acute enterovirus infection (57%) than in patients with other infections (18%). These findings suggest that the presence (18%). These findings suggest that the presence of total peptide-IgA or of polymeric coxsackie B5-IgA in serum is a specific marker of acute enterovirus infection. Finally, we show that the total peptide-IgA- and polymeric coxsackie B5-ELISAs may have a diagnostic value for the serodiagnosis of enterovirus infections when they are used in combination with enteroviral IgG-ELISA.

Activation of a varicella-zoster virus-specific IgA response during acute Epstein-Barr virus infection

The influence of an acute Epstein-Barr virus (EBV) infection on the serological parameters of persistent varicella-zoster virus (VZV) and herpes simplex virus (HSV) was studied. Sera from 161 patients with infectious mononucleosis caused by EBV and 178 age-matched controls were tested for HSV- and VZV-specific IgA. 98.7 percent of VZV-IgG-positive controls were negative for VZV-IgA, pointing to the stringent control of latent VZV in healthy individuals. During acute EBV infection, 33.8% of VZV-IgG-positive infectious mononucleosis patients produced VZV-specific IgA. This result may be explained either by reactivation of VZV due to transient suppression of cellular immune functions during acute EBV infection or by polyclonal stimulation caused by EBV. Due to the high incidence of HSV-IgA in healthy HSV-IgG-positive individuals, only a marginal effect of acute EBV infection on the appearance of HSV-specific IgA was found.

Serum and salivary responses to oral tetravalent reassortant rotavirus vaccine in newborns

Serum and salivary responses of 95 infants to either a standard (4 x 10(4) plaque-forming units (PFU), 47 neonates) or a high dose (4 x 10(5) PFU, 48 neonates) of tetravalent reassortant rhesus rotavirus vaccine (administered at 2 days and at 6 weeks of age) were evaluated in a double-blind clinical trial. Serum and salivary IgA antibodies to the rotavirus group A common antigen were determined by ELISA and radioimmunoassay (RIA). Serum neutralizing antibodies to rhesus rotavirus were determined by fluorescent focus reduction assay. No significant differences in responses to the high versus standard dose were noted in serum or saliva. Response was influenced by cord blood antibodies. All infants who were cord blood-negative for rhesus rotavirus neutralizing antibodies (nine who received the standard dose and 20 who received the higher dose) had serum responses, compared with 42-70% of those who were cord blood-positive. The serum response rate recorded for babies with cord blood neutralizing titres > 1000 was 44%. Infants being bottle fed had a higher serum response rate than did babies being breast fed exclusively. If serum and salivary responses were combined, the response rate reached 80% for bottle fed infants. Thus, determination of serum responses alone underestimates vaccine 'take' in infants, and more so in highly endemic areas than in areas subject only to sporadic outbreaks. However, determination of salivary responses in newborn breastfed infants may be inaccurate, due to possible persistence of antibodies derived from colostrum or breast milk.

HSV-IgA serum antibodies in cervical intraepithelial neoplasia and invasive cancer patients, and in their spouses: a case control study

Class-specific IgG and IgA antibodies to HSV were assayed in women with CIN (76), invasive cancer (52) (histological diagnosis) and age-matched controls (119), employing HSV-2-infected HEp-2 cells as antigen during IFA assay. We observed an elevated geometric mean titre (GMT) of serum antibody (IgG five-to eight-fold and IgA four-to five-fold) for the entire spectrum of cervical lesions, as compared to controls. The odds of finding HSV-IgA antibodies were highest with CIN III (OR = 22.0), followed by invasive carcinoma, and CIN I & II (OR = 9.5 and 5.2), respectively. Furthermore, the investigations with respect to married couples (husbands and wives) who volunteered to participate in this study (33 cases and 47 control group) also indicated relatively high antibody titres and increased frequency of HSV sero positivity amongst husbands of cases as compared to their wives, as well as the control group males and females. The contribution of HSV infection in women and/or their husbands to the risk of developing abnormal cervical lesions was analysed after adjusting for the same in respective counterparts. It was observed that the risk was increased 14-fold with HSV-IgA positivity of women, and that HSV-IgA positivity of husbands (male partners) further increased the risk 16-fold. This preliminary observation shows the importance of serum HSV-IgA antibodies as a risk indicator in cervical precancer and cancer lesions in women without a history of recent genital herpes lesions. The serum HSV-IgA may also be taken as an indicator of "high risk" males.

Detection of specific IgA antibodies to varicella zoster virus in serum of patients with Ramsay Hunt syndrome

Varicella zoster virus (VZV)-specific IgG and IgA antibody titers were determined in serial serum samples of 23 patients with Ramsay Hunt syndrome by the immunoperoxidase assay. Varicella zoster virus-specific IgG antibodies were found in the first serum samples of all the patients. In 80% of 20 patients in whom a serum sample was available within 5 days after the onset of the disease. VZV-specific IgA antibodies were detected. The second serum sample was VZV-specific IgA-positive in all of the patients. While all the healthy age- and sex-matched control subjects had VZV-specific IgG antibodies, VZV-specific IgA antibodies were detected in a low titer (dilution = 2) in only three of the subjects. By using VZV-specific IgA antibody titers greater than or equal to 2 and greater than or equal to 4 by the immunoperoxidase assay as a "cutoff" for younger and older patients with Ramsay Hunt syndrome, respectively, an early diagnosis of the disease can be obtained in 89% of the younger and in 64% of the older patients by a single serum sample.

Serum IgA antibodies in HSV asymptomatic genital infections

Cervico-vaginal swabs and serum samples from 81 women without herpes-associated clinical symptoms were examined for virus isolation and for the presence of IgA antibodies to herpes simplex virus (HSV) using the indirect fluorescent antibody technique. Nineteen of the 81 women were followed up for 2 years. Blood samples and swabs from cutaneous lesions were obtained from another group of 20 women (medical staff) with herpes labialis. By analysing the specific anti-HSV IgA antibodies, a higher geometric mean titre (GMT) was found in women with positive HSV-2 isolation (GMT = 380.03), as opposed to the GMT observed in women with negative HSV-2 (GMT = 63.43) or positive HSV-1 isolation (GMT = 55.15). Results from the longitudinal study also demonstrated that positive virus isolation always correlated with a marked rise in serum IgA antibody to HSV.

Virus-specific IgA in serum, saliva, and tears of children with measles

Measles-specific IgA antibody titres were determined by radioimmunoassay (RIA) for serial serum, saliva and tear samples obtained from 21 children with measles infection, from onset of rash until up to 14 months later. Serum IgA titres rose rapidly after onset of illness and remained detectable throughout the follow-up period. Virus-specific salivary IgA titres peaked at 4 to 7 days after onset of rash and decreased thereafter. Measles-specific lacrimal fluid IgA antibodies remained elevated for long periods of time; however, secretory component-bearing measles-specific antibodies in tears became for the most part undetectable by 1 month after onset of rash. These data raise anew the question of whether some form of viral latency is associated with the presence of virus-specific IgA antibody, or whether such antibody is simply a reflection of immune memory.

Specific serum IgA, IgG and IgM antibody determination by a modified indirect ELISA-technique in primary and recurrent herpes simplex virus infection

Twenty-three patients with a herpetic infection as diagnosed by a positive culture of herpes simplex virus (HSV) were studied with respect to serological responses of IgA, IgG and IgM antibodies in paired serum samples by an indirect (sandwich) enzyme linked immunosorbent assay (ELISA). Eight of the patients had a primary infection and 15 a recurrent one. In the ELISA test a detergent treated cell lysate of HSV type 1 was used as antigen. In the IgM assay all sera were pretreated with antihuman IgG with the purpose to precipitate IgG of the samples. The conjugate was a F(ab)2-fragment of antihuman-IgM. In primary infections all patients had significant titre rises of IgG and presence of high IgM titres in the convalescent serum. IgA antibodies were found in all of them, while titre rises were detected in 5/8. In recurrent infections titre rises of IgG and IgA antibodies were found in 4 and 5, respectively. Six had detectable IgM in one or both of the paired samples. The IgG titres were higher in recurrent infections than in primary, in contrast to IgM of which much higher titres were found in primary infections. It is concluded that in primary infections a conclusive serological diagnosis was established in all patients, whereas in recurrent infections this was achieved in two of three patients. The indirect ELISA method used for IgM detection was sensitive, reliable and convenient. Interfering rheumatoid factor was effectively eliminated by treatment with antihuman IgG.

Serologic detection of active infections with human herpes viruses (CMV, EBV, HSV, VZV): diagnostic potential of IgA class and IgG subclass-specific antibodies

In 175 sera from healthy persons as well as those suffering from primary or secondary herpes virus infections/reactivations, serum antibodies were assessed by an indirect ELISA in the immunoglobulin classes A, G and M and the subclasses G1-4, using carrier-fixed antigens (CMV, VZV, HSV) and monoclonal tracer antibodies. In a similar way EBV-specific antibodies were tested by an indirect IFT. Only IgG1 antibodies were detectable in nearly all persons. Virus-specific IgA and IgG3 may support conventional serological methods (IgM, IgG) indicating recent infection/reactivation with VZV, EBV and possibly CMV. Furthermore, differentiation of primary and secondary CMV and VZV infection was possible in some cases, when IgG3 was detectable before IgG1 in subsequent blood specimens. Recurrent herpes lesions could not be diagnosed serologically.

Tear and serum antibody levels in ocular herpetic infection: diagnostic precision of secretory IgA

A sensitive enzyme linked immunosorbent assay (ELISA) was developed to evaluate the potential of herpes simplex virus (HSV) specific antibodies in the diagnosis of herpetic eye infection. The presence of HSV specific secretory IgA (sIgA) in tears was found to be diagnostic of infection. However, serum and tear HSV specific IgG and IgA were not considered reliable indicators of active infection.

Persistence of serum IgA antibodies to herpes simplex, varicella-zoster, cytomegalovirus, and rubella virus detected by enzyme-linked immunosorbent assays

Enzyme-linked immunosorbent assays were used to detect IgG and IgA antibodies to herpes simplex virus (HSV), varicella-zoster virus (VZV), cytomegalovirus (CMV), and rubella virus in sera from 68 adult female gynaecological patients. Of the patients who had virus-specific IgG antibodies, the proportion who also had virus-specific IgA was 98% for HSV, 75% for VZV, 73% for rubella virus, and 42% for CMV. IgA antibodies to all four viruses were only found when specific IgG antibodies were also detected in the serum. These results suggest that virus-specific IgA may persist for several years; possible explanations for this are discussed.

Studies on HSV specific IgA antibodies in lacrimal fluid from patients with herpes keratitis by solid phase radioimmunoassay

A highly sensitive solid phase radioimmunoassay (RIA) was adapted for determination of herpes simplex virus (HSV) specific IgA antibodies in lacrimal fluids. The RIA procedure was applied to examine HSV IgA antibodies in serial samples of lacrimal fluid and in sera from 14 patients with herpes keratitis. HSV-specific IgA antibodies were detected in the lacrimal fluid of the affected eye in 12 of the 14 patients. HSV IgA antibodies were also detected in the lacrimal fluid of the unaffected eye of 7 of these patients in titers lower than those found in the corresponding affected eye. Evidence for local HSV antibody production in lacrimal fluid in herpes keratitis was supported by examination for antibodies to the unrelated measles antigen. Detection of lacrimal fluid HSV IgA antibodies might be a useful adjunct in rapid diagnosis of herpes keratitis. The advantage of characterizing the local immune response as well as viral expression in the affected vs. the unaffected eye in the same individual as a model for understanding the factors leading to subclinical vs. clinical manifestations of recurrent ocular herpes virus infections will be discussed.

Use of enzyme-labeled antigen for the detection of immunoglobulin M and A antibody to herpes simplex virus in serum and cerebrospinal fluid

A direct enzyme-linked immunosorbent assay (ELISA that used peroxidase-labeled antigen) was developed for detection of IgM and IgA antibody to herpes simplex virus (HSV). The assay uses immuno-affinity-purified antihuman IgM or IgA antibody-coated wells of microtiter plates to separate IgM or IgA from other classes of antibody in serum or cerebrospinal fluid (CSF). The presence of specific IgM or IgA is detected by subsequent, consecutive incubation with peroxidase-labeled antigen and substrate. HSV antigen was purified by sucrose gradient centrifugation and coupled with peroxidase by the periodate method. By examining sucrose-gradient-fractionated sera the assays were shown to be specific for IgM and IgA classes of antibody. None of the sera from patients with Epstein-Barr virus (n = 20), cytomegalovirus (n = 20), or varicella-zoster virus (n = 8) infection or with both rheumatoid factor and IgG antibody to HSV (n = 13) reacted positively. Only one out of 78 sera from healthy persons was positive for IgA antibody to HSV, and none for IgM antibody. All 33 patients with HSV infection developed HSV-IgA, 22 developed HSV-IgM. Of the 11 patients with primary infection, all had IgM antibody in their first sera and six had IgA antibody. The corresponding figures for the 22 patients with recurrent infection were five and nine. Furthermore, HSV-IgA antibody was found in serum and CSF of all five patients with HSV encephalitis in the second week after onset of symptoms, indicating the usefulness of the assay as a noninvasive technique for diagnosing HSV encephalitis.

Specific IgG and IgA antibodies to herpes simplex virus (HSV)-induced surface antigen in patients with HSV infections and in healthy adults

Herpes simplex virus (HSV)-specific IgG and IgA antibody response in patients with HSV infection and in healthy adults was studied by the immunoperoxidase antibody-membrane antigen (IPAMA) technique. In all HSV infections in which specific IgM antibodies were detected by enzyme-linked immunosorbent assay (ELISA), a significant rise in the titer of HSV IgG and IgA antibodies was found. In contrast, in patients with recurrent herpes labialis in which no specific HSV IgM antibodies were detected by ELISA, HSV IgG and IgA antibodies were not found to fluctuate significantly during the course of infection. A higher geometric mean titer (GMT) for HSV IgG and for IgA antibodies was found in seropositive individuals with a previous history of recurrent HSV than in seropositive individuals without a previous history of recurrent HSV infection. Nineteen of 26 HSV IgG seropositive healthy medical students without a previous history of recurrent HSV infection had HSV IgA antibodies to membrane antigen. The significance of this finding in understanding the mechanism of latency in healthy seropositive individuals without previous history of HSV recurrent infections is discussed.

Serum immunoglobulin A antibody to varicella-zoster virus in subjects with primary varicella and herpes zoster infections and in immune subjects

Immunoglobulin A (IgA) antibodies to varicella-zoster virus (VZV) were measured in sera from subjects with acute varicella and herpes zoster, VZV-immune subjects remote from infection, and recipients of a live attenuated varicella vaccine, using a solid-phase radioimmunoassay. Primary infection with VZV was associated with early production of IgA antibodies. Among 36 subjects with varicella tested 1 to 5 days after onset, 22 had detectable IgA, and all of the negative sera were obtained before day 3 of the varicella exanthem. VZV IgA was detected in one of three sera obtained more than 60 days after onset of the illness. Four of five sera obtained from subjects within 1 week of the onset of herpes zoster had measurable levels of IgA. Between 1 and 4 weeks after onset of zoster, all 10 subjects tested had detectable IgA to VZV. VZV IgA was detected as late as 63 days after the onset of herpes zoster. Of 10 vaccine recipients, 5 developed VZV IgA which was detected as early as 4 weeks and persisted for as long as 16 weeks after vaccination. VZV IgA was not detected in sera from 42 children who had no detectable IgG antibody to VZV. VZV IgA was found on only 3 of 23 sera from adults who had varicella more than 20 years before.

Human cytomegalovirus specific IgA antibodies detected by immunoperoxidase assay in serum of patients with cytomegalovirus infections

Cytomegalovirus (CMV)-specific IgA antibodies were determined by an immunoperoxidase assay in sequential serum samples of 10 patients with CMV infection in order to evaluate the feasibility of the use of this technique for diagnosis. In parallel, IgM and IgG antibodies to CMV were studied by enzyme-linked immunosorbent assay (ELISA) and by the immunoperoxidase assay, respectively. CMV IgA antibodies were detected in all 10 CMV patients studied. Specific IgM was detected earlier than IgA in only one of these ten patients. No CMV-specific IgA antibodies (titer less than 2) were detected in 45 medical students. Neither were they found in paired sera of 5 patients with herpes simplex infection, 5 patients with varicella, 6 patients with zoster and 2 patients with Epstein-Barr virus infection. The potential application of the indirect immunoperoxidase IgA assay for serodiagnosis of CMV infections is discussed.

Detection and persistence of specific IgA antibodies in serum of patients with hepatitis A by capture radioimmunoassay

The serum immunoglobulin A (IgA) response to hepatitis A virus (HAV) was investigated with a sensitive capture radioimmunoassay. In serial serum samples drawn from 15 patients with viral hepatitis A, IgA anti-HAV antibodies reached their highest titer between 1-2 weeks after onset and peak titers ranged from 10,000-20,000. Serum samples were available from six patients 30-32 months after onset of illness. These samples were all positive for IgA anti-HAV and some had titers similar to peak titers during illness. However, the height of the titration curves, expressed as the binding ratio (BR) at a dilution of 1/1000, was in all cases significantly lower at 30-32 months than during acute illness and early convalescence. The significance of the persistence of the IgA anti-HAV and possible reasons for the change in the BR are discussed.