Biomedical subjects

D T Purtilo

Publications and source records attributed to D T Purtilo.

At least 37 records · Page 2Linked to original sources

PubMed1991

Severe chronic active Epstein-Barr virus infection syndrome.

Reports of unusually severe lymphoproliferative disorders associated with extremely high antibody titers against Epstein-Barr virus (EBV) have recently increased. The syndrome, which we designated severe chronic active EBV infection syndrome, is characterized by persistent or intermittent fever, lymphadenopathy, and hepatosplenomegaly and primarily affects children and young adults. Polyclonal gammopathy and bone marrow suppression are generally observed, and some patients develop B-cell or T-cell lymphoproliferation or lymphoma. Frequently, EBV genomes are detectable in tissues infiltrated with lymphoid cells. Additionally, it is difficult to establish spontaneous or B95-8 EBV-induced cell lines despite the expression of an activated EBV infection. We review and report here the published medical literature and our own experience regarding patients with severe chronic active EBV infection syndrome in an attempt to understand this enigmatic syndrome and the possible pathogenetic mechanism(s) responsible for this disorder.

Chronic Disease↗

PubMed1991

Epstein-Barr viral genome in lymph nodes from patients with Hodgkin's disease may not be specific to Reed-Sternberg cells.

A possible etiologic role for Epstein-Barr virus (EBV) in Hodgkin's disease (HD) was investigated by probing for EBV genome in 52 biopsy specimens involved with HD and 43 hyperplastic lymph node specimens. Using dot-blot hybridization (Bam HIW probe), Southern blot hybridization (Xho I probe), and polymerase chain reaction analyses, 27%, 27%, and 58% of the nodes with HD were positive for EBV genome, respectively, as compared to 16%, 14%, and 43% in the hyperplastic lymph nodes. Clonal and nonclonal episomal EBV and linear replicating EBV genome were present in both conditions. Immunoglobulin heavy chain gene rearrangements were found in two clonal and two nonclonal EBV-positive HD cases, but not in the lymphoid hyperplasia cases. These findings and other recent reports showing EBV genome in benign lymphoid cells by in situ hybridization in Hodgkin's disease suggest that the characteristics of EBV infection in HD could be explained by the reactive cellular milieu, especially in the setting of defective immunity. The identification of EBV genome in Reed-Sternberg cells may, therefore, be a nonspecific phenomenon.

Gene Rearrangement↗

PubMed1991

Hematopathologic features of Epstein-Barr virus-induced human B-lymphoproliferation in mice with severe combined immunodeficiency. A model of lymphoproliferative diseases in immunocompromised patients.

The anatomical distribution, morphology, and clonality, of 'non-Hodgkin's lymphomas' in immunocompromised patients are usually distinctly different from NHL occurring in the general population. Mosier DE, Gulizia RJ, Baird SM, Wilson DB: Nature (London) 335:256, 1988 have described lymphoproliferative disease (LPD) of human B cell origin in mice with severe combined immunodeficiency (scid mice) after transfer of human peripheral blood mononuclear cells from Epstein-Barr virus-seropositive individuals. Reported herein is detailed information regarding the morphology, phenotypes, and clonality of LPD lesions in 10 of 18 scid mice that had developed LPD after transfer of peripheral blood mononuclear cells. These lesions were diffuse and monomorphic proliferations of immunoblastoid cells. They were invasive in their growth and often necrotic. Human B cell-related and activation-associated antigens were found on the LPD lesions, although the numbers of cells with the latter antigens were relatively small. Immunofixation electrophoresis for human immunoglobulins in sera of the majority of mice revealed oligoclonal populations, however, phenotypic and cytogenetic analyses showed no definite monoclonality. This scid mouse model is beneficial for understanding the early phases in the pathogenesis of LPD in immunocompromised patients.

Animals↗

PubMed1991

Lymphotropic viruses as etiologic agents of lymphoma.

DNA and RNA virus with immortalized lymphocytes are described including Epstein-Barr virus and HTLV-I. The roles of immune deficiency and genetic alterations occurring in a proliferating cell are also considered.

Animals↗

PubMed1991

Dual infections of the immune system in patients with chronic active Epstein-Barr virus infection mimicking chronic fatigue syndrome.

The etiologic bases of CFS are undetermined at the present time. It is very important to distinguish the patients with CFS as defined by the Centers for Disease Control (CDC) case definition of Holmes et al. from patients with physical and laboratory findings suggesting dual infections and/or underlying immunodeficiency. Particularly fruitful might be a longitudinal immunovirologic study of patients who exhibit CFS following a well-documented viral infection.

Diagnosis, Differential↗

PubMed1991

Ideas in pathology. Pivotal role of increased cell proliferation in human carcinogenesis.

Cancer develops secondary to multiple genetic events. Each time a cell divides there is a rare chance that a genetic error related to the carcinogenic process will occur. Thus, environmental agents or disease processes that produce sustained increased cell proliferation can enhance the likelihood of cancer development by providing additional cell divisions, each with an opportunity for spontaneous genetic error. Studies of hereditary cancers and of various DNA-damaging agents, such as radiation and certain viruses and chemicals, have provided insight into identification of the essential genes, but many examples of carcinogenesis in humans do not involve direct DNA damage. Also, most preneoplastic lesions in human carcinogenesis show increased proliferation compared with normal tissues, whether from increased mitotic rate, blocked differentiation, prolonged cell survival, or other mechanisms. Selected examples of proliferation-related carcinogenesis are described, including certain infectious agents, defective immune surveillance, hormonal imbalances, chronic inflammatory-regenerative processes, and exposure to various chemicals. A common biologic mechanism for these diverse stimuli is increased cell proliferation as a prelude to cancer. This mechanism seems essential to the genesis of many cancers in humans.

Animals↗

PubMed1990

Expression of Epstein-Barr virus-encoded proteins and B-cell markers in fatal infectious mononucleosis.

We assessed 33 lymphoid tissues from 15 patients, including 7 with X-linked lymphoproliferative disease (XLP) and 8 patients with sporadic fatal infectious mononucleosis (IM), to determine whether the cellular infiltrate had the immunophenotype and expressed Epstein-Barr virus (EBV)-encoded proteins characteristic of either EBV-immortalized lymphoblastoid cell lines (LCL) or EBV-carrying Burkitt lymphoma (BL) cells. The results of these studies revealed that in 13 cases the proliferating B cells were polyclonal, LCL-like, and in 2 cases they were monoclonal, malignant lymphoma-like.

Adult↗

PubMed1990

Low proliferative activity is associated with a favorable prognosis in peripheral T-cell lymphoma.

Peripheral T-cell lymphoma (PTCL) consists of a diverse group of post-thymic tumors bearing a mature T-cell phenotype and, excluding mycosis fungoides, comprises approximately 10-20% of the non-Hodgkin's lymphomas in the United States. This category of non-Hodgkin's lymphomas exhibits considerable morphological, immunological, and clinical diversity and is generally considered to be a high-grade malignancy. In the present study, paraffin-embedded biopsy specimens of lymph nodes from 31 patients with PTCL who were treated with curative intent were evaluated by flow cytometry for DNA ploidy and proliferative activity (PA). DNA ploidy was not predictive of the clinical outcome. However, low PA, defined by less than or equal to 10% of cells in S + G2M phase of cell cycle, was associated with a favorable prognosis. Patients with tumors having low PA had a significantly higher complete remission rate (100%) as compared to those with high PA (55%; P less than 0.02), and the predicted actuarial 4-year survival of those with low PA was 85% versus only 50% for those with high PA (P less than 0.04). This is the first report of the effects of PA and DNA ploidy in patients with PTCL who were treated with curative intent. Additional studies of similar patients are needed to confirm these findings.

Bone Marrow↗

PubMed1990

Partial Xq25 deletion in a family with the X-linked lymphoproliferative disease (XLP)

X-linked lymphoproliferative disease (XLP) results in exquisite vulnerability to EBV infection: fatal infectious mononucleosis (IM), acquired hypogammaglobulinemia and/or malignant lymphoma occur invariably following infection with the virus. We have identified the XLP locus using the DXS42 DNA probe having restriction length polymorphisms (RFLP). We report an interstitial deletion involving a portion of the Xq25 region in the X chromosome of an affected male, one sister, and their mother. Concordance has been established between the presence of a deletion and RFLP linkage analysis with the DXS42 probe in the kindred. This finding will contribute substantially to the mapping, cloning, and sequencing of the gene responsible for XLP.

Adult↗

PubMed1990

Comparison of the classical immunofluorescent antibody tests for Epstein-Barr virus with commercially available test kits.

Twenty reference sera with previously reported titers plus 10 normal seropositive and 10 seronegative sera were used to determine which assay for the detection of antibodies to Epstein-Barr virus should be utilized in our laboratory. By three commercially available test systems and by slides prepared in our laboratory, all techniques detected the same number of samples positive for IgG antibodies to viral capsid antigen (VCA) and Epstein-Barr virus-determined nuclear antigen (EBNA), but the geometric mean titers (GMTs) varied. Major discrepancies arose in the sensitivity of detection of early antigen-diffuse (EA-D) and -diffuse and restricted (EA-DR). Slides prepared in our laboratory gave the best results, detecting 12 of 12 (100%). Slides prepared according to Gull and Hillcrest detected 11 of 12 (92%), and those prepared according to Zeus detected 9 of 12 (75%). From these data, we conclude that all of these methods for detection of VCA and EBNA are adequate. However, in determining antibody levels to EA-D and EA-DR, great care should be taken as to the source of the slide and specificity and sensitivity.

Antibodies, Viral↗

PubMed1990

Differential cellular susceptibility to Epstein-Barr virus infection in a patient with X-linked lymphoproliferative disease.

Epstein-Barr virus (EBV) is often associated with lethal lymphoproliferative diseases in immunologically compromised individuals. Recently, we have studied a 20-month-old boy with X-linked lymphoproliferative disease (XLP) who had succumbed to infectious mononucleosis (IM) complicated by fulminant hepatitis and virus-associated hemophagocytic syndrome following EBV infection. EBV genomes were detected in peripheral blood lymphocytes (PBL), cervical and mesenteric lymph nodes, liver, spleen, thymus, and bone marrow. According to restriction endonuclease analyses, the EBV-DNA pattern was similar in all samples except for the EBV-DNA from the bone marrow. Additionally, circular EBV-DNA (suggesting a latent infection) predominated in spontaneously established lymphoblastoid cell lines (LCLs) derived from both the lymph node and cord lymphocytes co-cultured with PBL. In contrast, both circular and linear EBV-DNA (suggesting a lytic infection) were noted in spontaneously established LCLs derived from his PBL. Furthermore, LCLs derived from both the lymph node and cord lymphocytes co-cultured with PBL expressed fewer reactive cells for early antigen (EA) and viral capsid antigen (VCA) than spontaneous LCLs from his PBL, thus providing evidence for different B cellular susceptibility to EBV infection in this patient with XLP. Finally, defective EBV-specific cytotoxic T cell activity was observed in this patient. Latent EBV infected cells may easily escape immunosurveillance by the host. These findings may explain the fatal course of EBV infection in this patient.

Antigens, Viral↗

PubMed1990

Adenovirus infection in patients with Kawasaki disease.

Two outbreaks of Kawasaki disease at different times and areas (Kyoto in 1982 and Sapporo in 1985) of Japan were studied retrospectively for the presence of antibodies to adenoviruses and herpesviruses. Only 2 of 12 (16.7%) consecutive acute phase sera of patients from the outbreak in 1982 and 1 of 10 (10.0%) sera from 1985 showed positive antibodies for the common adenovirus antigen by a complement fixation (CF) test, whereas 10 of 16 (62.5%) age- and sex-matched controls during the outbreak of Kawasaki disease in 1985 were seropositive by the CF test. In contrast, using a recently developed enzyme-linked immunosorbent assay (ELISA), 9 patients (75.0%) in 1982 and 9 patients (90.0%) in 1985 had antibodies to adenovirus type 2. In addition, 5 of 10 (50.0%) of the 1982 and 6 of 9 (66.7%) of the 1985 patients who were seronegative for CF antibodies were positive for IgM antibodies to adenovirus type 2. Fifteen (93.8%) controls were positive for antibodies to adenovirus type 2 by ELISA and only two sera showed negative CF antibodies with positive IgM antibodies to adenovirus type 2. Sequential sera from 4 patients in 1985 had either IgM or IgG antibodies by ELISA and eventually three became seropositive by the CF test in time. Additionally, no significant difference was noted with antibody status to herpes simplex virus type 1 and 2 (HSV-1 and HSV-2), varicella zoster virus (VZV), and cytomegalovirus (CMV) between patients and controls.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenovirus Infections, Human↗

PubMed1990

Immunovirological studies of fatal infectious mononucleosis in a patient with X-linked lymphoproliferative syndrome treated with intravenous immunoglobulin and interferon-alpha.

We have studied a 19-year-old male with X-linked lymphoproliferative syndrome (XLP) and infectious mononucleosis (IM) who was treated with high-dose immunoglobulin (500 mg/kg/day) and recombinant interferon (IFN)-alpha (2 x 10(6) IU/m2/day). Fulminant hepatitis was delayed; however, virus-associated hemophagocytic syndrome, cholestatic jaundice, and renal failure occurred terminally. Initially, nonspecific natural killer (NK) cell activity against K562 cells was normal but it gradually decreased. Although reactive T cells were markedly increased in his blood during the acute phase, spontaneous EBV-positive cell lines were easily established. Additionally, his mononuclear cells produced IFN-gamma but not IFN-alpha prior to treatment. Based on results of in vitro studies, we conclude that both IFN-alpha and IFN-gamma production are likely necessary for inhibiting EBV immortalization in vitro. Both IFN-alpha and -gamma were produced in cultures of B95-8 EBV-infected mononuclear cells from EBV-seropositive healthy individuals. These results suggest that defective EBV-specific cytotoxic T cell activity accompanied with defective or discordant IFN-alpha and -gamma production permitted the development of fatal IM in this patient. Combined treatment with immunoglobulin and IFN-alpha appeared to be partially effective during the early stage of this disease.

Adult↗

PubMed1990

Severe chronic active Epstein-Barr virus infection syndrome and adenovirus type-2 infection.

Four patients from 4 to 24 years of age (3 males, 1 female) with generalized lymphadenopathy, hepatosplenomegaly, and intermittent fever associated with chronic active Epstein-Barr virus (EBV) infection were investigated. Laboratory data showed polyclonal gammopathy and a tendency for bone marrow suppression. Noteworthy were the extremely elevated immunoglobulin G (IgG) antibody titers to Epstein-Barr viral capsid antigen (VCA) (range, 10,240-81,920) and early antigen (EA) (range, 1,280-40,960). All patients had IgA antibodies to VCA and EA. Subtle, heterogeneous immune functional defects were observed in all four patients. Another unusual feature was our inability to establish spontaneous or B95-8 EBV-immortalized lymphoblastoid cell lines (LCLs) due to a marked cytopathic effect (CPE). Thus, we investigated for other viruses. Both IgG and IgM antibodies to adenovirus type-2 (Ad-2) were positive by enzyme-linked immunosorbent assay (ELISA) and immunofluorescence (IF) test, suggesting recent or activated Ad-2 infection had occurred. Dual active EBV and Ad-2 infections were likely etiologic in this severe chronic active EBV infection syndrome.

Adenoviridae Infections↗

PubMed1990

Immune deficiency as a risk factor in Epstein-Barr virus-induced malignant diseases.

Epstein-Barr virus (EBV) is a ubiquitous DNA virus that normally infects silently, establishing lifelong latency. Substantial empirical observations support the view that immunodeficiency is permissive in EBV-induced lymphoproliferative diseases (LPD). Primary immune deficient patients such as those with X-linked lymphoproliferative disease and individuals with acquired immune deficiency secondary to immunosuppressive drugs for organ transplantation or individuals infected with human immunodeficiency virus are also at very high risk for lethal LPD. The importance of immunodeficiency and EBV in the development of head and neck carcinomas and uterine cervical carcinoma is less clear. Methods are available for detecting immunodeficiency and EBV genome and thus preventive strategies are being developed to preclude LPD from occurring.

B-Lymphocytes↗

PubMed1990

Characterization of Epstein-Barr virus-induced lymphoproliferation derived from human peripheral blood mononuclear cells transferred to severe combined immunodeficient mice.

Mice with severe combined immunodeficiency (SCID) received 6 X 10(7) fresh human peripheral blood mononuclear cells (PBMC) intraperitoneally from Epstein-Barr virus (EBV)-seropositive and -seronegative donors. B95-8 EBV was inoculated intraperitoneally and intravenously to the mice 6 weeks after transfer of seronegative PBMC. Three of four mice transferred with PBMC from two EBV-seropositive donors and two of four mice from two EBV-seronegative donors inoculated with EBV developed fatal EBV-induced lymphoproliferative disease within 6 to 10 weeks. These tumors were oligoclonal or polyclonal by cytoplasmic immunoglobulin expression. Furthermore no consistent clonal chromosomal abnormalities were shown. Cell lines established from these tumors showed low cloning efficiency in soft agarose. In addition, latent membrane protein, B-lymphocyte activation antigen (CD23), and cell-adhesion molecules (ICAM-1, CD18) all were expressed in the EBV-positive infiltrating lymphoproliferative lesions in each mouse. These results suggest that lymphoid tumors are comparable to lymphoblastoid cell lines immortalized by EBV and are not malignant lymphomas such as Burkitt's lymphoma. This model may be useful for investigating mechanisms responsible for the growing numbers of lymphoproliferative diseases that are occurring in patients with inherited or acquired immunodeficiencies.

Animals↗

PubMed1990

Immunohistologic identification of Epstein-Barr virus-induced hepatitis reactivation after OKT-3 therapy following orthotopic liver transplant.

Reactivated Epstein-Barr virus infection associated with hepatitis appeared in a liver transplant patient receiving monoclonal OKT-3 antibody for rejection. The histologic findings in liver biopsy specimens characteristic of allograft rejection were observed prior to and during the initial phase of antirejection therapy. However, failure of a complete response to antirejection therapy promoted rebiopsy. The specimen showed portal infiltrates composed predominantly of plasma cells and immunoblasts. The presumptive diagnosis of Epstein-Barr virus hepatitis was confirmed by staining frozen liver tissue for Epstein-Barr virus nuclear-associated antigen. OKT-3 therapy was discontinued, and cyclosporine and steroid doses were reduced. Gradually, clinical features, serum aminotransferase and bilirubin levels, and the portal lymphoid infiltrate resolved. Epstein-Barr virus serology showed an increase in convalescent titers IgG-antiviral capsid antigen, and Epstein-Barr virus nuclear-associated antigen. The histologic, clinical, and laboratory features supporting the diagnosis of Epstein-Barr virus hepatitis in a liver transplant patient are presented and discussed. This diagnosis guided appropriate therapy.

Antibodies, Monoclonal↗

PubMed1990

Primary brain lymphoma in the immunocompetent host: relation to Epstein-Barr virus.

Epstein-Barr virus has been implicated in the pathogenesis of primary brain lymphoma in patients with congenital or acquired immunodeficiency states. To examine its role in central nervous system (CNS) lymphoma in the immunocompetent host, Epstein-Barr virologic studies were performed in six consecutive cases seen at our institutions. Virus DNA sequences were detected in only one of three tumor specimens studied by Southern blot hybridization. Serologic studies from the entire cohort disclosed past virus infection; however, antibody reactivity to virus-specific antigens in cerebrospinal fluid was limited to the patient harboring genome-positive tumor. Immunologic studies revealed hyperimmunoglobulin-E (range, 720 to 1040 micrograms/ml) in each of four patients tested. Our findings suggest that Epstein-Barr virus is an infrequent pathogen in nonimmunosuppressed patients with primary CNS lymphoma. Abnormalities in isotype-specific regulation of IgE production are common in such patients and may have pathogenetic implications.

Aged↗