PubMed HealthSearch

Biomedical subjects

M V Dahl

Publications and source records attributed to M V Dahl.

At least 19 recordsLinked to original sources

Binding of Trichophyton rubrum mannan to human monocytes in vitro.

We recently reported that the mannan component of Trichophyton rubrum cell wall (TRM) has an inhibitory influence on cell-mediated immune function in vitro. We now describe experiments designed to identify the target cell for this effect of TRM. T. rubrum mannan labeled with fluorescein (FITC-TRM) was incubated with peripheral blood mononuclear leukocytes, monocytes, or lymphocytes. Binding and uptake of the FITC-TRM were monitored by fluorescence microscopy and flow cytometry. Approximately 10% of mononuclear leukocytes were stained with this reagent and the fluorescent cells appeared to be monocytes by morphology. Virtually all purified monocytes and no purified lymphocytes stained with FITC-TRM. Flow cytometry to analyze FITC-TRM monocyte-specific binding of FITC-TRM involved the use of a phycoerythrin-labeled anti-CD14 antibody to identify monocytes. The only cells stained with FITC-TRM were those stained with the monocyte-specific antibody. The ability of monocytes to endocytose mannan was assessed by fluorescence microscopy. Cells were exposed to FITC-TRM and washed, and the staining pattern recorded periodically over a 48-h incubation period. After 15 min, staining was homogeneous and involved the entire cell surface; by 30 min, "patching" was observed; by 90 min, bright granules had formed along the cell border and a large number of small granules were present in the cytoplasm; by 8-12 h, the fluorescent granules were enlarged in size and reduced in number; by 24-36 h, the intensity of cytoplasmic fluorescence began to diminish; and, after 48 h, all fluorescent staining had disappeared. An additional feature of staining during the 8-12-h period was the appearance of a large round bright spot in the nuclear region of each cell, which may represent nucleolar staining. A role for "mannan receptors" is suggested by observations that FITC-TRM binding was prevented by unlabeled TRM or pretreatment of the monocytes with trypsin. Our finding that monocytes selectively and specifically bind TRM appears to identify the monocyte rather than the lymphocyte as the target cell for the inhibitory effect of mannan on cell-mediated immune function.

Adult

Dapsone suppresses integrin-mediated neutrophil adherence function.

The anti-inflammatory influence of dapsone may involve suppression of neutrophil chemotaxis to selected attractants, but other actions of the drug are likely also involved. We have discovered that dapsone may suppress migration of neutrophils to extravascular sites through inhibition of adherence functions required for neutrophil recruitment. Neutrophil adherence mediated by integrins (CD11/CD18 or Mac-1 family receptors) was measured in vitro in terms of binding of stimulated cells to albumin-coated wells of microtiter plates, using phorbol myristate acetate (PMA) and N-formylmethionyl-leucyl-phenylalanine (FMLP) as stimuli. Adherence was assessed by staining attached cells with crystal violet dye and measuring the dye concentration at OD590 using an automated plate reader. The role of integrins in this assay was confirmed by the ability of anti-integrin antibody to suppress stimulated neutrophil adherence. The OD590 value for cells adhering to albumin in the absence of stimulus and dapsone averaged 0.2 +/- 0.04 (SEM) over five experiments. In the presence of 0.1 microM PMA or 10(-6) M FMLP, the OD590 values averaged 0.88 +/- 0.1 and 0.75 +/- 0.12, respectively. Dapsone did not affect unstimulated neutrophil adherence but, when present with stimulus, produced a dose-related inhibitory effect on adherence. Fifty percent inhibitory doses were approximately 150 micrograms/ml dapsone for both stimuli. Sulfapyridine reproduced the inhibitory effect of dapsone, but two structurally related compounds, hydrochlorothiazide and furosamide, did not. The observed ability of dapsone to inhibit neutrophil chemotaxis under agarose to FMLP and interleukin-8 may also be explained by interference with integrin-mediated adherence required for motility in this assay system. To consider if dapsone might have a similar inhibitory influence on neutrophil adherence in vivo, we tested the stimulated adherence function of neutrophils isolated from three individuals on dapsone therapy for dermatitis herpetiformis. Stimulated adherence of patients' cells averaged less than 40 percent of the control value. Suppression of leukocyte integrin function may therefore also contribute to the ability of dapsone to inhibit neutrophil infiltration in neutrophilic dermatoses.

Cell Adhesion

Epidermolysis bullosa acquisita induced by GM-CSF: a role for eosinophils in treatment-related toxicity.

A patient treated with granulocyte-macrophage colony-stimulating factor (GM-CSF) developed eosinophilia and epidermolysis bullosa acquisita. The bullae were subepidermal, and filled with an inflammatory infiltrate composed predominantly of eosinophils. Immunofluorescence studies disclosed linear deposition of IgG, IgA and C3 at the basement membrane zone and immunoelectron microscopy demonstrated antibody deposition in the lamina densa and sublamina densa region; however, the patient's serum did not contain circulating antibody to basement membrane zone antigens. Staining with monoclonal antibodies revealed dense deposits of both eosinophil peroxidase and eosinophil major basic protein at the dermal-epidermal junction. The eosinophilia and skin lesions resolved upon discontinuation of GM-CSF. This case provides evidence for two hypotheses: (1) GM-CSF induced proliferation and activation of eosinophils may contribute to some of the toxicities of GM-CSF treatment, and (2) activated granulocytes, including eosinophils, may mediate blister formation in epidermolysis bullosa acquisita.

Aged

Binding and uptake of Trichophyton rubrum mannan by human epidermal keratinocytes: a time-course study.

Trichophyton rubrum infects skin. This fungus or its products might affect the function of epidermal cells. We previously reported that T. rubrum mannan (TRM) exhibits a suppressive effect on proliferation of human lymphocytes. The goal of the present study was to investigate the possibility of direct interaction of TRM with cultured normal human epidermal keratinocytes (EK). Mannan, a cell wall glycoprotein, was extracted from T. rubrum by precipitation with cetyltrimethylammonium bromide and conjugated with fluorescein isothiocyanate (FITC-TRM). After incubation of EK with 50 micrograms/ml FITC-TRM for 30 min, the surface of EK showed bright fluorescent staining. EK cultures pretreated with non-labelled TRM remained unstained. The fate of TRM bound to EK surface was determined in a time-course study. After pulse exposure to FITC-TRM, EK cultures were washed and incubated for various time periods. The EK moved surface mannan to the one area of cell membrane, so that at 4-6 h, the homogeneous staining of the entire cell surface was replaced by staining in a "cap" pattern. By 12 h, FITC-TRM was taken up into the cell, brought to the nuclear area and concentrated in the EK nucleoli. During the next 3 days nucleolar and cytoplasmic staining of the cells was observed. The intensity of fluorescence gradually diminished. On the 4th day, the sharp staining of organelles disappeared; instead, a large number of small fluorescent granules were seen intra- and extracellularly. By the 6th day after exposure, no EK staining remained. Thus, EK specifically bound, internalized and apparently catabolized TRM.(ABSTRACT TRUNCATED AT 250 WORDS)

Cell Division

Embolic abscesses in hereditary hemorrhagic telangiectasia.

Hereditary hemorrhagic telangiectasia is an inherited disorder in which patients may have multiple telangiectases and arteriovenous fistulas in the skin and internal organs. Patients can suffer from a variety of serious clinical complications, including abscess formation. We report two patients in whom neurologic symptoms developed from embolic abscesses, one for whom this complication was fatal. The reported incidence and microbiologic features of this complication are similar to that of endocarditis in patients with valvular heart disease. We believe that patients with hereditary hemorrhagic telangiectasia should receive similar antibacterial prophylaxis for procedures placing them at risk for bacteremia.

Abscess

An immunoinhibitory cell wall glycoprotein (mannan) from Trichophyton rubrum.

Trichophyton rubrum causes 90% of chronic dermatophyte infections. Most patients with widespread chronic T. rubrum infection fail to express a delayed hypersensitivity reaction to intradermally injected trichophytin. We propose that cell-mediated immunity to T. rubrum may be suppressed in chronic infections by the mannan cell wall component of the fungus. The proposed suppressive effect of T. rubrum mannan on cell-mediated immunity was tested by measuring the ability of extracted mannan to inhibit lymphoproliferative responses of human mononuclear leukocytes to antigens, mitogens, and an anti-T-cell receptor antibody (anti-CD3) in vitro. Mannan was found to be highly antigenic in two of five donors and weakly antigenic in the other three. Despite its antigenic property, mannan exhibited a dose-related ability to inhibit lymphoproliferation stimulated by other agents including 1) antigens from Candida albicans, T. rubrum, and tetanus toxoid (ID50 = 250 micrograms/ml); 2) anti-CD3 antibody (ID50 = 250 micrograms/ml); and 3) Phaseolus limensis mitogenic lectin (ID50 = 64 micrograms/ml). Mannan added to cultures later than 24 h after initiation had no inhibitory influence, but culture of cells with mannan for a period of 24 h prior to the addition of stimulus enhanced the inhibitory effect of the glycoprotein. Lymphoproliferation in response to recombinant interleukin-2 (IL-2) was not inhibited. The influence of time of addition of mannan and the failure of mannan to inhibit IL-2-stimulated lymphoproliferation demonstrate that the suppressive effect of mannan must be pharmacologic rather than cytotoxic. The observed ability of T. rubrum cell wall mannan to suppress cell-mediated immune function in vitro may provide an important clue to a mechanism enabling the fungus to avoid elimination in chronically infected patients.

Chronic Disease

Flare factors and atopic dermatitis: the role of allergy.

Atopic dermatitis is a genetically determined eczematous skin disease strongly influenced by environmental conditions called flare factors. Allergic reactions are one such flare factor. These reactions include contact urticaria, allergic contact dermatitis, and late phase reactions. Contact urticaria could induce eczema by eliciting scratching. A late phase reaction may be involved in eczema produced by prolonged epicutaneous applications of antigens in individuals with immediate sensitivity to these antigens. Mechanisms of allergic contact dermatitis might also elicit dermatitis. Environmental allergens may include mold, dust, mite, pollens, foods, danders and bacteria.

Allergens

Topical capsaicin treatment of chronic postherpetic neuralgia.

Uncontrolled studies have indicated that topically applied capsaicin may be a safe and effective treatment for postherpetic neuralgia. In a double-blind study 32 elderly patients with chronic postherpetic neuralgia were treated with either capsaicin cream or its vehicle for a 6-week period. Response to treatment was evaluated by visual analogue scales of pain and of pain relief, together with changes in a categoric pain scale and in a physician's global evaluation. Significantly greater relief in the capsaicin-treated group compared with vehicle was observed for all efficacy variables. After 6 weeks almost 80% of capsaicin-treated patients experienced some relief from their pain. Because capsaicin avoids problems with drug interactions and systemic toxicity, we suggest that topical capsaicin be considered for initial management of postherpetic neuralgia.

Administration, Topical

Inhibition of growth of Trichophyton rubrum by the myeloperoxidase-hydrogen peroxide-chloride system.

The myeloperoxidase-hydrogen peroxide-chloride (MPO-H2O2-Cl) system is an antimicrobial system of polymorphonuclear leukocytes. We demonstrated that the MPO-H2O2-Cl system is fungicidal for Trichophyton rubrum. Fungal growth of a synchronous cell culture of T. rubrum germlings was assayed by measuring the uptake of tritiated N-acetyl-D-glucosamine, and the viability of the fungi was assayed by counting colony-forming units. Cytotoxins produced by the interaction of myeloperoxidase with hydrogen peroxide and chloride ion were fungicidal for T. rubrum. Growth inhibition was abolished in the presence of catalase or L-methionine. Polymorphonuclear leukocytes through the MPO-H2O2-Cl system may prevent invasion and sepsis by dermatophytes even in the absence of specific immunity.

Acetylglucosamine

Hereditary mucoepithelial dysplasia. Case report and review of the literature.

Hereditary mucoepithelial dysplasia, a dyshesive, dyskeratotic epithelial syndrome caused by an abnormality in desmosomes and gap junctions, involves the mucosae, skin, hair, eyes, and lungs. A 16-year-old patient had nontender, fire-red mucosae; keratosis pilaris; diffuse, nonscarring alopecia; cataracts; photophobia; corneal vascularization; and decreased visual acuity. Histologic examination of gingival sections showed a dyshesive epithelium with atrophy, dyskeratosis, lack of keratinization, and unusual cytoplasmic inclusions. Results of electron microscopic studies showed a reduced number of desmosomes, amorphous intercellular material, and cytoplasmic inclusions resembling tonofilaments and gap junction material. The patient described in this report represents an apparently sporadic case of hereditary mucoepithelial dysplasia. Other cases described previously in the literature are reviewed. We believe this disorder should be brought to the attention of dermatologists because patients with hereditary mucoepithelial dysplasia have numerous skin problems and are susceptible to recurrent infection and potentially fatal bullous lung disease. Also, misinterpreted abnormal results from cervical Pap smears could lead to hysterectomy being performed unnecessarily on these patients.

Adolescent

Chronic, irritant contact dermatitis: mechanisms, variables, and differentiation from other forms of contact dermatitis.

Irritant dermatitis is an eczematous reaction to toxic chemicals contacting the skin. The mechanisms by which various chemicals elicit dermatitis are multiple. Strong irritants quickly elicit signs and symptoms of dermatitis, but weak irritants may not. Chronic cumulative exposure to weak irritants can elicit dermatitis which may mimic allergic contact dermatitis and mislead the physician and patient with respect to cause and preventative strategy. The skins of different people vary in susceptibilities to irritation. Susceptibility is also influenced by chemical properties, vehicles, concentrations, amounts applied to the skin surface, surface area, regional variations, length of exposure, method of exposure, age, sex, race, genetic background, environmental factors, hardening, concomitant disease, and the excited skin syndrome as well as treatment. Patch testing can help distinguish between allergens and irritants, but pitfalls may mislead.

Chronic Disease

Dosimetry in phototherapy cabinets.

Many skin diseases can be treated with phototherapy. The dose of ultraviolet radiation received at the skin surface should be recorded to guide subsequent treatment doses as well as to monitor cumulative dose. In order to see if a single reading from an electric dosimeter accurately reflected the dose of ultraviolet radiation received at the skin surface, 212 photoresponsive dosimeter badges were affixed at various sites to the skin of one side of a female volunteer. The volunteer was then exposed to ultraviolet A (UVA) radiation in a UVA light treatment cabinet. The monitors were then removed and the received dose recorded. Portions of the body facing the lights directly received the most irradiation. Areas inclined to the plane of the lamps, shaded areas, and anatomic areas near the top and bottom of the cabinet received the least. Dosimetry as recorded by an electronic monitor in the center of the cabinet decreased when a subject stood next to it. Evidently a single measurement of dose by an electronic monitor in an empty treatment cabinet does not necessarily reflect the amount of ultraviolet radiation received at any given anatomic site by a patient undergoing phototherapy.

Equipment Safety

Treatment of chronic postherpetic neuralgia with topical capsaicin. A preliminary study.

Continuing pain following herpes zoster is common in patients 60 years of age or older. Current treatments are generally unsatisfactory. The endogenous neuropeptide substance P is an important chemomediator of nociceptive impulses from the periphery to the central nervous system and has been demonstrated in high levels in sensory nerves supplying sites of chronic inflammation. In an attempt to alleviate the pain of 14 patients with postherpetic neuralgia, capsaicin (trans-8-methyl-N-vanillyl-6-nonenamide), known to deplete substance P, was applied topically to painful areas of skin for 4 weeks. Of the 12 patients completing this preliminary study, 9 (75%) experienced substantial relief of their pain. The only adverse reaction was an intermittent, localized burning sensation experienced by one patient with application of capsaicin. Although these results are preliminary, they suggest that topical application of capsaicin may provide a useful approach for alleviating postherpetic neuralgia and other syndromes characterized by severe localized pain.

Administration, Topical

Strategies for the management of recurrent furunculosis.

Furuncles are common infections of hair follicles. Staphylococcus aureus is frequently the causative agent, though other bacteria may also be pathogenic, especially for furuncles in the vulvovaginal area, the perirectal area, and the buttocks. A simple furuncle can be treated by incision and drainage. Systemic antibiotics are indicated in only special circumstances, and Gram stain is helpful in choosing an appropriate one. Some patients are plagued by recurrent furuncles because of follicular abnormalities, climatic conditions, colonization by pathogenic strains, reinfection, debility, or immunodeficiency. I present various strategies for treatment and prevention of recurrent furunculosis.

Furunculosis

Immunological resistance to dermatophyte infections.

Dermatophytic fungus infections are common and in the main confined to the stratum corneum. The way the body keeps these infections confined to the stratum corneum involves both nonspecific and specific factors. Cell-mediated immune reactions appear to be the major host defense against invasion. Appropriate cell-mediated immunity not only can limit the spread of dermatophytic fungi but also can rid the fungus from host skin. In contrast, the absence of cell-mediated immunity predisposes to severe and widespread infection and to chronic infection. Complement and polymorphonuclear leukocytes can interact with hyphae once they invade into viable tissue. These interactions are inhibitory to growth. In addition, the inflammation provoked by these interactions can increase epidermal turnover time and thereby force retreat of the fungus back into the stratum corneum or rid the fungus through desquamation. The role of specific antibodies to dermatophytic fungi is uncertain, but it is likely a minor one. High levels of antibodies do not protect against infection or allow resolution of established infection in the absence of other mechanisms. Antibodies may augment complement activation and accumulation of polymorphonuclear leukocytes, but it is unlikely they contribute directly to killing. Indeed, IgE antibodies to dermatophytic fungi develop in many patients with chronic infections.

Antibody Formation

Bullous pemphigoid and prurigo nodularis.

Bullous pemphigoid is a chronic blistering disorder characterized by specific clinical, histologic, and immunofluorescent findings. Several variants have been described, including pemphigoid nodularis, which may mimic or evolve from or into prurigo nodularis. The casual relationship between prurigo nodularis and bullous pemphigoid is unknown. We describe a patient with prurigo nodularis and no immunologic evidence of pemphigoid who subsequently developed bullae. Direct immunofluorescence then confirmed the diagnosis of bullous pemphigoid. Apparently this patient had prurigo nodularis and then developed bullous pemphigoid.

Aged