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Characterization of a Leishmania Tropica Antigen That Detects Immune Responses in Desert Storm Viscerotropic Leishmaniasis Patients

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Characterization of a Leishmania Tropica Antigen That Detects Immune Responses in Desert Storm Viscerotropic Leishmaniasis Patients Proc. Natl. Acad. Sci. USA Vol. 92, pp 7981-7985, August 1995 Medical Sciences Characterization of a Leishmania tropica antigen that detects immune responses in Desert Storm viscerotropic leishmaniasis patients (parasite/diagnosis/repetitive epitope/subclass) DAVIN C. DILLON*t, CRAIG H. DAY*, JACQUELINE A. WHITTLE*, ALAN J. MAGILLt, AND STEVEN G. REED*t§ *Infectious Disease Research Institute, Seattle, WA 98104; and tWalter Reed Army Institute of Research, Washington, DC 20307 Communicated by Paul B. Beeson, Redmond, WA, April 5, 1995 ABSTRACT A chronic debilitating parasitic infection, An alternative diagnostic strategy is to identify and apply viscerotropic leishmaniasis (VTL), has been described in immunodominant recombinant antigens to increase assay sen- Operation Desert Storm veterans. Diagnosis of this disease, sitivity and specificity. We report herein the cloning, expres- caused by Leishmania tropica, has been difficult due to low or sion, and evaluation of an immunodominant L. tropica anti- absent specific immune responses in traditional assays. We genT capable ofboth specific antibody detection and elicitation report the cloning and characterization of two genomic frag- of interferon y (IFN-y) production in peripheral blood mono- ments encoding portions of a single 210-kDa L. tropica protein nuclear cells (PBMCs) from VTL patients. These results useful for the diagnosis ofVTL in U.S. military personnel. The demonstrate the danger of relying on crude immunological recombinant proteins encoded by these fragments, recombi- assays for the diagnosis of subtle, albeit serious, VTL in Desert nant (r) Lt-1 and rLt-2, contain a 33-amino acid repeat that Storm patients. reacts with sera from Desert Storm VTL patients and with sera from L. tropica-infected patients with cutaneous leish- MATERIALS AND METHODS maniasis. Antibody reactivities to rLt-1 indicated a bias toward IgG2 in VTL patient sera. Peripheral blood mononu- Parasites. L. tropica isolates MHOM/SA/91/WR1063SS, clear cells from VTL patients produced interferon y, but not MCAN/SA/91 /WR1091SS, MHOM/SA/91/WR1092SS, interleukin 4 or 10, in response to rLt-1. No cytokine produc- MHOM/IQ/91/WR1095SS, MHOM/SA/92/WR2044SS; L. tion was observed in response to parasite lysate. The results tropica (Rupert); L. tropica (Azad); Leishmania amazonensis indicate that specific leishmanial antigens may be used to IFLA/BR/67/PH8; Leishmania braziliensis MHOM/BR/75/ detect immune responses in VTL patients with chronic infec- M2903; Leishmania chagasi MHOM/BR/82/BA-2, Cl; L. tions. donovani MHOM/Et/67/HU3; Leishmania guyanensis MHOM/BR/75/M4147; L. infantum IPT-1; L. major LTM p-2; L. major (Friedlander); and Trypanosoma cruzi MHOM/ Infection by the parasite Leishmania can result in a broad CH/00/Tulahuen C2 were used. Leishmania promastigotes spectrum of pathological outcomes in the human host, ranging and T. cruzi epimastigotes were cultured in axenic media. L. from simple self-healing cutaneous lesions to acute visceral major amastigotes were isolated from infected C.B-17 scid mice. leishmaniasis (VL), commonly referred to as kala-azar. The Patient Sera and PBMCs. The VTL patient group included differing pathologies usually correlate with infection by dif- eight culture-positive individuals, seven with confirmed L. fering species. Leishmania donovani and Leishmania infantum tropica infection and one with insufficient parasites available usually cause VL, with symptoms including fever, emaciation, for isoenzyme analysis. Four others were culture-negative but hypergammaglobulinemia, hepatosplenomegaly, and pancyto- either PCR or monoclonal antibody (mAb)-smear-positive. CL penia. Leishmania major and Leishmania tropica generally patient sera were from M. Grogl (Walter Reed Army Institute cause cutaneous leishmaniasis (CL). Exceptional cases have of Research, Washington, DC). Normal sera were from the been described, such as visceral outcomes in individuals in- American Red Cross (Portland, OR). fected with L. tropica (1, 2). Isolation of Lt-1 and Lt-2. L. tropica MHOM/SA/91/ More recently, exposure of U.S. soldiers to L. tropica has WR1063C genomic DNA was isolated and sheared by passage resulted in a variant form of visceral disease in several indi- through a 30-gauge needle to 2-6 kb. The library was con- viduals with confirmed infection with this organism (3, 4). structed in Lambda ZapII (Stratagene) by using EcoRI adap- Additional confirmed cases continue to arise at this time. tors. Expression screening was performed with a pool of Referred to as viscerotropic leishmaniasis (VTL), these infec- preadsorbed patient sera (8). tions differ from classical VL in the variable pathology ob- Expression of Recombinant L. tropica Antigens. Induced served, with several patients lacking both fever and hepato- bacterial pellets were lysed, and recombinant (r) Lt-1, rLt-lr, splenomegaly (4). In addition, serum anti-leishmanial antibody and rLt-2 were recovered from the inclusion bodies. rLt-1 and titers are much lower than those observed in patients with rLt-2 were solubilized in 8 M urea and rLt-lr in 4 M urea. The classical VL. Diagnosis of classical VL has utilized the elevated recombinant proteins were purified by ammonium sulfate antibody response to parasite antigens in tests involving sero- precipitation and preparative gel separation by SDS/PAGE in logical reactivity to whole or lysed promastigotes (5, 6) or to recombinant antigens (7). Confirmation is achieved by the Abbreviations: VTL, viscerotropic leishmaniasis; VL, visceral leish- isolation of live parasites from spleen, liver, bone marrow, or maniasis; CL, cutaneous leishmaniasis; PBMC, peripheral blood lymph nodes. Serological reactivity to promastigotes in VTL mononuclear cell; IL, interleukin; mAb, monoclonal antibody; TNF-a, patients is usually low or absent (4). tumor necrosis factor a; IFN, interferon; r, recombinant. tPresent address: Corixa Corp., 1124 Columbia, Suite 464, Seattle, WA 98104. The publication costs of this article were defrayed in part by page charge §To whom reprint requests should be sent at the t address. payment. This article must therefore be hereby marked "advertisement" in 1The sequence reported in this paper has been deposited in the accordance with 18 U.S.C. §1734 solely to indicate this fact. GenBank data base (accession no. U31221). 7981 Downloaded by guest on October 2, 2021 7982 Medical Sciences: Dillon et al. Proc. Natl. Acad. Sci. USA 92 (1995) 10% gels. Recombinant proteins were eluted from the gels and PBS-T) or rabbit sera (diluted 1:250 in PBS-T) on a rocker at dialyzed in phosphate-buffered saline (PBS), the concentra- room temperature. Filters were washed three times with tion was measured by the Pierce BCA assay, and purity was PBS-T and bound antibody was detected with 125I-labeled assessed by SDS/PAGE followed by Coomassie blue staining. protein A at 105 cpm/ml followed by autoradiography. Molecular Analysis of Lt-1 and Lt-2. Exonuclease III diges- Rabbit antiserum to rLt-1 was raised in an adult New tion was used to create overlapping deletions of the clones (9). Zealand White rabbit (R & R Rabbitry, Stanwood, WA) by an Single-strand template was prepared and sequenced with initial s.c. delivery of 200 ,ug of rLt-1 in 1 ml of Freund's Applied Biosystems automated sequencer model 373A or by incomplete adjuvant (Bethesda Research Laboratories) and Sanger dideoxynucleotide sequencing (10). Both strands of the 100 ,tg of muramyl dipeptide (Calbiochem), followed by two coding portion of the Lt-1 clone were sequenced. successive s.c. immunizations of 100 ,ug of rLt-1 in 1 ml of Genomic DNA was digested with a variety of enzymes, incomplete Freund's adjuvant at 3-week intervals. A final i.v. separated by agarose gel electrophoresis, and blotted on boost of 25 ,ug of rLt-1 was delivered after an additional 4 Nytran (Scheicher & Schuell). The L. tropica inserts were weeks and serum was collected 2 weeks later. labeled with [32P]dCTP by random oligonucleotide primers Proliferative Assays and Cytokine Production. Purified (Boehringer Mannheim) and used as probes. Hybridizations PBMCs were cultured as described (11). Both parasite lysate Lt-1 or Lt-2 were at involving the the probes performed 65°C, and rLt-1 were used at 10 jig/ml. Endotoxin levels of all the rLt-lr probe were per- and the hybridizations involving antigens were <5 pg/,ug. Supernatants were collected at 72 h formed at 0.2 M M M EDTA 60°C in NaH2PO4/3.6 NaCl/0.2 for cytokine assays. Capture ELISAs to detect interleukin overnight and washed to a stringency of 0.075 M NaCl/0.0075 (IL)-4, IL-10, and IFN-,y were performed as described (11). M sodium citrate (0.15 M NaCl/0.0150 M sodium citrate was Capture ELISAs to detect tumor necrosis factor a (TNF-a) used with Lt-lr probe), pH 7.0/0.5% SDS at the temperature of hybridization. used an anti-human TNF-a mAb (Immunex) and a polyclonal rabbit anti-human TNF-a sera (Immunex). Human rTNF-a Serology. ELISAs were performed as described (6). In was used to generate a standard curve with a sensitivity of 40 competition experiments, sera were preincubated for 30 min with S gg of rLt-lr at room temperature. Plates were washed pg/ml. five times with PBS-T (phosphate-buffered saline/0.1% Six patient and 6 normal donors were assayed for IL-4 Tween 20). For IgG subclass ELISA tests, plates were coated, production in response to rLt-1, and 3 patient and 3 normal blocked, and incubated with sera as described (6). After plates donors were assayed in response to parasite lysate. Three were washed five times with PBS-T, mouse anti-human IgGl, patient and 5 normal donors were assayed for IL-10 production IgG2, IgG3, and IgG4 mAb (Calbiochem) was added (50 ,lI of in response to rLt-1, and 5 patient and 8 normal donors were a 1:1000 dilution) and incubated 30 min.
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