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Neisseria meningitidis (Nm) disease occurs worldwide. Disease incidence rates can vary from 1 to 1000 cases per 100,000 with the highest incidence found in the sub-Saharan Africa meningitis belt. Nm has evolved a number of mechanisms to evade host immunity. This includes the production of genetic variants through re-combinatorial events, which is thought to have contributed to the evolution of hyper-invasive lineages that are largely responsible for meningococcal disease. Antigenic diversity of Nm surface proteins has been the main limitation in the design of broadly protective vaccines, particularly against capsular serogroup B strains. To overcome this problem, several Nm genomes have been sequenced in an effort to find highly sequence-conserved surface antigens recognized by the human immune system in order to develop a vaccine, which would be broadly protective against disease. Nm genomes contain over 2 million base pairs that contain between 2000 and 2500 open reading frames. Add to this the difficulty of identifying highly conserved recombinant antigens with strong intrinsic immunostimulatory properties, makes vaccine design and development a daunting task. Recent advances in our understanding of the interactions between innate and acquired immunity, and the discovery of pattern recognition receptors, including Toll-like receptors (TLRs), have ushered in a new set of adjuvant compounds, TLR agonists, which invoke strong humoral and cellular responses with nominal toxicity and adverse reactions. These insights have opened up new areas of vaccine research to combat invasive Nm disease.

In the search for a vaccine providing comprehensive protection against meningococcal disease, one vaccine currently under development contains the immunogenic proteins PorA and FetA in meningococcal outer membrane vesicles (OMVs). To achieve high levels of coverage against disease-causing isolates, the antigenic variability of these proteins could be overcome using knowledge of meningococcal epidemiology and population structure. In this study, the possible implications of variable expression levels of PorA and FetA on vaccine efficacy were investigated. Producing OMVs containing consistent amounts of FetA is difficult due to iron-repressed expression; therefore, meningococcal strains were constructed which constitutively expressed FetA at increased levels for OMV vaccine production and analysis. In mice, OMVs from modified strains induced antibodies against both PorA and FetA. These antibodies acted synergistically in a serum bactericidal assay; however, antibodies against FetA were weakly bactericidal alone. The potential to increase levels of PorA- and FetA-specific bactericidal antibodies with a prime-boost strategy, using OMV and protein inoculums, was also tested. While successful for a weakly-immunogenic PorA variant, a similar strategy did not increase bactericidal activity against FetA. Although antibodies against FetA can be induced following OMV immunisation, sufficient antigen expression in target bacteria is also required for bactericidal killing; therefore, the variability and regulation of porA and fetA transcription was investigated in a range of isolates. Despite differences in regulation among clonal complexes, variable expression is unlikely to be an issue for vaccine coverage. In particular, regulation of fetA by iron is reduced in many isolates due to a deletion in the sequence bound by the regulatory protein, Fur. Therefore, a vaccine targeting PorA and FetA may provide high levels of protection against meningococcal disease; however, an alternative formulation or immunisation strategy is required to improve coverage against FetA.

This diploma thesis deals with the issue of the attitude of parents towards selected infectious diseases which are preventable by vaccines in the Czech Republic. The primary focus is on parents' opinions on vaccination against invasive diseases caused by meningococci, haemophili and pneumococci. The theoretical part discusses the issue of vaccination, its importance and organizational structure; it further describes the selected pathogens, the diseases they cause and the epidemiological situation. It also considers the factors that may lead many parents to distrust and be critical of vaccination. The main aim of the practical part is to find out by means of an online questionnaire which social, geo-demographic, economic and other factors influence the choice of parents to have their children vaccinated against the given bacteria. Statistical methods of χ2 -independence test and binary logistic regression have been used to evaluate the data obtained from the questionnaire with the help of the SPSS program. The results show that parents with lower education and fewer children are more likely to get their child vaccinated; furthermore, it is the parents in the vicinity of where the outbreak of the given disease occurred or those who obtain sufficient information from a pediatrician and consider this...

Neisseria meningitidis, ou méningocoque, est une bactérie responsable de méningites et de septicémies, dont la forme la plus grave, purpura fulminans, est souvent fatale. Cette bactérie, qui réside naturellement dans le rhinopharynx de l’Homme, est pathogène lorsqu’elle atteint la circulation sanguine et entre en contact avec les cellules endothéliales. L’établissement d’une interaction étroite entre le méningocoque et les cellules endothéliales est essentiel à la résistance des bactéries au flux sanguin et à la colonisation vasculaire. Cette interaction peut conduire à une désorganisation massive des endothéliums périphériques et cérébraux permettant la dissémination de la bactérie. Ces processus dépendent de la primo-interaction des pili de type IV du méningocoque avec le récepteur endothélial CD147 et de l’activation du récepteur β2-adrénergique (β2AR). L’activation de voies de signalisation en aval du β2AR dans les cellules hôtes permet l’adhérence efficace et intime des bactéries à la surface des cellules endothéliales. Toutefois, comment les récepteurs CD147 et β2AR coopèrent pour promouvoir une interaction initiale efficace et rapide n’était pas connu. Au cours de ma thèse, j’ai donc analysé les éventuelles interactions et liens fonctionnels existants entre les récepteurs CD147 et β2AR et suivi, à l’aide de nouvelles approches d’imagerie à haute résolution, leur organisation moléculaire aux sites de contact bactéries/cellule. Mes travaux ont permis de révéler l’existence d’une interaction fonctionnelle entre les récepteurs CD147 et β2AR, et d’identifier un nouveau partenaire cytosolique interagissant directement avec ces récepteurs, l’α-actinine4 (Actn4). L’expression de l’Actn4 est requise pour l’assemblage organisé de ces récepteurs en complexes multimoléculaires aux sites de contact bactéries/cellule endothéliale. Cette organisation est déterminante pour générer une force suffisante à l’interaction initiale du méningocoque aux cellules endothéliales, et promouvoir l’activation rapide des voies de signalisation nécessaires à la consolidation de cette interaction. L’infection des cellules endothéliales par le méningocoque s’accompagne de la désorganisation des jonctions intercellulaires et l’ouverture d’une voie paracellulaire favorisant la dissémination tissulaire des bactéries. Ces évènements dépendent de l’activation de la petite GTPase Cdc42 et, en aval, de la relocalisation du complexe de polarité Par3/Par6/aPKC au site d’adhérence bactérien. Ce complexe moléculaire très conservé est impliqué dans la mise en place de la polarité baso-apicale des cellules endothéliales. La perte de la polarité cellulaire constituant un élément déterminant de la perte de l’intégrité vasculaire, dans une seconde partie de ma thèse, j’ai donc entrepris une analyse des événements de signalisation précoces conduisant au remodelage de l’organisation apico-basale des cellules endothéliales par N. meningitidis. Mes travaux montrent que rapidement après adhésion aux cellules endothéliales, le méningocoque induit la ré-orientation de l’axe de polarité noyau-centrosome des cellules en direction des bactéries et mettant en jeu un mécanisme original indépendant de l’activation de Cdc42 par le β2AR. Le recrutement des ERM (Ezrine et Moesin) et la polymérisation d’actine corticale au site d’infection semblent constituer des facteurs clé de cette étape précoce de modification de la polarité endothéliale induite par le méningocoque. Ainsi, ces études ont permis une avancée majeure dans notre compréhension du mécanisme d’adhésion du méningocoque aux cellules endothéliales et des événements moléculaires précoces conduisant à l’altération de l’intégrité vasculaire, deux étapes clés au cœur de la pathogénèse des infections invasives à méningocoque. / Neisseria meningitidis or meningococcus is a commensal bacterium of the human nasopharynx responsible for septicemia and meningitis. Establishment of a close interaction between meningococcus and endothelial cells is an important step in meningococcal pathogenesis as it promotes bacterial resistance to blood flow and vascular colonization, leading to major endothelial dysfunctions and bacterial dissemination into perivascular tissues. This process depends on the interaction of meningococcal type IV pili with the endothelial receptor CD147 and the activation of the β2 adrenergic receptor (β2AR). Activation of a cellular response downstream of β2AR activation is important to allow the efficient adhesion of meningococci at the endothelial cell surface. However, how CD147 and the β2AR cooperate to promote a rapid and efficient initial adhesion remained to be explored. During my thesis, I have analyzed the interaction and the functional link between these two receptors and, using super resolution microscopy, I have investigated their molecular organization at sites of bacterial adhesion. My work revealed a functional interaction in cis between CD147 and the β2AR and binding of these receptors complexes to the molecular scaffold protein α-actinin 4 (Actn4). Actn4 expression is required for the organized assembly of these receptors in highly-ordered complexes at bacterial adhesion sites. This specific organization is decisive to provide a sufficient binding strength of meningococcal type IV pili with endothelial receptors and to promote a rapid activation of downstream signaling events in a short time frame. Endothelial cell infection by N. meningitidis is associated with the disruption of intercellular junctions and the opening of a paracellular route favoring bacterial dissemination into tissues. These events are dependent on Cdc42 activation and on the relocalization of the Par3/Par6/aPKC polarity complex at bacterial adhesion sites. This molecular complex is conserved and involved in baso-apical polarity establishment in endothelial cells. Since endothelial polarity is essential in maintaining junction integrity, in a second part of my thesis work I have analyzed the early signaling events triggered by meningococcal infection with a particular emphasis on endothelial cell polarity modifications. I observed that bacterial adhesion rapidly induced a re-orientation of the nucleus-centrosome axis toward bacterial adhesion sites. Unexpectedly, this re-orientation was independent of Cdc42 activation downstream of the β2AR. In place, the ERM proteins (Ezrin and Moesin), along with cortical actin polymerization seem to be key factors in this process. This work contributes to the understanding of the meningococcal adhesion mechanism to endothelial cells and the early molecular events leading to the loss of vascular integrity. These two key steps are very important in the meningococcal pathogenesis.

Submitted by Priscila Nascimento (pnascimento@icict.fiocruz.br) on 2012-12-10T12:32:54Z No. of bitstreams: 1 iaralice-souza.pdf: 1338553 bytes, checksum: 59fa26df56bce23aa1b5861c460f716f (MD5) / Made available in DSpace on 2012-12-10T12:32:54Z (GMT). No. of bitstreams: 1 iaralice-souza.pdf: 1338553 bytes, checksum: 59fa26df56bce23aa1b5861c460f716f (MD5) Previous issue date: 2001 / Fundação Oswaldo Cruz. Instituto de Tecnologia em Imunobiológicos. Rio de Janeiro, RJ, Brasil. / Neisseria meningitidisdo grupo C é uma bactéria encapsulada causadora dediversas doenças, está associada à altas taxas de mortalidade e portanto é de grande importância para a saúde pública. Bio-Manguinhos está desenvolvendo uma vacina conjugada formada pela ligação covalente do polissacarídeo capsular àanatoxina tetânica e esta vacina, atualmente, está sendo avaliada em estudos clínicosde Fase II em crianças de 1 a 9 anos. A quantificação de componentes livres como polissacarídeos e proteínas faz parte do controle de processo de vacinas conjugadas e tem o objetivo de evitar o aparecimento de reações adversas exacerbadas e/ou redução da imunogenicidade do componente vacinal. A Organização Mundial de Saúde preconiza níveis máximos de proteína livre no conjugado vacinal de 5%, mas não estabelece um limite máximo para o polissacarídeo livre para a vacina conjugada contra o grupo C. Desta forma, o objetivo deste estudo foi desenvolver e validar métodos de controle de qualidade adequados para separar e quantificar estes componentes livres presentes na vacina meningocócica C conjugada brasileira, utilizando a técnica de eletroforese capilar (EC). Para a separação da proteína livre foram comparados os modos de eletroforese capilar de zona livre (CZE) e cromatografia eletrocinética micelar (MEKC). Diferentes condições de migração da amostravariando-se parâmetros como pH, temperatura, tensão, concentração do tampão, ciclodextrinas e de surfactante dodecil sulfato de sódio (SDS) foram estudadas. Os resultados demonstraram que a melhor separação do conjugado foi obtida por MEKC utilizando tampão tetraborato de sódio (TBNa) 150 mM, 25 mM de SDS, 60°C, 30 kV e pH 9,3. Entretanto, nos modos de EC estudados não foi possível obter a separação completa dos componentes, sendo necessária a utilização de outro processo. Por outro lado, por CZE foi possível observar a separação da proteína ativada da nativa, demonstrando a necessidade de otimização da reação de ativação da proteína, a fim de aumentar orendimento da reação de conjugação. A separação completa do açúcar livre presente no conjugado foi obtida empregando CZE utilizando tampão TBNa 50 mM, 40°C, 30 kV e pH 10. Com as condições escolhidas foi possível determinar o conteúdo de polissacarídeo livre nos lotes de conjugado e validar o método proposto, que se mostrou linear na faixa de 0,047 a 0,164 mg/mL, apresentou efeito matriz, 0,0154 mg/mL de limite de detecção e 0,0454mg/mL de limite de quantificação. Após as etapas de validação, foram quantificados alguns lotes de conjugado e observou-se um alto teor de açúcar livre nos lotes com longo período de estocagem a 4°C. Desse modo, fez-se a avaliação de um lote recentemente produzido e obteve-se o valor de 19,08% de polissacarídeo livre. A fim de estimar o tempo de estocagem máximo do conjugado foram realizadas análises com 30, 60 e 90 dias de estocagem a 4°C. Os valores encontrados até 60 dias não foram significativamente diferentes dosdeterminados no tempo zero. No entanto, com 90 dias de estocagem ocorreu uma modificação do perfil do conjugado que impossibilitou a sua quantificação. A metodologia desenvolvida e validada será introduzida no controle de qualidade do lote de conjugado que será submetido aos estudos clínicos de Fase III e na rotina da vacina conjugada estudada. Além disto, o conhecimento adquirido poderá ser empregado no controle de qualidade de outras vacinas conjugadas contra bactérias encapsuladas de interesse epidemiológico no país. / Neisseria meningitidisgroup C is an encapsulated bacterium that causes several diseases and is associated with high mortality rates becoming a serious public health problem. Bio-Manguinhos is developing a conjugate vaccine constituted by covalent attachment of capsular polysaccharide to tetanus toxoid, which iscurrently being evaluated in Phase II clinical studies in children between 1-9 years. Free components quantification is a vaccine process control assay and intended to prevent exacerbated adverse reactions occurrence and/or vaccine immunogenicity reduction. The World Health Organization recommends 5% of free protein maximum level in the conjugate vaccine, but does not set a limit for the free polysaccharide contents. Thus, the aim of this study was to develop and validate quality control methods appropriate to separate and quantify free components present in the conjugate vaccine against N. meningitidisgroup C, using capillary electrophoresis (CE) technique. For free protein separation, free capillary zone electrophoresis (CZE) and micellar electrokinetic chromatography (MEKC) were compared and different sample migration conditions were studied by varying parameters such as pH, temperature, voltage, buffer concentration, cyclodextrin and surfactant sodium dodecyl sulfate (SDS). The results showed that the best separation was obtained by MEKC using sodium tetraborate buffer (TBNA) 150 mM, 25 mM SDS, 60°C, 30 kV and pH 9.3. H owever, the CE did not induce a complete separation of the components suggesting that other techniques should be necessary. On the other hand, native and activated protein separation was possible using CZE, demonstrating the necessity of optimize protein activation reaction in order to increase the conjugation reaction yield. The total free sugar conjugate was completely separated from the conjugate by CZE using 50 mM TBNA buffer, 40°C, 30 kV and pH 10. In these conditions it was possible to determine the free polysaccharide content and validate the proposed method, which was linear in 0.047 to 0.164 mg/mL range, showed a matrix effect, 0.0154 mg/mL of detection limit and 0.0454 mg/mL ofquantification limit.After the validation steps, some conjugate batches were quantified and high levels of free sugar were observed in batches storaged at 4°C for long periods. On the other hand a conjugate batch recently produced was evaluated and showed19.08% of free polysaccharide. In order to estimate the maximum storage time a conjugate batch was analyzed30, 60 and 90 days after the production steps. The values found up to 60 days were not significantly different from that one determined at the initial time. However, with 90 days of storage there was a change in the conjugate profile that impaired its quantification. The methodology developed and validated will be used to evaluate the conjugate batch that will be submitted to Phase III clinical studies and in the routine quality controlof the conjugate vaccine. Moreover, the acquiredknowledge could be used in quality control of other conjugate vaccines against encapsulated bacteria of epidemiological importancein the country.