Reviewing essential public health functions in the Eastern Mediterranean Region post COVID-19 pandemic: a foundation for system resilience

The COVID-19 pandemic exposed vulnerabilities in many health systems worldwide with profound implications for health and society. The public health challenges experienced during the pandemic have highlighted the importance of resilient health systems, that can adapt and transform to meet the population's evolving health needs. Essential public health functions (EPHFs) offer a holistic, integrated and sustainable approach to public health by contributing to achieving several health priorities and goals. In recent years, there has been a focused effort to conceptualise and define the EPHFs. In this paper, we describe the collaborative approach undertaken by the WHO Eastern Mediterranean Region (EMR) and UK Health Security Agency and present the findings and results of the revised EPHFs, in view of lessons learnt from the COVID-19 pandemic and the current priorities for countries across the EMR. This included conducting a desktop review, a gap and bottleneck analysis and stakeholder consultation to arrive at the revised EPHF model including four enablers and nine core functions, including a new function: public health services. The EPHFs will offer countries a complementary and synergistic approach to strengthen health systems and public health capacities and contribute to the region's ability to effectively respond to future health challenges and emergencies. By focusing on the EPHFs, countries can work towards ensuring health security as an integral goal for the health system besides universal health coverage, thus strengthening and building more resilient and equitable health systems.

"Future-Proofing" Blood Processing for Measurement of Circulating miRNAs in Samples from Biobanks and Prospective Clinical Trials

Background: Quantifying circulating nucleic acids is an important new approach to cancer diagnosis/monitoring.Methods: We compared the suitability of serum versus plasma for measuring miRNAs using qRT-PCR and assessed how preanalytic variables that can affect circulating tumor DNA (ctDNA) quantification in plasma also influence miRNA levels.Results: Across 62 blood-derived specimens, plasma samples in EDTA, Streck-DNA, and Streck-RNA tubes showed significantly higher C_t values for multiple housekeeping miRNAs, compared with serum samples. For the EDTA-plasma tubes, this difference was only seen when including the high-speed centrifugation protocol used to optimize ctDNA extraction. In plasma samples derived from blood stored at room temperature for up to 14 days (conditions that typically apply to samples processed for biobanking), levels of endogenous housekeeping miRNAs gradually increased, in parallel with the hemolysis marker hsa-miR-451a, consistent with release from blood cells/platelets. It was necessary to normalize levels of the housekeeping miRNAs to those of hsa-miR-451a, to obtain the stable values needed for referencing test miRNA levels.Conclusions: Our data indicate that plasma samples prepared for ctDNA extraction are suboptimal for miRNA quantification and require the incorporation of multiple data normalization steps. For prospective studies designed to measure both miRNAs and ctDNA, the most suitable approach would be to obtain both serum (for miRNAs) and plasma (for ctDNA). If only plasma can be collected, we recommend an initial low-speed centrifugation step, followed by aliquoting the supernatant into parallel samples, one for direct miRNA quantification, and the other for a further high-speed centrifugation step to optimize ctDNA retrieval.Impact: These recommendations will help "future-proof" clinical studies in which quantification of circulating miRNAs is a component. Cancer Epidemiol Biomarkers Prev; 27(2); 208-18. ©2017 AACR.

A Robust Protocol to Quantify Circulating Cancer Biomarker MicroRNAs

Reverse-transcriptase quantitative PCR (RT-qPCR) is a widely used method for quantifying microRNAs (miRNAs) in cells and tissues. However, the quantification of miRNAs in the circulation presents specific challenges. Here, we describe an optimized protocol using a small amount of input material to assess serum sample quality and quantify levels of a panel of up to 20 miRNAs. This is achieved by multiplexing Taqman miRNA stem-loop primers in the reverse transcription step. An additional multiplexed pre-amplification step is used to increase the sensitivity of the final quantification step, which is carried out using standard Taqman qPCR methodology.

Effects on patients with asthma of eradicating visible indoor mould: a randomised controlled trial

BACKGROUND

It is not clear whether associations between respiratory symptoms and indoor mould are causal. A randomised controlled trial was conducted to see whether asthma improves when indoor mould is removed.

METHODS

Houses of patients with asthma were randomly allocated into two groups. In one group, indoor mould was removed, fungicide was applied and a fan was installed in the loft. In the control group, intervention was delayed for 12 months. Questionnaires were administered and peak expiratory flow rate was measured at baseline, 6 months and 12 months.

RESULTS

Eighty-one houses were allocated to the intervention group and 83 to the control group; 95 participants in 68 intervention houses and 87 in 63 control houses supplied follow-up information. Peak expiratory flow rate variability declined in both groups, with no significant differences between them. At 6 months, significantly more of the intervention group showed a net improvement in wheeze affecting activities (difference between groups 25%, 95% CI 3% to 47%; p = 0.028), perceived improvement of breathing (52%, 95% CI 30% to 74%; p<0.0001) and perceived reduction in medication (59%, 95% CI 35% to 81%; p<0.0001). By 12 months the intervention group showed significantly greater reductions than the controls in preventer and reliever use, and more improvement in rhinitis (24%, 95% CI 9% to 39%; p = 0.001) and rhinoconjunctivitis (20%, 95% CI 5% to 36%; p = 0.009).

CONCLUSIONS

Although there was no objective evidence of benefit, symptoms of asthma and rhinitis improved and medication use declined following removal of indoor mould. It is unlikely that this was entirely a placebo effect.

Gender is a major factor in determining the severity of mycoplasma respiratory disease in mice

Gender is a significant factor in determining the susceptibility to and severity of pulmonary diseases in both humans and animals. Murine respiratory mycoplasmosis (MRM), due to Mycoplasma pulmonis infection, is an excellent animal model for evaluation of the role of various host factors on the development of acute or chronic inflammatory lung diseases. MRM has many similarities to mycoplasma respiratory disease in humans. The purpose of the present study was to determine whether gender has a significant impact on lung disease due to M. pulmonis infection in mice. It was demonstrated that male mice consistently developed more severe disease in the lung parenchyma than did female mice. There was no gender difference in disease severity along the airways or any difference in mycoplasma numbers in lungs of male and female mice. Furthermore, surgical removal of reproductive organs reduced the severity of mycoplasma disease and the numbers of mycoplasma organisms recovered from lungs. Thus, gender plays a significant role in determining the severity of M. pulmonis disease. In fact, the gender of the host was a major factor in determining whether an acute or chronic inflammatory lung disease developed after infection with M. pulmonis.

An electronic simulator for testing infant apnoea monitors that uses actual physiologic data

An electronic simulator of physiologic signals used in infant monitoring has been designed, constructed and applied in the Collaborative Home Infant Monitor Evaluation (CHIME). A unique feature of the simulator is that it contains actual physiologic waveforms recorded from infants rather than artificial, idealized signals. The simulator stores breathing waveforms that can be used to test transthoracic-impedance- and inductance-plethysmography-based monitors, and heart rate channels are tested by playing a neonatal QRS complex at preset fixed rates or a variable rate as determined from infant recordings. The transfer characteristics of the simulator are constant over frequencies ranging from 0.5 to 8 Hz for the respiration channels. Data stored in memory are divided into 60 second epochs that can be presented to the monitor being tested in a programmable sequence. A group of 66 CHIME monitors was tested using a simulator programmed with 17 apnoea and bradycardia waveforms. The agreement between monitors as to the duration of detected apnoea decreases as the amount of artefact in the signal increases. Discrepancies between monitors in detecting apnoea duration were found to be similar to inconsistencies between CHIME investigators manually scoring similar waveforms.

No serologic evidence of an association found between Gulf War service and Mycoplasma fermentans infection

Occult occupational infection with Mycoplasma fermentans has been proposed as a cause for illness among Persian Gulf War veterans. Symptom data and sera from a 1994-1995 cross-sectional survey of Navy Seabees were used to select symptomatic and asymptomatic Gulf War veterans and nondeployed veterans to evaluate this hypothesis. Survey sera from 96 Seabees were matched to prewar (before September 1990) archived sera. Immunoblot serologic analyses were performed for M. fermentans in a controlled, blinded fashion. Both Gulf War veterans and nondeployed veterans had prewar and postwar serologic evidence of M. fermentans infection consistent with natural infection data. Among study subjects collectively, and stratified by Gulf War service, none of the immunoblot banding profiles (prewar or postwar) or their changes over time were associated with postwar symptoms. These serologic data do not support the hypothesis that Gulf War veterans have experienced Gulf War-related morbidity from M. fermentans infection.

Mycoplasma penetrans bacteremia and primary antiphospholipid syndrome

Mycoplasma penetrans, a rare bacterium so far only found in HIV-infected persons, was isolated in the blood and throat of a non-HIV-infected patient with primary antiphospholipid syndrome (whose etiology and pathogenesis are unknown).

Genotypic and phenotypic analysis of Mycoplasma fermentans strains isolated from different host tissues

A correlation was found between the expression of a specific Mycoplasma fermentans surface antigen (Pra, proteinase-resistant antigen) and the site of isolation of the organism from the infected host. Strains which expressed Pra were most frequently associated with cells of bone marrow origin, and strains which lacked expression of Pra were most commonly isolated from the respiratory tract, genital tract, and arthritic joints, i.e., epithelial cell surfaces. Pra was previously shown to be resistant to degradation by proteinases and was hypothesized to play a protective role at the organism surface and perhaps to influence which host tissue site was colonized by the organism. The methods used for this phenotyping scheme required isolation and growth of the mycoplasma in quantities sufficient for immunoblot analysis using monoclonal antibodies. We wanted to determine a more rapid and less cumbersome technique to supplement this method for determining the Pra phenotype directly in clinical specimens. Here we describe PCR studies to investigate the movement of a previously identified M. fermentans insertion sequence (IS)-like element. These data showed a correlation between a specific IS genotype and the Pra+ phenotype. Production of a 160-bp product using a single set of IS-based primers was associated with expression of Pra. The genomic IS location resulting in the 160-bp product was determined by using Southern blot analysis and was found to be a stable insertion site characteristic of genotype I strains. Additional analyses of sequences within and flanking the IS insertion sites revealed another pair of PCR primer sites which resulted in the consistent production of a 450-bp amplicon. The stability of this site was dependent on the absence of the IS-like element between the primer sites. The production of this 450-bp amplicon correlated with the Pra mutant phenotype and was characteristic of genotype II strains. The data showed that the sequence within the IS may be unstable and that reliable genotyping sequences are more easily found in the stable genomic sites which flank the IS element.

Isolation of Mycoplasma hominis from a brain abscess

Mycoplasma hominis is a commensal in the genital tract of women and has been associated with urogenital and extragenital infections. However, central nervous system infections with this organism in adults are very rare. Here we describe the recovery of M. hominis from a brain abscess associated with a postpartum infection. Seroconversion to the isolated strain was detected by both a metabolic inhibition test and an immunoblotting assay. This case demonstrates the pathogenic potential of M. hominis and the need for rapid recognition of the organism so that appropriate chemotherapeutic intervention can occur.

Epitope mapping of the variable repetitive region with the MB antigen of Ureaplasma urealyticum

One of the major surface structures of Ureaplasma urealyticum recognized by antibodies of patients during infection is the MB antigen. Previously, we showed by Western blot (immunoblot) analysis that any one of the anti-MB monoclonal antibodies (MAbs) 3B1.5, 5B1.1, and 10C6.6 could block the binding of patient antibodies to MB. Subsequent DNA sequencing revealed that a unique six-amino-acid direct tandem repeat region composed the carboxy two-thirds of this antigen. In the present study, using antibody-reactive peptide scanning of this repeat region, we demonstrated that the amino acids defining the epitopes for MAbs 3B1.5 5B1.1 and 10C6.6 are EQP, GK, and KEQPA, respectively. Peptide scanning analysis of an infected patient's serum antibody response showed that the dominant epitope was defined by the sequence PAGK. Mapping of these continuous epitopes revealed overlap between all MAb and patient polyclonal antibody binding sites, thus explaining the ability of a single MAb to apparently block all polyclonal antibody binding sites. We also show that a single amino acid difference in the sequence of the repeats of serovars 3 and 14 accounts for the lack of reactivity with serovar 14 of two of the serovar 3-specific MAbs. Finally, the data demonstrate the need to obtain the sequences of the mba genes of all serovars before an effective serovar-specific antibody detection method can be developed.

Sequence analysis of the chromosomal region around and within the V-1-encoding gene of Mycoplasma pulmonis: evidence for DNA inversion as a mechanism for V-1 variation

Although the variation of V-1 antigens of Mycoplasma pulmonis has been correlated with variable expression of the cytadherence properties of this organism and has been implicated as a virulence determining factor in M. pulmonis-induced murine respiratory disease, the precise function of these antigens remains unknown. We have cloned and characterized genes encoding V-1 from two M. pulmonis UAB CT V-1 variants that differ in hemadsorption properties. A comparison of the nucleotide sequences revealed that these two variant genes were identical in the 5'-most 724 nucleotides. Regions of extensive divergence that contained repeated sequences were found 3' to this conserved region. On the basis of their deduced amino acid sequences, one variant expressed a V-1 protein of 94.2 kDa presumptively containing 40 repeats of 17 amino acids and the other expressed a protein of 27.4 kDa consisting 2 direct, noncontiguous 9-amino-acid repeats. These general properties, as well as the presence of a prokaryotic lipoprotein acylation sequence (L-X-Y-C), indicated that the genes encoding V-1 were similar in structure to genes encoding other mycoplasma surface lipoproteins. Further analysis of sequences flanking these genes revealed that these variants arose via an inversion event which provided an interchange of the two variable regions as well as for the conserved region of these genes and immunoblot analyses using rabbit polyclonal antibodies specific for synthetic peptides derived from the sequences of the different variable regions indicated that DNA inversion acted as a switch which allowed only one of the two different genes to be expressed at any given time. This inversion model clearly provides a mechanism by which M. pulmonis can alter its surface architecture and also strongly suggests that the as-yet-undefined function of V-1 residues in the variable carboxy region of these proteins.

In vitro influence of Mycoplasma penetrans on activation of peripheral T lymphocytes from healthy donors or human immunodeficiency virus-infected individuals

Mycoplasma penetrans is a mycoplasma species newly isolated from the urine of human immunodeficiency virus (HIV)-infected individuals and presents the only case in which an association has been found between antibodies against a mycoplasma and HIV infection. To further explore the effects of M. penetrans on the immune system, we studied the influence of this mycoplasma on peripheral blood mononuclear cells (PBMCs) from healthy donors and HIV-infected individuals. M. penetrans induced, in addition to blastogenesis of PBMCs, a significant proliferative response associated with the expression of some activation markers such as CD69, HLA-DR, and CD25. This M. penetrans-dependent lymphocyte activation was observed not only in healthy donors but also in HIV-infected persons at different stages of the disease. In addition, our study revealed that both CD4+ and CD8+ T lymphocytes were responsive to M. penetrans. Interestingly, the mitogenic activity of M. penetrans was associated with mycoplasma cells but not with the supernatants of mycoplasma culture. The potent stimulating activity of M. penetrans on T lymphocytes from HIV-infected individuals is of particular interest in view of the supposed contribution of immune activation to HIV replication and disease progression.

Dopaminergic drugs in the medial preoptic area and nucleus accumbens: effects on motor activity, sexual motivation, and sexual performance

In two experiments, dopamine agonists and/or antagonists were injected into the medial preoptic area (MPOA) or the nucleus accumbens (NAcc) of male rats. The animals were then tested in an X-mase with four goal boxes, which contained a receptive female, a male, or were empty. In Experiment 1, the D1 antagonist SCH-23390 and the D2 antagonist raclopride in the MPOA decreased the percentage of trials on which the female's chamber was chosen, a measure of sexual motivation. Raclopride also decreased the number of animals that copulated after choosing the female's chamber. The 10-micrograms dose of the D3/D2 agonist quinelorane increased the latency to reach the female's chamber, slowed the onset of copulation, and decreased the number of intromissions preceding an ejaculation. In Experiment 2, 1- and 5-micrograms doses of quinelorane and of the mixed D1/D2 agonist apomorphine were injected bilaterally into the NAcc. Both doses of quinelorane increased the number of times that the subject did not select a chamber within 60 s. No drug in the NAcc affected specifically sexual motivation or performance. The results are consistent with differential influence of the MPOA and the NAcc on motor activity, sexual motivation, and sexual performance.

Characterization of a major Mycoplasma penetrans lipoprotein and of its gene

A novel mycoplasmal species designated as Mycoplasma penetrans has been isolated recently from patients infected with human immunodeficiency virus. p35, a major antigen extracted from the membrane of this mycoplasma using Triton X-114 has been found to be a lipoprotein. After proteolytic treatment of p35, the sequence of one of the resulting peptides was determined and a corresponding oligonucleotide was deduced. Using this oligonucleotide as a probe the p35 gene was cloned and sequenced. Sequence analysis revealed an amino-terminal signal peptide with a potential acylation site which would result in a 35.3 kDa mature product. In addition, the p35 gene was followed by an open reading frame with a corresponding polypeptide partially homologous to p35, in particular to the N-terminus region.

Small repeating units within the Ureaplasma urealyticum MB antigen gene encode serovar specificity and are associated with antigen size variation

Ureaplasma urealyticum is a common commensal of the female lower urogenital tract, yet it has been shown to be an important cause of chorioamnion infection, respiratory and central nervous system disease, and death in premature infants. It has been suggested that only certain serovars are capable of producing invasive disease. However, we previously showed that many serotypes are invasive and that perhaps antigen variability and host factors are more important determinants of ureaplasma infections than are different serotypes per se. The molecular characterization in this report describes a mechanism available to ureaplasmas for producing antigen variation. That antigen, designated MB and previously identified on U. urealyticum, contains serovar-specific and cross-reactive epitopes, is produced both in vitro and in vivo, is a predominant antigen recognized during ureaplasma infections of humans, undergoes a high rate of size variation in vitro, and is size variable on invasive ureaplasma isolates. In the present study, we cloned and sequenced the gene of the MB antigen from serovar 3, the serovar most commonly isolated from humans. The 3' two-thirds of the gene was shown to contain identical 18-nucleotide tandem repeats. PCR analysis and direct sequencing of two variants indicated that alterations within this repeat region are responsible for the size variation of the MB antigen. Intact recombinant serovar 3 MB antigen and truncated products, expressed by coupled in vitro transcription and translation of the cloned gene, were immunoprecipitated by both a serovar-specific monoclonal antibody and the serum of a U. urealyticum-infected patient, and these results identified the repeat region of the MB antigen as serovar defining. Resolution of the precise amino acids responsible for specific epitopes and characterization of similar genes in the other serovars should yield reagents useful in elucidating the role of antigen size variants in disease production and the role of specific antibody in protection from ureaplasma disease.

Ureaplasma urealyticum biovar specificity and diversity are encoded in multiple-banded antigen gene

Ureaplasma urealyticum is a commensal organism of the lower genital tract of females, but in a subpopulation of individuals, it can invade the upper genital tract. It is a significant cause of chorioamnionitis and neonatal morbidity and mortality. There are 14 recognized serovars of U. urealyticum; these can be divided into two distinct clusters or biovars. Biovar 1 is composed of serovars 1, 3, 6, and 14, Biovar 2 is composed of serovars 2, 4, 5, 7, 8, 9, 10, 11, 12, and 13. We previously identified a surface antigen, the multiple-banded (MB) antigen, which contains both serovar-specific and cross-reactive epitopes. Genotypic characterization of the C-terminal region of the MB antigen of serovar 3 indicates that serovar specificity and MB antigen size variation reside in that domain. In the present study, we used PCR analysis with primers derived from the serovar 3 MB antigen gene DNA sequence to determine if the MB antigen gene was present in the remaining 13 reference serovars as well as in invasive clinical isolates. The results indicated that not only was the MB antigen gene present in all serovars but that the genes' 5' regions were markers of biovar specificity and diversity. Further analysis of this region should reveal the phylogenetic relationship among serovars of U. urealyticum and, possibly, their invasive potential.

Cytopathogenicity of Mycoplasma fermentans (including strain incognitus)

Mycoplasma fermentans strain incognitus, an organism recently identified in tissues of patients with AIDS and in tissues of otherwise healthy adults with an acute fatal respiratory disease, was evaluated for cytopathogenicity for tracheal tissue in vivo and in vitro. In this study, the organism produced a chronic infection of the lower respiratory tract in LEW rats following intranasal inoculation and induced both ciliostasis and cytopathology in experimentally infected tracheal explants from rats. The time of onset of ciliostasis, type of cytopathogenicity, and localization of organism in strain incognitus were different from those in other strains of M. fermentans as well as other species of mycoplasmas isolated from humans. The results strongly support, but do not prove, that M. fermentans strain incognitus is an unusually invasive mycoplasma, as it was the only strain found within respiratory epithelial cells both in vivo and in vitro. Detection of the organism within the lamina propria also supported the organism's invasive potential. Further study of both the in vivo and in vitro models should provide insights into this potentially unique mycoplasma-host relationship.

Structural variations and phenotypic switching of mycoplasmal antigens

It is becoming apparent that a high rate of variability of surface structures is a ubiquitous property among mycoplasmas. The present study demonstrates how variations in the size of the V-1 antigen (a major surface antigen of Mycoplasma pulmonis thought to be associated with virulence) are reflected by phenotypic differences (cytadherence) that may play a role in virulence of the organism. Furthermore, a similar antigen is described for the human pathogen Urea-plasma urealyticum, and data are presented on the analysis of clinical isolates that demonstrate the potential for variation in the size of this antigen in vivo. Although no direct connection of antigen variation to natural disease has yet been presented, the data further document the tremendous potential for virulence-related diversity possessed by these organisms and emphasize the importance of a valid animal model for discerning the true relationship between variation and virulence.

Evaluation of intraspecies genetic variation within the 16S rRNA gene of Mycoplasma hominis and detection by polymerase chain reaction

Mycoplasma hominis is a heterogeneous species with DNA-DNA hybridization values ranging from 51 to 100%. We report here the sequencing of the 16S rRNA gene of a strain (183) that greatly differs from the type strain (PG21) of this species. Comparison of 16S rDNA sequences from these two strains showed limited differences, indicating that the two strains belong to the same rRNA species complex. Using these nucleotide sequence data, we established a rapid method for the detection of M. hominis by using polymerase chain reaction. This method was shown to be sensitive and specific when tested with reference strains and clinical isolates.

Ureaplasma urealyticum intrauterine infection: role in prematurity and disease in newborns

Ureaplasma urealyticum, a common commensal of the urogenital tract of sexually mature humans, is gaining recognition as an important opportunistic pathogen during pregnancy. While its etiologic significance in many aspects of adverse pregnancy remains controversial, recent evidence indicates that U. urealyticum in the absence of other organisms is a cause of chorioamnionitis. Furthermore, ureaplasmal infection of the chorioamnion is significantly associated with premature spontaneous labor and delivery. In at least some cases, it appears to be causal. Present evidence indicates that U. urealyticum is a cause of septicemia, meningitis, and pneumonia in newborn infants, particularly those born prematurely. There is strong but not definitive evidence that ureaplasmal infection of the lower respiratory tract can lead to development of chronic lung disease in very low-birth-weight infants. Although risk factors for colonization of the lower genitourinary tract have been identified, little information is available concerning risk factors for intrauterine infection and host immune responses to invasive infection. Recent establishment of animal models of respiratory and central nervous system diseases should provide an opportunity to evaluate risk factors, pathogenic mechanisms, and operative immune mechanisms. However, the most critical need is additional information concerning indications for diagnosis and treatment as well as efficacy of treatment.

Serotype diversity and antigen variation among invasive isolates of Ureaplasma urealyticum from neonates

Ureaplasma urealyticum has previously been isolated from the cultured cerebrospinal fluid of 13 of 418 newborn infants; additional bloodstream isolates were obtained from the same population. Ten of the 13 cerebrospinal fluid and 3 bloodstream isolates were available for serotyping in the present study. By the use of serotype-specific reagents, including monoclonal antibodies, 70% of the cerebrospinal fluid isolates were identifiable as serotype 1, 3, 6, 8, or 10; i.e., they represented 5 of the 14 established serotypes or both presently defined genomic clusters. One of the bloodstream isolates was identified as serotype 3. Our data support the hypothesis that the property of invasiveness for unreaplasmas is likely not limited to one or a few particular serotypes among the 14 established serovars. Additionally, our study has shown that even in isolates of the same serotype, there can be size variation in the antigens expressed. Therefore, it would appear that many serotypes are invasive and that perhaps antigen variability and host factors may be more important determinants for ureaplasma infections than different serotypes per se.

Protein and antigen variability among strains of Mycoplasma arthritidis

Six strains of Mycoplasma arthritidis isolated from different host tissues were examined for differences in their proteins and antigens by using one- and two-dimensional electrophoretic techniques as well as immunoblotting. One-dimensional electrophoresis revealed differences in concentrations of individual bands, but not differences in the overall banding pattern. By two-dimensional electrophoretic analysis, 25 proteins were identified as strain-variable whereas the majority of protein spots was strain-constant (about 195 after IEF-2D-PAGE and 145 after NEPHGE-2D-PAGE). Immunoblot analysis using an antiserum against the type-strain of Mycoplasma arthritidis (PG 6) revealed size-heterogeneity of antigens of all six strains. An epitopic relationship between these size-variant antigens could be demonstrated by using monospecific antibodies produced against some of these antigens of Mycoplasma arthritidis. Furthermore, we describe a highly variable antigen of Mycoplasma arthritidis similar to that shown previously in Mycoplasma pulmonis.

Cytopathic effects of Mycoplasma pulmonis in vivo and in vitro

This study was performed to evaluate the cytopathic features resulting from Mycoplasma pulmonis infection of tracheal organ cultures compared to with those seen in in vivo infection and to use this system to determine possible differences in cytopathic effects in two M. pulmonis variants found to cause different diseases in vivo. The attachment of M. pulmonis to respiratory epithelium was similar in vivo and in vitro. Cytopathic effects seen in both systems were also similar in loss of tight junctions between cells and exfoliation of respiratory cells, resulting in exposure of the subepithelial layer. These similarities indicate that the observed tissue damage is initiated by the mycoplasmas rather than by immunologic host responses but does not exclude the possibility that host responses may subsequently contribute to the cytopathological events. Comparison of the effects of the two variants (one known to cause death in vivo) did not reveal differences in vitro. This suggests that host factors (not present in vitro) may account for differences in virulence. Detailed in vitro studies allowed the identification of the time frame corresponding to the in vivo infection and also revealed the limitations of the in vitro system.

Protein and antigen heterogeneity among strains of Mycoplasma fermentans

The proteins and antigens of three strains of Mycoplasma fermentans were compared with those of a mycoplasma, designated "Mycoplasma incognitus," recently identified in tissues of AIDS patients. Previous studies have shown that "M. incognitus" is most likely not a new species but rather a strain of M. fermentans. In the present study, one- and two-dimensional electrophoretic analysis demonstrated the expected similarity between these mycoplasmas, but it also demonstrated several distinct protein differences. Nine proteins were identified as strain variable by two-dimensional gel electrophoresis. Also, immunoblot analysis using rabbit antiserum against the type strain of M. fermentans (strain PG 18) documented the occurrence of size heterogeneity in at least one and possibly two other antigens.

Efficacy of clarithromycin against Mycoplasma pneumoniae

The in-vitro susceptibility of Mycoplasma pneumoniae to clarithromycin, a new macrolide, was compared with that to erythromycin. A broth microdilution assay was used to evaluate 30 clinical isolates collected over a 15 year period from four countries (United States, Australia, Denmark and Japan). Clarithromycin inhibited the growth of all M. pneumoniae strains at low concentrations (less than or equal to 0.008 mg/l) similarly to erythromycin (less than or equal to 0.008 mg/l). In 120 outpatients with radiographically confirmed community acquired pneumonia (mean age 46.2 years), M. pneumoniae was detected culturally and/or serologically by ELISA and immunoblotting in 13% of patients, thus confirming the continued importance of this organism as a respiratory pathogen. M. pneumoniae isolates from these patients were shown to be equally susceptible to clarithromycin (less than or equal to 0.008 mg/l) and erythromycin (less than or equal to 0.008 mg/l). Both clarithromycin and erythromycin were effective in the treatment of community-acquired pneumonia. There were no statistically significant or clinically important differences between the two treatment groups with respect to clinical or radiographic resolution of disease or improvement in signs and symptoms. While the number of clinically evaluable patients with M. pneumoniae infections was small, both macrolides seemed equally effective.

Variable antigens of Ureaplasma urealyticum containing both serovar-specific and serovar-cross-reactive epitopes

Currently there are 14 recognized serovars of Ureaplasma urealyticum, and it has been postulated that only certain ones may be associated with disease and that lack of serovar-specific antibody may be an important risk factor. Unfortunately, ureaplasma antigens important in the human immune response and disease pathogenesis are poorly defined. By using sera from ureaplasma-infected patients and antiureaplasma monoclonal antibodies, the present study has demonstrated, for serovars 3, 8, and 10, antigens which (i) are species specific, (ii) contain both serovar-specific and cross-reactive epitope(s), (iii) are produced not only in vitro but also in vivo, (iv) undergo a high rate of structural variation in vitro, (v) are present and structurally variable on invasive ureaplasma isolates (i.e., those from placenta, lung, and cerebrospinal fluid), and (vi) are among the predominant antigens recognized during infections in humans. Furthermore, we have shown that monoclonal antibodies to these antigens can inhibit the growth of the organisms in vitro, indicating the potential for these antigens to be important for host defense.

Mycoplasma pulmonis V-1 surface protein variation: occurrence in vivo and association with lung lesions

The V-1 antigen of Mycoplasma pulmonis is exposed to the surface of the mycoplasma and has an immunoblot banding pattern that varies in vitro between and within strains. To determine if V-1 variation occurs in vivo, we infected C3H/HeNCr mice intranasally with 5 X 10(8) colony-forming units of M. pulmonis strain 5782C. We isolated M. pulmonis clones from the respiratory tracts of mice up to 28 days post-infection, then used anti-V-1 monoclonal antibody P39 to visualize their V-1 immunoblot banding patterns. By the 28th day following infection, 92% of the recovered clones had variant V-1 banding patterns. Additionally, there was a significant correlation between the severity of lung lesions and the percentage of V-1 variant clones recovered from the respiratory tracts of individual mice. These studies prove that V-1 variation does occur in vivo, and suggest that mice with more severe pulmonary lesions tend to have more V-1 variant clones as a percentage of the M. pulmonis population. Thus, variation in the V-1 protein may be a mechanism by which M. pulmonis persists in the in vivo environment, possibly by evasion of host immune surveillance or by alteration of its surface membrane to take better advantage of its environmental niche in the host.

High-frequency variation in Mycoplasma pulmonis colony size

Heterogeneity in colony size of the murine pathogen Mycoplasma pulmonis was examined. Subcloning experiments showed that colony size variation resulted from high-frequency genetic changes. About 3% of the colonies from any given subclone were variants, with as much as a fourfold change in colony diameter. When the variants were propagated in liquid broth, their doubling times in logarithmic growth phase reflected the colony sizes obtained on agar. Colony size variation correlated with changes in the electrophoretic properties of the V-1 surface antigen.

Subunit structure of the variable V-1 antigen of Mycoplasma pulmonis

It was previously shown that multiple structural variants of the V-1 antigen (variable antigen 1) of Mycoplasma pulmonis could be found within a single strain. This antigen is unusual in that it produces a ladder pattern after sodium dodecyl sulfate (SDS)-polyacrylamide gel electrophoresis. The present study showed that some variants of V-1 could be extracted into the aqueous phase of a phenol-H2O system. Analysis with anti-V-1 monoclonal antibodies showed that the phenol-H2O-extracted V-1 had a regular spacing of 3.1 kilodaltons (kDa) between bands and trypsinization of this extracted V-1 resulted in the gradual symmetrical collapse (2.9-kDa increments) of the ladder into a single band, suggesting the presence of multiple identical subunits within the V-1 structure. The upper band from the phenol-H2O-extracted V-1 was isolated and analyzed by SDS-polyacrylamide gel electrophoresis immunoblotting, resulting in the regeneration of the original ladder pattern with 3.1-kDa spacing between bands. When V-1 was boiled for increasing times in the presence of SDS, the staining intensity of the upper band decreased with the concurrent appearance of additional lower-molecular-weight bands. Finally, by using whole cells, it was found that the lower-molecular-weight species of the ladder pattern selectively partitioned into the hydrophobic phase of a Triton X-114 phase partitioning system, and the higher-molecular-weight bands were found in the aqueous phase. These data indicate that the V-1 bands are composed of subunits which may aggregate via hydrophobic interactions and that these aggregates at least partially dissociate when exposed to harsh denaturing conditions, resulting in the characteristic ladder pattern of V-1.

Adsorption of mycoplasma virus P1 to host cells

The adsorption of mycoplasma virus P1, a virus which infects some strains of Mycoplasma pulmonis, to host cells was examined. Mutants of M. pulmonis to which P1 virus did not adsorb were isolated. Proteins from the mutants and from wild-type cells were compared by two-dimensional polyacrylamide gel electrophoresis, and the only observed difference was in the surface antigen V-1. The electrophoretic properties of V-1 also correlated with the host range of the virus. These data strongly suggest that the V-1 antigen affects adsorption of P1 virus to host cells.

Protein antigens of genital mycoplasmas

Surface structures of the genital mycoplasmas Ureaplasma urealyticum and Mycoplasma hominis that are important in the human immune response and pathogenesis of disease are relatively poorly defined. In this study, an unusual antigen complex of U. urealyticum consisting of multiple bands forming a "ladder" pattern after electrophoretic separation was noted. It is similar to the variable V-1 surface antigen of Mycoplasma pulmonis. Data on U. urealyticum are only preliminary, but the ureaplasma antigen, if it proves to be analogous to V-1, may provide the antigenic determinants for distinguishing among serovars or serogroups and correlating them with pathogenicity. Surface proteins of M. hominis were identified with use of 125I surface labeling, [35S]methionine metabolic labeling, and immunoadsorption of rabbit antiserum. Comparison of M. hominis reference strains PG-21 and 4195 showed little homology between surface proteins, although with metabolic labeling they appeared essentially identical. Immunoblotting with patients' sera, using PG-21 as antigen, showed that most reactions were directed to surface proteins and that a 102K antigen (MH1) was recognized by 94% of the sera. MH1 was one of the few surface proteins of PG-21 that appeared to have counterparts in the other six reference strains, making MH1 a prime candidate for reliable and specific detection of M. hominis infection.

Accuracy of respiratory inductive plethysmographic cross-sectional areas

The present study was undertaken to evaluate whether the respiratory inductive plethysmograph (RIP) 1) reflects changes of cross-sectional area enclosed by its transducer band in the presence of deformations of shape or whether it 2) has a stable base line. Testing of RIP was carried out with a device incorporating a thermally compensated oscillator and digital demodulatory circuitry. This system, introduced to commerce in 1983, superceded the nonthermal compensated oscillatory and analog demodulator circuitry first used in 1977. Testing the effects of changing cross-sectional area was accomplished by stretching a standard RIP transducer band around wooden dowels placed in holes on a peg board grid to form 23 curved and 5 rectangular shapes. The output voltage from RIP was linear for both the curved and rectangular shapes for changes of cross-sectional area within a physiological range. However, the regression line of voltage vs. cross-sectional area for the rectangular shapes was parallel and slightly displaced from the regression line for the curved shapes due to mutual coupling of inductance in the corners. Base-line drift from a RIP transducer band stretched to enclose an elliptical shape was less than 2.5 mV over a 12-h observation period. Current RIP technology accurately reflects changes of cross-sectional area of physiological shapes and has a stable base line.

Heterogeneity among strains and a high rate of variation within strains of a major surface antigen of Mycoplasma pulmonis

Monoclonal and monospecific antibodies were used to characterize a major Mycoplasma pulmonis surface antigen complex, V-1. Heterogeneity of V-1 was detected among strains and a high frequency of variation was detected within subclones of single strains. Analysis of 18 different strains showed that no two displayed identical electrophoretic immunoblot patterns for V-1. Analysis of 50 filter clones from an individual strain (not previously filter cloned) revealed at least 10 different V-1 patterns. The two most frequently occurring patterns were expressed by 36% and 24%, respectively, of the total population. Serial subcloning (four separate series) of several of these original clones showed that the average rate of V-1 variation was 2 x 10(-3) per cell per generation. Immunoblots with different anti-V-1 monoclonal antibodies demonstrated that there were both structurally and antigenically different forms of this antigen. Also, two-dimensional polyacrylamide gel analyses showed that different forms of V-1 could vary in charge. This potential for variability in a major surface antigen of mycoplasmas could have important implications as to how the organism interacts with its host.

Protein variability among strains of Mycoplasma pulmonis

The proteins of Mycoplasma pulmonis were examined by two-dimensional polyacrylamide gel electrophoresis and immunoblotting. Comparison of profiles from silver-stained two-dimensional polyacrylamide gel electrophoresis of 18 strains of M. pulmonis allowed identification of five proteins that were strain variable. These variable proteins were not dependent on the medium used to grow the organisms and were shown by reaction with serum samples from naturally infected rats and mice to be produced in vivo and not to be medium components. Identification of strain-variable proteins may lead to an explanation of the differences in properties found among M. pulmonis strains.

Mycoplasma pulmonis proteins common to murine mycoplasmas

The proteins of Mycoplasma pulmonis were examined by two-dimensional polyacrylamide gel electrophoresis (2D-PAGE) and immunoblots using the following sera: antimedium, anti-M. arthritidis, anti-M. collis, anti-M. neurolyticum, and anti-M. muris. Fifteen proteins identified as genus-common were shared by M. pulmonis and at least one other mycoplasmal species. These proteins were shown not to be medium components, based on their reaction with antimedium serum.

Accuracy of respiratory inductive plethysmograph over wide range of rib cage and abdominal compartmental contributions to tidal volume in normal subjects and in patients with chronic obstructive pulmonary disease

We assessed the accuracy of the respiratory inductive plethysmograph in the supine position to spirometry by the two-body position, least squares calibration and single-body position, isovolume calibration procedures. The comparison was carried out simultaneously in normal subjects breathing naturally and with voluntarily controlled abdominal or thoracic breathing, and in patients with COPD breathing naturally and with voluntarily controlled abdominal breathing patterns. In both groups, there was no significant difference in estimation of tidal volume between the 2 calibration procedures for the various breathing patterns. There was greater deviation from spirometric tidal volume values for both calibration methods in patients with COPD during abdominal than during natural breathing. In the normal subjects, agreement between the rib cage and abdominal partitioning of tidal volume for both calibration methods was good, but in the patients with COPD there was greater variability. In normal subjects, over a wide range of rib cage and abdominal compartmental contributions to tidal volume, either calibration procedure appears satisfactory. For patients with COPD, if large changes occur in the distribution of rib cage and abdominal contributions to tidal volume, then validation of respiratory inductive plethysmography to spirometry must be rechecked.