<p>The objective with this Master’s thesis was to develop, implement and evaluate an iterative procedure for hierarchical clustering with good overall performance which also merges features of certain already described algorithms into a single integrated package. An accordingly built tool was then applied to an allergen IgE-reactivity data set. The finally implemented algorithm uses a hierarchical approach which illustrates the emergence of patterns in the data. At each level of the hierarchical tree a partitional clustering method is used to divide data into k groups, where the number k is decided through application of cluster validation techniques. The cross-reactivity analysis, by means of the new algorithm, largely arrives at anticipated cluster formations in the allergen data, which strengthen results obtained through previous studies on the subject. Notably, though, certain unexpected findings presented in the former analysis where aggregated differently, and more in line with phylogenetic and protein family relationships, by the novel clustering package.</p>

The objective with this Master’s thesis was to develop, implement and evaluate an iterative procedure for hierarchical clustering with good overall performance which also merges features of certain already described algorithms into a single integrated package. An accordingly built tool was then applied to an allergen IgE-reactivity data set. The finally implemented algorithm uses a hierarchical approach which illustrates the emergence of patterns in the data. At each level of the hierarchical tree a partitional clustering method is used to divide data into k groups, where the number k is decided through application of cluster validation techniques. The cross-reactivity analysis, by means of the new algorithm, largely arrives at anticipated cluster formations in the allergen data, which strengthen results obtained through previous studies on the subject. Notably, though, certain unexpected findings presented in the former analysis where aggregated differently, and more in line with phylogenetic and protein family relationships, by the novel clustering package.

In this investigation of immunotherapy (IT) children 6-16 years old with rhinoconjunctivitis due to birch polli­nosis were included. I. Methodological studies. To monitor IT a reliable provocation test is desirable. The conjunctival provocation test (CPT) was evaluated in 20 children with four repeated challenges. The test was found to have a good preci­sion, it was simple and appeared to be clinically safe. After repeated tests the levels of IgE antibodies against birch increased considerably in three children, indicating an immunological response. A pollen peak affects the symptoms of an atopic individual for several days. Thus pollen counts for previous days must be taken into account when relating symptom scores with the counts. A dynamic time series model was therefore developed by which groups of atopic patients could be compared when exposed to different amounts of pollens. II: Cross-reactivity between deciduous trees during IT. Immunotherapy with pollen allergen preparations made from either birch (B) or a mixture of birch, alder and hazel (M) were compared. As measured with symptom scores the children in the M group improved at least as much as those in the B group. In the B group but not in the M group the improvement correlated with immunochemical findings before IT or early during the treatment, probably an unsignificant finding. Otherwise there was little difference between the two groups. Analysis of sera with crossed radioimmunoelectrophoresis in 20 children revealed that 60% of the children below 13 years had de­veloped IgE antibodies during IT against allergens against which they had not been allergic before IT. This had no appearent clinical implications. III: Oral immunotherapy (OIT). A pilot study of 18 children treated with high doses of a birch pollen allergen preparation in enteric coated capsules and 8 untreated controls indicated that OIT was effective as shown by lower symptom scores, less conjuctival sensitivity and increased levels of IgE antibodies against birch. However, the gastrointestinal side-effects were pronounced. Therefore a second double-blind study, in 30 children, was performed reducing the side-effects through a different dose schedule. Compared with the placebo group, the ac­tively treated children had lower symptom scores (p = 0.04), reduced skin sensitivity (p = 0.01), increasing levels of IgE (p = 0.001) and IgG (p = 0.007) antibodies against birch before the birch pollen season and a suppression of the seasonal increase in levels of IgE antibodies against birch (p &lt;0.001). After three months of OIT but not after ten months they also had a lower sensitivity in CPT than the controls (p = 0.01). The intestinal permeability as assessed by the urinary recovery of differently-sized polyethyleneglycols was studied in 24 of the children during IT. No changes were seen in the group of actively treated children. In two ad­ditional children openly treated with OIT small bowel biopsies were taken with normal morphological findings. Thus OIT did not result in a generalized inflammation of the small bowel. / digitalisering@umu

Multi-Antigen-Komplexe wurden in der Vakzinologie als effizientes Modell genutzt, um eine breite Impfstoffabdeckung gegen mehrere Stämme desselben Pathogens zu erzielen. Hier werden die Ergebnisse zur menschlichen B-Zell-Reaktion auf einen Multi-Antigen-Komplex (Bexsero) in drei Impfstoffen (Vax1, Vax2 und Vax3) dargestellt. Bexsero ist ein Impfstoff, der aus vier Antigenen (fHbp-GNA2091, NHBA-GNA1030, NadA und OMV (NZ98-254)) für Neisseria meningitidis (Nm) B besteht. Bei allen drei Impfstoffen konnten außerordentlich diverse Immunglobuline (Ig) beobachtet werden, die als Reaktion auf Bexsero mit einzigartigen Ig-Genselektionsmustern erzeugt wurden. Die Daten zeigen auch Igs, die eine Reihe von Spezifitäten aufweisen (Bexsero-spezifisch-reaktive Igs (nur Vax3) oder polyreaktive Igs (Vax2, Vax3 und Vax4)) und Affinitäten (hochbindende, mäßig bindende, schwach bindende und nicht reaktive Igs). Es wurde keine eindeutige Korrelation zwischen spezifischen Ig-Genmerkmalen und Ig-Reaktivitätseigenschaften beobachtet, obwohl Igs von allen Impfstoffen kollektiv unterschiedliche Affinitäten innerhalb/zwischen Cluster-Igs und zwischen Nicht-Clustern von Bexsero aufweisen, was potenzielle Vorteile für einen breiten Schutz mit sich bringt. Ig-Gen-Merkmale und Antigen-Reaktivitätseigenschaften von Igs, die gegen NHBA (22 Igs), fHbp (2 Igs) und NadA (2 Igs) erzeugt wurden, sind ebenfalls gezeigt. Diese Ig zeigten schwache Bindungsaffinitäten, wenn sie an endogen exprimierten Antigenen auf Nm mc58 getestet wurden, möglicherweise aufgrund eines ungeordneten N-Terminus von NHBA. Es wurde eine Anreicherung von hochmutierten polyreaktiven Ig beobachtet. Es werden unterschiedliche Immunoselektivitätsgrade für die verschiedenen Antigene beobachtet, was auf eine Antigenimmunodominanz sowie auf Hinweise auf eine Epitopmaskierung hindeutet. Mit einem kontrollierbaren System von 4 Antigenen eröffnen die Daten die Möglichkeit die menschliche B-Zell-Reaktion auf Multi-Antigen-Komplexe zu verstehen und zeigen, dass ein umfassendes Verständnis über die feinen zellulären und humoralen Einzelheiten der Immunantworten des Impfstoffs während klinischer Studien erforderlich ist. / Multi-antigen complexes have been exploited in vaccinology as an efficient model, to achieve broad vaccine coverage against multiple strains of the same pathogen. Here, the findings on the human B cell response to a multi-antigen complex (Bexsero) in three vaccinees (Vax1, Vax2 and Vax3) are shown. Bexsero is a vaccine comprising of four antigens (fHbp-GNA2091, NHBA-GNA1030, NadA and OMV (NZ98-254)) for Neisseria meningitidis (Nm) B. Immensely diverse (isotype distribution, IgVH and IgJH gene usage, CDR3 length distribution and clonal selection) immunoglobulins (Igs) generated in response to Bexsero with unique Ig gene selection patterns in all three vaccinees was observed. The data also shows Igs that exhibit a range of specificities {Bexsero-specific-reactive Igs (Vax3 Only) or polyreactive Igs (Vax2, Vax3 and Vax4)} and affinities (highly binding, moderately binding, weakly binding and unreactive Igs). No unique correlation between specific Ig gene features and Ig reactivity properties was observed, albeit Igs from all vaccinees collectively exhibit varied affinities within/between cluster Igs, and amongst non-clusters to Bexsero, with potential advantages for broad protection. Ig gene features and antigen-reactivity properties of Igs generated against NHBA (22 Igs), fHbp (2 Igs) and NadA (2 Igs) are also shown. These Igs exhibited weak binding affinities when tested on endogenously expressed antigens on Nm mc58, potentially due to disordered N-terminal of NHBA. Enrichment of highly mutated polyreactive Igs was observed. Varying degrees of immunoselectivity to the different antigens, suggesting antigen immunodominance as well as evidence of epitope masking are observed. With a controllable system of 4 antigens, the data opens a potential window to understanding the human B cell response to multi-antigen complexes and evinces the need for expansive understanding of the fine cellular and humoral details of vaccine immune responses during clinical trials.