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Infect Immun, July 1998, p. 3264-3269, Vol. 66, No. 7
0019-9567/98/$04.00+0
Copyright © 1998, American Society for Microbiology. All rights reserved.
Cloning of the Gene Encoding the 44-Kilodalton
Antigen of the Agent of Human Granulocytic Ehrlichiosis
and Characterization of the Humoral Response
Jacob W.
Ijdo,1
Wei
Sun,1
Yan
Zhang,1
Louis A.
Magnarelli,2 and
Erol
Fikrig1,*
Section of Rheumatology, Department of
Internal Medicine, Yale University School of Medicine, New Haven,
Connecticut 06520-8031,1 and
The
Connecticut Agricultural Experiment Station, New Haven, Connecticut
065042
Received 12 February 1998/Returned for modification 24 March
1998/Accepted 10 April 1998
 |
ABSTRACT |
Antibodies in the sera of patients with human granulocytic
ehrlichiosis (HGE) commonly recognize a 44-kDa antigen. We cloned the
gene encoding the 44-kDa protein of the agent of HGE (aoHGE) by probing
an aoHGE lambda ZAP II genomic DNA expression library with sera from
aoHGE-infected mice. The gene, hge-44, is part of a
multigene family, with sequence similarity to the Anaplasma marginale msp-2 genes. RNA-PCR studies confirmed that
hge-44 is expressed by aoHGE cultured in HL-60 cells and by
aoHGE during murine infection. Recombinant HGE-44, expressed and
purified as a glutathione transferase fusion protein, was used as the
substrate in immunoblots to help diagnose HGE. Antibodies in eight sera from eight patients with HGE and in two sera from two aoHGE-infected mice bound recombinant HGE-44. Antibodies in the sera of healthy individuals or patients with Ehrlichia chaffeensis or
Borrelia burgdorferi infection did not recognize HGE-44. We
conclude that hge-44 is a member of a multigene family and
that hge-44 is expressed and elicits specific antibodies
during infection.
 |
INTRODUCTION |
Human granulocytic ehrlichiosis
(HGE) is a recently recognized tick-borne infectious disease in the
United States and Europe (4, 5, 10, 24, 26). Ixodes
scapularis is a vector of the agent of HGE (aoHGE)
(21), an organism that is closely related to Ehrlichia
equi and Ehrlichia phagocytophila (6). Clinical infection produces acute symptoms including fever, leukopenia, thrombocytopenia, and myalgias; severe secondary complications can
occasionally result in death (1, 13). Diagnosis may be aided
by the identification of the characteristic aoHGE morulae in
neutrophils in a peripheral blood smear (4) or by DNA
detection methods such as PCR (6). Serologic tests such as
immunofluorescence (IFA) (1, 17, 18) and immunoblotting with
E. equi-infected equine neutrophils or aoHGE cultured in
HL-60 cells have also proven helpful for diagnosis (15, 28).
The aoHGE 44-kDa protein is commonly recognized by immunoglobulin M
(IgM) and IgG antibodies in the sera of patients with HGE (8, 15,
19, 28). Examination of aoHGE isolated from different patients
reveals that although this antigen usually migrates at about 44 kDa,
the molecular size may vary from 42 to 49 kDa, suggesting molecular
structural differences which may account for the observed antigenic
diversity (3, 30). Fractionation studies indicate that the
44-kDa protein may be located in the aoHGE outer membrane
(30). It has recently been shown that sera from mice
immunized with aoHGE lysates are sufficient to partially protect mice
from aoHGE infection (25). This murine aoHGE antiserum has
high concentrations of antibodies that bind the 44-kDa protein, suggesting that 44-kDa-protein-specific antibodies may play a role in
immunity against infection. This immunogenic antigen may therefore be
important in pathogenesis and laboratory diagnosis and serve as a
candidate for an HGE vaccine. The gene encoding the aoHGE 44-kDa
antigen has now been cloned, and the humoral response to the
recombinant protein has been characterized.
 |
MATERIALS AND METHODS |
Isolation of HGE organisms.
The promyelocytic cell line
HL-60 (ATTC CCL 240) was cultured in Iscove's modified Dulbecco's
medium supplemented with 20% fetal bovine serum and was maintained at
37°C with 5% carbon dioxide (11). HL-60 cells were
infected with the NCH-1 strain of aoHGE and cultured (15).
The cell density was maintained at between 5 × 105
and 1.5 × 106 cells per ml by feeding the cells twice
a week. If the cell count was below 5 × 105 cells per
ml, fresh HL-60 cells were added to a final concentration of 1 × 106 cells per ml. Light microscopy slides of cultured HL-60
cells were air dried, stained with Diff-Quik (Baxter Healthcare Corp., Miami, Fla.), and examined for aoHGE infection.
Large volumes of infected HL-60 cells were grown for purification of
bacteria by Renografin density gradient centrifugation as described
previously (7, 12) with some modifications. Briefly,
cultures with at least 70% aoHGE-infected HL-60 cells were centrifuged
and resuspended in phosphate-buffered saline (PBS)-0.1% glucose.
HL-60 cells were lysed by shearing with a 21-gauge needle, and the
cellular debris was pelleted by centrifugation at 1,500 × g (Sorvall RT600B; Sorvall, Newtown, Conn.) for 10 min. The
supernatant was collected and incubated with RNase and DNase
(Boehringer, Mannheim, Germany) (final concentration, 50 µg/ml). By
using Renografin with a noncontinuous gradient of 42 and 30% (Hypaque
76; Nycomed Inc., New York, N.Y.), ultracentrifugation was performed at
87,000 × g for 75 min at 4°C in an SW-28 swing bucket rotor (Beckman, Fullerton, Calif.). The interface band was
collected in a sterile pipette, dissolved in SPGN (7.5% sucrose, 3.7 mM KH2PO4, 7 mM K2HPO4
and 5 mM L-glutamine), and pelleted at 12,000 × g (Sorvall rotor SS-34), and the HGE bacteria were resuspended in SPGN at a concentration of 2 µg/µl and stored at
70°C.
HGE library construction, screening, and sequencing.
For
construction of the lambda ZAP II aoHGE genomic DNA expression library,
purified aoHGE was used to extract DNA as described previously
(22). After random shearing of 100 µg of aoHGE DNA, EcoRI adapters were ligated to the ends and subsequently
size fractionated (from 1 to 9 kb), and DNA was inserted into the
lambda ZAP II vector (Stratagene, La Jolla, Calif.). The lambda ZAP II phages were plated on a lawn of Escherichia coli XL-1 Blue
(Stratagene), and protein expression was induced with 10 mM
isopropyl-
-D-thiogalactoside (IPTG).
In order to identify immunogenic aoHGE proteins, nitrocellulose filters
containing the expressed proteins were incubated with
hyperimmune
murine antiserum (1:1,000 dilution). Hyperimmune antiserum
was produced
by immunizing 10 C3H/HeJ mice with a lysate of purified
aoHGE in
complete Freund's adjuvant and boosting the animals twice
with the
same preparation in incomplete Freund's adjuvant at 2-week
intervals.
This serum has been shown to contain high concentrations
of antibodies
that bind the 44-kDa antigen in aoHGE lysates (
25).
After
being washed, the nitrocellulose filters were incubated
with a 1:5,000
dilution of alkaline phosphatase-conjugated goat
anti-mouse IgG
antibody (Sigma, St. Louis, Mo.), washed again,
and then immersed in
5-bromo-4-chloro-3-indolylphosphate-nitroblue
tetrazolium (BCIP-NBT)
(KPL, Gaithersburg, Md.) for color visualization.
After secondary screening, reactive clones were subjected to in vivo
excision by simultaneous infection of
E. coli XL-1 Blue
cells with R408 helper phage (Stratagene), resulting in replication
and
recircularization of a single-stranded DNA molecule of the
cloned
insert and the pBluescript vector. This single-stranded
plasmid was
then packaged, secreted, and made double stranded
by reinfection with
fresh
E. coli XL-1 Blue cells. Plasmid DNA
was purified and
sequenced by using the T3 and T7 primers and
additional internal
primers at approximate distances of 250 bp,
so that both strands of the
clone were sequenced entirely.
Partial internal protein sequencing.
aoHGE bacteria,
purified from infected HL-60 cultures, were lysed, dissolved in sample
buffer (5% 2-mercaptoethanol, 10% glycerol, 2% sodium dodecyl
sulfate [SDS], and 0.8% bromophenol blue in 6.25 mM Tris buffer, pH
6.8), and heated for 10 min at 100°C. SDS-polyacrylamide gel
electrophoresis (SDS-PAGE) was performed with 20 µg of aoHGE protein.
The 44-kDa band was excised from the gel and used for peptide
sequencing at the Yale Protein Purification and Analysis Facility.
Because amino-terminal sequencing was not successful, the protein was
subjected to in-gel trypsin digestion, and two aliquots were selected
for sequencing by matrix-assisted laser desorption-ionization mass
spectrometry, yielding two peptide sequences from the 44-kDa protein.
Protein expression and purification.
By using
5'-AAACCCGAATTCATGTCTATGGCTATAGTCATGGCTGGG-3' and
5'-ATATATCTCGAGTCATTAAAAAGCAAACCTAACACC-3' primers, a
PCR-derived subclone of EM3C (a phage clone that contained the
hge-44 gene [see Results]) containing the full-length gene
sequence was then constructed in frame with the glutathione
S-transferase (GT) gene by using the pMX vector
(23). This clone, designated hge-44-pMX, was used
to transform E. coli XL-1 Blue. After lysis of the cells and
pelleting of the cell membranes, the soluble fraction (supernatant) and
the cell pellet were subjected to SDS-PAGE and stained with Coomassie
blue. Part of the GT-HGE-44 fusion protein appeared to be in the
soluble fraction. GT-HGE-44 was then purified from the whole-cell
lysate by using a glutathione-Sepharose-4B column.
PCR and RNA-PCR.
Total aoHGE RNA, isolated from cultured and
purified aoHGE, was used as a template for PCR to verify the presence
and expression of hge-44. The primers used for PCR and
RNA-PCR were 5'-AGCGTAATGATGTCTATGGC-3', starting at
position 43, and 5'-ACCCTAACACCAAATTCCC-3', starting at
position 1322. The denaturing, annealing, and extension temperatures were 94, 58, and 72°C, respectively, for 1 min at each step for 30 cycles, yielding an expected product of 1,279 bp. For RNA-PCR, total
RNA was isolated from cultured HGE bacteria and from spleens of
experimentally infected mice, by using a Micro RNA isolation kit
(Stratagene). First-strand cDNA was synthesized with random primers
from 5 µg of total aoHGE RNA and splenic RNA. Control studies were
performed without reverse transcriptase to eliminate the possibility of
DNA contamination.
Southern blotting.
DNA of aoHGE (5 µg per lane) was
digested with restriction enzymes BamHI, BglII,
KpnI, and PstI, electrophoresed, blotted onto
nylon membranes (Hybond; Amersham, Arlington Heights, Ill.), and probed
with insert of EM3C. The probe was labeled by use of a nonradioactive
chemiluminescence kit (ECL; Amersham). After hybridization, blots were
washed with 2× SSC (1× SSC is 0.15 M NaCl plus 0.015 M sodium
citrate), 1× SSC, and 0.5× SSC for 15 min each and then exposed to
X-ray film (Kodak, Rochester, N.Y.) for 24 h.
Immunoblotting.
SDS-PAGE separation of recombinant protein
was performed by using 10% acrylamide gels under reducing conditions
(22). Two micrograms of GT-HGE-44 or GT (control) dissolved
in sample buffer (5% 2-mercaptoethanol, 10% glycerol, 2% SDS, and
0.8% bromophenol blue in 6.25 mM Tris buffer, pH 6.8) and heated for
10 min at 100°C was loaded onto each lane of the gel. Molecular mass
standards (Bio-Rad Laboratories, Hercules, Calif.) were used for each
panel. Protein was transferred to nitrocellulose, and the blocking
procedure was performed with PBS-5% nonfat dry milk. The antigen was
incubated with a 1:100 dilution of human or murine serum, washed three
times with PBS-0.2% Tween, and then incubated with the secondary
conjugated antibody and washed three times in PBS-0.2% Tween. The
second antibody, alkaline phosphatase-conjugated F(ab')2
anti-human or anti-mouse IgM or IgG (Sigma), was used as specified by
the manufacturer.
Human and murine sera.
Previously characterized sera from
persons with HGE were used (15). All of the patients lived
in areas where HGE was endemic and had clinical signs and symptoms
which were compatible with HGE, including fever, leukopenia, or
thrombocytopenia and myalgias. All patients had morulae in peripheral
neutrophils and/or had serum antibodies to aoHGE, as detected by IFA.
The IFA test was independently performed at the State of Connecticut
Agricultural Experiment Station Reference Laboratory (18).
Moreover, subjects had antibodies to aoHGE that were readily detected
in immunoblots with aoHGE lysates as the substrate (15).
In addition, sera from healthy individuals, patients with
Ehrlichia chaffeensis infection, and persons who had Lyme
borreliosis were kindly provided by J. G. Olson, Centers for
Disease Control and Prevention, Atlanta, Ga., by the Connecticut State
Health Department, and by the clinical diagnostic laboratory of the
Section of Rheumatology, Yale University School of Medicine. Sera were
also available from earlier studies on aoHGE-infected or naive
(control) mice (25).
Nucleotide sequence accession number.
The nucleotide
sequence has been submitted to GenBank (accession no. AF037599).
 |
RESULTS |
Cloning of the hge-44 gene.
aoHGE was subjected to
SDS-PAGE, and the 44-kDa antigen was identified on a Coomassie
blue-stained gel and excised. Amino-terminal peptide sequencing did not
yield any sequence; therefore, internal protein sequencing was
attempted. The 44-kDa antigen was digested with trypsin, and two
peptides were subjected to sequence analysis. The identified peptide
sequences were Val-Glu-Leu-Glu-Ile-Gly-Tyr-Glu-Arg and
Val-Val-Gly-Asp-Gly-Asp-Tyr-Asp-Asp-Leu-Pro, and both had similarity
with the protein sequences of the major surface protein encoded by
msp-2 of Anaplasma marginale (9), a
related organism that causes bovine anaplasmosis (20).
A lambda ZAP II aoHGE genomic DNA expression library was then
constructed to identify phage clones that expressed immunoreactive
antigens, specifically focusing on the 44-kDa protein. Primary
and
secondary screening of 5,000 colonies by using hyperimmune
murine sera
identified three phage plaques that expressed proteins
that bound aoHGE
antibodies. One clone, designated EM3, contained
a partial open reading
frame (ORF) with similarity to the
A. marginale msp-2 gene
family.
One of the two protein sequences obtained from the aoHGE 44-kDa protein
was contained in the predicted amino acid sequence
of the coding
sequence of EM3. The 5' sequence of the EM3 ORF
was not present in the
insert, and we postulated that the second
44-kDa peptide sequence was
contained within this region. The
library was then probed with a 217-bp
sequence generated by PCR
(from nucleotide 390 to 607) (Fig.
1), yielding 20 positive plaques
from
5,000 plaques. Eight clones were then randomly picked for
further
analysis. One clone, designated EM3C, contained potentially
a
full-length ORF and the predicted amino acid sequence containing
both
of the peptides that were identified from the 44-kDa aoHGE
protein
(Fig.
1). This aoHGE gene was designated
hge-44, and the
deduced amino acid sequence had substantial similarity (62% similarity
and 53% identity) with the
A. marginale msp-2 product,
especially
at the 3' half of the sequence (Fig.
2). A short stretch at the
amino terminus
has much lower similarity and is not shown in Fig.
2. Hydrophobicity
analysis suggests that there is at least one
possible membrane-spanning
domain between amino acids 335 and
358. The amino terminus contains a
putative start codon and a
hydrophobic core of 16 amino acids, as
predicted by the Kyte-Doolittle
plot obtained by using the Macvector
program (Oxford Molecular
Group Inc., Campbell, Calif.), followed by
the putative cleavage
site at six amino acids from the end of the
hydrophobic core.

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FIG. 1.
Nucleotide sequence of hge-44 (from clone
EM3C) and the deduced protein sequence. The putative cleavage site is
indicated by a triangle. Underlined are the two peptide sequences that
were obtained from the native aoHGE 44-kDa antigen and show a perfect
match with the predicted amino acid sequence. The stop codon is
indicated by an asterisk.
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FIG. 2.
Bestfit alignment of HGE-44 (top row) and MSP-2 (bottom
row) protein sequences. Identical amino acids are indicated by a
vertical line. Conservative substitutions are indicated by one dot
where the residue comparison values are 0.1 and by two dots where the
residue comparison values are 0.5. ... . . denotes a gap used
to better align the sequences.
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|
Some of the other clones contained only partial ORFs, which were found
to have substantial similarity with sequence at the
3' end of
hge-44 but differed significantly in other areas, as
shown
in Fig.
3. A Southern blot hybridization
was then performed,
by using the restriction enzymes
BamHI,
BglII,
KpnI, and
PstI,
which do not
have restriction sites within the full-length EM3C
ORF. An
hge-44 probe, generated by PCR with EM3C as a template,
would therefore be expected to reveal one hybridizing band if
hge-44 is a single-copy gene. However, Southern blot
hybridization
revealed multiple bands, suggesting that there are
several sequences
that hybridize with EM3C (not shown).

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FIG. 3.
Schematic map of clones that have similarity with
hge-44. The hge-44 DNA sequence is divided into
five areas represented by black, gray, white, hatched, and dark gray
boxes. Clones that share similar sequences within these regions are
shown by the presence of the same boxes. Lack of sequence similarity is
represented by a single line. The hatched sequence area of the
hge-44 gene is shared by all clones. Arrows indicate that
inserts extend beyond the hge-44 sequence.
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|
PCR and RNA-PCR.
To confirm that hge-44 was present
in the genome of aoHGE, the hge-44 gene was directly
amplified from purified aoHGE DNA (Fig.
4, lane 5). Furthermore, to verify that
hge-44 was expressed by aoHGE, total RNA from cultured aoHGE
and from spleens of aoHGE-infected mice was prepared for RNA-PCR. The
products of RNA-PCR were of the expected size of 1,279 nucleotides
(Fig. 4, lanes 1 and 2), and the sequencing of the PCR products
confirmed that hge-44 was transcribed both by aoHGE cultured
in HL-60 cells and in vivo in aoHGE-infected mice.

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FIG. 4.
RNA-PCR with total RNA from cultured aoHGE (lane 1) and
from spleens from aoHGE-infected mice (lane 2), showing a 1,279-bp
fragment. A product is not present in the controls (without reverse
transcriptase) of cultured aoHGE RNA and spleen RNA (lanes 3 and 4, respectively), demonstrating that there was no DNA contamination. Total
ehrlichial DNA was used as a template for the positive control (lane
5), and PCR buffer solution served as the negative control (lane 6).
The molecular size marker (lane M) is the 1-kb ladder.
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|
Expression of the hge-44 gene and immunoblotting.
PCR was used to amplify hge-44 and subclone the gene into
the pMX expression vector, such that it was in frame with the GT-coding sequence. Expression in E. coli produced a soluble
GT-HGE-44 fusion protein of the expected size of 70 kDa on a Coomassie
blue-stained gel (Fig. 5A, lane 4), while
GT (control) was also expressed and yielded a band at 26 kDa (Fig. 5A,
lane 3). E. coli lysates that expressed GT-HGE-44 or GT
were then probed with serum from a patient with HGE in an IgG
immunoblot (Fig. 5B). The patient serum reacted with GT-HGE-44 (Fig.
5B, lanes 2 and 4) but not with GT (Fig. 5B, lanes 1 and 3). The band
at 70 kDa in E. coli containing the GT-HGE-44 expression
plasmid demonstrates that low-level GT-HGE-44 synthesis occurs in the
absence of IPTG (Fig. 5B, lane 2). Sera from normal healthy individuals
did not recognize either protein (not shown). The GT-HGE-44 was then
purified by using a glutathione column and used as a substrate in
further immunoblotting studies.

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FIG. 5.
Expression of GT-HGE-44. (A) Coomassie blue staining of
E. coli lysates that expressed GT (lanes 1 and 3) and
GT-HGE-44 (lanes 2 and 4). Lanes 1 and 2, no IPTG induction; lanes 3 and 4, with IPTG induction. (B) The E. coli lysates in panel
A were probed with patient serum in an IgG immunoblot, showing
reactivity to GT-HGE-44 but not to GT. The numbers on the left of each
panel are molecular masses in kilodaltons.
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|
A total of 26 human sera were then tested for IgM and IgG by
immunoblotting with purified recombinant GT-HGE-44 as the substrate.
Representative immunoblots are shown in Fig.
6. The sera included
those from eight
patients with HGE (
15), five patients with
E. chaffeensis infection, six patients with Lyme borreliosis,
and
seven normal healthy individuals. Sera from patients with
E. chaffeensis or
Borrelia burgdorferi infection had
high-titer
antibodies in
E. chaffeensis IFA or
B. burgdorferi enzyme-linked
immunosorbent assay, respectively. All
sera from HGE patients
were obtained between 4 days and 6 weeks after
the onset of symptoms,
except for patient 2, whose serum was obtained
10 weeks after
diagnosis. Six of the eight sera from patients with HGE
had detectable
IgM to recombinant HGE-44, and sera from all eight
patients with
HGE had discernible IgG. Faint bands below 70 kDa
represent degradation
products of the recombinant GT-HGE-44. The two
HGE sera that had
only IgG were obtained at 3 and 10 weeks,
respectively. None of
the sera from patients with
E. chaffeensis or
B. burgdorferi infection
showed
reactivity to recombinant HGE-44. In addition, normal healthy
individuals did not have antibodies that bound GT-HGE-44. None
of the
sera that were tested bound recombinant GT (control) in
immunoblotting
(not shown).

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FIG. 6.
IgM and IgG immunoblots of purified GT-HGE-44 probed
with sera from patients with HGE (A), patients with E. chaffeensis infection (B), normal healthy volunteers (C), patients
with Lyme disease (D), and aoHGE-infected mice (E) (IgG only).
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Sera from two mice that were experimentally infected with aoHGE were
also examined for antibodies (Fig.
6). Mice were infected
by allowing
aoHGE-infected ticks to engorge to repletion (
25).
Infection
was documented by the identification of morulae in the
murine
neutrophils and cultivation of aoHGE in HL-60 cells from
murine blood
(
25). Sera were obtained from the mice after 1
month of
infection. Both animals had HGE-44 antibodies. As expected,
serum from
an uninfected mouse did not have antibodies that bound
to GT-HGE-44
(not shown).
 |
DISCUSSION |
In this study, we describe the cloning and characterization of
hge-44, which codes for the immunogenic 44-kDa protein of
aoHGE. hge-44 has similarity with the A. marginale
msp-2 gene family. All sera of patients with HGE that were tested
had antibodies recognizing the recombinant HGE-44 on immunoblots. This
suggests that a serologic assay with recombinant HGE-44 as a substrate may facilitate laboratory diagnosis of HGE.
A. marginale is an arthropod-borne hemoparasite that induces
severe anemia, abortion, and death in cattle (20). The close phylogenetic relationship between A. marginale and the
E. phagocytophila group, including aoHGE, has been
elucidated by using the 16S ribosomal DNA sequences (2, 6,
27). It is therefore not surprising that hge-44 has
some similarity with the msp-2 gene family and that
hge-44 may also be part of a group of closely related aoHGE genes. In A. marginale, the surface proteins encoded by the
msp-2 genes are antigenic variants and elicit protective
responses, suggesting a possible mechanism to evade the host immune
response (9). It is conceivable that different isolates of
aoHGE may express homologs of hge-44 and that aoHGE and
A. marginale could employ similar strategies for survival
within the host. Further studies need to investigate the role of HGE-44
with respect to potential protective immune responses. Already it has
been demonstrated that sera from mice immunized with aoHGE-lysates
(which contain high concentrations of antibodies that readily recognize
HGE-44) afford protection against tick-borne aoHGE infection
(25).
We have shown that a recombinant HGE-44 immunoblot can be used for the
laboratory diagnosis of HGE. Eight HGE patient sera had either IgM or
IgG antibodies that bound recombinant HGE-44, suggesting that an
HGE-44-based assay is possible. However, larger numbers of HGE patients
need to be tested in order to estimate the sensitivity of this assay.
As expected, sera from healthy volunteers did not bind HGE-44.
Moreover, none of the sera from patients with Lyme disease or E. chaffeensis infection showed reactivity to recombinant HGE-44,
suggesting that HGE-44 antibodies are specific for HGE. Serologic IFA
assays currently being used in the diagnosis of HGE contain E. equi- or aoHGE-infected cells as the substrate and consequently
may occasionally yield false-positive results. The false-positive
results in assays for aoHGE, E. chaffeensis, or B. burgdorferi infection are presumably due to cross-reactive antibodies that bind heat shock proteins and other antigens that are
present in many bacteria (14, 16, 28, 29). An HGE-44-based assay could help to reduce these difficulties. Furthermore, the use of
a recombinant HGE-44 as the substrate, rather than whole aoHGE
organisms, eliminates the need to cultivate aoHGE and the possible
effects that in vitro culture can cause with respect to pathogen
stability, infectivity, and antigenic expression. Finally, recombinant
HGE-44 can now be tested as a substrate for an automated enzyme-linked
immunosorbent assay, which should reduce the cost and improve the
interlaboratory and intralaboratory reliabilities of serodiagnostic
assays for HGE.
HGE is a newly recognized tick-borne infection, and the role of the
host immune response to this pathogen in disease remains to be
elucidated. The gene, hge-44, encoding the major antigen of
aoHGE is part of a gene family with similarity to A. marginale msp-2. The cloning of this gene represents a first step towards understanding the genetic structure of this pathogen.
 |
ACKNOWLEDGMENTS |
This work was supported in part by the CDC (HR8/CCH113382-01) and
NIH (AI-41440). J.W.I. is a Daland Fellow of the American Philosophical
Society and is supported by a fellowship from the L.P. Markey
Charitable Trust. E.F. is the recipient of a Burroughs Wellcome
Clinical Scientist Award in Translational Research.
 |
FOOTNOTES |
*
Corresponding author. Mailing address: Section of
Rheumatology, Department of Internal Medicine, Yale University School
of Medicine, 604 Laboratory of Clinical Investigation, 333 Cedar St.,
New Haven, CT 06520-4080. Phone: (203) 785-4080. Fax: (203) 785-7053. E-mail: erol.fikrig{at}yale.edu.
Editor: J. R. McGhee
 |
REFERENCES |
| 1.
|
Aguero-Rosenfeld, M. E.,
H. W. Horowitz,
G. P. Wormser,
D. F. McKenna,
J. Nowakowski,
J. Munoz, and J. S. Dumler.
1996.
Human granulocytic ehrlichiosis: a case series from a medical center in New York State.
Ann. Intern. Med.
125:905-908.
|
| 2.
|
Anderson, B. E.,
J. E. Dawson,
D. C. Jones, and K. H. Wilson.
1991.
Ehrlichia chaffeensis, a new species associated with human ehrlichiosis.
J. Clin. Microbiol.
29:2838-2842[Abstract/Free Full Text].
|
| 3.
|
Asanovich, K. M.,
J. S. Bakken,
J. E. Madigan,
M. Aguero-Rosenfeld,
G. P. Wormser, and J. S. Dumler.
1997.
Antigenic diversity of granulocytic ehrlichia isolates from humans in Wisconsin and New York and a horse in California.
J. Infect. Dis.
176:1029-1034[Medline].
|
| 4.
|
Bakken, J. S.,
J. S. Dumler,
S. M. Chen,
M. R. Eckman,
L. L. Van Etta, and D. H. Walker.
1994.
Human granulocytic ehrlichiosis in the upper midwest United States. A new species emerging?
JAMA
272:212-218[Abstract/Free Full Text].
|
| 5.
|
Brouqui, P.,
J. S. Dumler,
R. Lienhard,
M. Brossard, and D. Raoult.
1995.
Human granulocytic ehrlichiosis in Europe.
Lancet
346:782-783[Medline].
|
| 6.
|
Chen, S. M.,
J. S. Dumler,
J. S. Bakken, and D. H. Walker.
1994.
Identification of a granulocytotropic ehrlichia species as the etiologic agent of human disease.
J. Clin. Microbiol.
32:589-595[Abstract/Free Full Text].
|
| 7.
|
Chen, S. M.,
J. S. Dumler,
H. M. Feng, and D. H. Walker.
1994.
Identification of the antigenic constituents of Ehrlichia chaffeensis.
Am. J. Trop. Med. Hyg.
50:52-58.
|
| 8.
|
Dumler, J. S.,
K. M. Asanovich,
J. S. Bakken,
P. Richter,
R. Kimsey, and J. E. Madigan.
1995.
Serologic cross-reactions among Ehrlichia equi, Ehrlichia phagocytophila, and human granulocytic ehrlichia.
J. Clin. Microbiol.
33:1098-1103[Abstract].
|
| 9.
|
Eid, G.,
D. M. French,
A. M. Lundgren,
A. F. Barbet,
T. F. McElwain, and G. H. Palmer.
1996.
Expression of major surface protein 2 antigenic variants during acute Anaplasma marginale rickettsemia.
Infect. Immun.
64:836-841[Abstract].
|
| 10.
|
Fingerle, V.,
G. L. Goodman,
R. C. Johnson,
T. J. Kurtti,
U. G. Munderloh, and B. Wilske.
1997.
Human granulocytic ehrlichiosis in southern Germany: increased seroprevalence in high-risk groups.
J. Clin. Microbiol.
35:3244-3247[Abstract].
|
| 11.
|
Goodman, J. L.,
C. Nelson,
B. Vitale,
J. E. Madigan,
J. S. Dumler,
T. J. Kurtti, and U. G. Munderloh.
1996.
Direct cultivation of the causative agent of human granulocytic ehrlichiosis.
N. Engl. J. Med.
334:209-215[Abstract/Free Full Text].
|
| 12.
|
Hanson, B. A.,
C. L. Wisseman,
A. Waddell, and D. J. Silverman.
1981.
Some characteristics of heavy and light bands of Rickettsia prowazekii on Renografin gradients.
Infect. Immun.
34:596-604[Abstract/Free Full Text].
|
| 13.
|
Hardalo, C. J.,
V. Quagliarello, and J. S. Dumler.
1995.
Human granulocytic ehrlichiosis in Connecticut: report of a fatal case.
Clin. Infect. Dis.
21:910-914[Medline].
|
| 14.
|
IJdo, J. W.,
Y. Zhang,
M. L. Anderson,
D. Goldberg, and E. Fikrig.
1998.
Heat shock protein 70 of the agent of human granulocytic ehrlichiosis binds to Borrelia burgdorferi antibodies.
Clin. Diagn. Lab. Med.
5:118-129.
|
| 15.
|
IJdo, J. W.,
Y. Zhang,
E. Hodzic,
L. A. Magnarelli,
M. L. Wilson,
S. R. Telford,
S. W. Barthold, and E. Fikrig.
1997.
The early humoral response in human granulocytic ehrlichiosis.
J. Infect. Dis.
176:687-692[Medline].
|
| 16.
|
Kolbert, C. P.,
E. S. Bruinsma,
A. S. Abdulkarim,
E. K. Hofmeister,
R. B. Tompkins,
S. R. Telford,
P. D. Mitchell,
J. Adams-Stich, and D. H. Persing.
1997.
Characterization of an immunoreactive protein from the agent of human granulocytic ehrlichiosis.
J. Clin. Microbiol.
35:1172-1178[Abstract].
|
| 17.
|
Magnarelli, L. A.,
J. S. Dumler,
J. F. Anderson,
R. C. Johnson, and E. Fikrig.
1995.
Coexistence of antibodies to tick-borne pathogens of babesiosis, ehrlichiosis, and Lyme borreliosis in human sera.
J. Clin. Microbiol.
33:3054-3057[Abstract].
|
| 18.
|
Nicholson, W. L.,
J. A. Comer,
J. W. Sumner,
C. Gingrichbaker,
R. T. Coughlin,
L. A. Magnarelli,
J. G. Olson, and J. E. Childs.
1997.
An indirect immunofluorescence assay using a cell culture-derived antigen for detection of antibodies to the agent of human granulocytic ehrlichiosis.
J. Clin. Microbiol.
35:1510-1516[Abstract].
|
| 19.
|
Nyindo, M.,
I. Kakoma, and R. Hansen.
1991.
Antigenic analysis of four species of the genus Ehrlichia by use of protein immunoblot.
Am. J. Vet. Res.
52:1225-1230[Medline].
|
| 20.
|
Palmer, G. H.,
G. Eid,
A. F. Barbet,
T. C. McGuire, and T. F. McElwain.
1994.
The immunoprotective Anaplasma marginale major surface protein 2 is encoded by a polymorphic multigene family.
Infect. Immun.
62:3808-3816[Abstract/Free Full Text].
|
| 21.
|
Pancholi, P.,
C. P. Kolbert,
P. D. Mitchell,
K. D. Reed, Jr.,
J. S. Dumler,
J. S. Bakken,
S. R. Telford III, and D. H. Persing.
1995.
Ixodes dammini as a potential vector of human granulocytic ehrlichiosis.
J. Infect. Dis.
172:1007-1012[Medline].
|
| 22.
|
Sambrook, J.,
E. F. Fritsch, and T. Maniatis.
1989.
Molecular cloning: a laboratory manual, 2nd ed., p. 9.19.
Cold Spring Harbor Laboratory, Cold Spring Harbor, N.Y.
|
| 23.
|
Sears, J. E.,
E. Fikrig,
T. Y. Nakagawa,
K. Deponte,
N. Marcantonio,
F. S. Kantor, and R. A. Flavell.
1991.
Molecular mapping of Osp-A mediated immunity against Borrelia burgdorferi, the agent of Lyme disease.
J. Immunol.
147:1995-2000[Abstract].
|
| 24.
|
Sumpton, K. J.,
D. J. M. Wright,
S. J. Cutler, and B. A. S. Dale.
1995.
Human granulocytic ehrlichiosis in the UK.
Lancet
346:1487-1488[Medline].
|
| 25.
|
Sun, W.,
J. W. IJdo,
S. R. Telford,
E. Hodzic,
Y. Zhang,
S. W. Barthold, and E. Fikrig.
1997.
Immunization against the agent of human granulocytic ehrlichiosis in a murine model.
J. Clin. Invest.
100:3014-3018[Medline].
|
| 26.
|
Walker, D. H., and J. S. Dumler.
1996.
Emergence of the ehrlichiosis as human health problems.
J. Emerg. Infect. Dis.
2:18-29.
[Medline] |
| 27.
|
Weisburg, W. G.,
M. E. Dobson,
J. E. Samuel,
G. A. Dasch,
L. P. Mallavia,
O. Baca,
L. Mandelco,
J. E. Sechrest,
E. Weiss, and C. R. Woese.
1989.
Phylogenetic diversity of the rickettsiae.
J. Bacteriol.
171:4202-4206[Abstract/Free Full Text].
|
| 28.
|
Wong, S. J.,
G. S. Brady, and J. S. Dumler.
1997.
Serological responses to Ehrlichia equi, Ehrlichia chaffeensis, and Borrelia burgdorferi in patients from New York State.
J. Clin. Microbiol.
35:2198-2205[Abstract].
|
| 29.
|
Wormser, G. P.,
H. W. Horowitz,
J. Nowakowski,
D. Mckenna,
J. S. Dumler,
S. Varde,
I. Schwartz,
C. Carbonaro, and M. Aguero-Rosenfeld.
1997.
Positive Lyme disease serology in patients with clinical and laboratory evidence of human granulocytic ehrlichiosis.
Am. J. Clin. Pathol.
107:142-147[Medline].
|
| 30.
|
Zhi, N.,
Y. Rikihisa,
H. Y. Kim,
G. P. Wormser, and H. W. Horowitz.
1997.
Comparison of major antigenic proteins of six strains of the human granulocytic ehrlichiosis agent by Western immunoblot analysis.
J. Clin. Microbiol.
35:2606-2611[Abstract].
|
Infect Immun, July 1998, p. 3264-3269, Vol. 66, No. 7
0019-9567/98/$04.00+0
Copyright © 1998, American Society for Microbiology. All rights reserved.
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-
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-
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-
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-
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-
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[Full Text]
-
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[Full Text]
-
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[Abstract]
[Full Text]
-
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[Abstract]
[Full Text]
-
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37: 3540-3544
[Abstract]
[Full Text]
-
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37: 2887-2892
[Abstract]
[Full Text]
-
Walls, J. J., Aguero-Rosenfeld, M., Bakken, J. S., Goodman, J. L., Hossain, D., Johnson, R. C., Dumler, J. S.
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37: 2968-2973
[Abstract]
[Full Text]
-
Zhi, N., Ohashi, N., Rikihisa, Y.
(1999). Multiple p44 Genes Encoding Major Outer Membrane Proteins Are Expressed in the Human Granulocytic Ehrlichiosis Agent. J. Biol. Chem.
274: 17828-17836
[Abstract]
[Full Text]
-
van Dobbenburgh, A., van Dam, A. P., Fikrig, E.
(1999). Human Granulocytic Ehrlichiosis in Western Europe. NEJM
340: 1214-1216
[Full Text]