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Biomedical subjects

C M Black

Publications and source records attributed to C M Black.

At least 19 recordsLinked to original sources
PubMed1992

Distinguishing Chlamydia species by restriction analysis of the major outer membrane protein gene.

Clinical isolates of Chlamydia pneumoniae from diverse geographic locations and strains of other Chlamydia species were typed by polymerase chain reaction (PCR) amplification of the major outer membrane protein (MOMP) gene followed by restriction fragment length polymorphism analysis of the product. Use of synthetic primers corresponding to highly conserved regions of the MOMP gene resulted in amplification of a 1070 bp product in laboratory strains and clinical isolates of C. pneumoniae, C. trachomatis and C. psittaci. PCR products were digested with restriction enzymes Alu I and Mbo I and separated by polyacrylamide gel electrophoresis. Restriction fragment patterns varied in length from 8-12 bands of 30-400 bp in size in Alu I digests, and 6-7 bands of 50-400 bp in size in Mbo I digests. Strains representing different chlamydia species were easily distinguishable by this method, as were different serovars of C. trachomatis. Strains of C. pneumoniae tested include laboratory strain TW-183 and recent clinical isolates from Atlanta, Brooklyn, Wisconsin and Norway. One combination of primers reacted with C. psittaci strains and C. pneumoniae strain TW-183, but not with other strains of C. pneumoniae tested regardless of the concentration of DNA in the sample. With use of a pan-reactive primer combination, however, restriction patterns were similar in all strains of C. pneumoniae tested. This gene typing technique can be valuable for distinguishing the three chlamydial species and potentially strains of C. pneumoniae in clinical and epidemiologic studies.

Bacterial Outer Membrane Proteins↗
PubMed1992

Alpha interferon-2a (Roferon-A) in the treatment of diffuse cutaneous systemic sclerosis: a pilot study. UK Systemic Sclerosis Study Group.

Intramuscular alpha-interferon improved or stabilized skin score in 10/14 (71%) patients with diffuse cutaneous systemic sclerosis. In 64% of patients, their treating physicians rated it as having stabilized or improved the disease. However, it had no significant effect on grip strength, digital contractures, respiratory function or visceral involvement. Type I collagen synthesis was significantly reduced in fibroblasts cultured from clinically 'uninvolved' skin but not in those from lesional skin. Amino-terminal procollagen III peptides in the interferon treated group were not significantly reduced after 6 months of therapy but showed a trend towards stabilization and reduction compared to disease matched controls on no therapy.

Adult↗
PubMed1992

The evolution of a case of overlap syndrome with systemic sclerosis, rheumatoid arthritis and systemic lupus erythematosus.

An unusual case of overlap syndrome which evolved over a 12-year period is described. The patient initially presented with limited cutaneous systemic sclerosis. She then developed seropositive erosive rheumatoid arthritis and subsequently vasculitis with positive lupus serology. There was no evidence that she had mixed or undifferentiated connective tissue disease, and antibody to ribonuclearprotein was negative. This unusual combination of connective tissue disorders in one patient is reported and the literature is reviewed.

Arthritis, Rheumatoid↗
PubMed1992

The clinical and immunogenetic features of patients with autoantibodies to the nucleolar antigen PM-Scl.

The clinical and laboratory features of 32 patients with anti-PM-Scl were studied. Patients with this rare autoantibody suffered from a homogenous overlap connective tissue disease defined by Raynaud phenomenon (32/32), features of scleroderma (31/32), arthritis (31/32, erosive in 9/32), myositis (28/32), lung restriction (25/32), calcinosis (15/32), and sicca (11/32). Significant renal and neurologic involvement was uncommon. All patients examined (22/22) had HLA-DR3, and 50% of these patients were homozygous. Our patients responded favorably to moderate immunosuppression and, with therapy, the disease generally has a good prognosis; over 50% of our series (17/32) remained well on minimal or no immunosuppression after a median follow-up of 8 years.

Adolescent↗
PubMed1992

High resolution computed tomography as a predictor of lung histology in systemic sclerosis.

BACKGROUND: The relative proportions of fibrosis and inflammation seen by open lung biopsy examination is a predictor of disease outcome in fibrosing alveolitis. This study was designed to assess the ability of high resolution computed tomography to predict the histological appearance of open lung biopsy specimens from patients with systemic sclerosis. METHODS: Twenty abnormal biopsy specimens from 12 patients were assessed; abnormalities were categorised as fibrotic (fibrosis exceeding inflammation) or inflammatory (inflammation equal to or exceeding fibrosis). Computed tomography appearances were scored for the lobe from which the biopsy specimen was taken; scans were graded from parenchymal opacification alone through to a reticular pattern alone. RESULTS: Two lobar appearances were identified on computed tomograms: amorphous parenchymal opacification equal in extent to reticulation (grade 3) and a predominantly reticular pattern (grade 4). There was a significant association between a fibrotic histological appearance and a grade 4 computed tomogram, and between an inflammatory histological appearance and a grade 3 computed tomogram. Computed tomography grade 4 was associated with a fibrotic histological appearance in 12 out of 13 lobes, and grade 3 with an inflammatory histological appearance in four out of seven lobes. CONCLUSION: Computed tomography discriminated between biopsy specimens that were predominantly fibrotic and a smaller group with a larger amount of inflammation.

Adult↗
PubMed1992

Sterile mediastinal gas mimicking abscess in aortic aneurysm repair.

Six weeks after aortic aneurysm repair, computed tomography (CT) showed mediastinal gas where absorbable gelatin sponge (Gelfoam) was used. A leukocyte scan labeled with indium 111, however, was normal and surgical exploration showed no infection. Sterile gas collections may be seen following absorbable gelatin sponge use many weeks after surgery and 111In-labeled leukocyte scanning may be a useful differential test.

Abscess↗
PubMed1991

Immunogenetic prediction of pulmonary fibrosis in systemic sclerosis.

75 systemic sclerosis patients were independently tested for pulmonary fibrosis, autoantibodies, and MHC class II genes. 24 of 42 (57%) patients with pulmonary fibrosis had either HLA DR3/DRw52a or anti-Scl-70 vs 2 of 33 (6%) patients without pulmonary fibrosis. The presence of DR3/DRw52a or anti-Scl-70 gives a relative risk of 16.7 for the development of pulmonary fibrosis in a patient with scleroderma--a risk substantial enough to require careful monitoring of these patients and treatment at an early stage of disease.

Autoantibodies↗
PubMed1991

Treatment of systemic vasculitis with pooled intravenous immunoglobulin.

The therapeutic effect of a course of high-dose, pooled, intravenous immunoglobulin (IVIg) on disease activity and circulating antineutrophil cytoplasm antibodies (ANCA) was investigated in 7 patients with systemic vasculitis. 5 had active disease despite conventional immunosuppression, and 2 had not received any treatment. All 7 had clinical improvement, which was sustained in 6 and transient in 1. The fall in ANCA concentrations to a mean of 51% of the pre-treatment values was maintained during follow-up. C-reactive protein concentration also dropped considerably. IVIg seemed to confer a useful therapeutic effect without adverse reaction.

Adult↗
PubMed1991

Optimization of binding capacity and specificity of protein G on various solid matrices for immunoglobulins.

Streptococcal protein G is a more versatile and efficient alternative to staphylococcal protein A in purifying immunoglobin G (IgG) isotypes from various animal species. Optimizations are most dramatic with goat IgG, which binds protein G 55 times better than protein A. Using GammaBind G (a recombinant form of protein G (Genex Corp.)), we optimized binding capacity and specificity for IgG. Protein G was covalently coupled to three different matrices (CNBr-Sepharose, Tresyl-Sepharose, and Affigel-10) and compared with protein A-CNBr-Sepharose. Equal volumes of human, mouse, and goat serum samples were equilibrated into Hepes/NaOH buffers with various ionic strengths (i.e., concentrations of NaCl) and pH values and allowed to bind to affinity columns of proteins G and A. Bound ligands were eluted with 8.0 M urea, 0.05-M Tris/HCl, pH 8.00. Bound fractions were assayed for protein concentration and analyzed by sodium dodecyl sulfate polyacrylamide electrophoresis. The optimal conditions for binding IgG to protein G are 1.0 M NaCl and pH 8.0 for human, mouse, and goat.

Animals↗
PubMed1991

Immunoglobulin G subclass values in healthy black and white children.

To determine whether IgG subclass concentrations differed between healthy black and white children, we measured IgG1, IgG2, IgG3, and IgG4 immunoglobulins by enzyme-linked immunosorbent assay in sera from 246 black children aged 6 to 42 months. We then compared these values with the normal values established for 664 white children aged 6 to 60 months. The IgG1, IgG2, and IgG4 subclass concentrations of the black children were lower than those for white children; many of the values were below the 95% confidence limits established for white children: 46 (19%) of 246 IgG2 values and 19 (8%) of 246 IgG4 values for black children were below the normal limits. We compared the geometric mean values for black and white children, as determined for each 6-month age grouping between 6 and 42 months of age; 367 of the 664 white children were less than 42 months of age and were included in this analysis. The geometric mean values for IgG1, IgG2, and IgG4 levels were consistently lower for black children than for white children. The differences were significant for IgG1 subclass values of those children older than 24 months and for IgG2 and IgG4 values of those children older than 18 months. No consistent differences were noted for IgG3 subclass values. We conclude that young black children have lower IgG1, IgG2, and IgG4 serum concentrations than are found in white children. If normal IgG values for white children are used, healthy black children may be erroneously classified as IgG subclass deficient. The mechanism and biologic relevance of these population differences need to be evaluated.

Black People↗
PubMed1991

Pyroelectric vidicon thermography and cold challenge quantify the severity of Raynaud's phenomenon.

Thermographic images of the hands of patients with primary and secondary Raynaud's phenomenon and of a group of normal subjects, recorded before and after cold provocation using a pyroelectric vidicon thermal imaging system, showed differences in thermal distribution patterns that were characteristic of primary Raynaud's phenomenon (RP), scleroderma (RS) and normal, and were exaggerated by cold provocation. The responses to cold challenge, assessed by computing the mean temperature of the hand as it recovered from cold challenge and plotting these values against time to produce a rewarming curve, were also characteristic of the patient and the normal groups, and gave an indication of the severity of circulatory impairment. Methods are described for the simple numerical characterization of these parameters.

Adolescent↗
PubMed1991

Antigenic variation among strains of Chlamydia pneumoniae.

The antigenic profiles of six strains of Chlamydia pneumoniae were analyzed by the microimmunofluorescence test (MIF) and immunoblotting with human serum and murine monoclonal antibody. MIF-derived antibody titers in serum samples from culture-positive patients were four- to eightfold higher against autologous isolate antigen than they were against the prototype antigen strain TW-183. Sera of patients with respiratory illness that were culture negative and complement fixation positive for Chlamydia spp. produced higher titers by MIF against a strain of C. pneumoniae isolated in the area than they did against TW-183. For two of five cases, the criteria for establishing the diagnosis of acute infection were met only with use of the antigen from the local strain; TW-183 was inadequate for this purpose. Immunoblot profiles revealed antigenic differences between strains that varied with the human serologic response; i.e., unique antigens were recognized by the sera of some individuals and not by the sera of others. Using the reactivity of a genus-specific monoclonal antibody against a major outer membrane protein, we found that strain CWL-011, isolated in Atlanta, Ga., may possess a major outer membrane protein with a molecular mass between those of C. trachomatis L2 and other C. pneumoniae strains. These data provide evidence of several new and unique serotypes of C. pneumoniae and suggest that the serologic diagnosis of C. pneumoniae infection may require the use of antigens from more than one strain of this species.

Antibodies, Bacterial↗
PubMed1991

A double blind, randomised, multicentre comparison of two doses of intravenous iloprost in the treatment of Raynaud's phenomenon secondary to connective tissue diseases.

OBJECTIVE: To compare low (0.5 ng/kg/min) and standard dose (2 ng/kg/min) iloprost (a stable carbacyclin analogue of prostacyclin) in patients with Raynaud's phenomenon secondary to connective tissue disorders. DESIGN: Double blind, random allocation, three six hour infusions on consecutive days. Follow up period eight weeks. SETTING: Rheumatology units, five teaching hospitals. PATIENTS: 55 Patients with Raynaud's phenomenon (greater than seven attacks per week), 32 secondary to well documented classical progressive systemic sclerosis (American Rheumatism Association criteria), 11 CREST syndrome, 5 mixed connective tissue disease, 1 rheumatoid arthritis, 1 Sjögren's syndrome, 1 childhood dermatomyositis, and 4 abnormal nailfold capillaroscopy and antibody profiles but no definite diagnosis. INTERVENTIONS: All other treatment for Raynaud's phenomenon was discontinued two weeks before entry. 28 Patients were randomly allocated to receive the low dose, 27 the standard dose. Differing dilutions allowed infusion rates to be started at 10 ml/h with increments of 10 ml/h every 15 minutes until infusion rates reached 0.5 ng/kg/min and 2 ng/kg/min respectively. MAIN OUTCOME MEASURE(s)--Reduction in frequency, duration, and severity of attacks of Raynaud's phenomenon. Assessment of ulcer and ischaemic lesion healing. RESULTS: Both dosage regimens were equally effective in reducing severity, frequency, and duration of Raynaud's attacks. Ulcer healing occurred to similar degree in both treatment groups (standard dose 44%, low dose 39%). Low dose was associated with significantly fewer side effects. CONCLUSIONS: Both dosage regimens reduce severity of Raynaud's phenomenon and encourage ulcer healing. Low dose was associated with fewer side effects and was better tolerated by the patients.

Adult↗
PubMed1991

Structural features of interstitial lung disease in systemic sclerosis.

Most studies of lung histology in systemic sclerosis have been based on autopsy specimens and consequently emphasize end-stage fibrotic disease. Although occasional pathologic descriptions of open-lung biopsies have recognized the presence of inflammatory cells, suggesting a similarity to "lone" cryptogenic fibrosing alveolitis, the two conditions have never been formally compared. In this study we describe the morphologic features of 49 open-lung biopsies from 34 systemic sclerosis patients with interstitial lung disease, many of whom had their lung disease diagnosed at an early stage. None had pulmonary hypertension. Examination of lung tissue by light microscopy showed the earliest changes to include patchy lymphocyte and plasma cell infiltration of the alveolar walls, interstitial fibrosis, and increased macrophages but only occasional polymorphonuclear cells and lymphocytes in the alveolar spaces. Alveolitis was not observed without fibrosis. Comparison of 22 biopsies with a similar number from patients with lone cryptogenic fibrosing alveolitis, matched for age and sex, revealed no qualitative or quantitative differences, other than a higher prevalence of focal lymphoid hyperplasia (follicular bronchiolitis) in the systemic sclerosis patients than in the lone cryptogenic fibrosing alveolitis controls (23 and 5%, respectively). There was an inverse correlation between the extent of interstitial inflammation and patients' age (p less than 0.05), disease duration (p less than 0.05), and age at onset of systemic sclerosis (p less than 0.01). There was also an inverse correlation between DLCO and interstitial fibrosis (p less than 0.01) and loss of lung architecture (p less than 0.05). Ultrastructural studies of eight systemic sclerosis biopsies showed evidence of endothelial and epithelial injury together with interstitial edema and excess collagen deposition. Occasional mast cells were observed, often in close contact with interstitial fibroblasts, but there were no tubuloreticular structures or evidence of immune complexes.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

Human markers for IgG2 and IgG4 appear to be on the same molecule in the chimpanzee.

It has been reported that all four immunoglobulin G (IgG) subclasses present in human serum are also present in chimpanzee serum, as detected with antibodies specific for the human IgG subclasses. We used monoclonal antibodies (mAb) specific for human IgG subclasses to measure concentrations of the four subclasses in the chimpanzee sera. Initial ELISA studies indicated that epitopes for all four human subclasses are present in chimpanzee sera. The concentrations of IgG1, IgG2 and IgG3 were similar in human and chimpanzee sera, but the registered concentrations of IgG4 were different. Absorption of IgG2-reactive material from chimpanzee serum with IgG2 mAb resulted in removal of IgG4-reactive material as well. Conversely, absorption of IgG4-reactive material removed IgG2-reactive material. IgG2-reactive material, isolated from chimpanzee serum using solid-phase anti-IgG2 mAb, reacted with anti-IgG4 mAb, and isolated IgG4-reactive material reacted with anti-IgG2 mAb. Three anti-IgG2 mAb and five anti-IgG4 mAb, each of which react with separate epitopes on their respective human isotype, were used in these studies. We conclude that chimpanzee serum contains only three IgG isotypes related to those of humans, one of which contains determinants related to both human IgG2 and IgG4.

Adult↗