FimH adhesin of type 1 fimbriae is a potent inducer of innate antimicrobial responses which requires TLR4 and type 1 interferon signalling

Components of bacteria have been shown to induce innate antiviral immunity via Toll-like receptors (TLRs). We have recently shown that FimH, the adhesin portion of type 1 fimbria, can induce the innate immune system via TLR4. Here we report that FimH induces potent in vitro and in vivo innate antimicrobial responses. FimH induced an innate antiviral state in murine macrophage and primary MEFs which was correlated with IFN-beta production. Moreover, FimH induced the innate antiviral responses in cells from wild type, but not from MyD88(-/-), Trif(-/-), IFN-alpha/betaR(-/-) or IRF3(-/-) mice. Vaginal delivery of FimH, but not LPS, completely protected wild type, but not MyD88(-/-), IFN-alpha/betaR(-/-), IRF3(-/-) or TLR4(-/-) mice from subsequent genital HSV-2 challenge. The FimH-induced innate antiviral immunity correlated with the production of IFN-beta, but not IFN-alpha or IFN-gamma. To examine whether FimH plays a role in innate immune induction in the context of a natural infection, the innate immune responses to wild type uropathogenic E. coli (UPEC) and a FimH null mutant were examined in the urinary tract of C57Bl/6 (B6) mice and TLR4-deficient mice. While UPEC expressing FimH induced a robust polymorphonuclear response in B6, but not TLR4(-/-) mice, mutant bacteria lacking FimH did not. In addition, the presence of TLR4 was essential for innate control of and protection against UPEC. Our results demonstrate that FimH is a potent inducer of innate antimicrobial responses and signals differently, from that of LPS, via TLR4 at mucosal surfaces. Our studies suggest that FimH can potentially be used as an innate microbicide against mucosal pathogens.

Bladder tuberculosis after BCG therapy

The initial treatment of bladder cancer is transurethral resection (TUR), but this cancer recurs at an important rate, and has 14% chance of progression after TUR alone. Intravesical chemotherapy with Bacillus Calmette-Guerin (BCG) is effective against recurrence and progression of bladder cancer. However, this therapeutic expose to many local and systemic side-effects. We report a case of 63-year-old man who presented bladder tuberculosis after a BCG therapy, which required 6 months of antitubercular therapy.

Tumor necrosis factor alpha- and inducible nitric oxide synthase-producing dendritic cells are rapidly recruited to the bladder in urinary tract infection but are dispensable for bacterial clearance

The role of dendritic cells (DC) in urinary tract infections (UTI) is unknown. These cells contribute directly to the innate defense against various viral and bacterial infections. Here, we studied their role in UTI using an experimental model induced by transurethral instillation of the uropathogenic Escherichia coli (UPEC) strain 536 into C57BL/6 mice. While few DC were found in the uninfected bladder, many had been recruited after 24 h, mostly to the submucosa and uroepithelium. They expressed markers of activation and maturation and exhibited the CD11b+ F4/80+ CD8- Gr-1- myeloid subtype. Also, tumor necrosis factor alpha (TNF-alpha)- and inducible nitric oxide synthase (iNOS)-producing CD11bINT DC (Tip-DC) were detected, which recently were proposed to be critical in the defense against bacterial infections. However, Tip-DC-deficient CCR2-/- mice did not show reduced clearance of UPEC from the infected bladder. Moreover, clearance was also unimpaired in CD11c-DTR mice depleted of all DC by injection of diphtheria toxin. This may be explained by the abundance of granulocytes and of iNOS- and TNF-alpha-producing non-DC that were able to replace Tip-DC functionality. These findings demonstrate that some of the abundant DC recruited in UTI contributed innate immune effector functions, which were, however, dispensable in the microenvironment of the bladder.

Postlarval Protopolystoma spp. kidney infections in incompatible Xenopus spp. induce weak resistance to heterospecifics

Protopolystoma xenopodis and Protopolystoma orientalis are polystomatid monogeneans respectively specific to the parapatric anurans Xenopus laevis and Xenopus muelleri. Parasite larval stages may invade the kidneys of foreign Xenopus spp. but die before migration to the definitive urinary bladder site. Laboratory experiments to assess the effect of a primary incompatible kidney infection on a secondary compatible infection found: (1) a small, significant decrease in the survivorship of P. xenopodis kidney stages (23-37 days p.i. at 25 degrees C) in X. laevis laevis previously challenged with P. orientalis; (2) a significant effect of prior P. orientalis challenge on P. xenopodis development and establishment in the urinary bladder of X. laevis 100 days p.i. (at 21 degrees C); (3) no effect of prior P. xenopodis challenge on adult P. orientalis establishment in X. muelleri (at 21 degrees C), but a significant negative influence on reproductive output (days 0-50 post-patency). Partial cross-resistance to heterospecifics may therefore be induced by Protopolystoma spp. infections in the kidneys of an incompatible host, demonstrating that at least some elements of the host response are non-species specific. The effects observed were weak compared to the strong host resistance known to be generated by an established compatible primary infection with respect to conspecifics. This difference suggests that strong acquired resistance to Protopolystoma species is species-specific and/or induced only by older stages surviving in compatible hosts.

Intracellular bacterial biofilm-like pods in urinary tract infections

Escherichia coli entry into the bladder is met with potent innate defenses, including neutrophil influx and epithelial exfoliation. Bacterial subversion of innate responses involves invasion into bladder superficial cells. We discovered that the intracellular bacteria matured into biofilms, creating pod-like bulges on the bladder surface. Pods contained bacteria encased in a polysaccharide-rich matrix surrounded by a protective shell of uroplakin. Within the biofilm, bacterial structures interacted extensively with the surrounding matrix, and biofilm associated factors had regional variation in expression. The discovery of intracellular biofilm-like pods explains how bladder infections can persist in the face of robust host defenses.

Light chain amyloidosis of the urinary bladder. A site restricted deposition of an externally produced immunoglobulin

AIMS

To identify the amyloid protein in a patient with amyloidosis localised to the urinary bladder, and to see whether subtyping of the protein by sequence analysis increases the understanding of the selection of the urinary bladder as the site of amyloid deposition.

METHODS

A patient with gross haematuria and a congophilic mass in his urinary bladder was evaluated further. Characterisation of the amyloid protein was performed using conventional histological and immunohistochemical methods. Determination of the N-terminal amino acid sequence of the amyloid protein was performed using protein sequencers.

RESULTS

The patient's history, physical examination, and laboratory evaluation excluded the involvement of other organs, justifying a diagnosis of amyloidosis localised to the urinary bladder. Histological and immunological studies showed that the amyloid protein deposited in the urinary bladder of the patient was probably of the amyloid light chain type. No plasma cells or lymphocytes were seen in sections of the urinary bladder and lower ureter adjacent to the amyloid deposits. Molecular analysis showed the sequence NFMLTQPHSISGSPG, which assigned the amyloid protein to either the Vlambda(I) or the Vlambda(VI) immunoglobulin (Ig) light chain families.

CONCLUSIONS

The findings suggest that the amyloid protein in this patient originated outside the urinary bladder. The heterogeneity of the Ig proteins in known cases of amyloidosis of the lower urinary tract suggests that the amino acid residues, which determine the Vlambda subtyping, have no major role in restricting the deposited protein to the urinary bladder.

[Low-intensity laser irradiation in patients with urinary tuberculosis]

Combined surface radiation of renal projection area and intravascular laser radiation of blood (AZOR-2K unit) were used in combined treatment of 54 patients with urinary tuberculosis. Analysis of immunological and hematological indices of peripheral blood of patients before and after the combined treatment showed that low-intensity laser radiation activates local system of T-helpers which after specific antigenic impact differentiate into T-helpers-1. The latter synthesize in loco gamma-interferon, TNF-alpha and beta and IL-2 stimulating bactericidal mechanisms directed at destruction of M. tuberculosis and resolution of the infection focus.

Schistosoma haematobium-induced urinary tract morbidity correlates with increased tumor necrosis factor-alpha and diminished interleukin-10 production

This study examined the hypothesis that the nature of the host cellular immune response to schistosome ova is a risk factor for urinary tract morbidity in areas in which Schistosoma haematobium is endemic. S. haematobium-infected children and adolescents with bladder pathology assessed by ultrasonography had 54-fold greater tumor necrosis factor (TNF)-alpha production and a 120-fold greater ratio of TNF-alpha to interleukin (IL)-10 release by peripheral blood mononuclear cells in response to egg antigens, in comparison with control children and adolescents matched by age, sex, and infection severity. Mycobacterial antigens also stimulated 7-fold more TNF-alpha among subjects with bladder morbidity than in control subjects, which suggests an innate predisposition to enhanced TNF-alpha production. Levels of egg antigen-induced IL-4 and -5 and interferon-gamma were equivalent in subjects with and without bladder pathology. Thus, children and adolescents predisposed to increased TNF-alpha production to S. haematobium infection are more likely to develop an exaggerated granulomatous response to ova trapped in the bladder wall, with associated urinary tract pathology.

Treatment of mice with staphylococcal enterotoxin B enhances resolution of an induced Escherichia coli urinary tract infection and stimulates production of proinflammatory cytokines

Staphylococcal enterotoxin B (SEB) is a superantigen that causes mass proliferation of murine Vbeta8+ T cells via major histocompatibility complex (MHC) class II molecules and leads to their apoptosis or anergy. SEB also stimulates other MHC class II-bearing cells to proliferate and secrete cytokines, some of which might enhance early host defenses against urinary tract infections (UTIs). We investigated the effect of SEB administration on the course of an induced Escherichia coli UTI in mice. Treatment with SEB 3 or 7 days before the infection had no effect on UTI resolution. However, when SEB was administered at the time of infection, bacterial colonization in the bladders was reduced at time points between 6 h and 3 days. This reduction was not due to a physiological effect, such as increased urinary glycosaminoglycans, or altered pH, nor was SEB bactericidal for the inoculum. Cytokine production in the spleens and bladders of SEB-treated and/or infected mice was evaluated by reverse transcription-PCR. SEB treatment resulted in increased levels of interleukin-2 (IL-2), IL-4, IL-6, and IL-10 mRNAs in the spleen and IL-1alpha, IL-6, granulocyte-macrophage colony-stimulating factor, and tumor necrosis factor alpha transcripts in the bladder. Also, liver cells from SEB-treated mice expressed IL-6 mRNA, which induces the production of acute-phase proteins. These data indicate that SEB treatment in vivo leads to enhanced UTI resolution through a mechanism that may include direct stimulation of effector cells in the bladder, the action of cytokines induced in the spleen, or cytokine-mediated induction of acute-phase proteins.

Prenatal diethylstilbestrol exposure and self-reported immune-related diseases

OBJECTIVE

To compare self-reports of immune-related diseases in diethylstilbestrol (DES) daughters and controls. Prenatal exposure to DES has been associated with several malformations in the lower genital tract, a higher prevalence of adenosis, and increased risk of clear cell adenocarcinoma, and estrogen-dependent tumors. Lately, reports have been published indicating a link between DES exposure and alterations in the immune system. The present study focuses on the possible clinical consequences of an affected immune system.

STUDY DESIGN

DES daughters (n=170) and control women (n=123) completed questionnaires containing lists of immune-related diseases, specified into three categories (i) allergies, (ii) auto-immune disorders, and (iii) infectious diseases.

RESULTS

DES daughters reported significantly more disease conditions than the controls. Analyses for separate disease categories (allergies, auto-immune disorders, infectious disease), yielded a statistically significant difference only for infectious disease. Within this last category, two infectious diseases yielded highly significant differences: bladder infection and measles.

CONCLUSION

The present findings suggest that DES daughters are at higher risk of developing immune-related disease states.

Localized amyloidosis of the lower genitourinary tract: a clinicopathological and immunohistochemical study of nine cases

A series of nine cases of localized amyloidosis of the lower genitourinary tract are reported. The patients comprised six males and three females with an age range of 50-79 years at initial presentation. Clinically and on cystoscopy, the lesions were often diagnosed as neoplasms. Histologically, seven cases had typical features of localized amyloid deposits, while two cases had an unusual appearance with a florid histiocytic and giant cell reaction. Using an immunoperoxidase staining method the deposits were non-reactive with antibodies to serum amyloid A protein, prealbumin and beta 2 microglobulin, while equivocal immunoreactivity was seen with anti-light chain antibodies.

Soluble interleukin-2 receptor levels and immune activation in patients with schistosomiasis and carcinoma of the urinary bladder

Soluble interleukin-2 receptor (sIL-2R) level in serum is a marker of immune regulation and lymphocyte activation. Highly elevated levels of sIL-2R in serum were observed in patients of schistosomiasis with carcinoma of the bladder (SCB) and carcinoma of the bladder without schistosomiasis (CB) compared with patients with carcinoma of the prostate with or without schistosomiasis and normal healthy controls. Patients with SCB, who had an elevated percentage of cells expressing CD38+ activation antigen and CD71+ transferrin receptors in circulation, also had elevated levels of sIL-2R in serum. There were few interleukin-2 receptor (CD25+) positive cells in circulation in some patients with SCB. Despite this, the sIL-2R levels were extremely elevated. Our data suggest that in SCB, CD38+ and CD71+ cells may be the source of secretion of sIL-2R in serum. This relationship was confirmed by phenotypic characterizations of mononuclear cells and sIL-2R levels in individual patients. Measurements of sIL-2R levels in serum may provide a sensitive method of immune activation in patients with SCB.

Immunopathologic analysis of human urinary bladder cancer. Characterization of two new antigens associated with low-grade superficial bladder tumors

The authors have further characterized the normal human tissue distribution and tumor expression of two highly restricted tumor-associated antigens, detected by mouse monoclonal antibodies M344 and 19A211, which are primarily expressed on low-grade superficial urinary bladder tumors. This study was conducted using immunohistochemical staining of frozen and deparaffinized sections of human normal and tumor tissues. The antigens are stable and well preserved on deparaffinized tissue sections. M344 antibody identifies a high-molecular-weight determinant on a cytosolic protein component of over 300,000 Mr. This antigen was not detected on any normal tissue analyzed, including 14 specimens of normal urothelium and 22 cases of cystitis; however, M344 was positive in 74.5% of Ta-T1 tumors and 11% of T3-T4 tumors. 19A211 antibody identifies a sialylated epitope on a cytoplasmic protein complex of 100,000 to 200,000 Mr. This antigen also was expressed preferentially on low-grade superficial bladder tumors (77% Ta-T1) and less frequently on deeply infiltrating tumors (10% T3-4). 19A211 was negative on all normal cells tested, with the exception of umbrella cells, in approximately 25% of the normal urothelium and cystitis specimens studied. Either one or both of these tumor-associated antigens are detected in approximately 80% of low-grade papillary superficial tumors and carcinoma in situ of the urinary bladder. The expression of these antigens on a subset of low-grade bladder tumors, known to progress in only about 10% of cases, suggests that phenotypic differences may reflect biologic potential. Beyond their possible biologic significance, antibodies M344 and 19A211 may provide clinically useful probes for early detection and stratification of urinary bladder tumors.

Primary localized amyloidosis of the bladder: an immunohistochemical study of a case

We report a case of primary localized amyloidosis of the bladder causing renal failure. Immunohistochemically, amyloid fibril protein originated from the lambda type light chain of immunoglobulin.

[Actinomycosis of the bladder in a girl]

Abdominal actinomycosis is a rare finding in pediatric patients and its location in the urinary bladder is exceptional. On the other hand, immunodepression can be found in several disorders including that of actinomycosis. The purpose of this study was to report a case of urinary bladder actinomycosis seen in a seven year old girl. No risk factors were found. It was diagnosed as an abdominal tumor which was successfully surgically removed and treated with penicillin. During her recovery, she suffered from a transitory cell-mediated depression of her immune system which later returned to normal once treatment as installed. The pathogenesis of actinomycosis is presented and a review of the literature is cited. Actinomycosis; immunodepression; bladder.

Painful bladder syndrome--a clinical and immunopathological study

Painful bladder syndrome is a clinical diagnosis in patients with symptoms of varying severity which always include frequency and suprapubic pain and occasionally include dysuria, nocturia and urgency persisting for more than 3 months with no loss of bladder capacity and no overt infection. Immunofluorescence studies of biopsy specimens in 38 female patients were assessed and correlated with the duration and severity of symptoms, and also with routine histology (including mast cell infiltration and integrity of the glycosaminoglycans layer), in order to assess the role of immunological mechanisms in this distressing condition. The results indicated that submucosal angiogenesis and persistence of antigen-antibody complex in vessel walls could be responsible for this syndrome.

Primary localized amyloidosis of the bladder with a monoclonal plasma cell infiltrate

A case of primary tumour-like amyloidosis of the urinary bladder is described. The plasma cell infiltrate around the amyloid deposition revealed monoclonality by both immunoperoxidase and immunofluorescence methods and the amyloid gave a staining reaction consistent with AL type. A local tissue based immunocyte dyscrasia appears to be responsible for the tumour-like amyloid deposition.

New aspects of pathogenesis of lower urinary tract infections

Current theories about the pathogenesis and immunology of urinary tract infections (UTI) and the role of host defense mechanisms are discussed. The ascending route of infection is responsible for the vast majority of UTI, and colonization of the periurethral region by group-specific Escherichia coli precedes the development of UTI. Several bacterial virulence factors have been identified in organisms responsible for UTI. In urine, the most important inhibitory factors are a very high or low osmolality, a high urea concentration, a high organic acid concentration, and a low pH. There are many new antimicrobial agents which facilitate the process of bacterial eradication, especially of microorganisms that were resistant to previously available antibiotics.

Significance of plasma tissue polypeptide antigen determination for diagnosis and follow-up of urothelial bladder cancer

Plasma concentrations of tissue polypeptide antigen (TPA) were determined in 104 patients with all stages and grades of urinary bladder cancer. Patients with evidence of bacterial or virus infections were excluded. In addition, follow-up controls after treatment were performed. At a rate of 5% false positive values, the diagnostic sensitivity for the tumour stage pTis/pT1 was 63% and for the stages pT2-4 it was 76%. Patients with proved lymph node or distant metastases showed elevated values in 100% of cases. A positive correlation was found between the 3 grades of malignancy and the TPA concentrations. Except for the tumour diagnosis, TPA is a valuable parameter for follow-up controls. Our results show a very good correlation of the plasma TPA concentration with tumour progression as well as with stabilisation and regression after treatment.

The effects of oral and combined parenteral/oral immunization against an experimental Escherichia coli urinary tract infection in mice

A double oral immunization (PO/PO) with an outer membrane protein (OMP) from a human uropathogenic strain of Escherichia coli, resulted in the partial protection of mice infected per urethrally with the same strain. Complete protection was achieved by immunizing with OMP in Freund's complete adjuvant (FCA), intramuscularly (i.m.), followed by an oral boost (i.m./PO). The PO/PO protocol stimulated mainly local urinary antibody synthesis, particularly IgA, whilst the i.m./PO regimen resulted in the appearance of both serum and urine antibodies. A single dose of OMP, 6 days after infection, rendered the mice resistant to reinfection, in contrast to non-immunized mice, and led to a significant increase in urine, serum and bile IgA anti-OMP levels. Our results confirm previous reports that the urinary tract forms part of the common mucosal immune system and provides further evidence for immunological memory in mucosal immunity. These results also demonstrate that our OMP preparation is a highly effective immunizing antigen, and that such preparations may be suitable as oral vaccines against urinary tract infection in humans.

Studies of A, B or O (H) surface antigen specificity: carcinoma in situ and non-malignant lesions of the bladder

A, B or O (H) antigens identical to those that designate blood groups have been shown to be present on normal urothelial cells. Since the loss of these antigens, as measured by the specific red cell adherence test, has been associated with an increased malignant potential of low stage bladder carcinomas it was considered important to examine the specificity of this test by applying it to nonmalignant bladder lesions as well as to specimens of carcinoma in situ in which gross papillary lesions might not be present. Cells lining the lesions of cystitis and cystitis glandularis, appearing to be normal histologically, also were found to be positive for the presence of the A, B or O (H) antigens in all samples. In contrast, 4 specimens of squamous metaplasia, also appearing normal histologically, were negative by the specific red cell adherence testing. Finally, 7 of 8 specimens of carcinoma in situ were antigen-negative, with the remaining lesion showing only minimal adherence of red cells. Further analysis along similar lines is needed to determine the specificity of the specific red cell adherence test to define more clearly its clinical usefulness.

[E antigen (HBeAG) and surface antigen (HBsAg) in bladder schistosomiasis]

The problem of the relationship between surface B antigen and schistosomiasis or other parasitic infections which are transmitted though the skin is not still resolved. Serum samples from 54 Somalian patients infected by Schistosoma haematobium were tested for the presence of the surface B antigen (HBsAg) and the e-antigen (HBeAg). The HbsAg was found in 14.8 per cent of these patients, while among controls (47 cases) the frequency was of 34.0 p]er cent; no e-antigen was found among the patients and controls, the prevalence of anti-HBs antibodies was of 57.4 per cent among the patients with urinary schistosomiasis and of 44.6 per cent among the controls; a low rate of anti-e antibodies was found in the patients (7.4%) and in the controls (10.6%). These observation seem to indicate that the problem of an increased frequency of hepatitis B virus markers among patients with urinary schistosomiasis needs for further investigation.

[Inhibition of EA and EAC rosette formation by sera of patients with vesical schistosomiasis]

Circulating immune complexes were investigated by the E.A. and E.A.C. rosette inhibition test in sera samples from patients infested by Schistosoma haematobium. About 60% of the patients demonstrated significantly higher inhibition values than controls. The material inhibiting E.A.C. rosette formation was precipitated by 3.5% polyethilene glycol, thus excluding the role of C3 fragments and suggesting that inhibition was due to immune complexes.

Abnormal monocyte function in bladder cancer patients

We evaluated 39 patients with various stages of bladder carcinoma to determine alterations in monocyte function. Since the monocyte plays an important role in the effector arm of the immune system defective function may explain the host's inability to destroy neoplastic cells. As a group these 39 patients demonstrated defective monocyte monocyte function. There was no correlation between tumor stage and degree of chemotactic defect. Patients with invasive carcinoma had a significant return of monocyte chemotactic response toward normal postoperatively (p less than 0.005). Monocyte function was improved also in 3 patients who received Bacillus Calmette-Guerin immunotherapy (p less than 0.05).

Measurement of urinary CEA-like substance. An aid in management of patients with bladder carcinoma

Urine and serum samples from patients with bladder carcinomas were studied for the occurrence of and variations in CEA content before, during, and after radiation therapy. The concentration of CEA-like substances in urine increased with a more advanced clinical stage of the tumor, although there were large intercase variations. In serum, slightly increased values were noted only in advanced cases. During radiation therapy, high CEA values were found at around mid-course. This could be related to a breakdown of tumor tissue. Judging from data for urine from radiation-treated prostatic carcinomas without known tumors in the bladder, radiation alone was not responsible for the elevation of CEA. Urinary infections contributed to raised levels of CEA-like substances in some cases. At the end of successful radiation therapy (as verified by cystoscopy, cytology, and clinical examination), 25 patients had CEA values in the urine comparable to normal values (14 +/- 7 ng CEA/ml). The decrease was significant from the initial values to those after radiotherapy (p less than 0.01). Four patients whose tumors persisted had high values (68 +/- 46 ng CEA/ml). In patients who had previously received radiation treatment for bladder carcinomas, CEA values were high in 20 with recurrences (58 +/- 36 ng CEA/ml) while they were lower in 13 who were free of recurrence (14 +/- 6 ng CEA/ml). These findings indicate that urinary CEA determinations may be used in the immediate followup and management of patients treated for bladder carcinoma. It also appears to be of prognostic significance.

Antibodies to Candida albicans in hospital patients with and without spinal injury and in normal men and women

The presence of serum agglutinins and precipitins to Candida albicans in men and women who had impaired bladder function following spinal injury is compared with that in other patients in hospital and in apparently fit men and women. Antibody levels which have commonly been regarded as significant were found in 35 of 76 patients who had urinary candidiasis; in 10 of 52 patients who had spinal injury without urinary candidiasis; in eight of 57 patients who had neither of these conditions, and in nine of 191 normal men and women. Observations are made on the antigens involved in these reactions and on the need for standardization of both reagents and techniques.