Molecular heterogeneity of C2 deficiency.
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Biomedical subjects
Publications and source records attributed to N E Goeken.
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In a previous study, we identified glutamic acid at position 58 in DR (beta 1*1101) as critical for the epitopes recognized by the DRw11-specific mAb GS88.2, as well as the I-LR1 mAb that recognizes a polymorphic epitope on DR(alpha,beta 1*1101) and some DP molecules. The purpose of this study was to determine whether other polymorphic residues contribute to these epitopes and whether DR beta glutamic acid or alanine 58 and DP beta glutamic acid 56, the analogous position in DP beta, contribute to epitopes recognized by other anti-class-II mAb and allosera. Site-directed mutagenesis and transfection were used to produce cells bearing wild-type or mutant class II molecules that were analyzed with mAbs by flow cytometry and with human allosera by absorption and subsequent microcytotoxicity assays. These studies demonstrate that the residue at DR beta position 58 plays a central role in at least three different mAb epitopes and an epitope recognized by anti-DRw11 allosera. Substitution of glutamic acid for alanine at position 58 of eight DR beta chains caused gain of binding of four mAbs to all of the mutant molecules, except DR(alpha,beta 4*0101). These data suggest that the side chains of DR beta 58 and DP beta 56 point outward from the alpha-helix and directly contact antibody.
Premature neonates require blood transfusions, and biological parents may wish to be directed donors. Biological mothers pose a potential danger because their plasma may contain antibodies that will react with blood cell antigens inherited by the infant from the father. We studied 25 healthy, pregnant women at the time of delivery for the presence of antibodies against red blood cell, leukocyte and platelet antigens. Mothers known to have red cell antibodies earlier in pregnancy were excluded, and no new red cell antibodies appeared at delivery. Antileukocyte and antiplatelet antibodies were found in 16 and 12% of mothers, respectively. Because these antibodies have the potential to cause adverse reactions when transfused passively, we suggest that either biological mothers not provide blood components containing plasma for their neonates or that maternal red cells and platelets be given as washed products.
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Acute posterior multifocal placoid pigment epitheliopathy is a chorioretinal inflammatory disease occurring in young, healthy adults. Its cause is unknown, although it frequently follows a flulike illness. We reexamined 30 patients with documented acute posterior multifocal placoid pigment epitheliopathy to determine their HLA class I antigen (A and B) and class II antigen (DR and DQ) distribution. The HLA class I antigen B7 was found in 12 patients (40.0%) compared with 63 controls (16.6%) (relative risk, 3.38). The class II antigen DR2 was present in 17 patients (56.7%) compared with 107 controls (28.2%) (relative risk, 3.34). The specific role of HLA antigens in uveitis is unknown, but the finding of an increased prevalence of HLA-B7 and HLA-DR2 antigens in patients with acute posterior multifocal placoid pigment epitheliopathy suggests an immunogenetic predisposition to acquiring this disease.
Human monocytes cultured in monolayer for 6 days were found to secrete a factor that suppressed the T cell proliferative response to soluble Ag and to alloantigens. The elaboration of this monocyte suppressor factor (MSF) was not inhibited by indomethacin. It has an apparent Mr of 50 to 60 kDa. It does not inhibit soluble IL-1 in the murine thymocyte costimulator assay but does inhibit the activity of membrane bound IL-1, which we observed to be almost exclusively IL-1 alpha. MSF contains elevated amounts of plasminogen activator inhibitor (PAI) when measured either as bioactivity or in an ELISA. Its immunosuppressive properties are inhibited by anti-PAI antibody. Furthermore, the eluate but not the effluent of an anti-PAI immunoabsorbent column contains all of the immunosuppressive activity. Based on these data we suggest that MSF is, in fact, PAI and postulate that the mechanism of action is inhibition of the plasmin cascade, thereby preventing the release of membrane bound IL-1. This suggests that monocytes possess an autoregulatory circuit that may have implications for the kinetics of the inflammatory response.
The role of secreted and membrane-bound IL-1 in the activation of human T cells by monocyte-associated, processed antigen was examined. The IL-1 is secreted from antigen-pulsed plastic-adherent monocytes for only 24 h after isolation. After extensive washing, however, these monocytes are fully capable of stimulating T cells to proliferate. The T cells require less than 24 h of exposure to the monocytes to become activated and can then be cultured alone in fresh media. Addition of exogenous IL-1 does not enhance T-cell responsiveness in this model. Anti-IL-1 beta antibody does not inhibit the response, although we observed that pulsed monocytes have significant membrane-bound IL-1 assayed as biologic activity in the murine thymocyte costimulator assay. These studies suggest that secreted IL-1 is not required for the activation of human T cells and that membrane-bound IL-1 serves this function. The data further suggest that these two forms of IL-1 may be functionally distinct and that IL-1 beta is not the major component of membrane-bound IL-1. The possible relationship of these findings to the clinical efficacy of IL-1 inhibitors, such as corticosteroids, is discussed.
Forty patients with advanced hematologic malignancies or severe aplastic anemia received marrow grafts from partially mismatched, unrelated marrow donors. All patients were administered conventional prophylaxis for acute graft-v-host disease (GVHD) consisting of methotrexate and low-dose glucocorticoids. All but two patients who survived at least 30 days showed durable engraftment. Six patients survive 17+ to 36+ months following transplantation. Severe acute GVHD was seen in 47% of the patients; however, no direct correlation between GVHD and the degree of mismatching could be determined. Fatal infections were seen in 29 patients, and in the majority the infection occurred after the granulocyte count had risen to greater than 500 cells/microL. We conclude that the problems encountered in this pilot study can potentially be solved, and that further studies with this type of marrow grafting are warranted.
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Heat-treated monocytes (1 hr, 45 degrees C) cannot present soluble antigen or mitogen to purified autologous T cells. This is despite normal viability and normal expression of class II MHC antigens. They do not secrete IL-1 nor stimulate secretion of IL-2 by T cells. Addition of exogenous IL-1 or IL-2 does not, however, reconstitute the response to soluble antigen. Furthermore, even after overnight pulsing with antigen prior to heat treatment under circumstances in which the antigen is known to be appropriately processed, stimulation of T-cell proliferation still does not occur. Thus there appear to be at least two discrete lesions produced by heating: failure of IL-1 production, per se, and intrinsic failure to present previously processed antigen. It is also hypothesized that heat treatment may produce alterations in Ia molecules which specifically disallow transduction of the proliferation signal to T cells.
Human memory cells acquire resistance to several types of suppressor cells, including MLR generated suppressor cells. These data suggest one possible mechanism of that resistance, namely retention of IL-2 receptors in the resting state. Cells from a 7-day MLR were separated on a single step percoll gradient. All proliferating cells were found in the interface. Pellet cells were nondividing. Interface and pellet cells had equivalent memory function in a secondary MLR. Thus, there appear to be at least two subpopulations of memory cells, including one that is primed without undergoing division. These subpopulations are functionally distinct. Interface memory cells were 30-50% more resistant than pellet memory cells to MLR generated suppressor cells. On culture day 10, neither pellet nor interface cells displayed significant spontaneous proliferation but exogenous Interleukin 2 (IL-2) produced up to five times as much proliferation in interface cells as in pellet cells. Further, FACS analysis with an anti-TAC equivalent antibody also showed that significantly more interface cells have surface receptors for IL-2. Thus, cells that had previously divided continue to have more and/or higher affinity receptors for IL-2 even after return to the resting state. If a mechanism of suppression in the mixed lymphocyte reaction is to reduce the synthesis/release of Il-2, memory cells may acquire their relative resistance to this suppression by virtue of the increased IL-2 sensitivity of this discrete subpopulation.
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Analysis of retrospective data, obtained on 216 patients from 27 centers transplanted across some form of positive lymphocyte cross-match in a noncurrent serum, revealed that actuarial 1-yr graft survival was 69% in first transplants and 53% in recipients of second or subsequent transplants. Graft outcome did not correlate with peak antibody levels, change in antibody from peak to current, remoteness in time of the most recent positive serum, the number or timing of sera cross-matched, the technique or target cell cross-matched, or the degree of positivity of the most recent positive serum. Although a concurrent control population was not available, these results support the concept that acceptable graft survival can be achieved despite a positive cross-match with noncurrent sera.
It is estimated that 60-70% of patients who might benefit from a bone marrow transplant will not have a suitably matched, related donor. We have, therefore, designed a clinical experiment to test the safety and feasibility of using marrow from partially matched, unrelated donors. This paper details our transplant experience in the first eight patients with leukemia. The first four patients had advanced leukemia at the time of transplantation. Each showed hematopoietic recovery, but all died from septic complications largely related to extended neutropenia encompassing both the pre-marrow-grafting and the post-marrow-grafting period. The next four patients were in remission at the time of transplantation. Each showed prompt and sustained hematopoiesis with variable graft-versus-host disease (GVHD). No acute or chronic GVHD was seen in two patients, grade II (skin only) was seen in one patient, and grade IV (skin, liver, and gut) was seen in one patient. One patient has died from sepsis five-and-one-half months following transplantation, and three are alive and well six-and-one-half to nine-and-one-half months postengraftment. This preliminary experience, together with several case reports in the literature, leads us to conclude that bone marrow transplantation with partially matched, unrelated marrow is a safe and feasible approach. If these results are confirmed by longer follow-up in a larger group of patients, the development of marrow donor pools would appear to be justified.
Cyclosporine is a potent new immunosuppressive agent utilized in clinical organ transplantation. Available evidence suggest that it interferes with the secretion of interleukin-2. However, the long term efficacy of cyclosporine in preventing allograft rejection may depend on a relative sparing of suppressor cells early in the allogeneic response, allowing them to mature and effect a state of operational tolerance. If this is the case, cyclosporine must not affect antigen priming or recognition. Two patients in our center underwent allogeneic spleen transplant in conjunction with renal and pancreatic transplant. Both patients were treated with therapeutic levels of cyclosporine during the course of transplant. Neither developed any clinical signs of renal or pancreatic transplant rejection. Both patients developed graft-versus-host disease and eventually required allogeneic (donor) splenectomy. Studies performed on the splenocytes recovered from these specimens demonstrate alloantigen-specific cytotoxic T cell precursors. These studies demonstrate that although cyclosporine can prevent allograft rejection it does not necessarily prevent or ameliorate graft-versus-host disease. Furthermore, cyclosporine does not prevent in vivo T cell priming of alloantigen recognition. The primed cytotoxic precursors can be expanded in the presence of exogenous interleukin-2 to become fully active cytoxic cells.
DRw52 (formerly MT2) is a human Ia alloantigen that is expressed in linkage disequilibrium with DR3, 5, w6, and w8. Although there is general agreement that the DRw52 determinant resides on biochemically defined DR molecules, conflicting evidence exists regarding whether DRw52 resides on one or both DR molecules, DQ and DR molecules, or DR and BR molecules. Six anti-DRw52 allosera and three DRw52-like monoclonal antibodies were used to identify the Ia molecules that bear the DRw52 and DRw52-like determinants from DR5 and DRw6 homozygous cells. Based on these two-dimensional gel studies, the DRw52 allodeterminant appears to reside on a subset of DR molecules from DR5 and DRw6 cells. In contrast, the determinants defined by the three anti-DRw52-like monoclonal antibodies were found to reside on one DR molecule, on the second DR molecule, or on both DR molecules, respectively. Therefore, there is considerable complexity of Ia antigenic determinants that are associated with DR3, 5, w6, and w8 at the population level.
Agranulocytosis developed in a patient who was receiving propylthiouracil. Using a microgranulocytotoxicity assay, serum taken from the patient was shown to be strongly granulocytotoxic when tested against the patients granulocytes and those obtained from two of eight normal subjects. Tests for granulocyte agglutinins and for lymphocytotoxicity were negative. Granulocytotoxic activity decreased as the patient's peripheral granulocyte count recovered. Cytotoxicity was shown to be mediated by a complement-dependent IgM antibody.
In these investigations, human lymphocytes primed in vitro in MLR have been employed as a model for human memory cells and have been compared to naive lymphocytes from the same donor. Both the stimulatory requirements and the regulation of these cells were found to differ significantly. The dose of stimulators giving a maximal primary (I) response was less than 10% the dose of restimulating cells giving a maximal secondary (II) response. II responses were further found to be inversely related to the original I response. This was associated with at least two separate regulatory phenomena. Suppressor cell induction was enhanced at high priming doses while memory cell precursors were preferentially stimulated at very low priming doses. Priming of memory cells could also be demonstrated to occur in the absence of any detectable I proliferation by utilizing platelets or heat treated stimulators. Memory cells were also a much more resistant than naive cells to both alloantigen induced suppressor cells and to culture activated monocyte suppressor cells. This in vitro model suggests that the human I and II responses to alloantigen have both distinct triggering requirements and differential sensitivity to regulatory cells. It is suggested that preferential formation of memory cells under conditions that require no proliferation and which are suboptimal for suppressor cell generation and the acquired resistance of memory cells to down regulation by suppressor cells may contribute to the poor graft prognosis of sensitized renal transplant patients.