Immune control of murine coccidiosis: CD4+and CD8+T lymphocytes contribute differentially in resistance to primary and secondary infections

The effect of treatment with monoclonal antibodies (Mabs) which deplete CD4+or CD8+T lymphocytes, on infections withEimeriaspp. was examined in NIH mice. Treatment with anti-CD4 Mab increased susceptibility to primary infections withE. vermiformisorE. pragensisand reduced the subsequent resistance of the mice to homologous challenge. Similar treatment of immune mice did not affect their resistance to re-infection but this was reduced in mice depleted of CD8+T lymphocytes. In mice immunized withE. vermiformisthe effect of CD8+-depletion was very slight, apparent only as the presence of small numbers of oocysts in the faeces of some mice; in mice immunized withE. pragensisthere was a small, though significant, increase in oocyst production, compared with controls and anti-CD4-treated groups. These results confirm the importance of mechanisms involving the function of CD4+T lymphocytes in the control of primary infections withEimeriaspp. and indicate that CD8+cells play some part in the expression of resistance to reinfection. They also show that a major part of this resistance was not affected by either of the treatments given.

Failure of nude (athymic) rats to become resistant to reinfection with the intestinal coccidian parasite Eimeria nieschulzi or the nematode Nippostrongylus brasiliensis

The course of each of three successive infections with Eimeria nieschulzi in nude (athymic) rats was the same as the primary infection in nu/+ animals, with the production of more oocysts. This indicates that resistance to reinfection with this parasite is mediated by T lymphocytes but that these cells do not control the duration of the life cycle, since oocyst production was not prolonged in the nu/nu rats. After the three infections with E. nieschulzi, the rats were exposed twice to the intestinal nematode Nippostrongylus brasiliensis, and the nu/nu were completely susceptible even to the second infection. Egg production by both infections in the nu/nu animals was similar and continued at a high plateau level for 28 days before falling to a low level. It appears that the strain of N. brasiliensis used in this study is unable to sustain high egg production for more than 4 weeks in T cell deficient rats.

Design and Fabrication of Piezoresistive Microcantilever Array for Stress-based Biochemical Detection

Abstract not Available.

Vaccination against coccidiosis: host strain-dependent evocation of protective and suppressive subsets of murine lymphocytes

BALB/c mice are normally more resistant than C57BL/6 (B6) mice to infection with Eimeria vermiformis, but these phenotypes can be reversed by oral or parenteral vaccination with a crude antigen prepared from the parasite. Treatment of mice with antibodies specific for CD4+ or CD8+ T cells showed that the increased susceptibility of vaccinated BALB/c mice was associated with the presence of CD4+ T cells. This finding was confirmed when the recipients of CD4+ T cells selected from the mesenteric lymph nodes (MLN) of vaccinated BALB/c mice produced more oocysts after challenge than the recipients of a similar population of cells from sham-vaccinated mice. The residual population of cells (presumably enriched for CD8+ T cells, 'CD8+'), on the other hand, conferred some protection and, in B6 mice, the findings were reversed. Thus, vaccination induced suppressive or protective CD4+ cells and protective or suppressive 'CD8+' cells, depending upon the normal resistance/susceptibility phenotype of the host. Examinations of the isotypes (IgG1, IgG2a) of specific serum antibodies, and of the levels of IFN-gamma and IL-5 cytokines released by MLN cells stimulated ex vivo, did not allow any further characterization of the mechanisms involved.

Comparison of single-dose oral granisetron versus intravenous ondansetron in the prevention of nausea and vomiting induced by moderately emetogenic chemotherapy: a multicenter, double-blind, randomized parallel study

PURPOSE

The antiemetic effectiveness and safety of single-dose oral granisetron were compared with intravenous (I.V.) ondansetron in chemotherapy-naive patients who received moderately emetogenic chemotherapy.

PATIENTS AND METHODS

In this double-blind, parallel-group study, patients naive to emetogenic chemotherapy (N = 1,085) who were scheduled to receive cyclophosphamide- (500 to 1,200 mg/m2) or carboplatin (> or = 300 mg/m2) based chemotherapy, were randomized to receive either oral granisetron (n = 542) or I.V. ondansetron (n = 543). Efficacy assessments included the proportion of patients in each treatment group with total control over the 24 and 48 hours following chemotherapy initiation, as well as incidence and severity of nausea and emesis and use of antiemetic rescue medication. Prophylactic corticosteroids were allowed. Safety assessment was based on patients' reports of adverse experiences.

RESULTS

Approximately 80% of patients received prophylactic corticosteroids. Single-dose oral granisetron (2 mg) and I.V. ondansetron (32 mg) resulted in equivalent levels of total emetic control during the first 48 hours after chemotherapy. The proportion of nausea- and emesis-free patients at 24 and 48 hours were also approximately equivalent. The most commonly reported adverse experiences were headache, asthenia, and constipation. More patients who received ondonsetron than granisetron reported dizziness (9.6% v 5.4%, respectively; P = .011) and abnormal vision (4.2% v 0.6%, respectively; P < .001).

CONCLUSION

A single oral dose of granisetron (2 mg) resulted in equivalent levels of antiemetic protection as I.V. ondansetron (32 mg). Both agents were well tolerated, although more dizziness and abnormal vision were reported with ondansetron. Because the two antiemetic regimens exhibited equivalent efficacies, additional factors such as convenience and cost of therapy should be considered.

Clinical and methodological issues in antiemetic therapy: a worldwide survey of experts' opinions. Multinational Association of Supportive Care in Cancer

During the 1995 Multinational Association of Supportive Care in Cancer (MASCC) Congress, a consensus conference was planned by the Subcommittee for Antiemetics. To define the topics to be discussed, a questionnaire containing both clinical and methodological issues was sent to 118 experts in 31 countries. The questionnaire contained 33 items on clinical and 19 items on methodological issues, and each response was rated on a 4-level categorical scale. The clinical issues were evaluated for interest, that is clinical importance, and feasibility, that is availability of sufficient data to make them suitable topics for the consensus conference. About 60% of questionnaires were returned, with a small number of missing responses. The responses to the items of clinical interest showed that about two-thirds of the issues identified by the Subcommittee were found by the experts to be of at least high interest, but often the availability of data was found to be insufficient for their discussion. Prevention of acute emesis induced by cisplatin and by moderately emetogenic chemotherapy and the optimal intravenous dose and schedule of the 5-HT3 receptor antagonists were the items with the highest interest and feasibility. The issues in the methodological section were also mostly found to be of at least high interest. The distinction between acute and delayed emesis, the evaluation of the persistence of antiemetic efficacy in subsequent cycles of chemotherapy and the statistical analysis of delayed emesis were the methodological issues in which the highest interest was recorded. Data collected will be used to define the main topics to be discussed during the planned consensus conference.

Oral vaccination against coccidiosis: responses in strains of mice that differ in susceptibility to infection with Eimeria vermiformis

Four strains of mice with different susceptibilities to Eimeria vermiformis were orally dosed with a crude antigen prepared from sporulated oocysts of the parasite, with or without cholera toxin as adjuvant. The effect on subsequent challenge infections depended on the resistance and susceptibility phenotypes of the host: oocyst production was reduced in susceptible C57BL/6 and NIH mice but increased in resistant BALB/c and C3H mice. Despite this contrast, no fundamental differences were detected between the immune responses of BALB/c and C57BL/6 mice, either to vaccination or after superimposed infection, but the suppressing and enhancing effects of vaccination were transmissible to naive recipients via suspensions of mesenteric lymph node cells. The results obtained are compared with those previously reported for parenterally immunized BALB/c and C57BL/6 mice.

T-cell receptor gamma--delta lymphocytes and Eimeria vermiformis infection

The role of T-cell receptor gamma--delta T lymphocytes in coccidiosis was examined by determining the course of infection with Eimeria vermiformis in BALB/c mice depleted of gamma--delta lymphocytes by treatment with GL3 monoclonal antibody. The replication of the parasite in primary infections was not greatly, or consistently, affected by this treatment, and there was no correlation between the extent of depletion of small intestinal intraepithelial lymphocytes and the number of oocysts produced. The resistance of immunized mice to challenge was not compromised by depletion of intraintestinal epithelial lymphocytes when their depletion was effected at the time of primary infection and/or administration of the challenge inoculum. Thus, T-cell receptor gamma--delta T lymphocytes do not appear to be crucial to the establishment, or the control, of primary infection with E. vermiformis and are not principal mediators of the solid immunity to challenge that this infection induces.

Double-blind, randomized comparison of the antiemetic efficacy of intravenous dolasetron mesylate and intravenous ondansetron in the prevention of acute cisplatin-induced emesis in patients with cancer. Dolasetron Comparative Chemotherapy-induced Emesis Prevention Group

PURPOSE

To assess the comparative antiemetic efficacy of single-dose intravenous (IV) dolasetron mesylate and ondansetron in preventing cisplatin-induced nausea and vomiting.

PATIENTS AND METHODS

Cancer patients (n = 609) receiving first-course cisplatin chemotherapy were randomized to one of three treatments: 1.8 or 2.4 mg/kg dolasetron mesylate salt (equivalent to 1.3 and 1.8 mg/kg dolasetron base, respectively) or 32 mg ondansetron. Each treatment was infused over 15 minutes, 30 minutes before cisplatin administration. Patients were stratified to cisplatin doses of > or = 70 and less than 91 mg/m2 (n = 368) or > or = 91 mg/m2 (n = 241), administered over < or = 3 hours. Protocol-defined efficacy criteria included complete response (zero emetic episodes and no rescue medication), major response (1 to 2 emetic episodes and no rescue medication), and patients' report of nausea severity and satisfaction recorded on a 100-mm visual analog scale (VAS).

RESULTS

The three treatments met protocol-specified criteria for equivalence. Complete response rates for dolasetron mesylate 1.8 mg/kg, 2.4 mg/kg, and ondansetron, respectively, were 49.2%, 45.6%, and 50.4% for patients in the lower cisplatin stratum (mean, 74.7 mg/m2) and 36.8%, 31.3%, and 31.8% in the higher cisplatin stratum (mean, 100.6 mg/m2). No significant differences were observed in the extent of nausea with either dolasetron dose compared with ondansetron. Less nausea was noted with 1.8 mg/kg dolasetron compared with the 2.4 mg/kg dose (P = .044) All three antiemetic treatments were well tolerated. Asymptomatic electrocardiogram changes were recorded with both dolasetron and ondansetron.

CONCLUSION

A single IV dose of dolasetron mesylate (1.8 or 2.4 mg/kg) has comparable safety and efficacy to a single 32-mg IV dose of ondansetron in patients receiving cisplatin chemotherapy.

Management of cisplatin-induced delayed emesis

High-dose cisplatin chemotherapy induces a biphasic pattern of emesis. Following the initial peak of emesis, which occurs during the first 8 h after cisplatin, there is a reduction in the occurrence of symptoms with a further increase in the incidence of nausea and emesis which are most severe 48-72 h following cisplatin administration. This latter phase of emesis is defined as delayed emesis and is distinct from the prolonged emesis which occurs after non-cisplatin chemotherapy such as cyclophosphamide. The incidence and severity of delayed emesis is influenced by the dose of cisplatin, being particularly severe in patients receiving doses > 100 mg/m2. Patients who have good control of acute emesis experience less delayed emesis. For this reason, clinical trials designed to evaluate antiemetics for delayed emesis should be carefully designed; ideally patients should be randomized to different treatments after the first 24 h. Studies which have used this design have shown that metoclopramide plus dexamethasone is an effective treatment. However, approximately 50% of patients may experience delayed emesis despite this treatment. The efficacy of the 5-HT3 receptor antagonists in the control of cisplatin-induced delayed emesis in phase II studies has been equivocal and large well-controlled studies with these agents are needed to establish their role in this setting.

Efficacy and safety of oral granisetron versus oral prochlorperazine in preventing nausea and emesis in patients receiving moderately emetogenic chemotherapy

PURPOSE

To compare the efficacy and safety of oral granisetron hydrochloride tablets with that of oral prochlorperazine sustained-release capsules in preventing nausea and emesis induced by moderately emetogenic chemotherapeutic agents.

PATIENTS AND METHODS

In this multicenter, double-blind, randomized, parallel group study, oral granisetron and oral prochlorperazine were compared in 230 chemotherapy-naive, adult cancer patients who received moderately emetogenic chemotherapy. Patients were stratified by gender and randomized to receive either 1.0 mg oral granisetron HCI twice a day for 7 days, or 10 mg oral prochlorperazine sustained-release capsules twice a day for 7 days. The first dose was given 1 hour before initiation of chemotherapy and the second dose 12 hours after the first dose. Patients were evaluated for emetic episodes, extent of nausea, and adverse events for 7 days after the start of chemotherapy. Primary efficacy parameters were complete response (no emetic episodes, no greater than mild nausea, no antiemetic rescue) and total control (no emetic episodes, no nausea, no antiemetic rescue) in the 24 hours after the start of chemotherapy.

RESULTS

Granisetron was significantly more effective than prochlorperazine in achieving a complete response (74% vs. 41%, respectively) and total control of nausea and vomiting (58% vs. 33%, respectively) at the 24-hour assessment. Complete response at 24 hours was significantly higher in the granisetron-treated patients than in prochlorperazine-treated patients. In women, granisetron showed a complete response rate of 69% versus 38% with prochlorperazine; in men, granisetron showed a complete response rate of 92% versus 61% with prochlorperazine. Both regimens were well tolerated, with headache (36% for granisetron, 29% for prochlorperazine) and constipation (31% for granisetron, 6% for prochlorperazine) the most common adverse events.

CONCLUSIONS

: Oral granisetron 1 mg twice a day was significantly more effective than oral prochlorperazine sustained release capsules 10 mg twice a day in complete response and total control of nausea and vomiting at 24 hours after chemotherapy. Both agents were well tolerated.

Responses to vaccination in strains of mice that differ in susceptibility to coccidiosis

BALB/c mice are normally resistant to infection with Eimeria vermiformis than C57BL/6 (B6) mice, but these phenotypes were reversed by prior vaccination with crude antigens prepared from developmental stages of the parasite: B6 mice were protected, and BALB/c mice were made more susceptible. Infections with a heterologous species, E. pragensis, were unaffected when this was given either alone or together with E. vermiformis. In both strains of mice, vaccination induced serum antibody responses to E. vermiformis and the levels were boosted by superimposed infection, the highest values being found in BALB/c mice. Cellular responses in the mesenteric lymph nodes (MLN), as indicated by cellularity and proliferation, either unstimulated or restimulated in vitro with E. vermiformis antigen, were decreased in both strains, but markedly more in BALB/c than B6. The capacity of MLN cells to transfer immunity to naive recipients was lowered by vaccination of BALB/c donors but unimpaired in vaccinated B6 mice. Responses to the mitogen, concanavalin A, and to unrelated antigens (human erythrocytes and fowl gamma globulin) were unaffected. Thus, parenteral vaccination, which increased the susceptibility of BALB/c mice to infection with E. vermiformis, had a depressing effect on some specific immune responses in the MLN. It was surprising to find some reduction in the cellular responses of the MLN of B6 mice also, although they were protected by vaccination.

Cytotoxic effects of natural killer cells have no significant role in controlling infection with the intracellular protozoon Eimeria vermiformis

The course of infection with Eimeria vermiformis in C57BL/6J; NK cell-defective C57BL/6J bg/bg; BALB/c; T-cell-defective BALB/c nu/nu; and T-cell-, B-cell-, and NK cell-defective BALB/c x C57BL/6 scid/scid bg/bg mice was monitored. For young C57BL/6J mice, the bg/bg mutants consistently produced fewer oocysts than the controls; there were no differences between older mice of these strains. Wild-type BALB/c mice were more resistant to infection than the nu/nu and scid/scid bg/bg mutants, but there was no difference between the mutants. Treatment of BALB/c mice with poly(I.C) had no effect on the course of infection. These findings confirm the ineffectiveness of NK cells in this system.

Comparative clinical trial of granisetron and ondansetron in the prophylaxis of cisplatin-induced emesis. The Granisetron Study Group

PURPOSE

To compare the efficacy and safety of granisetron and ondansetron, serotonin (5-HT3) receptor antagonists shown to be effective in the prevention of chemotherapy-induced emesis.

PATIENTS AND METHODS

In a double-blind, randomized, stratified, parallel-group study, the efficacy and safety of granisetron and ondansetron were compared in 987 chemotherapy-naive patients who received cisplatin in doses > or = 60 mg/m2. Granisetron was administered as a single dose of 10 or 40 micrograms/kg before the start of chemotherapy. Ondansetron was administered in doses of 0.15 mg/kg before and 4 and 8 hours after the start of chemotherapy. The three treatment groups were well-matched with respect to demographic characteristics and the dose of cisplatin administered.

RESULTS

For all evaluations, single doses of granisetron 10 or 40 micrograms/kg were as effective as three 0.15-mg/kg doses of ondansetron. Total control (no vomiting, no retching, no nausea, and no use of rescue) was attained by 38%, 41%, and 39% of all patients who received granisetron 10 microgram/kg, granisetron 40 micrograms/kg, and ondansetron, respectively. No vomiting or retching and no use of rescue antiemetics were reported in 47%, 48%, and 51% of patients who received granisetron 10 micrograms/kg, granisetron 40 micrograms/kg, and ondansetron, respectively; no nausea and no use of rescue antiemetics were reported in 39%, 42%, and 40% of patients, respectively.

CONCLUSION

All three treatment regimens were well-tolerated. The results of this study indicate that a single dose of granisetron 10 or 40 micrograms/kg is as effective as three doses of ondansetron 0.15 mg/kg in the prevention of nausea and vomiting induced by cisplatin chemotherapy.

Treatment of malignant pleural mesothelioma with cisplatin, mitomycin C and alpha interferon

From October 1990 to September 1991, 20 consecutive patients with histologically proven malignant pleural mesothelioma (MPM), secondary to environmental exposure to asbestos or erionite, were treated with cisplatin, mitomycin C and alpha interferon (cisplatin 50 mg/m2 i.v. on day 1 of a 21-day cycle; mitomycin C 10 mg/m2 i.v. day 1 of cycles 1,3 and 5; alpha-2b-interferon 10 x 10(6) units i.m., 4 h prior to cisplatin and 10 x 10(6) units i.v. immediately prior to cisplatin day 1 of each cycle). Eighty-two treatment cycles were administered to 19 evaluable patients. Two patients attained a partial response. Eleven patients had stable disease and 6 had disease progression. Toxicities included interferon-related fever and flu-like symptoms, and vomiting. Actuarial median survival was 15 months. Three patients are alive at 20+, 21+ and 27+ months. We conclude that while the addition of alpha interferon to cisplatin and mitomycin C did not result in an objective response higher than previously reported with the cytotoxic agents alone, the trend towards an improvement in median survival as compared to a well-matched historical group suggests some benefit from the inclusion of interferon.

Immunization against experimental coccidiosis produces contrasting results in inbred mice of differing susceptibility to infection

Pretreatment of inbred mice with intravenous and/or intraperitoneal injection of an antigen prepared from sporozoites of Eimeria vermiformis modulated the course of infection with the parasite in a manner that depended on the resistance-susceptibility phenotype of the host. Mice with a resistant background (BALB) produced more oocysts and those with a susceptible background (C57BL) produced fewer oocysts than their respective controls. The optimum conditions for producing these effects were established, and evidence is presented which suggests that the phenomenon might also apply in the target host, the chicken.

Interactions between infections with Eimeria spp. and Trichinella spiralis in inbred mice

Parasitological and immunological interactions between Eimeria vermiformis or E. pragensis and Trichinella spiralis were investigated during concurrent infections in NIH, BALB/c and B10.G inbred mice. The establishment of T. spiralis was unaffected by the presence of either coccidium, but expulsion of adult worms was delayed significantly in mice infected with E. vermiformis; E. pragensis did not have this effect. Replication of E. vermiformis was enhanced in concurrent infections with T. spiralis, but that of E. pragensis was reduced. Specific immune responses to each parasite were unaffected in mice infected with T. spiralis and E. pragensis, but levels of some responses were reduced when T. spiralis and E. vermiformis were combined. Thus both in vitro antigen-induced proliferation of mesenteric lymph node cells (MLNC) and intestinal mastocytosis were lower than in singly infected mice. Mitogen (Con A) responsiveness of MLNC was not affected in mice infected with T. spiralis and E. vermiformis, and cells from these mice were capable of transferring protective immunity to the nematode in naive recipients. Injection of monoclonal antibody to interferon gamma, a major component of the cytokine response to E. vermiformis, did not prevent delay of worm expulsion in concurrent infections. The results are discussed in terms of possible interactions between the T helper cell subsets or the inflammatory components of the responses induced by each parasite.

Clinical activity of a cytotoxic fusion protein in the treatment of cutaneous T-cell lymphoma

PURPOSE

A phase I trial in patients with refractory hematologic malignancies was performed at our institution to test the clinical relevance of the selective cytotoxic activity of the interleukin-2 (IL-2)-diphtheria toxin fusion protein, DAB486IL-2. A subset of five patients from this trial, all with cutaneous T-cell lymphomas (CTCL), forms the basis of this report.

PATIENTS AND METHODS

Two treatment schedules were used. One patient received DAB486IL-2 at a dose of 0.075 mg/kg/d intravenous (i.v.) bolus over 15 minutes daily for 5 consecutive days. The other four patients received DAB486IL-2 at a dose of 0.1 mg/kg as an i.v. infusion over 180 minutes weekly for 5 consecutive weeks.

RESULTS

Three of the five CTCL patients achieved significant tumor responses. One patient attained a complete clinical and pathologic response (CR), which has been sustained without any interval treatment for 33+ months. Two other patients achieved partial responses (PRs) of 17+ and 4 months' duration, respectively. Treatment was well tolerated. The most common adverse effect was a transient increase in hepatic transaminases experienced by all five patients.

CONCLUSION

The growth factor-cytotoxin fusion protein DAB486IL-2 demonstrated significant clinical activity with acceptable toxicity in a group of heavily pretreated patients with CTCL.

Immunity to coccidiosis: genetic influences on lymphocyte and cytokine responses to infection with Eimeria vermiformis in inbred mice

Cellular and cytokine responses to infection with Eimeria vermiformis were compared in BALB/c (resistant) and C57BL/6 (B6-susceptible) inbred mice. Cellular responses in the mesenteric lymph node (MLN) occurred sooner after primary infection in the resistant BALB/c strain. In contrast, proliferative responses occurred earlier after challenge in B6 mice. Resting levels of CD4 + ve and CD8 + ve T-lymphocytes in the MLN differed between the two strains but the relative numbers of each subset remained relatively constant throughout primary infection. MLN cells taken at intervals after infection were assayed for release of the cytokines IFN-gamma, IL-5 and IL-10 after culture in vitro with the mitogen Concanavalin A (Con-A) or with parasite antigen. With either stimulus cells from resistant BALB/c mice released IFN-gamma and IL-5 earlier after infection than did B6 cells. The strains had a comparable absolute ability to produce IFN-gamma but BALB/c cells released more IL-5 than did B6, levels declining, rather than increasing, during primary infection in the latter. Only cells from BALB/c mice released IL-10 during infection. Cells taken after a secondary infection released relatively little cytokine after pulsing in vitro. These data suggest that the difference in response phenotype between the two strains when infected with E. vermiformis reflect a kinetic, rather than a qualitative, difference in ability to mount protective T-helper (Th) cell subset responses. No evidence was found for a Th2-mediated interference with ability to release IFN-gamma, the cytokine most closely associated with protective immunity.

Intestinal changes associated with expression of immunity to challenge with Eimeria vermiformis

To provide more information on the mechanisms involved in the immune inhibition of eimeria infections, NIH mice were adoptively immunized against infection with Eimeria vermiformis by the transfer of mesenteric lymph node cells from primed animals and homologously challenged. Subsequent changes in the architecture and cellular composition of the intestine were compared with those observed in similarly challenged susceptible control mice and correlated with the development of the parasite in the two groups. Actively immunized mice were also examined. In adoptively immunized mice, the development of E. vermiformis was inhibited within 3 days of administering the challenge inoculum. Concurrent changes in the intestine included lymphocytic infiltration, crypt hyperplasia, flattening of the crypt epithelium, and a reduction in the number of Paneth cells. Hyperplasia of goblet and pyroninophilic cells in response to challenge, although accelerated and enhanced in adoptively immunized hosts, occurred after the inhibition of the parasites, and mastocytosis was not observed in these animals, findings which suggest that the activities of goblet, pyroninophilic, and mast cells were not instrumental in reducing the numbers of parasites. The intestines of immunized mice contained fewer intraepithelial lymphocytes at the time of inhibition of the parasites than did those of the controls. The protective effects and intestinal changes described above did not differ appreciably from those seen after challenge of mice that had been immunized by infection.

Eimeria tenella: localization of the sporozoites in the caecum of the domestic fowl

When sporozoites of Eimeria tenella were inoculated into an isolated horn of the bicornuate caecum of the domestic fowl, replicating infections, culminating in the production of oocysts, were found, almost exclusively, in the inoculated horn. In contrast, sporozoites of E. tenella introduced into the bloodstream via a superficial vein induced infections of equivalent intensity in both horns of the caecum. These findings are discussed with reference to (1) the detection (by tissue transfer) of infective sporozoites in samples of cardiac blood and vascular tissues taken within 3 to 18 h of the oral inoculation of oocysts, and (2) the (previously published) observation that the sporozoites of E. tenella are transported from the superficial epithelium of the caecum (site of invasion) to the crypts (site of initial development) within host intra-epithelial lymphocytes. We suggest that a local inflammatory response to the invasion of sporozoites may be responsible for their re-location in proximity to the site of entry. This could act by directing the homing (or retention) of the parasite-bearing lymphocytes, and/or by providing a stimulus for the sporozoite to leave its transporting cell.

A single-blind comparison of intravenous ondansetron, a selective serotonin antagonist, with intravenous metoclopramide in the prevention of nausea and vomiting associated with high-dose cisplatin chemotherapy

Ondansetron (GR 38032F), a selective antagonist of serotonin subtype 3 receptors, is effective in the prevention of emesis associated with cisplatin as well as other chemotherapeutic agents. In this randomized, single-blind, multicenter, parallel group study, we compared the efficacy and safety of intravenous (IV) ondansetron with IV metoclopramide in the prevention of nausea and vomiting associated with high-dose (greater than or equal to 100 mg/m2) cisplatin chemotherapy. Three hundred seven patients receiving their first dose of cisplatin, either alone or in combination with other antineoplastic agents, were randomized to receive ondansetron 0.15 mg/kg IV every 4 hours for three doses or metoclopramide 2 mg/kg IV every 2 hours for three doses, then every 3 hours for three additional doses. The study prohibited the concurrent administration of other antiemetics or dexamethasone. Patients receiving ondansetron had a higher rate of complete protection from emesis (40% v 30%, P = .07), a higher complete plus major response rate (65% v 51%, P = .016), a lower rate of failure (21% v 36%, P = .007), and a lower median number of emetic episodes (one v two, P = .005) than did those receiving metoclopramide. The median time to the first emetic episode was longer on ondansetron (20.5 v 4.3 hours, P less than .001). Adverse events occurred in 48% of patients receiving ondansetron and 69% of those receiving metoclopramide (P less than .001). Akathisia and acute dystonic reactions occurred only on metoclopramide; headache (controlled with acetaminophen) was significantly more frequent with ondansetron. Ondansetron is more effective, produces fewer adverse events, and is easier to administer than metoclopramide for the prevention of emesis associated with high-dose cisplatin chemotherapy.

Interferon-gamma-mediated effects upon immunity to coccidial infections in the mouse

The effect of treatment with a monoclonal antibody (MoAb) capable of neutralising interferon-gamma (IFN-gamma) on the course of coccidial infections in mice (C57BL/6 and NIH infected with Eimeria vermiformis or E. pragensis, and BALB/c infected with E. pragensis) was examined. The results differed with the species of parasite, the strain of mouse, the measure of infection and whether the infection was a primary or secondary one. The replication of E. vermiformis in primary infections was enhanced in both C57BL/6 and NIH mice, but less MoAb was required in NIH than in C57BL/6 to produce similar effects. In neither strain did treatment prevent priming or interfere with the complete immunity to challenge normally induced by moderate infection with E. vermiformis. The replication of E. pragensis in primary infections was not affected in any of the strains of mouse but the clinical effects were exacerbated. Priming with E. pragensis was unaffected by treatment but the partial immunity to challenge, normally induced by infection with this species, was reduced when MoAb was given 2 h before challenge. This reduction was evident as an increased faecal output of oocysts and loss of body weight. These results confirm the role of IFN-gamma in resistance to coccidiosis and further emphasise the complexity of the immune response in this disease.

Eimeria vermiformis: differences in the course of primary infection can be correlated with lymphocyte responsiveness in the BALB/c and C57BL/6 mouse, Mus musculus

BALB/c and C57BL/6 mice are high- and low-responders, respectively, to infection with Eimeria vermiformis, this genetically determined difference being immunologically mediated. In order to identify the level at which response phenotype is determined, the proliferation of mesenteric lymph node cells and their ability to transfer immunity adoptively were investigated in each strain; the development of circulating serum antibodies to E. vermiformis was also determined. In all respects BALB/c mice responded earlier than the C57BL/6 but peak values were similar in both strains. The relationship between the temporal differences noted and the characteristic, differing course of the primary infection in the two strains is discussed.

Gamma interferon controls Eimeria vermiformis primary infection in BALB/c mice

Neutralization of endogenous gamma interferon by treatment with a rat monoclonal antibody caused enhancement of infection with the protozoon Eimeria vermiformis in naive BALB/c mice. The effect was dose dependent and was apparent when a monoclonal antibody was given at 2 h before infection or up to 7 days postinfection, but it decreased with increasing time postinfection between days 4 and 7. The titers of parasite-specific antibodies in the serum were not significantly affected by the injection of monoclonal antibodies. Treatment during priming did not prevent the development of resistance to challenge, and treatment at the time of challenge did not abrogate established immunity. The results indicate that gamma interferon is involved in the control of primary infection with E. vermiformis in BALB/c mice but not in the expression of immunity to challenge.

Immunity to coccidiosis: T-cell control of infection with Eimeria vermiformis in mice does not require co-operation with inflammatory cells

The necessity for co-operation between lymphocytes and myeloid-derived inflammatory cells in the mediation of anti-coccidial immunity was investigated using mice infected with Eimeria vermiformis. Reciprocal exchange of immune lymphocytes between H-2 compatible strains of contrasting susceptibility to infection (resistant BALB/B and susceptible C57BL/10) resulted in successful transfer of immunity in both homologous and heterologous exchanges. Recipients of immune cells, whatever their original response phenotype, expressed a high degree of immunity to infection, indicating that the differential susceptibility of the strains is a property of their lymphoid cells and is not attributable to their capacity to mount inflammatory responses. This conclusion was confirmed by the successful adoptive transfer of immunity into NIH mice previously exposed to 600 rad X-irradiation; at this level of irradiation inflammatory responsiveness is severely depressed. Additional confirmation that strain-response phenotype is lymphocyte dependent and that immune lymphocytes can mediate their effects against E. vermiformis without the intervention of inflammatory cells was obtained from studies on the mucosal mast cell response to infection. No correlation existed between the development of intestinal mastocytosis, an index of T-cell-mediated inflammatory responsiveness, and the expression of resistance to E. vermiformis in BALB/c (resistant), C57BL/10 (susceptible) and NIH (susceptible) mice.

Eimeria vermiformis and E. mitis: inhibition of development in vivo by cyclosporin A

Treatment of the host (Mus musculus, Gallus domesticus) with cyclosporin A during infection with Eimeria vermiformis or E. mitis resulted in a reduction in the numbers of oocysts passed in the feces and/or a delay in patency. The general immunosuppressive effects of the treatment were confirmed in chickens by monitoring their antibody responses to human erythrocytes and lymphoproliferative responses to phytohemagglutinin. Nevertheless, mice and chickens treated with cyclosporin A during a primary infection with E. vermiformis or E. mitis, respectively, were immune to subsequent challenge with these organisms. Thus, cyclosporin A did not interfere with priming. The antiparasite effect of the drug did not allow an evaluation of its effect on established immunity to the coccidia when it was administered at the time of challenge. In an exceptional treated chicken, however, delayed patency of the challenge infection was followed by the production of a number of oocysts similar to that found in unprimed animals. This suggests that the mechanisms of immunity to challenge may be susceptible to disruption by cyclosporin A.

Mediation of immunity to Eimeria vermiformis in mice by L3T4+ T cells

Immunity to infection with Eimeria vermiformis was transferred in NIH mice by both the nylon wool-adherent (B-cell-enriched) and nonadherent (T-cell-enriched) fractions of lymphocytes (spleen and mesenteric lymph node) taken from infected donors. Transfer was more variable with the adherent fraction, and when contaminating T cells were removed by treatment with anti-Thy1 monoclonal antibody (MAb) and complement, this fraction lost all protective activity. The protective effect of T-cell-enriched populations of mesenteric lymphocytes was abrogated by treatment with anti-L3T4 MAb and complement in vitro before transfer or by opsonization with this MAb in vitro before intravenous inoculation into recipients. Similar treatments of cells with anti-Lyt2 MAb did not have this effect, confirming that Thy1+ L3T4+ cells mediate the adoptive transfer of immunity to E. vermiformis. Thy1+ L3T4+ cells were also shown to limit the replication of E. vermiformis in primary infections: mice depleted of this subset (by thymectomy followed by intravenous injection of anti-L3T4 MAb) passed greater numbers of oocysts over a longer period of time than did mice similarly depleted of Lyt2+ cells.

Immunity to coccidiosis: adoptive transfer in NIH mice challenged with Eimeria vermiformis

The development of a reliable model for the adoptive transfer of immunity to coccidiosis (infection with Eimeria vermiformis in NIH mice) is described. More than 10(8) of a mixture of spleen and mesenteric lymph node (MLN) cells, given either intravenously or intraperitoneally, were required to transfer a significant degree of protection. Dividing cells, present in the donors at 10 or 14 days after priming, but not at 5 or 19 days, were shown to be the effectors. When examined separately, MLN cells were found to be superior to spleen cells, and the injection of as few as 5 x 10(7) was capable of substantially reducing the oocyst output from a challenge inoculum. The recipients of cells from primed mice had earlier, and sometimes higher, titres of specific antibodies in the serum but, overall, there was no correlation between these titres and protection. Further characterization of the cells responsible for adoptively transferring immunity to this infection should now be possible.

Eimeria tenella: effects of immunity on sporozoites within the lumen of the small intestine

The effect of immunity on the numbers of sporozoites of Eimeria tenella recoverable from the lumen of the small intestine 1 hr after an oral challenge inoculum of oocysts was examined. The experiments were carried out in chickens which had been given an immunizing inoculum of oocysts 9 or 18 days earlier, and the results were compared with those obtained in a control, unprimed, but similarly challenged, group. Similar numbers of "challenge" sporozoites were found in the intestinal washes of control and 18 day primed chickens but there were fewer in the 9 day primed groups. The titers of antisporozoite IgA antibodies (measured by indirect fluorescence) were higher in the gall bladder bile of the 9 day primed groups but resistance to reinfection (measured by the output of oocysts in the feces after challenge with oocysts orally or with sporozoites intracecally) was greater in the 18 day primed group. Although fewer in number, the challenge sporozoites recovered from the intestinal washes of 9 day primed chickens appeared to be morphologically normal when examined by light microscopy. Also, they were as infective as sporozoites recovered from unprimed control, or 18 day primed, groups when injected intracecally into naive chickens. The findings indicate that, whereas reduction of the number of sporozoites of E. tenella in the lumen of the small intestine (presumably caused by the action of secreted antibodies) can be a means of reducing the effective challenge inoculum, this mechanism does not play a major role in the expression of immunity.

Eimerian life cycles: the patency of eimeria vermiformis, but not Eimeria pragensis, is subject to host (Mus musculus) influence

The ability of Eimeria vermiformis and Eimeria pragensis to produce oocysts in primary infections is influenced by host factors. Oocyst production and the duration of patency were determined for each species in: NIH mice, normal or immunosuppressed (by X-irradiation or injection of cortisone acetate), and strains of mice: nu/+, nu/nu; BALB/c, C57BL/6 known (E. vermiformis), or suspected (E. pragensis), to be of contrasting susceptibility to infection. The effect of induced or genetic susceptibility on the reproduction of E. vermiformis resulted in increases in both oocyst production and the duration of patency. Eimeria pragensis was less affected, with smaller increases in the numbers of oocysts produced and no significant prolongation of patency. The implications of these findings with respect to eimerian life cycles are discussed.

Susceptibility to coccidiosis: contrasting course of primary infections with Eimeria vermiformis in BALB/c and C57/BL/6 mice is based on immune responses

The effects of three immunosuppressive treatments--whole body irradiation and injections of cortisone acetate or cyclophosphamide, on the course of primary infections with Eimeria vermiformis were investigated in 'resistant' BALB/c and 'susceptible' C57BL/6 mice. Immunosuppression (and the nude athymic mutation in BALB/c mice) resulted in increased reproduction of the parasite in both strains of mice, indicating some immunological control of primary infections. The effect was, however, very much more marked in the BALB/c mice, resulting in an alteration in the relative susceptibilities of the two strains. The findings are discussed and it is suggested that the basis for the differences observed in the course of infection in normal BALB/c and C57BL/6 mice lies in their immune responses to this parasite.

Systemic release of mucosal mast cell protease during infection with the intestinal protozoal parasite, Eimeria nieschulzi. Studies in normal and nude rats

The systemic secretion of rat mucosal mast cell protease (RMCPII), a major product of rat mucosal mast cells (MMC), was examined during primary infections with the protozoan parasite, Eimeria nieschulzi in CFH/B, athymic (rnu/rnu) and euthymic (rnu/+) rats. Release of RMCPII into the blood stream (2.9 micrograms/ml of serum) of normal rats occurred within 1 day after infection. This response developed 3-6 hours after inoculation with oocysts, was dose-dependent, and was found in both naive and immune rats. Maximal release of RMCPII (4.5 micrograms/ml of serum) in naive rats occurs 9 days after primary infection, whereas the numbers of MMC and concentrations of mucosal RMCPII were maximal 14 days after infection, by which time the systemic RMCPII response had begun to decline. The numbers of MMC and concentrations of mucosal RMCPII in uninfected nude rats were similar to those in the heterozygous (rnu/+) litter-mates. After infection, the numbers of MMC and concentrations of mucosal RMCPII increased in the heterozygotes but not in nude rats. Similarly, RMCPII was detected systemically only in the heterozygotes.

Infection with Eimeria tenella: modulation of lymphocyte blastogenesis by specific antigen, and evidence for immunodepression

The blastogenic effects of specific parasite antigen and of mitogens on the lymphocytes of chickens infected with Eimeria tenella were examined. Lymphocytes from infected chickens were stimulated to divide when cultured with parasite antigen, but their responses to the T-cell mitogen, phytohemagglutinin (PHA), were depressed throughout the period of infection. Responses to the B-cell mitogen, lipopolysaccharide (LPS), were depressed during the first week of infection but enhanced in the second week. The inclusion of plasma samples from infected chickens in the culture medium depressed the responses of normal spleen lymphocytes to PHA, suggesting that soluble suppressor factors are generated during infection.

Coccidiosis: rapid depletion of circulating lymphocytes after challenge of immune chickens with parasite antigens

Characteristic changes in the numbers of peripheral blood leukocytes occurred after specific challenge of chickens immunized by infection with the intracellular intestinal coccidian parasite Eimeria maxima. Within minutes of enteric or intravenous challenge with viable parasites or with soluble parasite antigen, the numbers of circulating lymphocytes and, to a lesser extent, of heterophils were reduced. This was followed by a period of leukocytosis, the main cellular constituents of which were heterophils and lymphocytes. Indirect fluorescent staining with antisera to T- or B-lymphocytes showed the depletion in lymphocytes to be accounted for mainly by a reduction in the number of T-cells. The leukopenia after oral challenge, found in immunized birds, could be transferred to normal birds by the intravenous injection of serum, plasma, extracts of leukocytes, or suspensions of viable spleen cells.

Susceptibility to coccidiosis: effect of strain of mouse on reproduction of Eimeria vermiformis

The reproduction of Eimeria vermiformis in different strains of phenotypically normal mice and in mice with various immunological characteristics or defects was compared. In some strains of phenotypically normal mice there were marked differences in oocyst production, both in terms of numbers and in the duration of patency, allowing the strains to be classified as resistant or susceptible to infection with E. vermiformis. These differences were apparent only in primary infections; both types of strain were equally resistant to reinfection. Amongst the strains of mice with immunological deficiencies, reproduction of the parasite was greatest in the athymic (nu/nu) mutants and these mice were completely susceptible to reinfection. Strains of mice with lowered or defective antibody production, or with defective neutrophils and low NK cell activity (bg/bg) were more susceptible than the relevant controls to primary infection but all developed substantial immunity to reinfection. Asplenic (Dh/+) mutants were remarkably resistant to infection.

A functional homologue of mammalian secretory component exists in chickens

The existence of a molecule in chickens homologous to the secretory component of mammals has long been in dispute. An intravenous injection of [14C]fucose was given to chickens as a marker for newly synthesized glycoproteins and then unlabeled human IgA was injected intravenously half an hour later. It was shown that the human IgA subsequently appeared in the bile of the chickens combined with a [14C]fucose-labeled molecule; the chicken IgA in these bile samples was similarly labeled. Radiolabeled human secretory IgA was not transported in large amounts across the chicken liver in vivo and neither was purified chicken bile IgA. These results indicate that a molecule exists in chickens which behaves in a manner analogous to mammalian secretory component.

Coccidiosis: T-lymphocyte-dependent effects of infection with Eimeria nieschulzi in rats

The intestinal pathology caused by infection with Eimeria nieschulzi was investigated and comparisons were made between the effects in athymic nude (rnu/rnu) rats and their heterozygous (rnu/+) litter-mates. Most of the changes noted, i.e. increase in gut weight, partial villous atrophy and increased numbers of mast, goblet and pyroninophilic cells were shown to be largely or wholely thymus dependent. The numbers of intraepithelial lymphocytes were decreased in both groups during the period of study. The peripheral blood leucocyte response was similar in both groups of rats during a primary infection but differed after a challenge inoculum, indicating that the secondary type of response which occurred in the rnu/+ rats was thymus dependent, as is resistance to reinfection.

Immunity to coccidia in chickens: adoptive transfer with peripheral blood lymphocytes and spleen cells

Suspensions of cells prepared from the caecal tonsils and spleen, and the peripheral blood lymphocytes of chickens immune to Eimeria maxima, were tested for their ability to transfer resistance to syngeneic recipients. The intravenous injection of approximately 6 x 10(8) spleen cells or peripheral blood lymphocytes caused a significant reduction of oocyst production by the challenged recipients, in comparison with controls which were uninjected or given cells from birds susceptible to E. maxima. Peripheral blood lymphocytes appeared to be most effective when obtained 10-15 days after a primary, or 3-10 days after a secondary inoculation of oocysts. The peripheral blood lymphocytes which participate in the early response to challenge of immune birds were not found to be protective. When given intraperitoneally, greater numbers of spleen cells were required to reduce oocyst production, and small numbers of caecal tonsil cells were ineffective. The ability of the various cell suspensions to transfer antibody and cell-mediated responses was monitored with 'marker' antigens. There was some indication that both types of response were involved in protection.