In humans of all ages, the cell wall-less and genome-reduced species Mycoplasma pneumoniae can cause infections of the upper and lower respiratory tract. The well-documented occurrence of major peaks in the incidence of community-acquired pneumonia cases reported world-wide, the multifaceted clinical manifestations of infection and the increasing number of resistant strains provide reasons for ongoing interest in the pathogenesis of mycoplasmal disease. The results of recent studies have provided insights into the interaction of the limited virulence factors of the bacterium with its host. In addition, the availability of complete M. pneumoniae genomes from patient isolates and the development of proteomic methods for investigation of mycoplasmas have not only allowed characterization of sequence divergences between strains but have also shown the importance of proteins and protein parts for induction of the immune reaction after infection. This review focuses on selected aspects of the humoral host immune response as a factor that might influence the clinical course of infections, subsequent protection in cases of re-infections and changes of epidemiological pattern of infections. The characterization of antibodies directed to defined antigens and approaches to promote their induction in the respiratory mucosa are also preconditions for the development of a vaccine to protect risk populations from severe disease due to M. pneumoniae.

In humans of all ages, the cell wall-less and genome-reduced species Mycoplasma pneumoniae can cause infections of the upper and lower respiratory tract. The well-documented occurrence of major peaks in the incidence of community-acquired pneumonia cases reported world-wide, the multifaceted clinical manifestations of infection and the increasing number of resistant strains provide reasons for ongoing interest in the pathogenesis of mycoplasmal disease. The results of recent studies have provided insights into the interaction of the limited virulence factors of the bacterium with its host. In addition, the availability of complete M. pneumoniae genomes from patient isolates and the development of proteomic methods for investigation of mycoplasmas have not only allowed characterization of sequence divergences between strains but have also shown the importance of proteins and protein parts for induction of the immune reaction after infection. This review focuses on selected aspects of the humoral host immune response as a factor that might influence the clinical course of infections, subsequent protection in cases of re-infections and changes of epidemiological pattern of infections. The characterization of antibodies directed to defined antigens and approaches to promote their induction in the respiratory mucosa are also preconditions for the development of a vaccine to protect risk populations from severe disease due to M. pneumoniae.

A exposição limitada ao Plasmodium chabaudi induz proeminente imunidade celular, associada à proteção de células T da apoptose. Este estudo tem como objetivo verificar a influência da carga parasitária na geração e manutenção dos linfócitos T e B de memória ao P. chabaudi. Assim, camundongos C57BL/6 foram submetidos à infecção tratada (subpatente) ou não (patente) com cloroquina após a inoculação de 106 eritrócitos parasitados (EP) e analisados nos dias 0, 20, 60, 120 e 200. Com relação à memória de linfócitos T, no dia 20, as freqüências de células CD4+ memória/ativadas e respondedoras aos EP foram significativamente maiores nos animais do grupo subpatente. Os níveis máximos de IgG2a específica foram encontrados no dia 120 em ambos os grupos. O desafio dos animais com 108 EP mostrou que a imunidade protetora declina progressivamente, mas os grupos ainda são capazes de estabelecer resposta secundária eficiente que elimine o parasita. Assim, podemos concluir que a carga parasitária influencia a fase aguda, mas não impede a geração e manutenção das células T e B de memória. / One of the main characteristics of malaria is the intense policlonal activation of splenic T and B lymphocytes induced by the parasite and the consequent elimination, through apoptosis, of part of these cells. However, the limited exposure to the bloodstage malaria seems to induce a prominent cellular immunity, associated with the protection of T lymphocytes from apoptosis. With this in mind, this study aimed to verify the influence of the parasite load in the generation and maintenance of memory T and B cells specific for Plasmodium chabaudi chabaudi AS. In order to evaluate this idea, C57BL/6 mice were infected with 106 parasitized red blood cells (pRBC) and submitted to a patent (untreated) or subpatent infection (controlled with sub-curative doses of chloroquine every time parasitemia reached 1%). Splenocytes from these mice were analyzed at 20, 60, 120 and 200 days after infection, regarding the pRBC-specific T cell proliferation and the expression of surface molecules, as CD4, CD8, CD62L, CD45RB, CD44, CD45R-B220 and IgG. The parasitemia and the splenocyte phenotype were also monitored after the challenge with 108 pRBC. Regarding T cell memory, at day 20 of infection, the frequencies of effector/activated CD4+ T cells (CD62LLOW CD45RBLOW/HIGH) were significantly increased in animals from the patent group, which was strict linked with the highest cellular activation observed in these animals. On the other hand, the total numbers of pRBCproliferating T (CD4+ and CD8+) cells per spleen were approximately 3-fold increased in subpatent animals, indicating that these cells were protected from apoptosis as a result of the limited exposure to the parasite. However, in both groups, these parameters decreased to values similar to those in controls at day 200. The splenocytes from both groups produced Th1 cytokines in response to pRBC in all times of analysis, but at the early phase of infection, Th2 cytokines were also observed, but without differences between the infected groups. Regarding memory B cells, the frequency of sIgG+ cells was increased at day 20 of infection, when 11% and 9% of CD45R+ cells from patent and subpatent animals were positive, respectively. For both groups, specific IgG2a antibodies attained maximum serum levels at day 120, but at day 200, it is possible to observe a significant decrease of these levels only in the serum of patent mice. Moreover, at day 200 of infection, mice of subpatent group showed significantly higher amounts of IgG2a that recognized the intra-erythrocytic forms of the parasite and the surface of infected erythrocytes. Challenge of mice with 108 pRBC showed that protective immunity progressively decline with time and despite the higher levels of specific antibody in subpatent mice, both groups showed similar protection. In experiments of adoptive transference to CD28-/- mice, cells from 200-day infected mice were able to produce specific IgG2a antibodies, in a T CD4+ cell dependent way. In addition, we verified that CD45R+ cells of subpatent mice, when transferred to CD28-/- mice, secreted higher amounts of specific IgG2a and IgG1 antibodies, comparing to cells of patent mice. So, from this work, we can conclude that the parasite load has a great influence in the early immune response to P. chabaudi malaria and it also affects the generation and/or maintenance of memory B cells. Furthermore, according to our data, at least during the analyzed period, the loss of protective immunity against this parasite does not seem to be influenced by the acute-phase parasite load, but it can be a consequence of the progressive decline of T-cell memory response that occurs in patent and subpatent groups with time of infection.

Dados sorológicos sobre doenças imunopreveníveis são úteis para avaliar o sucesso de programas de imunização e a identificação de populações suscetíveis. Nos últimos 20 anos, as campanhas de imunização na infância foram eficientes no controle da difteria em muitos países. No entanto, uma taxa importante da população adulta continua suscetível à doença, uma vez que os níveis de anticorpos protetores reduzem com o passar do tempo. A infecção pelo HIV-1 leva a uma perda progressiva das funções imunes. Com o aumento da expectativa de vida dos pacientes HIV-1, e a maior incidência de infecções, torna-se importante a avaliação dos níveis de anticorpos antitoxina diftérica nestes grupos. O objetivo deste estudo foi avaliar os níveis de anticorpos antitoxina diftérica e a contagem de linfócitos T (LT) em indivíduos infectados ou não pelo HIV -1, assistidos no Instituto de Biologia do Exército (IBEx). Investigamos a correlação entre níveis de anticorpos específicos e os seguintes parâmetros dos grupos de estudo: sexo, faixa etária, categoria militar ou civil; vacinação prévia contra difteria; número de LT CD4+ e CD8+; e entre os indivíduos HIV-1 positivos a correlação com a carga viral e a terapia com antirretrovirais potentes (HAART). Para a quantificação de anticorpos antitoxina diftérica utilizou-se um kit ELISA (IBL Immuno-Biological Laboratories, Hamburg, Alemanha) e amostras de sangue de 180 indivíduos, sendo que 75 eram doadores de sangue e 105 eram pacientes positivos para o HIV-1. Aproximadamente 60% dos indivíduos estavam parcialmente protegidos contra a difteria (IgG específica &#8805; 0,1 < 1,0 UI/mL). Entre os doadores de sangue, 56% dos indivíduos estavam protegidos (IgG específica &#8805; 1,0 UI/mL) contra a doença, contra apenas 29 % dos indivíduos positivos para HIV-1. Em relação aos doadores de sangues de origem civil não se observou correlação entre os níveis de IgG e a idade, enquanto que, para os militares observou-se uma correlação inversa. Não houve diferença significativa na resposta de anticorpos para difteria entre os indivíduos soropositivos com CD4+ baixo ou normal. Pacientes com HAART mostraram uma resposta significativamente mais baixa de anticorpos (média geométrica de 0.39 IU/mL, n = 84) do que os pacientes não tratados (média geométrica de 0.58 IU/mL, n = 19). A diferença na idade média dos pacientes não tratados (46 anos) e tratados com HAART (35 anos) provavelmente influenciou estes resultados, já que os níveis de anticorpos contra a difteria declinam com o tempo. A existência em nossa comunidade de adultos (militares e civis) suscetíveis à difteria, incluindo os indivíduos soropositivos, reforça que a imunização a cada 10 anos e os estudos soroepidemiológicos são muito importantes e devem ser estimulados. / Serologic data on diseases that are preventable by vaccine are useful to evaluate the success of immunization programs and to identify susceptible subgroups. In the last 20 years the childhood immunization program has been efficient in the control of the diphtheria in many countries. However, an important rate of adult population remains susceptible to the illness, since diphtheria protective antibodies decline with time. HIV-1 infection leads to a progressive loss of immune functions. With the increase of life expectancy of HIV-1 patients, and also the increment of infections, it is important to known the antibody levels to diphtheria toxin in these population. The aim of this study was to evaluate the IgG levels to diphtheria toxin and T lymphocytes (LT) counts in HIV-1 infected and non- infected individuals assisted at the Instituto de Biologia do Exército (IBEx), Rio de Janeiro. We investigated the correlation between specific antibody levels and the following parameters of the study groups: gender, age-group, military or civilian origin, previous diphtheria immunization, CD4+ and CD8+ counts. For HIV-1 patients, we also analysed the correlation of specific antibodies with viral load and the use of highly active antiretroviral therapy HAART. A commercial diphtheria-ELISA kit (IBL Immuno-Biological Laboratories, Hamburg, Alemanha) was used to evaluate IgG levels in serum samples of 180 individuals. Blood donors accounted for 75 individuals and 105 subjects were HIV-1 patients. About 60% of individuals were partially protected against diphtheria (specific IgG levels &#8805; 0,1 < 1,0 IU/mL). About 56% of blood donors were protected against diphtheria (specific IgG > 1.0 IU/mL). Howerver, only 29% of HIV-1 patients showed the same level of protective antibodies. For the civilian blood donors, there were no correlation between specific antibody levels and age group. In contrast, a negative correlation was observed in the military group. There were no differences in diphtheria serology according to CD4+ counts of HIV-1 patients or blood donors. Interesting, HAART- treated (n = 84) patients showed a significantly lower antibody response (geomean of 0.39 IU/mL) than untreated patients (geomean of 0.58 IU/mL, n = 19). As tetanus and diphtheria antibodies tend to decrease with time, the difference in age between HAART-treated patients (mean of 46 years) and those not being treated (mean of 35 years) might introduce a bias in the study. Concluding, the existence of susceptible military and civilian adults in our community, including HIV-1 patients, reinforce that reliable seroepidemiological data and immunization campaigns should be routinely stimulated.

Dados sorológicos sobre doenças imunopreveníveis são úteis para avaliar o sucesso de programas de imunização e a identificação de populações suscetíveis. Nos últimos 20 anos, as campanhas de imunização na infância foram eficientes no controle da difteria em muitos países. No entanto, uma taxa importante da população adulta continua suscetível à doença, uma vez que os níveis de anticorpos protetores reduzem com o passar do tempo. A infecção pelo HIV-1 leva a uma perda progressiva das funções imunes. Com o aumento da expectativa de vida dos pacientes HIV-1, e a maior incidência de infecções, torna-se importante a avaliação dos níveis de anticorpos antitoxina diftérica nestes grupos. O objetivo deste estudo foi avaliar os níveis de anticorpos antitoxina diftérica e a contagem de linfócitos T (LT) em indivíduos infectados ou não pelo HIV -1, assistidos no Instituto de Biologia do Exército (IBEx). Investigamos a correlação entre níveis de anticorpos específicos e os seguintes parâmetros dos grupos de estudo: sexo, faixa etária, categoria militar ou civil; vacinação prévia contra difteria; número de LT CD4+ e CD8+; e entre os indivíduos HIV-1 positivos a correlação com a carga viral e a terapia com antirretrovirais potentes (HAART). Para a quantificação de anticorpos antitoxina diftérica utilizou-se um kit ELISA (IBL Immuno-Biological Laboratories, Hamburg, Alemanha) e amostras de sangue de 180 indivíduos, sendo que 75 eram doadores de sangue e 105 eram pacientes positivos para o HIV-1. Aproximadamente 60% dos indivíduos estavam parcialmente protegidos contra a difteria (IgG específica &#8805; 0,1 < 1,0 UI/mL). Entre os doadores de sangue, 56% dos indivíduos estavam protegidos (IgG específica &#8805; 1,0 UI/mL) contra a doença, contra apenas 29 % dos indivíduos positivos para HIV-1. Em relação aos doadores de sangues de origem civil não se observou correlação entre os níveis de IgG e a idade, enquanto que, para os militares observou-se uma correlação inversa. Não houve diferença significativa na resposta de anticorpos para difteria entre os indivíduos soropositivos com CD4+ baixo ou normal. Pacientes com HAART mostraram uma resposta significativamente mais baixa de anticorpos (média geométrica de 0.39 IU/mL, n = 84) do que os pacientes não tratados (média geométrica de 0.58 IU/mL, n = 19). A diferença na idade média dos pacientes não tratados (46 anos) e tratados com HAART (35 anos) provavelmente influenciou estes resultados, já que os níveis de anticorpos contra a difteria declinam com o tempo. A existência em nossa comunidade de adultos (militares e civis) suscetíveis à difteria, incluindo os indivíduos soropositivos, reforça que a imunização a cada 10 anos e os estudos soroepidemiológicos são muito importantes e devem ser estimulados. / Serologic data on diseases that are preventable by vaccine are useful to evaluate the success of immunization programs and to identify susceptible subgroups. In the last 20 years the childhood immunization program has been efficient in the control of the diphtheria in many countries. However, an important rate of adult population remains susceptible to the illness, since diphtheria protective antibodies decline with time. HIV-1 infection leads to a progressive loss of immune functions. With the increase of life expectancy of HIV-1 patients, and also the increment of infections, it is important to known the antibody levels to diphtheria toxin in these population. The aim of this study was to evaluate the IgG levels to diphtheria toxin and T lymphocytes (LT) counts in HIV-1 infected and non- infected individuals assisted at the Instituto de Biologia do Exército (IBEx), Rio de Janeiro. We investigated the correlation between specific antibody levels and the following parameters of the study groups: gender, age-group, military or civilian origin, previous diphtheria immunization, CD4+ and CD8+ counts. For HIV-1 patients, we also analysed the correlation of specific antibodies with viral load and the use of highly active antiretroviral therapy HAART. A commercial diphtheria-ELISA kit (IBL Immuno-Biological Laboratories, Hamburg, Alemanha) was used to evaluate IgG levels in serum samples of 180 individuals. Blood donors accounted for 75 individuals and 105 subjects were HIV-1 patients. About 60% of individuals were partially protected against diphtheria (specific IgG levels &#8805; 0,1 < 1,0 IU/mL). About 56% of blood donors were protected against diphtheria (specific IgG > 1.0 IU/mL). Howerver, only 29% of HIV-1 patients showed the same level of protective antibodies. For the civilian blood donors, there were no correlation between specific antibody levels and age group. In contrast, a negative correlation was observed in the military group. There were no differences in diphtheria serology according to CD4+ counts of HIV-1 patients or blood donors. Interesting, HAART- treated (n = 84) patients showed a significantly lower antibody response (geomean of 0.39 IU/mL) than untreated patients (geomean of 0.58 IU/mL, n = 19). As tetanus and diphtheria antibodies tend to decrease with time, the difference in age between HAART-treated patients (mean of 46 years) and those not being treated (mean of 35 years) might introduce a bias in the study. Concluding, the existence of susceptible military and civilian adults in our community, including HIV-1 patients, reinforce that reliable seroepidemiological data and immunization campaigns should be routinely stimulated.

A exposição limitada ao Plasmodium chabaudi induz proeminente imunidade celular, associada à proteção de células T da apoptose. Este estudo tem como objetivo verificar a influência da carga parasitária na geração e manutenção dos linfócitos T e B de memória ao P. chabaudi. Assim, camundongos C57BL/6 foram submetidos à infecção tratada (subpatente) ou não (patente) com cloroquina após a inoculação de 106 eritrócitos parasitados (EP) e analisados nos dias 0, 20, 60, 120 e 200. Com relação à memória de linfócitos T, no dia 20, as freqüências de células CD4+ memória/ativadas e respondedoras aos EP foram significativamente maiores nos animais do grupo subpatente. Os níveis máximos de IgG2a específica foram encontrados no dia 120 em ambos os grupos. O desafio dos animais com 108 EP mostrou que a imunidade protetora declina progressivamente, mas os grupos ainda são capazes de estabelecer resposta secundária eficiente que elimine o parasita. Assim, podemos concluir que a carga parasitária influencia a fase aguda, mas não impede a geração e manutenção das células T e B de memória. / One of the main characteristics of malaria is the intense policlonal activation of splenic T and B lymphocytes induced by the parasite and the consequent elimination, through apoptosis, of part of these cells. However, the limited exposure to the bloodstage malaria seems to induce a prominent cellular immunity, associated with the protection of T lymphocytes from apoptosis. With this in mind, this study aimed to verify the influence of the parasite load in the generation and maintenance of memory T and B cells specific for Plasmodium chabaudi chabaudi AS. In order to evaluate this idea, C57BL/6 mice were infected with 106 parasitized red blood cells (pRBC) and submitted to a patent (untreated) or subpatent infection (controlled with sub-curative doses of chloroquine every time parasitemia reached 1%). Splenocytes from these mice were analyzed at 20, 60, 120 and 200 days after infection, regarding the pRBC-specific T cell proliferation and the expression of surface molecules, as CD4, CD8, CD62L, CD45RB, CD44, CD45R-B220 and IgG. The parasitemia and the splenocyte phenotype were also monitored after the challenge with 108 pRBC. Regarding T cell memory, at day 20 of infection, the frequencies of effector/activated CD4+ T cells (CD62LLOW CD45RBLOW/HIGH) were significantly increased in animals from the patent group, which was strict linked with the highest cellular activation observed in these animals. On the other hand, the total numbers of pRBCproliferating T (CD4+ and CD8+) cells per spleen were approximately 3-fold increased in subpatent animals, indicating that these cells were protected from apoptosis as a result of the limited exposure to the parasite. However, in both groups, these parameters decreased to values similar to those in controls at day 200. The splenocytes from both groups produced Th1 cytokines in response to pRBC in all times of analysis, but at the early phase of infection, Th2 cytokines were also observed, but without differences between the infected groups. Regarding memory B cells, the frequency of sIgG+ cells was increased at day 20 of infection, when 11% and 9% of CD45R+ cells from patent and subpatent animals were positive, respectively. For both groups, specific IgG2a antibodies attained maximum serum levels at day 120, but at day 200, it is possible to observe a significant decrease of these levels only in the serum of patent mice. Moreover, at day 200 of infection, mice of subpatent group showed significantly higher amounts of IgG2a that recognized the intra-erythrocytic forms of the parasite and the surface of infected erythrocytes. Challenge of mice with 108 pRBC showed that protective immunity progressively decline with time and despite the higher levels of specific antibody in subpatent mice, both groups showed similar protection. In experiments of adoptive transference to CD28-/- mice, cells from 200-day infected mice were able to produce specific IgG2a antibodies, in a T CD4+ cell dependent way. In addition, we verified that CD45R+ cells of subpatent mice, when transferred to CD28-/- mice, secreted higher amounts of specific IgG2a and IgG1 antibodies, comparing to cells of patent mice. So, from this work, we can conclude that the parasite load has a great influence in the early immune response to P. chabaudi malaria and it also affects the generation and/or maintenance of memory B cells. Furthermore, according to our data, at least during the analyzed period, the loss of protective immunity against this parasite does not seem to be influenced by the acute-phase parasite load, but it can be a consequence of the progressive decline of T-cell memory response that occurs in patent and subpatent groups with time of infection.