Protease inhibitor deficiencies in patients with angio-oedema.
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Biomedical subjects
Publications and source records attributed to E Bleumink.
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A group of 281 patients with chronic urticaria was classified into various subtypes and compared with 357 healthy controls for PI types of alpha1-antitrypsin. Total alpha 1-antitrypsin was measured by the Mancini technique, and PI types were determined by isoelectric focusing. The MZ phenotype and the Z gene frequency were significantly more frequent in the urticaria group. The Z gene predominated in the groups with cold urticaria and acquired angio-oedema. The total group of chronic urticaria patients showed a significant decrease in total alpha 1-antitrypsin compared with the control group (P less than 0.03). Deficiencies in alpha 1-antitrypsin may predispose to the development of certain types of urticaria and angio-oedema.
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Fractions of normal rat serum were purified using gel chromatography and their molecular weights were analysed using gradient polyacrylamide gel electrophoresis (PAGE). The fractions were tested for their capacity to affect in vitro glomerular polyanion (GPA) in rat kidney tissue whereas their vascular enhancing capacity in vivo after intradermal injection into the rat skin was analysed. GPA impairment in vitro was estimated after incubation of the fractions with tissue sections for 2 h at 37 degrees C and subsequent staining for sialoproteins with colloidal iron. Enhanced vascular responses were assayed using a standard vascular permeability test in the rat skin. The results show that a factor with an estimated molecular weight of 120 000 was responsible for a dose-related activity in both test systems studied. The activity of this fraction could be inhibited by various plasma kallikrein-inhibiting protease inhibitors, whereas in addition the skin response could be inhibited by pyridinolcarbamate and not by histamine- or serotonin-inhibiting drugs. From the inhibition patterns in vivo and in vitro as well as from the estimated molecular weight of the fraction, it is suggested that a plasma kallikrein-like factor might be responsible for the activities observed. We feel that further study of this fraction in rat or human serum is worthwhile in particular with respect to nephrotic conditions associated with GPA loss.
The effect of some irritants on the barrier function of the skin was assessed by means of water vapour loss measurements. 100 microliter of the test substance in distilled water were applied to the skin for a period of 48 h, using large Finn chambers. The exposures were done in a test panel of 42 subjects. Sodium lauryl sulfate (2%), cocobetaine (2%), crotonaldehyde (0.75%) with sodium lauryl sulfate (0.5%) and dimethyl sulfoxide (50%) markedly influenced water vapour loss. Sodium hydroxide (1%) had less effect on water vapour loss, although the increase was significant (p less than 0.05). Phenol (5%) and benzalkonium chloride (0.2%) did not significantly influence the loss of water through the skin. It is concluded that subclinical effects of chemicals on the barrier function may be of importance in the development of irritant contact dermatitis, but that this capacity is probably not the only factor which determines the potential of a substance to contribute to the development of irritant contact dermatitis. A chemical which has little or no effect on the function of the horny layer may have a toxic effect on the viable cells of deeper layers of the skin. This toxic effect may also be an important subclinical factor in the development of irritant contact dermatitis.
A method to assess the irritancy of chemicals on human skin that is based on measurements of skin (water) vapor loss (SVL) is presented. The SVL measurements were performed with the Servo Med Evaporimeter in a group of 27 healthy volunteers. Four surfactants, distilled water, and NaCl 0.9% in distilled water were assayed. For the exposures a chamber technique was used. Sodium lauryl sulfate and cocobetaine most markedly influenced the loss of water through the skin. Polysorbate-60 and sodium laurate had less effect on SVL. The mean difference between the test substances were found statistically significant, except for the mean difference between sodium laurate and polysorbate-60 (p greater than 0.1) and between polysorbate-60 and distilled water (p greater than 0.05). The reactions of the tested subjects to the surfactants suggest that each individual has his own pattern of susceptibility to these substances. The mean values of the SVL measurements were compared with the macroscopically perceptible morphologic changes of the exposed test sites. The results of the SVL measurements. The correlation coefficient between the mean values of both methods was found to be high (r = 0.98).
The diagnosis of Weber-Christian disease was made by clinical and histopathologic findings in a 25-year-old woman who had recurrent nodules on the legs and arms. The patient's history also disclosed multiple episodes of swelling trauma. Histopathologic examination of the lesions showed a prominent vasculitis. Studies of serum complement and kallikrein levels and of the fibrinolysis-clotting system showed a decrease in the levels of C3, C4, and total hemolytic complement activity and deficiencies (less than 20% of the normal values) of alpha 1-antitrypsin (alpha 1-AT) and antichymotrypsin activity. Chemical analyses of the patient's alpha 1-AT indicated a PiZZ genotype. Intermediate values of both inhibitor levels were detected in six family members. It is assumed that protease-inhibitor deficiencies predispose the development of panniculitis and vasculitis on trauma.
The irritancy on human skin of 13 toilet soaps was assessed by means of water vapour loss measurements. The tests were performed on healthy skin of the volar side of the forearm in a panel of 33 subjects. The exposures were done using the Finn chamber method. Skin water vapour loss was measured by means of an "evaporimeter". All soaps--tested in 2 g/v% solutions--were found to lead to a statistically significant increase of water vapour loss as compared to the control sites. Synthetic detergents based on alkyl sulfates, particularly Lactacyd, generally had a relatively greater effect on skin vapour loss as compared with the other products. On the whole the differences between the products were small. It appears that every person probably has his own pattern of susceptibility to wash-active agents.
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The influence of a number of liquid soaps and detergents on the barrier function of the human skin was investigated by means of skin vapour loss (S.V.L.) measurements. Five liquid cleansers for body use and two liquid dish-cleansers were assayed on the volar side of the forearm. The measurements were performed on 20 healthy volunteers before and after the application of 1 ml of 2 vol.% solution. Five testpersons had to be excluded from the group because of theoretical reasons. The effect on the skin by the applied soaps and detergents was expressed in the average increase of S.V.L. X C. A considerable intra- as well as inter-subject variation of S.V.L. after the application of the test substances could be noted. Each person showed his own pattern of susceptibility. Skin reactions to soaps and detergents as measured by S.V.L. depend not only on the nature of the tested substances but also differ considerably from one person to another. The osmolarity of a test solution may play a role of importance in the irritant effects of soaps and detergents.
Caterpillar spicule venoms were extracted and studied for the following activities: arginine ester (BAEE) hydrolase, tyrosine ester (ATEE) hydrolase, protease (casein digestion) and phospholipase A (indirect hemolytic activity). Crude spicule venom of E. chrysorrhoea preferably hydrolyzed BAEE in contrast to E. subflava venom, which hydrolyzed ATEE in preference to BAEE. This difference was confirmed by Sephadex G-100 elution profiles. The esterase activity in E. chrysorrhoea venom was separated into two peaks with average mol. wts. of 96,000 and 44,000. The first peak demonstrated optimal BAEE hydrolysis at pH 8.6 and 37 degrees C, whereas the second peak optimally hydrolyzed both BAEE and ATEE at pH 8.45 and pH 8.6 at 45 degrees C respectively. The esterase activity in E. subflava venom was separated into two peaks with average mol. wts of 63,000 and 32,000 showing optimal hydrolysis of BAEE at pH 8.9 and 37 degrees C, and of ATEE at pH 7.75 and pH 8.5 at 40 degrees C. The column fractions showed comparable proteolytic activity, irrespective of differences between their esterase activities. The presence of phospholipase A (PLA) enzyme in crude spicule venom of both species was evident from their indirect hemolytic activities. The PLA activity eluted with the void volume and seems to be associated with some high molecular weight protein. Under the assay conditions used, E. subflava venom contained 50-100 times less PLA activity than E. chrysorrhoea venom.
The spicule venoms of Euproctis chrysorrhoea and Euproctis subflava were investigated for their capacity to hydrolyze chromogenic tripeptide substrates with selective affinities for various serine proteases. Seven substrates were assayed with affinities for trypsin and thrombin, trypsin and urokinase, serine proteases, chymotrypsin, glandular kallikrein, plasma kallikrein and plasmin. Venom material has a broad spectrum of affinities for the substrates with relative high plasma kallikrein activities. In E. chrysorrhoea venom, trypsin-like activities predominated, whereas E. subflava venom hydrolyzed, in preference, substrates with an affinity for chymotrypsin. The venoms were fractionated on Sephadex G-100, leading to three fractions, all having serine protease activity. The ratios of substrate specificities were markedly different, indicating that in both caterpillar venom preparations at least two separate serine proteases are present. In addition, in human plasma, inhibitor activity could be detected to the kallikrein activity of E. chrysorrhoea, but not of E. subflava. The trypsin-like activity was not inhibited by human plasma. These and earlier studies warrant the assumption that serine proteases, particularly kallikrein, are major factors in the elicitation of clinical symptoms observed after contact with caterpillar spicules.
The irritancy of low concentrations of commercially available soaps and detergents (surfactants) in bar form was determined by means of measurements of water loss of the skin. The percentage of increase of vapor (water) loss after application of the soap solutions was taken as a measure of skin irritancy. The tests were performed in 19 human volunteers with 1% solutions of Sporex, Devela, Lux, Lactacyd and Aveenoderm. Devela and Lactacyd were found to provoke marked effects, Lux was less harmful whereas Sporex and Aveenoderm did not lead to a considerable increase of skin vapor loss. Longitudinal studies showed that the irritant properties of soap solutions are additive. The results suggest that the influences of the pH of a soap solution on the skin-damaging effort is less important than assumed thus far.
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Four commercially available corticosteroid preparations were assayed for their capacity to suppress patch test reactions with contact allergens (nickel sulfate, nitrofuralum, potassium dichromate, epoxy resin, wood tars and Maneb) in sensitized individuals (n=14). Beta-methasone valerate, betamethasone dipropionate, hydrocortisone-17-butyrate and triamcinolone acetonide (0.05-0.7% solutions in isopropanol or ethanol) were applied under occlusion in amounts of 0.01, 0.02 and 0.04 ml, respectively. Patch tests were performed on the pretreated skin sites. The patches were removed 24 h after application and the reactions were read 15 min and 24 h later. The intensity of the reactions and the size of the infiltrated areas of the pretreated sites were measured and compared with those of a control patch test. Topical application of corticosteroids was found to have a suppressive effect both on the intensity as well as on the size of the epicutaneous reactions. No marked difference in the suppression effect of the four corticosteroids could be observed.
To investigate the influence of sex-steroids on the in vitro correlate of cell-mediated immunity (CMI), blood samples from 49 women on hormonal contraceptives were tested on the lymphocyte response to the mitogens phytohemagglutinin (PHA) and concanavalin A (Con-A). Sixteen women were taking oral contraceptives of combined oestrogen/progestogen of the same brand (low oestrogenic and middle range progestogenic activity); 15 had received intramuscular injections of medroxyprogesterone acetate and 18 women were using a sequential pill. The results were compared with those of 18 women not taking contraceptive steroids and matched for age. No significant changes were observed between the different groups. Considering the previously found alterations in dinitrochlorobenzene (DNCB) skin test reactivity by sex steroids, it is hypothesized that sex-steroids have little or no influence on the central proliferative phase of the immune response, but have a profound effect on the efferent phase.