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Biomedical subjects

M Shaw

Publications and source records attributed to M Shaw.

At least 19 recordsLinked to original sources

Experimental allergic encephalomyelitis. T cell trafficking to the central nervous system in a resistant Thy-1 congenic mouse strain.

BACKGROUND: The understanding of recognition events that underlie the migration of antigen-specific T cells to a target organ during immune-mediated damage will be integral to the therapy of a number of human conditions of proven or suspected autoimmune etiology. In experimental allergic encephalomyelitis (EAE), the laboratory model of the human demyelinating disease, multiple sclerosis, previous studies have concentrated on susceptible strains and have shown that myelin-specific T cells play an early, key role in central nervous system (CNS), lesion formation. Not known in this model is whether in EAE-resistant strains, similar antigen-specific T cells possess the ability to recognize CNS endothelium and infiltrate the CNS. EXPERIMENTAL DESIGN: Myelin basic protein (MBP)-responsive T cells derived from mice of the C57BL/6 strain (bearing the Thy-1.2 allele) were adoptively transferred to the Thy-1.1 congenic strain C57BL/Ka. Some recipients were given a subsequent challenge with MBP in adjuvant, a protocol recently shown to break resistance in this strain and cause EAE. On the basis of the difference in Thy-1 allele, T cell trafficking was followed in this EAE-resistant congenic strain following the different sensitization protocols. RESULTS: In C57BL/Ka mice receiving adoptively transferred C57BL/6 cells followed by MBP challenge, donor MBP-responsive Thy-1.2+ lymphocytes were detected by immunocytochemistry in the Thy-1.1 host CNS and also in peripheral lymphoid organs. In mice given MBP-sensitized cells without additional antigen challenge, although Thy-1.2+ cells were found in the spleen and lymph nodes, similar cells could not be found in the CNS, and animals displayed neither clinical nor pathologic signs of EAE. Donor T lymphocytes appeared in the host CNS with clinical onset, 10 to 14 days after challenge. When mice went into remission, Thy-1.2+ lymphocytes could not be found in the CNS, but were still present in peripheral lymphoid organs up to 3 months after challenge. From the total number of infiltrating cells, T cell receptor-alpha beta+ cells constituted 27% in perivascular cuffs, 15% in meninges, and 13% in the parenchymal infiltrates in the spinal cord. Thy-1.2+ cells contributed up to about 40% of total T cell receptor-alpha beta+ lymphocytes. Approximately 60% of all infiltrating T cells expressed L3T4 (helper/inducer), whereas 18% expressed Lyt-2 (suppressor/cytotoxic). The majority of infiltrating cells were memory and activated cells expressing on their surface Pgp-1 and CD 25. Immunostaining for cytokines showed that the majority of infiltrating cells belonged to the TH1 subset and contained interferon-gamma and tumor necrosis factor-alpha, while a minority were positive for interleukin-4. CONCLUSIONS: These results suggest that: (a) T lymphocytes from an EAE-resistant strain of mouse are capable of homing to the CNS; (b) T lymphocytes from an EAE-resistant strain express phenotypic characteristics, activation, memory, and cytokine profiles similar to infiltrating cells derived from susceptible strains; and (c) the presence of donor T cells in the recipient CNS correlates with clinical and histopathologic signs of EAE.

Animals

Microsurgical approach to the abdominal thoracic duct in the rat: considerations in the collection of lymphocytes.

In experiments involving the collection of thoracic duct lymphocytes the anatomy of the abdominal thoracic duct in the rat has been further defined. In general, the abdominal thoracic duct lies posterior and to the left of the aorta between the renal arteries and the diaphragm. There are variations in the microsurgical approach to the classically described location of this organ that should be noted by investigators attempting to identify and dissect this structure.

Animal Welfare

The feasibility of studying drug-induced acute hepatitis with use of Medicaid data.

To determine the feasibility of the use of Medicaid data to study drug-induced acute liver disease, we reviewed the medical records of 414 patients receiving Medicaid, age 20 or older, with an ICD-9-CM inpatient billing code consistent with acute hepatitis. Of the patients whose records were reviewed, 15.9% were alcoholics, 31.9% had acute hepatitis A or B, 13.5% were intravenous drug users, 8.2% had acute cholecystitis or choledocholithiasis, and 4.1% had received a blood transfusion within the previous 6 months. No diagnosis of liver disease was found in 10.6% of the patients, and 5.7% had chronic liver disease. Of the 169 patients with idiopathic acute liver disease identified, many had very mild liver disease and were hospitalized for reasons other than liver disease. We conclude that Medicaid billing data has high reliability and validity for the diagnosis of acute liver disease. However, primary medical records are essential for the study of drug-induced hepatitis, to be able to exclude other causes of liver disease, and to obtain information not included in the computer data.

Acute Disease

The effect of BCG on thoracic duct lymphocytes.

Adoptive immunotherapy is becoming increasingly more important in the management of advanced malignancies. This report describes the results of immunomodulation therapy with BCG in the Dunning tumor. In addition it describes new techniques in the harvesting of lymphocytes. Thoracic duct lymphocytes from 34 rats were evaluated for the effect of the presence of the Dunning R-3327 AT-3 tumor as well as for the response to bacillus Calmette Guerin (BCG). Both tumor and BCG resulted in significant changes in the helper/suppressor T cell ratios.

Animals

Coordinate loss of growth regulatory factors following castration of rats carrying the Dunning R3327 G prostatic tumor.

Hormonal manipulation of prostate cancer is an effective therapy for metastatic disease. Unfortunately, following an initial response tumors reestablish themselves as hormone independent variants and progress. This study was designed to assess the interrelationship of cytokeratin P (Cyto P), vimentin, epidermal growth factor receptor (rEGF) and tissue testosterone following androgen deprivation therapy. Animals bearing the hormone dependent Dunning R3327 G subline prostatic adenocarcinoma were surgically castrated and progressing tumors from both hormone intact and castrated groups were quantitatively assayed for immunohistologic reactivity against the described markers. The results demonstrate a significant (p < 0.05) decrease in cytokeratin (Cyto P), rEGF and testosterone levels following castration. When the expression of both rEGF and Cyto P are related to the tissue testosterone content, it is observed that the ratio between rEGF and testosterone remains essentially unchanged (0.65 +/- 0.21 to 0.65 +/- 0.41), suggesting that in the Dunning R3327 G subline, rEGF expression is coordinately under androgen control. At least some cytokeratin expression also appears to be particularly sensitive to androgen levels, since the ratio between Cyto P and testosterone decreased from 0.92 +/- 0.39 to 0.35 +/- 0.41 following castration. In contrast, following castration, the expression of vimentin was unaffected.

Adenocarcinoma

Descriptive epidemiology of agranulocytosis.

BACKGROUND: To determine the incidence of agranulocytosis, a descriptive epidemiologic study was performed. METHODS: With the use of computerized Medicaid billing data from 1980 through 1985 from Minnesota, Michigan, and Florida, the ratio of persons hospitalized with a discharge diagnosis of neutropenia to persons with any claim for medical service was first used as an estimate of the incidence rate of the condition. Patients with cancer and patients receiving cytotoxic and immunosuppressive drugs were excluded. The information provided by a review of medical records for a subset of neutropenia cases was used to determine the proportion with neutropenia after excluding cases with recurrent or chronic neutropenia, and to determine the proportion with agranulocytosis. RESULTS: The incidence rates (95% confidence intervals) of agranulocytosis, excluding recurrent or chronic disease, were 2.3 (1.4 to 3.7), 7.7 (6.6 to 8.9), and 15.4 (11.3 to 20.4) per million per year in each state, respectively. The overall incidence was 7.2 (6.3 to 8.1) per million per year. CONCLUSIONS: Agranulocytosis is an extremely uncommon condition. The excess risk of agranulocytosis due to any drug other than cytotoxic drugs must, therefore, be very low.

Adolescent

Characterization of cellular infiltrates in the rat urinary bladder following BCG and thiotepa intravesical therapy.

We examined rat urinary bladders following intravesical administration of BCG and thiotepa. BCG administration resulted in a relatively greater increase in the mucosal infiltration of mononuclear cells relative to polymorphonuclear cells (P less than 0.01) compared to the thiotepa treated bladders. This finding suggests that the mode of action of the therapeutic effects of these agents may be different. These results may also suggest that the mechanism of action of BCG might be immunologic in nature.

Administration, Intravesical

Cytoreductive surgery impedes metastasis and enhances the immune response: a preliminary report.

In an effort to determine the effect of cytoreductive surgery on the metastatic process, MAT-LyLu flank tumors were excised from Copenhagen x Fischer rats and the effects of this surgery on metastatic lung lesions were observed. Cytoreduction resulted in a decrease in lung lesions (P less than 0.05). Adjuvant cyclophosphamide (CTX) further enhanced this beneficial effect. A concurrent increase in the helper/suppressor ratios suggested that this beneficial response might be mediated by the host's immune response.

Animals

Using a claims database to investigate drug-induced Stevens-Johnson syndrome.

In order to explore a priori hypotheses about drug-induced Stevens-Johnson Syndrome (SJS), a case-control study was initiated using data from COMPASS, a computerized data base consisting of Medicaid claims data. The records of 3.8 million patients in five U.S. states were searched to identify patients with an inpatient diagnosis of ICD-9-CM code 695.1 (erythema multiforme-EM). Out of the total of 367 cases that were identified, primary medical records for 249 were sought and 128 (51.4 per cent) of these were obtained. The remainder could not be obtained because: in 36 (29.8 per cent) the hospital refused to provide medical records; in 33 (27.3 per cent) there were transcription errors; in 20 (16.5 per cent) the state could not translate the identification number, primarily because the patients lost Medicaid eligibility too long before our request; in 27 (22.3 per cent) the hospital could not locate the patient's record; and in 5 (4.1 per cent) there were other reasons. Of those with a medical record, 121 (94.5 per cent) had a skin diagnosis and 109 (85.2 per cent) had a diagnosis compatible with ICD-9-CM code 695.1 specified on their discharge summary. However, in 35 (27.3 per cent) an expert reviewer felt that the discharge diagnosis was incorrect. In 50 (39 per cent) the computer diagnosis was incorrect. Only 19 (14.8 per cent) were judged by the expert reviewer to truly have Stevens-Johnson Syndrome, and an additional 37 (28.9 per cent) were judged to have erythema multiforme minor. Thus, the computerized diagnosis agreed very well with the diagnoses specified on the discharge summary. However, EM is frequently misdiagnosed, ICD-9-CM code 695.1 contains multiple other diagnoses which are not EM, and much of hospitalized EM is EM minor. Thus, studies of SJS cannot be performed except in patients whose medical records are available.

Adolescent

GM-CSF restoration of a differentiated (growth factor-regulated) phenotype in an anaplastic tumor.

GM-CSF (granulocyte-macrophage-derived colony-stimulating factor) is a differentiation agent that stimulates bone marrow activity in patients receiving chemotherapy. GM-CSF (1 microgram/ml daily for 10 days), administered intralesionally, was evaluated to determine whether it would restore a more differentiated phenotype to an anaplastic, rapidly growing, hormone-independent variant (R3327 MAT-LyLu) of the Dunning prostatic adenocarcinoma. Immunohistology was used to quantitate the expression of epithelial growth factor receptors (rEGF) and the tissue testosterone content. GM-CSF therapy significantly (P less than 0.05) restored rEGF expression and tissue testosterone to levels associated with better differentiated, slower growing, androgen-dependent Dunning variants (R3327 H and G). GM-CSF may have a role in treatment of prostatic cancers by promoting androgen and epithelial growth factor regulation.

Adenocarcinoma

No causal relationship between transdermal scopolamine and seizures: methodologic lessons for pharmacoepidemiology.

Because of case reports suggesting that use of transdermal scopolamine might be associated with the subsequent development of seizures, a retrospective cohort study was performed with computerized Medicaid claims data. Patients receiving transdermal scopolamine were compared with patients receiving diphenhydramine, meclizine, prochlorperazine, and promethazine. A four-fold increased risk of seizures after transdermal scopolamine use was observed in the claims data. However, this was not supported by the primary medical records. All patients who had seizures after using transdermal scopolamine either had seizures before receiving the drug as well or did not really suffer from seizures. The original finding appeared to be the result of the use of transdermal scopolamine for "dizziness, rule out seizures"; the ICD-9-CM coding system does not include "rule out" diagnoses. Thus these data do not confirm the existence of an association between seizures and the use of transdermal scopolamine. In addition, this study demonstrates the usefulness of pharmacoepidemiology studies in documenting drug safety and the importance of obtaining primary medical records when performing pharmacoepidemiologic studies with claims data.

Administration, Cutaneous

A population-based study of Stevens-Johnson syndrome. Incidence and antecedent drug exposures.

To determine the incidence of Stevens-Johnson syndrome, a descriptive epidemiology study was performed using computerized Medicaid billing data from 1980 to 1984 from the states of Michigan, Minnesota, and Florida. The ratio of persons hospitalized with a discharge diagnosis of erythema multiforme (ICD-9-CM code 695.1) to persons with any claim for medical service was first used as an estimate of the incidence rate of the disease. Then, since the ICD-9-CM code for erythema multiforme includes other illnesses in addition to Stevens-Johnson syndrome and because these illnesses are frequently misdiagnosed, the information provided by a review of medical records for a subset of cases of erythema multiforme was used to determine the proportion of patients with true Stevens-Johnson syndrome. The incidence rates of Stevens-Johnson syndrome were 7.1 (6.1 to 8.2), 2.6 (1.6 to 4.0), and 6.8 (4.3 to 10.3) per million per year in each state, respectively. Penicillins, especially aminopenicillins, were frequently used in the 19 patients judged to be true cases of Stevens-Johnson syndrome. In conclusion, Stevens-Johnson syndrome is a uncommon condition. The excess risk of Stevens-Johnson syndrome due to any drug must, therefore, be very low.

Adolescent

Constitutive expression of a groEL-related protein on the surface of human gamma/delta cells.

Rabbit antibodies to hsp58 (P1), the human homologue of the Escherichia coli stress protein groEL, react specifically in indirect immunofluorescence and complement-dependent microcytoxicity experiments with a cell surface antigen expressed constitutively by T cell lines bearing gamma/delta receptors. This anti-hsp58-reactive antigen is not demonstrable on T cells that express alpha/beta receptors or on various cells that lack T cell receptors. Certain evidence was obtained to suggest that the target antigen on the surface of gamma/delta T cells is a approximately 77-kD protein distinct from intracellular hsp58 and known members of the hsp70 stress protein family. While the exact nature and significance of this anti-hsp58-reactive protein remain to be determined, these data may help to clarify the roles of groEL-related stress proteins and gamma/delta cells that recognize groEL homologous in immunologic defense against infection and in autoimmune disease.

Antibodies

Glycoprotein specificity of cold-reactive IgM antilymphocyte autoantibodies in systemic lupus erythematosus.

Sera from patients with systemic lupus erythematosus frequently contain IgM antibodies to glycoproteins of Mr 46,000 and approximately 200,000 isolated from nonionic detergent lysates of mature T cells by affinity chromatography with solid-phase wheat germ agglutinin. Autoantibodies of this specificity correlate strongly with the presence of IgM anti-T cell autoantibodies, as determined by independent indirect immunofluorescence and complement-dependent microcytotoxicity assays, and are specifically absorbed by incubation of patient serum with viable T cells. Collectively, the data suggest that gp46 and, to a lesser extent, gp approximately 200 represent major targets of IgM antilymphocyte autoantibodies in systemic lupus erythematosus.

Antibody Specificity

An immunohistologic characterization of human prostatic atypical hyperplasia.

In an effort to better distinguish the morphologic relationship of atypical hyperplasia of the prostate to benign prostatic hypertrophy and prostatic cancer, 43 prostate specimens were analyzed with ten immunohistologic markers. Two cytokeratin antibodies appeared useful (Cyto M and Cyto P, with the latter slightly more discriminatory). In summary, it appears that atypical hyperplasia is immunohistopathologically related to both benign prostatic hypertrophy and prostatic cancer, having characteristics of both.

Aged

Effect of early and delayed difluoromethylornithine pretreatment upon cyclophosphamide chemotherapy.

The Dunning R3327 MAT-LyLu prostatic adenocarcinoma was utilized to study the effectiveness of an early versus delayed difluoromethylornithine (DFMO)-induced polyamine-depleted environment on cyclophosphamide (CTX) chemotherapy. DFMO (2%) was administered either at the time of tumor inoculation (early) or 36 h after tumor implantation (delayed). CTX (50 mg/kg) was administered to both DFMO groups in two doses; the first 36 h after initiation of DFMO therapy, and the second 1 week later. Each protocol (early and delayed) for combined DFMO/CTX chemotherapy significantly reduced tumor sizes with the earlier DFMO protocol appearing slightly more effective (p less than 0.001 and 0.02, respectively). DFMO administered alone was not significantly effective with either protocol.

Adenocarcinoma