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Concept: Antibodies


Recent epidemics of Zika virus (ZIKV) have been associated with congenital malformation during pregnancy and Guillain-Barré syndrome. There are two ZIKV lineages (African and Asian) that share >95% amino acid identity. Little is known regarding the ability of neutralizing antibodies elicited against one lineage to protect against the other. We investigated the breadth of the neutralizing antibody response following ZIKV infection by measuring the sensitivity of six ZIKV strains to neutralization by ZIKV-confirmed convalescent human serum or plasma samples. Contemporary Asian and early African ZIKV strains were similarly sensitive to neutralization regardless of the cellular source of virus. Furthermore, mouse immune serum generated after infection with African or Asian ZIKV strains was capable of neutralizing homologous and heterologous ZIKV strains equivalently. Because our study only defines a single ZIKV serotype, vaccine candidates eliciting robust neutralizing antibody responses should inhibit infection of both ZIKV lineages, including strains circulating in the Americas.

Concepts: Immune system, Antibody, Protein, Neutralizing antibody, Bacteria, Acid, Antibodies, Congenital disorder


BACKGROUND: The objective of this study was to compare celiac disease (CD)– specific antibody tests to determine if they could replace jejunal biopsy in patients with a high pretest probability of CD. METHODS: This retrospective study included sera from 149 CD patients and 119 controls, all with intestinal biopsy. All samples were analyzed for IgA and IgG antibodies against native gliadin (ngli) and deamidated gliadin peptides (dpgli), as well as for IgA antibodies against tissue transglutaminase and endomysium. RESULTS: dpgli were superior to ngli for IgG antibody determination: 68% vs. 92% specificity and 79% vs. 85% sensitivity for ngli and dpgli, respectively. Positive (76% vs. 93%) and negative (72% vs. 83%) predictive values were also higher for dpgli than for ngli. Regarding IgA gliadin antibody determination, sensitivity improved from 61% to 78% with dpgli, while specificity and positive predictive value remained at 97% (P < 0.00001). A combination of four tests (IgA anti-dpgli, IgG anti-dpgli, IgA anti- tissue transglutaminase, and IgA anti-endomysium) yielded positive and negative predictive values of 99% and 100%, respectively and a likelihood ratio positive of 86 with a likelihood ratio negative of 0.00. Omitting the endomysium antibody determination still yielded positive and negative predictive values of 99% and 98%, respectively and a likelihood ratio positive of 87 with a likelihood ratio negative of 0.01. CONCLUSION: dpgli yielded superior results compared with ngli. A combination of three or four antibody tests including IgA anti-tissue transglutaminase and/or IgA anti- endomysium permitted diagnosis or exclusion of CD without intestinal biopsy in a high proportion of patients (78%). Jejunal biopsy would be necessary in patients with discordant antibody results (22%). With this two-step procedure, only patients with no CD-specific antibodies would be missed.

Concepts: Immune system, Antibody, Fc receptor, Glycoproteins, Positive predictive value, Negative predictive value, Antibodies, Coeliac disease


CDC has updated the interim guidance for U.S. health care providers caring for pregnant women with possible Zika virus exposure in response to 1) declining prevalence of Zika virus disease in the World Health Organization’s Region of the Americas (Americas) and 2) emerging evidence indicating prolonged detection of Zika virus immunoglobulin M (IgM) antibodies. Zika virus cases were first reported in the Americas during 2015-2016; however, the incidence of Zika virus disease has since declined. As the prevalence of Zika virus disease declines, the likelihood of false-positive test results increases. In addition, emerging epidemiologic and laboratory data indicate that, as is the case with other flaviviruses, Zika virus IgM antibodies can persist beyond 12 weeks after infection. Therefore, IgM test results cannot always reliably distinguish between an infection that occurred during the current pregnancy and one that occurred before the current pregnancy, particularly for women with possible Zika virus exposure before the current pregnancy. These limitations should be considered when counseling pregnant women about the risks and benefits of testing for Zika virus infection during pregnancy. This updated guidance emphasizes a shared decision-making model for testing and screening pregnant women, one in which patients and providers work together to make decisions about testing and care plans based on patient preferences and values, clinical judgment, and a balanced assessment of risks and expected outcomes.

Concepts: Immune system, Health care, Childbirth, Epidemiology, United States, Immunology, Antibodies, World Health Organization


A major advance in the search for an HIV vaccine has been the development of a near-native Envelope trimer (BG505 SOSIP.664) that can induce robust autologous Tier 2 neutralization. Here, potently neutralizing monoclonal antibodies (nAbs) from rabbits immunized with BG505 SOSIP.664 are shown to recognize an immunodominant region of gp120 centered on residue 241. Residue 241 occupies a hole in the glycan defenses of the BG505 isolate, with fewer than 3% of global isolates lacking a glycan site at this position. However, at least one conserved glycan site is missing in 89% of viruses, suggesting the presence of glycan holes in most HIV isolates. Serum evidence is consistent with targeting of holes in natural infection. The immunogenic nature of breaches in the glycan shield has been under-appreciated in previous attempts to understand autologous neutralizing antibody responses and has important potential consequences for HIV vaccine design.

Concepts: Immune system, Antibody, Protein, Neutralizing antibody, Immunology, Antibodies, HIV vaccine, Gp120


We aimed to determine whether the levels of total serum IgM and IgG, together with specific antibodies against malondialdehyde-conjugated low-density lipoprotein (MDA-LDL), can improve cardiovascular risk discrimination.

Concepts: Immune system, Glycoproteins, Blood, Myocardial infarction, Atherosclerosis, Cardiovascular disease, Immunology, Antibodies


To date, no immunization of humans or animals has elicited broadly neutralizing sera able to prevent HIV-1 transmission; however, elicitation of broad and potent heavy chain only antibodies (HCAb) has previously been reported in llamas. In this study, the anti-HIV immune responses in immunized llamas were studied via deep sequencing analysis using broadly neutralizing monoclonal HCAbs as a guides. Distinct neutralizing antibody lineages were identified in each animal, including two defined by novel antibodies (as variable regions called VHH) identified by robotic screening of over 6000 clones. The combined application of five VHH against viruses from clades A, B, C and CRF_AG resulted in neutralization as potent as any of the VHH individually and a predicted 100% coverage with a median IC50 of 0.17 µg/ml for the panel of 60 viruses tested. Molecular analysis of the VHH repertoires of two sets of immunized animals showed that each neutralizing lineage was only observed following immunization, demonstrating that they were elicited de novo. Our results show that immunization can induce potent and broadly neutralizing antibodies in llamas with features similar to human antibodies and provide a framework to analyze the effectiveness of immunization protocols.

Concepts: Immune system, Antibody, Neutralizing antibody, Vaccination, Immunology, Humoral immunity, Immunity, Antibodies


OBJECTIVE.: First Degree Relatives (FDR) of Rheumatoid Arthritis (RA) patients sharing genetic and environmental risk factors for RA may represent a pre-RA state. Anti-cyclic citrullinated protein/peptide antibodies (ACPA) appear years before the onset of RA. We determined the prevalence of various ACPA in RA FDR. METHODS.: Subjects were RA patients (n=88), unaffected FDR (n=50) and healthy controls (n=20). Six different types of ACPA were determined by ELISA. Joint and periodontal disease symptoms were self-reported. Patients and FDR were HLA-typed for the Shared Epitope (SE) and the RA-protective alleles, HLA-DRB*1301/1302. RESULTS.: FDR had a high prevalence of ACPA (48%) compared to controls (10%). The prevalence of the SE and smoking in FDR were also high (62% and 49% respectively). 13/32 (41%) of all ACPA in FDR was of the IgA isotype. The most commonly expressed IgG ACPA targeted citrullinated vimentin, occurring in 20% of FDR. FDR had an average of 1 type of ACPA, whereas, RA patients expressed a median of 5 different ACPA. The only FDR to later develop RA expressed 4 different ACPA. Joint and PD symptoms in FDR were significantly associated with smoking (OR 5.714; 95%CI: 1.151-28.3 and OR 12.25; 95%CI: 2.544-58.99 respectively), but not with ACPA. CONCLUSIONS.: The rate of ACPA positivity in unaffected FDR of RA patients with a high prevalence of the SE and smoking was 48%; whereas, ACPA were rare in healthy controls. ACPA in FDR was most commonly of the IgA isotype, but IgG ACPA targeting citrullinated vimentin was also frequently found. © 2013 American College of Rheumatology.

Concepts: Immune system, Antibody, Epidemiology, Rheumatoid arthritis, Rheumatology, Antibodies, Periodontal disease, Anti-citrullinated protein antibody


The presence of anti-citrullinated protein antibodies (ACPA) and IgM-rheumatoid factor (IgM-RF) years before the clinical diagnosis of rheumatoid arthritis (RA) suggests they are possibly involved in the pathogenic process underlying RA. In this study, we analysed whether anti-carbamylated protein (anti-CarP) antibodies, a novel autoantibody system against carbamylated proteins, can also be detected in healthy individuals before they developed RA.

Concepts: Immune system, Antibody, Protein, Nutrition, Rheumatoid arthritis, Rheumatology, Antibodies, Rheumatoid factor


Several neonatal Fc receptor (FcRn) variants of an anti-tumor necrosis factor (TNF)-α humanized monoclonal IgG antibodies (mAbs) were developed but the effect of their differential FcRn binding affinities on pharmacokinetic (PK) behavior were difficult to be definitively measured in vivo due to formation of anti-therapeutic antibody (ATA). A semi-mechanistic model was developed to investigate the quantitative relationship between the FcRn binding affinity and PK of mAbs in cynomolgus monkey with the presence of ATA.

Concepts: Immune system, Antibody, Fc receptor, Glycoproteins, Immunology, Immunoglobulin G, Antibodies, IgG


Clostridium difficile produces two major virulence toxins, Toxin A (TcdA) and Toxin B (TcdB). Anti-toxin antibodies, especially neutralizing antibodies, have been shown to be associated with lower incidence of C. difficile infection (CDI) recurrence and antibody levels are predictive of asymptomatic colonization. The development of an assay to detect the presence of neutralizing antibodies in animal and human sera for the evaluation of vaccine efficacy is highly desired. We have developed such an assay which allows for the quantification of the effect of toxins on eukaryotic cells in an automated manner. We describe here the optimization of this assay to measure toxin potency as well as Neutralizing Antibody (NAb) activity against C. difficile toxins using Design of Experiment (DOE) methodology. Toxin concentration and source, cell seeding density, and sera-toxin pre-incubation time were optimized in the assay using Vero cells. The assay was shown to be robust, and to produce linear results across a range of antibody concentrations. It can be used to quantify neutralizing antibodies in sera of monkeys and hamsters immunized with C. difficile toxoid vaccines. This assay was shown to correlate strongly with traditional assays which rely on labor intensive methods of determining neutralizing antibody titers by visual microscopic inspection of intoxicated cell monolayers. This assay has utility for the selection and optimization of C. difficile vaccine candidates.

Concepts: Immune system, Antibody, Protein, Neutralizing antibody, Bacteria, Antibodies, Intravenous immunoglobulin, Clostridium difficile