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Biomedical subjects

C Cunningham-Rundles

Publications and source records attributed to C Cunningham-Rundles.

At least 91 records · Page 5Linked to original sources
PubMed1985

Rescue of IgM, IgG, and IgA production in common varied immunodeficiency by T cell-independent stimulation with Epstein-Barr virus.

We previously defined three categories of B-cell defects in common varied immunodeficiency (CVI): failure to produce IgG and IgA in response to T cell-dependent (TD) stimulation by Staphylococcus bacteria (Sac) plus pokeweed mitogen or B-cell inducing factor (BIF), failure to produce any immunoglobulin, and failure of Sac-induced proliferation and differentiation. The present study includes the responses of 22 CVI patients to T cell-independent (TI) stimulation by Epstein-Barr virus (EBV). In the majority of patients, EBV-stimulated B cells showed normal proliferation and IgM production. In addition, IgG and IgA production was in the range of that for EBV-stimulated normal cells in many patients. Among 11 patients with no TD production of immunoglobulin of any isotype, two showed normal IgM secretion in response to EBV and five others had significant but subnormal responses. Four patients never had humoral responses despite repeated testing and removal of potentially suppressing T cells and monocytes. Concanavalin A stimulation of the T cells from all the patients tested resulted in the production of B-cell inducing factor at higher levels than for normal donor T cells, as assayed on normal Sac-stimulated B cells. These results show that many cases of B-cell defects in CVI patients involving TD production of IgM, switching to TD production of IgG and IgA, and mitogen responses to Sac are not absolute defects. The B cells will respond normally to some stimuli.

Adolescent↗
PubMed1985

Intravenous immune serum globulin in immunodeficiency.

This study was undertaken to compare intravenous gamma-globulin (IVGG) for 1 year in patients with primary immune defects who had previously been treated with intramuscular gamma-globulin (IMGG). Forty-three patients were available for analysis. After administration of 300 mg/kg of IVGG every 3 weeks, blood immunoglobulin levels increased to within 1 SD of normal for the patient's ages. In 5 patients, this dosage regimen did not raise the immunoglobulin levels satisfactorily, although they were still better than those achieved with IMGG. In 18 patients, treatment benefits became apparent after 5 - 6 months of treatment. Substantial improvement was observed in 70% of these patients. Sixteen reactions occurred with 638 infusions, an incidence rate of 2.5%. If 2 patients with an IgM macroglobulin and 1 patient with an anti-IgA antibody were excluded, the reaction incidence would probably have been 1%.

Follow-Up Studies↗
PubMed1985

Cross-reactive idiotypes in immunoglobulin A-deficient sera.

Mice of inbred strains immunized with simple antigens can produce antibodies that share similar V regions, which result in serologic similarities called cross-reactive idiotypes (CRI). In this study, we considered the possibility that IgA-deficient humans, who are continuously immunized via the intestinal tract by dietary protein, might also produce antibodies sharing CRI. For this, anti-casein antibodies were isolated from the blood of 16 adult IgA-deficient donors (4 Finns and 12 North Americans) and an autologous anti-anti-casein from the blood of one of the Finnish donors. In addition, a heterologous anti-anti-casein was raised to the casein-anti-casein immune complexes of this donor. Comparing the activities of the two anti-idiotypes, it was found that both bind anti-casein in the region of the antigen binding site, but that each binds additional determinants not located within this region, with the heterologous reagent having more affinity for these latter determinants than the autologous anti-idiotype. Using both reagents in enzyme-linked immunosorbent assay inhibition assays, extensive cross-reactivities between anti-caseins were demonstrated. Using the autologous anti-idiotype, 5 of 16 anti-caseins were found to share CRI, and with the heterologous reagent 12 of 16 shared CRI. In both assays, the anti-caseins of Finnish donors displayed more cross-reactivity than those derived from Northern American donors. These studies show that specific, commonly shared CRI can be identified in this human system in which antibodies are raised as a result of natural immunization across the gastrointestinal mucosa.

Adult↗
PubMed1985

Pulmonary cell populations in the immunosuppressed patient. Bronchoalveolar lavage findings during episodes of pneumonitis.

Bronchoalveolar lavage (BAL) cell populations were determined in 47 immunosuppressed patients during episodes of pulmonary disease. Thirty six patients had AIDS and 11 had conventional causes of immunosuppression. Pulmonary disease was due to a variety of infectious and noninfectious causes and was similar in both groups. In the AIDS patients, the mean BAL cell proportions were 64.2 +/- 3.7 percent alveolar macrophages (MACS), 28.7 +/- 3.4 percent lymphocytes, 3.5 +/- 1.8 percent polymorphonuclear cells (PMN) and 1.6 +/- 0.6 percent eosinophils (EOS). The non-AIDS group had similar findings in the BAL, with 59.3 +/- 8.3 percent MACS, 34.8 +/- 7.2 percent lymphocytes, 5.5 +/- 1.7 percent PMN and 0.4 +/- 0.2 percent EOS. The most striking finding in each group was a significant increase in both the proportion and absolute number of lymphocytes compared to controls. This was in marked contrast to the peripheral blood findings of lymphopenia. There was no characteristic cell profile diagnostic of any specific pulmonary disease. There was also no direct relationship of the cells present to respiratory symptoms, roentgenographic abnormalities or survival from pulmonary disease. This study demonstrates that although there was wide individual variation in lavage findings, a local pulmonary inflammatory reaction consisting predominantly of lymphocytes occurs in the immunosuppressed host during episodes of lung disease. The significance of this lymphocyte alveolitis and the complex host pathogen interaction responsible for determining the cell populations present in the lungs of these patients requires further study.

Acquired Immunodeficiency Syndrome↗
PubMed1985

Intravenous usage of gammaglobulin: humoral immunodeficiency, immune thrombocytopenic purpura, and newer indications.

Intravenous gammaglobulin is effective therapy of ITP and other autoantibody-mediated immune cytopenias. All children as well as adults unresponsive to splenectomy or with known immune deficiency are probably the best candidates for treatment with IVGG. Its major advantage, in addition to its efficacy of treatment and possible remission-inducing effect, is that it has the fewest side effects of any treatment of ITP so that it is the best maintenance therapy of patients when effective. Future uses of IVGG remain to be determined. Premature infants with a high mortality from sepsis and with hypogammaglobulinemia due to termination of pregnancy prior to transplacental antibody transfer may benefit from IVGG. A preliminary study suggested such benefit and also showed safety of IVGG treatment in that there was no impaired immune responsiveness of these prematures at 2 years of age (28). Another potential usage of IVGG involves the treatment of the hypogammaglobulinemia associated with certain types of malignancy. Patients with CLL, especially in the advanced stages, are often hypogammaglobulinemic. Multiple myeloma and Waldenstrom's macroglobulinemia are two other B-cell malignancies associated with antibody production defects which might benefit from antibody replacement therapy. Therapeutic IgG levels may be harder to obtain due to hypercatabolism of immunoglobulin. The issue of immune hyporesponsiveness during intensive chemotherapy is also unexplored. Secondary antibody responses do not seem to be impaired, but primary responses, as tested in numerous immunization studies, are decidedly impaired. Certain protocols, especially those treating high-risk acute leukemias and neuroblastoma during induction therapy are intensive with high rates of sepsis, and may warrant trials of prophylactic IVGG. Similarly, some form of humoral prophylaxis is becoming an important part of the handling of the patient undergoing bone marrow transplantation not only to prevent bacterial sepsis but also to prevent cytomegalovirus (CMV) interstitial pneumonitis. A likely additional usage is gammaglobulin replacement for patients undergoing plasmapheresis, especially if performed multiple times. Finally, the broad spectrum of antibacterial and antiviral antibodies present in the preparations (such as anti-CMV, anti-Group B strep, and antiendotoxin) and the ease and safety of delivery allow the preparations to be used in situations where a hyperimmune preparation might be desired and/or where more than one pathogen is possible. In summary, IVGG is a treatment capable of safely conferring significant benefits to selected patients.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1984

Detection of H-Y in the enzyme-linked immunosorbent assay.

We have developed a new enzyme-linked immunosorbent assay for determination of H-Y phenotype in the human. This assay, which measures the inhibition of the reaction of a monoclonal anti-H-Y antibody and a mouse testis extract as a source of H-Y antigen, was applied to the supernatant of lymphocytes from ten normal male and ten normal female subjects. Introduction of supernatant from male cells gave readings of 69%-78% of those obtained with testis supernatant alone; female-cell supernatant did not inhibit the reaction (89%-102%).

Adult↗
PubMed1984

Interleukin-2 correction of defective in vitro T-cell mitogenesis in patients with common varied immunodeficiency.

We studied the ability of phytohemagglutinin (PHA) and two anti-T-cell monoclonal antibodies, OKT3 and Pan T2, to induce interleukin-2 (IL2) production and proliferation in peripheral blood lymphocytes (PBL) from 14 patients with combined varied immunodeficiency (CVI). The median values of endogenous IL2 produced by mitogen-stimulated PBL was significantly lower in patients than controls irrespective of the mitogen used. The patients, taken as a group, had a significantly decreased in vitro PBL response to mitogen stimulation when compared to controls. With the addition of a highly purified human IL2 preparation, the proliferative response in the majority of patients was significantly improved with all mitogens. Three patient groups could be distinguished: Group A (3/14) had full restoration of proliferative response with the addition of IL2, Group B (5/14) had partial restoration, and Group C (6/14) had no significant response. The monoclonal antibody, Pan T2, recognized a T-cell proliferative defect in 5 of 14 patients which neither PHA nor OKT3 recognized. This was not significantly corrected by the addition of IL2. This T-cell proliferative defect correlated with the lack of B-cell proliferation and immunoglobulin production in response to B-cell mitogens in three-fourths of the patients assayed. These data show that CVI patients are a heterogeneous group but have in common a decreased in vitro production of IL2 resulting in a proliferative defect which is correctable at least in part, in vitro, in the majority by the addition of purified IL2.

Adolescent↗
PubMed1984

Dietary protein antigenemia in humoral immunodeficiency. Correlation with splenomegaly.

Enhanced gastrointestinal absorption of dietary substances is an important feature of normal neonatal life that also exists in particular disease states such as selective IgA deficiency and atopic allergy. In these studies, it is shown that patients with hypogammaglobulinemia have increased absorption of dietary bovine antigens and that most patients have large amounts of these proteins present in the serum even after an overnight fast. The amounts of such proteins were found to be correlated with spleen size and/or peripheral lymphoid hypertrophy. Interestingly, three patients with X-linked agammaglobulinemia did not have detectable amounts of these proteins in the serum nor did they have splenomegaly or lymphadenopathy. It is speculated that hypogammaglobulinemic patients have a specific gastrointestinal mucosal lesion that permits the chronic excessive absorption of dietary antigens and may result in lymphoid hypertrophy.

Adult↗
PubMed1984

Normalization of serum C1q after intravenous immunoglobulin infusions in hypogammaglobulinemia: dependence upon methods of immunoglobulin preparation.

Low levels of serum complement subcomponent C1q may accompany primary humoral immunodeficiency diseases such as sex-linked agammaglobulinemia, severe combined immunodeficiency, and common varied immunodeficiency. This selective depression of C1q is proportional to the degree of hypogammaglobulinemia, and is corrected in severe combined immunodeficiency by bone marrow transplantation or in hypogammaglobulinemia by immunoglobulin infusions, possibly because C1q is stabilized by IgG by reversible interactions which reduce extravascular degradation. In this study it is shown that a pH 4.0 treated intravenous gamma-globulin (ivGG) and a reduced and alkylated ivGG can equally increase levels of serum IgG, but that only the pH 4.0 preparation can raise C1q levels into the normal range. These findings show that some of the methods used to produce immunoglobulins suitable for intravenous use may hinder the ability of these molecules to stabilize Clq. The clinical implications of this observation remain unclear.

Acquired Immunodeficiency Syndrome↗
PubMed1984

Polyclonal immunoglobulin secretion in patients with common variable immunodeficiency using monoclonal B cell differentiation factors.

B cells from 25 patients with common variable immunodeficiency (CVI) were tested for their ability to differentiate under the influence of B cell differentiation factors (BCDF), derived from T cell hybridomas or T cell clones. 11 patients generated Ig plaque-forming cells in the range comparable to that of normal controls with supernatant from the T cell hybrid MOP 1L. With various hybrid or clone supernatants, differing response patterns emerged. Four patients who failed to respond to MOP 1L responded to T cell clone supernatant RAC. Another who failed to respond to both MOP 1L and RAC responded to T cell hybrid supernatant MTP 7. These results indicate that these supernatants contain different BCDFs and suggest heterogeneity in the differentiation states of B cells in CVI. In addition, three patients demonstrated exaggerated responses to BCDF, and evidence was obtained from B cells of these patients for increased BCDF receptor density. Thus, the accumulated evidence indicates that T cell defects may be a primary pathogenetic mechanism in common variable immunodeficiency, and purified BCDF may be of therapeutic value.

Antigens, Differentiation, B-Lymphocyte↗
PubMed1984

Efficacy of intravenous immunoglobulin in primary humoral immunodeficiency disease.

Twenty-one patients with primary humoral immunodeficiency were treated for 1 year with a chemically intact immunoglobulin, 300 mg/kg body weight given intravenously every 3 weeks, to compare immunoglobulin levels and clinical status with results achieved after standard treatment with intramuscular immunoglobulin given previously for 1 year. A substantial reduction of specific acute illnesses and antibiotic use was found for 18 of the 21 patients, particularly during the second 6 months of treatment. Average IgG levels before intravenous infusion were increased 243 mg/dL over previous intramuscular pre-injection levels. Adverse effects were recorded for 2.5% of infusions.

Absenteeism↗
PubMed1983

Intravenous gammaglobulin treatment of chronic idiopathic thrombocytopenic purpura.

High-dose intravenous gammaglobulin (IVIgG) was given to 12 children and adults with chronic idiopathic thrombocytopenic purpura (ITP) to avoid splenectomy or because they either failed to respond to or required maintenance with high doses of steroids and/or immunosuppressives. The average platelet count increase to initial therapy was 239,500/microliters (range 23,000-790,000). A concomitant IgG Fc receptor blockade, measured by IgG-sensitized 51Cr-labeled autologous erythrocytes, was seen in 11 of 11 patients tested, both splenectomized and not splenectomized, lasting 3-4 wk. Six or more months after treatment, 2 children are in remission, 2 children and 2 adults are stable requiring no therapy with platelet counts of approximately 50,000 and 30,000, respectively, 3 children require maintenance IVIgG therapy at 2-10-wk intervals, and 1 child and 2 adults have become refractory to further IVIgG. Splenectomy was not performed in 4 children. Two adults were able to discontinue daily prednisone. The 3 patients who became unresponsive to Swiss Red Cross gamma-globulin (IgSRK) therapy did so in conjunction with a markedly elevated platelet-associated IgG and IgM. Serum IgM increased an average of 103 mg/dl after the IVIgG infusions. No significant side effects were seen.

Adolescent↗