Delayed cutaneous hypersensitivity response in tetanus toxoid sensitized rhesus monkeys: predictor of anergy and value in tuberculin skin testing

The primary problem in using the tuberculin skin test in nonhuman primates is the clinical uncertainty concerning the animal's ability to elicit a delayed cutaneous hypersensitivity response. A negative tuberculin skin test can only be meaningful if the animal can produce a delayed cutaneous hypersensitivity reaction. Veterinarians deliberately sensitize animals to antigens in the form of prophylactic vaccination. Therefore, if nonhuman primates were deliberately sensitized to an antigen capable of producing a hypersensitivity response, that antigen should serve as a positive control for delayed cutaneous hypersensitivity reactions. Tetanus toxoid was chosen because repeated immunizations with this antigen is recommended routine medical practice for nonhuman primates housed outdoors. Twenty juvenile, male rhesus (Macaca mulatta) monkeys were selected for this study. The monkeys were assigned randomly to one of two groups of ten animals. The test group was vaccinated with tetanus toxoid intramuscularly at 1 month intervals for a total of three vaccinations. The control group was treated the same except saline was administered rather than tetanus toxoid. Following sensitization, the two groups of animals were challenged with tetanus toxoid intradermally. Eight of the ten monkeys in the test group responded to the tetanus toxoid while none of the control groups responded to the tetanus toxoid. Elicitation of a delayed cutaneous response in animals sensitized to tetanus antigen before challenge may serve as a positive control for delayed cutaneous hypersensitivity. This simple test may serve as a useful adjunct in making objective clinical decisions concerning anergy-suspect animals.     

Unusual lesion morphology and skin test reaction for Mycobacterium avium complex in macaques

Three rhesus (Macaca mulatta) and one cynomolgus (M. fascicularis) monkey were euthanized because of positive reactions to intradermal tests with mammalian Old Tuberculin (mOT). All the animals had gross or microscopic lesions consisting of unitized macro- or microgranulomas with central necrosis, involving the lung or mesenteric lymph nodes. Small numbers of acid fast organisms were demonstrated in the lesions. Mycobacterium avium complex, serotype 2 was isolated from three of the cases. The cases were unusual because the lesion morphology and mOT hypersensitivity were more typical of mammalian tuberculosis than avian tuberculosis in monkeys.     

Application of an enzyme immunoassay for detecting antibodies in sera of Macaca fascicularis naturally exposed to Mycobacterium tuberculosis.

An enzyme immunoassay (EIA) was developed for detecting mycobacterial antibodies in the sera of 22 Macaca fascicularis following a natural outbreak of tuberculosis. EIAs were conducted using four antigens (lysozyme, triton, or deoxycholate extracts of Mycobacterium tuberculosis or a purified protein derivative) and two conjugates (protein A or antihuman). Mycobacterial antibodies were detected in two of two culture-positive monkeys, in nine of ten tuberculin test-suspect monkeys (culture-negative), and in five of ten tuberculin test-negative monkeys (culture-negative). Results indicate EIA may be of practical value in detecting monkeys exposed to M. tuberculosis.     

Diagnosis of tuberculosis in macaques, using whole-blood in vitro interferon-gamma (PRIMAGAM) testing

During the fall of 2001, a tuberculosis outbreak caused by Mycobacterium bovis occurred in a conditioned colony of rhesus (Macaca mulatta) and cynomolgus (Macaca fascicularis) macaques at Stanford University School of Medicine. During this outbreak, we evaluated the diagnostic performance of a new in vitro tuberculosis screening test (PRIMAGAM). The PRIMAGAM test measures the interferon-gamma (IFNgamma) response to purified protein derivatives (PPDs) of M. bovis and M. avium. On the basis of the results of the last test administered before necropsy, the PRIMAGAM test had good sensitivity (68%) and excellent specificity (97%), compared with the disease status, as determined by the presence or absence of gross and/or histologic lesions indicative of tuberculosis. By contrast, sensitivity and specificity of the tuberculin skin test (TST) was 84 and 87%, respectively. Both tests suffered from intermittent positive and negative reactions on repeat testing. Overall, however, there was no significant difference (P = 0.09, McNemar's chi2-test) and moderate agreement (kappa = 0.52) between these two tests. Lastly, the IFNgamma response to bovine PPD was significantly lower in infected cynomolgus macaques. Moreover, each test failed to detect tuberculosis in three cynomolgus macaques. Fortunately, they were different animals; therefore, we recommend the parallel use of the TST and PRIMAGAM test for maximal overall sensitivity in a tuberculosis screening program, especially for cynomolgus macaques.     

Tuberculin Activity of Mycobacterial Fractions Obtained by Chromatography

Commercial purified protein derivatives (PPD), old tuberculin (OT), the bacillary extract, and the culture filtrate of Mycobacterium tuberculosis H37Ra were submitted to Sephadex G-25 and diethylaminoethyl (DEAE)-cellulose chromatography. The ability of the fractions obtained to elicit delayed dermal hypersensitivity in M. tuberculosis H37Ra-infected guinea pigs was studied. Skin tests with Sephadex fractions in M. tuberculosis H37Ra-infected guinea pigs showed that the tuberculin activity was localized in the first fraction. All other Sephadex fractions were nonessential and nonspecifically irritating. Fractions from chromatography of Sephadex G-25 fraction 1 on DEAE-cellulose columns showed that all but the first were able to elicit delayed hypersensitivity reactions. There was a variability in the capacity to elicit the tuberculin reaction according to the fraction injected and the stage of tuberculous infection in guinea pigs. Compared to the others, the seven lots of commercial PPD were variable in composition and content. They contained both essential and nonessential materials for the tuberculin reaction. Sephadex fraction 1 would appear to be a better tuberculin as it excludes nonessential nonspecifically irritating elements and contains the complement able to elicit the tuberculin reaction. Its methodological simplicity would be economically advantageous.     

Outbreak of Mycobacterium bovis in a conditioned colony of rhesus (Macaca mulatta) and cynomolgus (Macaca fascicularis) macaques

We describe a tuberculosis outbreak caused by Mycobacterium bovis in a conditioned colony of rhesus (Macaca mulatta) and cynomolgus (Macaca fascicularis) macaques. Animals in five rooms were exposed, but most (16/27) infections were confined to the room that housed a mixed population of cynomolgus and rhesus macaques. In this room, rhesus (8/8) and cynomolgus (10/11) macaques naturally exposed to M. bovis were infected at nearly identical rates (Fisher exact test, 2-tailed P = 1). The clinical signs of disease and pathologic lesions in infected macaques, however, were moderately different between the two species. Rhesus macaques were more likely (5/8) to exhibit clinical signs of persistent coughing and inappetance, and had more severe pulmonary lesions. By contrast, clinical signs of disease were seen in only 1 of 19 cynomolgus macaques, and overall, the pulmonary lesions were often focal and less severe, although some still had severe involvement of the lungs similar to that seen in rhesus macaques. These differences should be taken into consideration when developing or evaluating a tuberculosis-screening program. On the basis of observations made during this outbreak, we recommend that alternative screening methods such as the PRIMAGAM test and the ESAT-6 ELISA, be incorporated into the screening program to aid in the identification of infected animals.     

Suppression of lymphocyte stimulation by anterior hypothalamic lesions in the guinea pig

Anterior hypothalamic lesions in the guinea pig inhibited lymphocyte stimulation in whole blood cultures with the antigen tuberculin and with the mitogen phytohemagglutinin (PHA) and suppressed the delayed cutaneous hypersensitivity response to tuberculin. The lesions did not affect the stimulation of purified lymphocytes with either tuberculin or PHA. The anterior hypothalamic lesions had no effect on the absolute number of T and B lymphocytes.     

Stimulation of cynomolgus peripheral blood lymphocytes with tetanus toxoid and smallpox vaccine

The cynomolgus monkey was studied as an animal model to investigate the cell-mediated immunity induced by vaccines. Optimal conditions are described to isolate peripheral blood lymphocytes. Lymphocyte transformation tests were performed with tetanus toxoid and smallpox vaccine. Antigen-specific lymphocyte transformations with smallpox vaccine could only be demonstrated when lymphocytes were obtained from vaccinated monkeys. Tetanus toxoid appeared to be a weak antigen. However, after adsorption of the toxoid to aluminum phosphate, a significant antigen-specific lymphocyte transformation was observed.     

Tetanus antibody titers and duration of immunity to clinical tetanus infections in free-ranging rhesus monkeys (Macaca mulatta)

Prior to 1985 tetanus was a major cause of mortality in the free-ranging colony of rhesus monkeys on Cayo Santiago, accounting for almost a quarter of annual deaths. In 1985 and 1986 all animals (except infants) received primary and booster doses, respectively, of tetanus toxoid. In subsequent years primary immunizations were given to all yearlings, and boosters were administered to all 2-year-old animals during the annual capture of the colony. The main objectives of the tetanus immunization program were to reduce the pain and suffering caused by tetanus infections and to decrease mortality in the colony. Other objectives were to evaluate the efficacy of the two-dose tetanus toxoid immunization protocol and to determine whether additional boosters might be required to provide adequate long-term protection against tetanus infections. The immediate effect of the mass immunization program was the elimination of clinical tetanus infections in the population and a 42.2% reduction in the overall mortality rate. Since the immunization program began, no cases of tetanus have been observed in the colony, except in two unimmunized infants, and it has not been necessary to give tertiary injections of tetanus toxoid to maintain protection against infection. A sample collected in 2004 of the original cohort of monkeys immunized in 1985 and 1986 showed that 93.3% (14/15) had protective tetanus antibody titers (>0.01 IU/ml) at the ages of 20-23 years, which is close to the life expectancy of the Cayo Santiago rhesus macaques. Two intramuscular doses of tetanus toxoid provided long-term, if not lifelong, protection against tetanus for rhesus monkeys living in a tropical clime where tetanus is enzootic and the risk of infection is great.     

Experimental Infection with Mycobacterium Avium,Serotype 2, in Pigs

A porcine strain of Mycobacterium avium, Serotype 2, was used for intravenous inoculation of pigs in doses 5, 1, 10−1, 10−2 and 10−3 mg (1 mg = 78 × 106 viable units), 2 pigs per dose. Dose 5 mg proved fatal for both of the inoculated pigs, which were killed in extremis 64 and 69 days, respectively, after inoculation. Dose 1 mg caused clinical disease in 1 of 2 pigs, but was not lethal. Post mortem, the clinically affected pigs showed a generalized granulomatous tuberculosis. The other pig given 1 mg and the pigs given smaller doses, showed no clinical signs, and lesions and presence of acid-fasts were mostly limited to the lymph nodes of the lung, liver and digestive tract. All the pigs showed delayed hypersensitivity to avian PPD tuberculin (1000 t.u.) and some of them cross-reacted with human PPD tuberculin (1000 t.u.). The clinically affected pigs gave a very weak response to tuberculin, the others a strong response. The smallest dose capable of establishing an infection and producing tuberculous lesions was not determined, but seems to be less than 10−3 mg (78000 viable organisms).     

Delayed response task performance as a function of age in cynomolgus monkeys (Macaca fascicularis)

We compared delayed response task performance in young, middle-aged, and old cynomolgus monkeys using three memory tests that have been used with non-human primates. Eighteen cynomolgus monkeys—6 young (4–9 years), 6 middle-aged (10–19 years), and 6 old (above 20 years)—were tested. In general, the old monkeys scored significantly worse than did the animals in the two other age groups. Longer delays between stimulus presentation and response increased the performance differences between the old and younger monkeys. The old monkeys in particular showed signs of impaired visuo-spatial memory and deteriorated memory consolidation and executive functioning. These results add to the body of evidence supporting the utility of Macaca fascicularis in studies of cognition and as a potential translational model for age-associated memory impairment/dementia-related disorders.     

Stimulating Role of Toxoids-laden Liposomes in Oral Immunization against Diphtheria and Tetanus Infections

Liposomes have been produced by injecting an ether solution of a mixture of lecithin and cholesterol into a diluted solution of prewarmed diphtheria and tetanus toxoids followed by elimination of the stream of ether vapour by vacuum.In a preliminary study, adjuvant effects of liposomes on the systemic and mucosal immune response have been studied. When a mixture of diphtheria toxoid (DT) and tetanus toxoid (TT) entrapped in liposomes were administered parenterally or orally in rabbit, a significant rise of specific antibodies against both toxoids was noticed. In monkeys receiving a mixture of DT and TT entrapped in liposomes orally, the antibody response after two and three ingestions of this product was mild but when liposomes containing toxoids were adsorbed with aluminium hydroxide in a similar experiment, a significant rise in the specific antibody response in monkey against both toxoids was recorded. Adult volunteers, similarly receiving a mixture of DT and TT, entrapped in liposomes and adsorbed with aluminium hydroxide have shown a significant rise in specific circulating antitoxins. In order to compare the efficacy of this technique of human oral immunization with the previous method, whereby a plant medicinal seed (LRS) was used as adjuvant in oral immunization of man, a second group of volunteers were simultaneously and similarly treated as suggested previously. The comparative results are discussed in the present report.     

Chronic immune stimulation accelerates SIV-induced disease progression

The contribution of chronic immune stimulation on the progression of lentivirus-induced disease was evaluated in the SIVmac251 macaque model of AIDS. Following SIV inoculation, seroconversion and control of the acute viral replication phase, repeated immune stimulations with tetanus toxoid (TT), keyhole limpet hemocyanin (KLH) and allogeneic peripheral blood mononuclear cells (PBMC) were initiated in four monkeys. These animals showed a significant shortening of survival when compared with eight non-immune-stimulated control animals inoculated with the same route, dose and stock of SIVmac251 (median survival 9.5 months versus 17 months, P = 0.010). In addition, when the comparison was extended to another 22 control animals of different origin but inoculated by the same route with similar doses and stocks of SIVmac251, the difference in survival was still significant (9.5 versus 18 months, P = 0.003). This accelerated progression of symptomatic disease was not accompanied with significant increases in plasma viral loads, but suboptimal antibody responses to the immunizing antigens were noted, correlating with the length of survival. These findings may have implications for HIV-infected humans suffering from chronic infectious diseases.     

Rhesus monkey model for Leishmania major transmitted by Phlebotomus papatasi sandfly bites

Leishmaniasis research needs a near-human model for investigations of natural infection processes, immunological responses and evaluation of treatments. Therefore, we developed a reproducible system using Leishmania major Yakimoff & Schokhor (Trypanosomatidae: Kinetoplastida), the cause of Old World zoonotic cutaneous leishmaniasis (ZCL), transmitted to rhesus monkeys Macaca mulatta (Zimmerman) (Primates: Cercopithecidae) by sandfly bites of experimentally infected Phlebotomus papatasi (Scopoli) (Diptera: Psychodidae). Eight monkeys of presumed Indian origin (Leishmania naive) were exposed to bites of female sandflies that had been infected with L. major by membrane-feeding on human blood seeded with amastigotes isolated from hamster footpad lesions. Infection rates of membrane-fed sandflies averaged > 85% seven days after the infective feed, with uniformly high numbers of promastigotes in the stomodaeal valve region of the sandfly gut. Nodules and ulcerating dermal lesions developed on 7/8 monkeys 2-4 weeks post-bite and persisted for 3-7 months. Monkeys also developed satellite lesions beyond the area of sandfly bites on the head, but not on the chest. Three re-challenged monkeys developed lesions that healed faster than lesions from their primary challenges. After infection, monkeys developed delayed type hypersensitivity (DTH) responses to a panel of Leishmania skin test antigens (LSTA) and, when tested by ELISA and IFA, showed significant post-infection antibody titres which typically rose for approximately 170 days and then gradually receded during the next 100 days following the first challenge. After the second challenge, antibody titres spiked higher within approximately 50 days and receded more rapidly. In contrast, four rhesus macaques of Chinese origin developed no lesions following infected sandfly bites, although they raised antibodies and LSTA reactions, indicating subclinical infection.     

Comparison of different methods for diagnosis of bovine tuberculosis from tuberculin- or interferon-gamma-reacting cattle in Spain

Of 1479 cattle from herds in Northwestern Spain previously diagnosed as tuberculosis (TB) positive, 218 animals which gave a positive tuberculin or interferon-gamma reaction were examined at the slaughterhouse. Medial retropharyngeal and caudal mediastinal lymph nodes, and any tissues containing lesions suspected to be tuberculous, were removed and submitted to the laboratory. Three techniques for diagnosis of TB were used: post mortem examination (PME), smear staining by means of auramine O method (AOM), and culture isolation in Coletsos and Lowenstein-Jensen media followed by confirmation of M. tuberculosis complex organisms using PCR (CIM-PCR). Only 123 (29.9%) of the 412 samples collected showed typical tuberculous lesions. Confirmed M. tuberculosis complex organisms were isolated in 144 cases, 114 of which were from tissues showing lesions (success rate of 92.8%). Smears were found positive in 113 cases, 96 of which came from lesions suspected to be tuberculous (success rate of 78.0%). The sensitivities of CIM-PCR compared with those of PME and AOM were 92.7% and 85.7%, respectively. Statistical analysis revealed that PME and AOM are good indicators of the presence of M. tuberculosis complex organisms in tuberculin- or interferon-gamma reacting cattle.     

Compartmentalization of a CD4+ T lymphocyte subpopulation in tuberculous pleuritis

The study of T lymphocytes from pleural fluid and tissue of patients with tuberculous pleuritis provides an opportunity to evaluate the human immune response to infection at the site of disease activity. Therefore, we investigated the phenotype and function of CD4+ pleural fluid cells from patients with tuberculous pleuritis. Pleural fluid was enriched with CD4+CDw29+ T lymphocytes, which are thought to represent "memory" T cells. Immunoperoxidase staining of pleural tissue confirmed the predominance of CD4+CDw29+ T lymphocytes at the site of disease activity. CD4+ subpopulations were evaluated for their ability to contribute to a cell-mediated immune response against Mycobacterium tuberculosis by assaying immune function in vitro. Pleural fluid-derived CD4+CDw29+ cells, but not CD4+CDw29- lymphocytes, proliferated vigorously and produced high levels of IFN-gamma when stimulated with purified protein derivative of M. tuberculosis. CD4+CDw29+ clones produced IFN-gamma specifically in response to purified protein derivative of M. tuberculosis but not to an irrelevant Ag, tetanus toxoid. IFN-gamma levels were markedly elevated in pleural fluid, compared to peripheral blood, suggesting production of this lymphokine in vivo at the site of tissue inflammation. The sum of these data indicate that, in tuberculous pleuritis, CD4+CDw29+ cells are concentrated at the site of disease activity, produce IFN-gamma and are likely to play an important role in the local human cell-mediated immune response to M. tuberculosis.     

Characteristics of the immune response of inoculated and intact animals to the administration of toxigenic and nontoxigenic strains of Clostridium tetani

In experiments on guinea pigs the immune reactions of the animals immunized and not immunized against tetanus in response to the injection of C. tetani spores were studied. In the immunized animals an increase in the production of tetanus antitoxin, the development of delayed hypersensitivity and the activation of the mechanisms of cell-mediated immunity were observed. The nonimmunized animals showed specific changes in the T-system of immunity without the appearance of the clinical symptoms of tetanus, which is, probably, one of the mechanisms of natural immunity.     

Liposomes as adjuvant for combination vaccines

In the present study tetanus toxoid (TT) loaded liposomes and diphtheria toxoid (DT) loaded liposomes were prepared by reverse phase evaporation method and after combining these two vaccines the potential advantages were investigated. Prepared systems were characterized for the size, shape and entrapment efficiency. SDS-PAGE analysis of TT and DT was also performed. The selected liposomal formulations were administered subcutaneously to Balb/c mice and their immune responses were determined using ELISA after 15, 30, 45 days. After boosting the maximum immune response was observed after 45 days and was found to be 0.831 and 0.749 for TT loaded liposome and DT loaded liposomes respectively. When the mice were immunized subcutaneously with the physical mixture of TT loaded liposomes and DT loaded liposomes the immune response for the combination vaccine was found to be 1.44 and 0.741 for the TT and DT respectively. The result showed that the immune response of TT increased when it was combined with DT in liposomes. This confirms adjuvantcity of DT vis-a-vis immunogenicity. Thus, carrier mediated cocktail vaccination holds promise for clinical applications.     

Altered immune responses in apolipoprotein E-deficient mice

Apolipoprotein E (apoE) is a 34 kDa glycosylated protein with multiple biological properties. In addition to its role in cholesterol transport, apoE has in vitro immunomodulatory properties. Recent data suggest that these immunomodulatory effects of apoE may be biologically relevant, and apoE-deficient mice have altered immune responses after bacterial inoculation and increased susceptibility to endotoxemia induced by lipopolysaccharide (LPS). To better understand the mechanism by which apoE-modulates immune responses, we tested the role of human apoE isoforms in assays of human T cell proliferation, and analyzed the immune responses of apoE-deficient mice. Both the E3 and E4 isoforms of apoE induced similar suppression of human lymphocyte function in assays of T cell proliferation, including mitogenic responses to phytohaemagglutin (PHA), stimulation of the T cell receptor with alphaCD3, and antigen-specific response to tetanus toxoid. ApoE-deficient mice showed no quantitative differences in thymic, splenic, or bone marrow lymphocyte populations, nor were there in vitro abnormalities in splenocyte proliferation after stimulation with alphaCD3 to suggest an inherent T cell defect in apoE-deficient mice. ApoE deficient animals, however, had significantly higher levels of antigen-specific IgM after immunization with tetanus toxoid, and impaired delayed type hypersensitivity responses as compared to control C57-BL/6 mice.These results support a growing body of evidence demonstrating an interplay between lipid metabolism and immune responses, and suggest that apoE plays a biologically relevant role in regulating humoral and cell-mediated immunity.     

Multidrug chemotherapy of tuberculosis in rhesus monkeys

Occurrence of tuberculosis caused by Mycobacterium bovis in a colony of rhesus monkeys allowed evaluation of a modern multidrug therapeutic regimen. Fifteen tuberculin positive rhesus monkeys with disseminated tuberculosis were evaluated for extent of disease by radiographic techniques, physical examination and laparotomy prior to treatment. Monkeys were divided into treatment groups of 3, 6 and 12 months duration and were treated once daily with isoniazid, rifampin and ethambutol. All animals survived their treatment course, had marked clinical improvement and rapid resolution of radiographically demonstrable lesions. Lesion regression evaluated by necropsy and histopathology correlated positively with length of treatment interval. Mycobacterium bovis was not isolated from any animal following treatment. Multidrug chemotherapy of tuberculosis was considered successful and practical in rhesus monkeys at the 12 month treatment interval. Chemotherapy may provide a reasonable alternative to destruction of valuable animals infected with tuberculosis.