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Biomedical subjects

R A Metcalfe

Publications and source records attributed to R A Metcalfe.

At least 19 recordsLinked to original sources
PubMed2003

HLA-G does not have a pathophysiological role in Graves' disease.

AIMS: It has been suggested that the non-classic HLA class I molecule HLA-G plays a role in autoimmune disease by protecting tissues from damage by infiltrating cytotoxic T cells. Such infiltration occurs in the thyroid of patients with Graves' disease (GD) and Hashimoto's thyroiditis (HT) and can eventually result in tissue destruction. The aim of the current study was to analyse thyroid tissue and thyrocytes obtained from individuals with autoimmune thyroid disease for the expression of HLA-G. METHODS: HLA-G expression was analysed in thyroid tissue taken from six patients with GD and one with HT by reverse transcriptase polymerase chain reaction. Thyroid tissue samples isolated from six patients with multinodular goitre (MNG) were used as non-autoimmune controls. HLA-G expression was also examined in cultured thyroid follicular cells (TFCs). RESULTS: The expression of HLA-G was not detected in the thyroid gland of patients with either GD, HT, or MNG. Furthermore, HLA-G expression could not be detected in cultured patient TFCs under basal conditions or after stimulation with the proinflammatory cytokines-interleukin 1alpha, interferon gamma, and tumour necrosis factor alpha. CONCLUSIONS: HLA-G expression does not occur in the thyroid of patients with GD, indicating that HLA-G does not play a pathophysiological role in this autoimmune disorder. Although the expression of HLA-G was not detected in the thyroid sample of the patient with HT, a greater sample size would be required to conclude that HLA-G does not have a part to play in this autoimmune thyroid disease.

Actins↗
PubMed2001

High-dose leptin activates human leukocytes via receptor expression on monocytes.

Leptin is capable of modulating the immune response. Proinflammatory cytokines induce leptin production, and we now demonstrate that leptin can directly activate the inflammatory response. RNA expression for the leptin receptor (Ob-R) was detectable in human PBMCs. Ob-R expression was examined at the protein level by whole blood flow cytometry using an anti-human Ob-R mAb 9F8. The percentage of cells expressing leptin receptor was 25 +/- 5% for monocytes, 12 +/- 4% for neutrophils, and 5 +/- 1% for lymphocytes (only B lymphocytes). Incubation of resting PBMCs with leptin induced rapid expression of TNF-alpha and IL-6 mRNA and a dose-dependent production of TNF-alpha and IL-6 by monocytes. Incubation of resting PBMCs with high-dose leptin (250 ng/ml, 3-5 days) induced proliferation of resting cultured PBMCs and their secretion of TNF-alpha (5-fold), IL-6 (19-fold), and IFN-gamma (2.5-fold), but had no effect on IL-4 secretion. The effect of leptin was distinct from, and additive to, that seen after exposure to endotoxin or activation by the mixed lymphocyte reaction. In conclusion, Ob-R is expressed on human circulating leukocytes, predominantly on monocytes. At high doses, leptin induces proinflammatory cytokine production by resting human PBMCs and augments the release of these cytokines from activated PBMCs in a pattern compatible with the induction of Th1 cytokines. These results demonstrate that leptin has a direct effect on the generation of an inflammatory response. This is of relevance when considering leptin therapy and may partly explain the relationship among leptin, proinflammatory cytokines, insulin resistance, and obesity.

Adult↗
PubMed2000

Facial nerve palsy secondary to internal carotid artery dissection.

We report facial palsy as the sole cranial neuropathy complicating an ipsilateral internal carotid artery dissection. A previously healthy 44-year-old man developed retro-orbital and temporal headache with associated nausea while engaged in modest physical exercise. On the following morning he noticed a left ptosis and miotic pupil. One week later he woke with a left facial weakness. On the same day he had a 90-minute episode of expressive dysphasia. Magnetic resonance imaging and angiography demonstrated left internal carotid artery dissection. The temporal association between our patient's facial nerve palsy and typical features of spontaneous internal carotid artery dissection suggests a common aetiology. We suggest that involvement of the VII cranial nerve in isolation followed disruption of an anomalous nutrient artery. The delay in clinical manifestation may imply extension of the dissection.

Adult↗
PubMed2000

High-dose growth hormone does not affect proinflammatory cytokine (tumor necrosis factor-alpha, interleukin-6, and interferon-gamma) release from activated peripheral blood mononuclear cells or after minimal to moderate surgical stress.

High-dose GH therapy, with GH doses 10-20 times the normal replacement dose for GH-deficient adults, has been used as an anti-catabolic agent in a number of different patient groups. A recent study, however, has shown an increase in mortality in critically ill patients treated with high-dose GH. The increased mortality was associated with multiorgan failure, septic shock, and uncontrolled infection, suggesting that GH may have altered the immune response. The GH receptor and GH are both expressed in peripheral blood mononuclear cells (PBMCs); thus, GH could act as either an endocrine or an autocrine modulator of the immune response. We have examined the hypothesis that high-dose GH therapy may induce proinflammatory cytokines, which are implicated in septic shock. To do this we measured cytokine production by PBMCs incubated in conditions that simulated high-dose GH therapy, and we measured cytokine levels in patients undergoing laparoscopic cholecystectomy who were randomized to receive either high-dose GH therapy (13 IU/m2 x day) or placebo. To confirm the biological activity of GH in our cell culture system we used a Stat5 functional assay. In this assay GH induced a bell-shaped curve, with a maximal response at GH levels between 100-1,000 ng/mL. PBMCs from healthy volunteers were incubated with GH in doses from 1-1,000 ng/mL for 6-72 h under resting conditions and after activation with endotoxin and the mixed lymphocyte reaction. Studies were repeated with PBMCs from six individuals using a GH dose of 100 ng/mL (the level of GH found after high-dose GH therapy) and an endotoxin dose that gave a submaximal response (0.01 ng/mL). GH had no effect on cell proliferation or the production of tumor necrosis factor-alpha (TNFalpha), interleukin-6 (IL-6), or interferon-gamma (IFNgamma). In patients undergoing laparoscopic cholecystectomy there was a time-related effect of surgery on cytokine levels. There was a rise in IL-6 and a fall in TNFalpha at 24 h after surgery; however, high-dose GH therapy had no effect on the cytokine response. We considered the possibility that endogenous GH production by PBMCs could influence the cytokine response in activated PBMCs; however, incubation of PBMCs in the presence of the GH receptor antagonist, B2036, had no effect on TNFalpha, IL-6, or IFNgamma production by PBMCs in either the mixed lymphocyte reaction or when activated by endotoxin. These results suggest that high-dose GH therapy does not alter the proinflammatory cytokine response to surgery or endotoxin. The results do not exclude an effect of GH on the immune response, but they suggest that the mortality seen in critically ill patients may be due to factors other than immune modulation.

Adult↗
PubMed1999

Graves' disease and thyroid associated ophthalmopathy triggered by 131I treatment of non-toxic goiter.

A 39-year-old Danish woman was treated with an oral dose of 400 MBq 131I for a non-toxic goiter with compression symptoms. Serum anti-TPO and TSH receptor antibodies were negative before radioiodine therapy. The patient developed hyperthyroidism four months after treatment and ophthalmopathy after another three months. TSH receptor stimulating and blocking antibodies, eye muscle IgA and IgG were measured and an increase in stimulating TSH receptor antibodies were found concomitant with development of hyperthyroidism. IgG class antibodies against porcine eye muscle antigens and eye muscle fibroblasts were elevated and unchanged during the follow-up. A significant increase in IgA class antibodies against porcine eye muscle antigens was seen concomitant with development of ophthalmopathy. It is speculated that 131I has led to an exacerbation of eye muscle as well as TSH receptor stimulating antibodies and possibly leading to the development of ophthalmopathy, or at least is associated with it.

Adult↗
PubMed1998

The participation of proliferative keratinocytes in the preimmune response to sensitizing agents.

The aims of this study were to investigate whether keratinocytes are capable of playing a direct preimmune role in the pathophysiology of allergic contact dermatitis (ACD) and to examine to what extent the degree of differentiation might influence this. We measured the ability of sensitizing agents to up-regulate intercellular adhesion molecule 1 (ICAM-1) expression in cultured normal human keratinocytes (NHK) and in the transformed human keratinocyte HaCaT cell line. In proliferative HaCaT cells, following a 24 h exposure, nickel compounds, para-phenylenediamine (pPD) and 1-chloro-2,4-dinitrobenzene produced a concentration-dependent up-regulation of ICAM-1 expression without reducing cell viability, while K2Cr2O7 led to ICAM-1 up-regulation at cytotoxic concentrations, and CrCl3 was without effect. In NHK, NiSO4 and pPD induced ICAM-1 expression to a significantly greater extent in proliferative cells than in differentiated cells, where involucrin expression was measured to assess the differentiation state. NiSO4- or pPD-pretreatment of proliferative HaCaT cells enhanced T-cell binding, which was abolished by neutralizing antibodies to ICAM-1 or CD18. Our investigations concerning the involvement of oxidative stress in the induction of ICAM-1 expression in response to sensitizing agents were inconclusive. The oxidizing agents FeCl3 and H2O2 up-regulated ICAM-1 expression in HaCaT cells but there was no clear relationship between the ability of agents to induce ICAM-1 expression and their ability to alter the levels of reduced glutathione. Although pPD increased interleukin-1 alpha release from NHK, this cytokine was not capable of inducing ICAM-1 expression in NHK. Tumour necrosis factor-alpha, which does induce ICAM-1 expression in NHK, was not detected in response to pPD, arguing against an autocrine pathway of ICAM-1 induction in response to pPD. In summary, we report the direct interaction of sensitizing agents with keratinocytes leading to the generation of immune signals, particularly by proliferative keratinocytes, suggesting an active role for the proliferative keratinocyte in the pathophysiology of ACD.

Allergens↗
PubMed1998

The modulation of the human sodium iodide symporter activity by Graves' disease sera.

The transport of iodide into the thyroid, catalyzed by the Na+/I- symporter (NIS), is the initial and rate-limiting step in the formation of thyroid hormones. To study the basic characteristics of the human (h) NIS, we have established a Chinese hamster ovary cell line stably expressing the hNIS (CHO-NIS9). In agreement with previous work on the rat NIS, iodide uptake in these cells was initiated within 2 min of the addition of 131I, reaching a plateau after 30 min. Both perchlorate and thiocyanate inhibited iodide uptake in a dose-dependent manner, with inhibition evident at concentrations of 0.01 and 0.1 micromol/L, respectively, and reaching complete inhibition at 20 micromol/L and 500 micromol/L, respectively. Ouabain, which blocks the activity of the Na+/K+ adenosine triphosphatase, also inhibited iodide uptake in a dose-dependent manner, starting at concentrations of 100 micromol/L and reaching maximum inhibition at 1600 micromol/L, indicating that iodide uptake in these cells is sodium dependent. CHO-NIS9 cells were further used to study 88 sera from patients with Graves' disease, for iodide uptake inhibitory activity, which were compared with sera from 31 controls. Significant iodide uptake inhibition was taken as any inhibition in excess of the mean + 3 SD of the results with the control sera. On this basis, 27 (30.7%) of the Graves' sera, but none of the controls, inhibited iodide uptake in CHO-NIS9. IgGs from these patients also inhibited iodide uptake, indicating that this inhibitory activity was antibody mediated. In summary, we have established a CHO cell line stably expressing the hNIS and shown that antibodies in GD sera can inhibit iodide uptake in these cells. This further emphasizes the role of NIS as a novel autoantigen in thyroid immunity.

Animals↗
PubMed1998

Detection of CD40 on human thyroid follicular cells: analysis of expression and function.

Thyroid follicular cells (TFC) are a common target of autoimmune attack, but the role they play in inciting and maintaining this attack is unclear. TFC express cytokines, adhesion molecules, and class I and II major histocompatibility complex molecules, but without additional signals that costimulate T cells, they may down-regulate, rather than stimulate, T cell function. In this report, we have investigated whether TFC can express the CD40 molecule, which plays a crucial role in the reciprocal two-way communication between T and B cells. We have shown by immunohistochemistry and flow cytometry that CD40 is expressed by TFC in vivo and in vitro in both autoimmune and nonautoimmune glands. CD40 expression was up-regulated by interleukin-1alpha and interferon-gamma, but not by TSH. Although there was no significant effect of CD40 ligation on cAMP synthesis or [3H]thymidine incorporation, there was a significant increase in interleukin-6 release by TFC. Thus, although TFC do not express members of the B7 family of T cell costimulators, they do express CD40, indicating the possibility of mutually stimulatory T cell-TFC interaction. This has important implications, both for TFC synthesis of immunological mediators and for the biasing of T cell behavior toward a T helper 2-type phenotype.

Antithyroid Agents↗
PubMed1998

Differential effect of thyroid-stimulating hormone (TSH) on intracellular free calcium and cAMP in cells transfected with the human TSH receptor.

The thyroid-stimulating hormone (TSH) binds to a receptor which activates adenylate cyclase and elevates cAMP concentration. In addition, effects of TSH on intracellular calcium and inositol phosphate accumulation have been reported. However, the mechanism of TSH-stimulated accumulation of inositol phosphates and elevation of calcium levels is unresolved. Previous work from this laboratory has shown TSH to cause acute transient increases in intracellular calcium in pig, human and FR TL-5 rat thyroid cells as well as in cell transfected with the human TSH receptor (JPO9 cells) in some (but not all) experiments. The aim of this study was to investigate the variability of the calcium response to TSH in JPO9 cells to learn more about the nature of this calcium signal induction. Calcium responses to TSH were determined using the fluorochrome fura-2 in both monolayers of adherent cells and adherent single cells. The responses to a single addition and to repetitive additions of TSH were compared. We also determined the cAMP response to TSH using these two protocols of TSH addition. Our data show that, whereas the cAMP response to TSH is highly predictable and consistent and does not require multiple exposures to TSH, cells were unlikely to respond to TSH with an increase in calcium unless they received multiple challenges with the hormone. A single addition of 10 mU/ml TSH failed to increase calcium in any of 40 single cells examined and in only 4 of 15 monolayers of cells (27%) examined; in contrast, 10 of 12 monolayers eventually responded with an increase in calcium after multiple exposure to TSH and 18 of 67 single cells. Similar data were obtained whether calcium was measured in single cells or in populations of cells. We also demonstrated cooperativity between an adenosine derivative, N6-(L-2-phenylisopropyl)adenosine, and TSH such that their co-administration resulted in a consistent and marked elevation in calcium levels not achieved with either agonist alone. In summary, we suggest that the coupling between the TSH receptor and the intracellular signalling system that leads to activation of intracellular calcium in JPO9 cells requires repetitive stimulation or the influence of other agonists, in contrast with the coupling between the TSH receptor and activation of the adenylate cyclase enzyme.

Animals↗
PubMed1998

The sodium iodide symporter gene and its regulation by cytokines found in autoimmunity.

Iodide concentration by the thyroid gland, an essential step for thyroid hormone synthesis, is mediated by the Na+/I- symporter (NIS). To identify factors that may regulate this process, we have studied NIS gene expression in the Fisher rat thyroid cell line (FRTL-5) by a semi-quantitative reverse transcription-polymerase chain reaction (RT-PCR) technique. Increasing concentrations of bovine TSH (0.1, 1, 10, 50 and 100 mU/l), with or without tumour necrosis factor-alpha (TNF alpha), interferon-gamma (IFN gamma) or interleukin-1 alpha (IL-1 alpha) were added to FRTL-5 cells previously deprived of TSH for a minimum of 5 days. RNA was extracted and samples were studied for NIS expression. TSH enhanced NIS mRNA expression in a dose-dependent manner, with induction evident at 0.1 mU/l, reaching a peak at 50 mU/l, an effect detected after 6 h of stimulation, but not in the first 2 h. Both TNF alpha and, to a lesser extent, IL-1 alpha inhibited basal and TSH-induced NIS expression. High concentrations of IFN gamma also downregulated TSH-stimulated NIS mRNA expression. Using the same technique, we also investigated NIS mRNA tissue distribution in two male and one female Wistar rats. High levels of NIS expression were detected in the thyroid, stomach, and mammary gland, lower levels were found in the intestine, adipose tissue and liver, borderline levels were expressed in the salivary gland, and no expression was detected in the kidneys. In summary, we have shown that TSH upregulates rat NIS gene expression in vitro, and this induction can be modulated by cytokines. Analysis of the distribution of rat NIS mRNA ex vivo demonstrated variable levels of NIS transcription in different tissue samples.

Adipose Tissue↗
PubMed1997

Failure to find an association between hepatitis C virus and thyroid autoimmunity.

A high frequency of hepatitis C antibodies has been reported from France in patients with autoimmune thyroiditis. Two cases of Hashimoto's thyroiditis in association with chronic active hepatitis and hepatitis C infection have also been reported. We have examined this potential association in 46 patients with autoimmune hypothyroidism and found that 16 apparently had hepatitis C antibodies in one of the two commercially available enzyme-linked immunosorbent assays (ELISA), but all patients were negative in a confirmatory commercially available recombinant immunoblot assay (RIBA-3) indicating that none of the patients were truly positive for hepatitis C antibodies. We also tested sera from 111 patients with proven hepatitis C infection and found no increased prevalence of thyroid autoantibodies. These results suggest that hepatitis C infection is not a risk factor for the development of thyroid autoimmunity in the United Kingdom.

Adult↗
PubMed1997

Is subclinical ovarian failure an autoimmune disease?

Young women with unexplained infertility who exhibit elevated basal serum follicle stimulating hormone (FSH) concentrations (>10 IU/l) have poor outcomes in in-vitro fertilization. A subgroup of these women has regular menses, representing 'subclinical' ovarian failure, which may have an autoimmune basis and could potentially be treated by immunosuppression. To investigate this further, a range of immunological markers was used to assess autoimmune activity in 14 women aged <40 years with elevated FSH compared with 15 infertile women with normal FSH and 10 pre-menopausal, healthy controls. All samples were taken during natural menstrual cycles. Organ-specific antibodies against ovary, endometrium and thyroid, and non-organ-specific antibodies against histones and cardiolipin, were not significantly increased in elevated FSH patients compared with other control groups. Soluble CD23 and soluble intercellular adhesion molecule concentrations were not elevated in the sera of the women tested, and circulating T cell subsets remained unaltered. Significantly, increased concentrations of the complement breakdown product C3a and terminal complement complexes were detected in the elevated FSH group compared with the normal FSH group, although the latter also had significant complement activation compared with laboratory controls. Autoimmunity appears as an infrequent cause of 'subclinical' ovarian failure, but there is evidence of activation of complement in the sera of infertile women.

Adult↗
PubMed1997

Analysis of antibody-dependent cell-mediated cytotoxicity in autoimmune thyroid disease.

There is no consensus on the role of antibody-dependent cell-mediated cytotoxicity (ADCC) in autoimmune thyroid disease; recent reports have suggested that antibodies mediating ADCC are found particularly in patients with primary myxoedema, occur less frequently in Hashimoto's thyroiditis and are absent in Graves' disease. Using an ADCC assay with a single source of effector and target cells, and expressing results as lytic units, we have found antibodies capable of mediating ADCC in 9 of 17 patients with primary myxoedema, 9 of 22 patients with Hashimoto's thyroiditis and 6 of 22 patients with Graves' disease. There was no significant difference between the groups in this distribution. Mean levels of ADCC activity were not significantly different comparing primary myxoedema and Hashimoto's thyroiditis patients, although levels were lower in Graves' disease patients compared to those with Hashimoto's thyroiditis (P < 0.05). There was no correlation between TPO antibodies (total IgG or IgG subclasses) measured by ELISA and ADCC activity. These results suggest that thyroid antigens besides TPO are involved in ADCC and that antibodies mediating ADCC are not restricted to subgroups of patients with autoimmune thyroid disease.

Antibody-Dependent Cell Cytotoxicity↗
PubMed1996

The effect of soluble complement receptor 1 (sCR1) and human thyroid antibodies on the course of experimental autoimmune thyroiditis in rats.

Experimental autoimmune thyroiditis (EAT), induced by immunisation of rats with thyroid extract and complete Freund's adjuvant, has been used as a model to study the effects of complement inhibition mediated by soluble complement receptor 1 (sCR1) administration during the initial phase of the disease. There was no effect of sCR1 on the severity of thyroiditis at day 28 after immunisation or on the levels of thyroid antibodies, whether sCR1 was given during the first or second week after immunisation. Human IgG containing high levels of thyroid peroxidase antibodies given to rats at the time of immunisation caused significant worsening of thyroiditis severity (P < 0.01 compared to animals receiving normal IgG) but sCR1 again had no effect in this variant of the EAT model. The results indicate that complement does not play a major role in the initial phase of tissue injury in EAT and complement inhibition does not impair the generation of an autoimmune response against the thyroid, although it remains possible that complement activation is important during the chronic phase of disease maintenance in human autoimmune thyroid disease.

Animals↗
PubMed1995

Acute pre-tibial myxoedema following radioiodine therapy for thyrotoxic Graves' disease.

A 54-year-old woman was treated with an oral dose of 555MBq of 131I radioiodine for thyrotoxicosis. She had no clinically detectable extrathyroidal manifestations of Graves' disease at the time, but within two months developed moderately severe ophthalmopathy and very extensive thyroid dermopathy affecting her face, arms, hands and feet, in addition to the classic pre-tibial area. Although she developed mild post radioiodine hypothyroidism, this was detected at an early stage and its treatment had no effect on the extrathyroidal signs. Thyrotrophin receptor antibodies (TRAb) were positive before treatment (22% inhibition of TSH binding in neat serum), rose to very high levels following radioiodine (97.6% inhibition), and fell progressively over the following year during treatment with prednisolone. Thyroglobulin autoantibodies became detectable following radioiodine but thyroid peroxidase antibodies were undetectable throughout. Serum and purified IgG from blood samples obtained prior to steroid therapy and over the subsequent year were tested on a dermal fibroblast cell line in vitro for the stimulation of synthesis of glycosaminoglycans, protein and DNA, but no increase in radiolabel incorporation was apparent for any sample when compared to controls. The temporal relation between the radioiodine and the acute onset of dermopathy and ophthalmopathy, together with the abrupt rise in TRAbs, indicates a probable causal association. However, the absence of in-vitro fibroblast stimulation would suggest that the pathogenesis of Graves' dermopathy is not dependent solely on any simple humoral factor.

Autoantibodies↗
PubMed1994

Cloning and analysis of IgM anti-thyroglobulin autoantibodies from patients with Hashimoto's thyroiditis.

Hashimoto's thyroiditis is an autoimmune disease in which autoantibodies reactive to a number of thyroid antigens are made. In order to investigate the autoantibody repertoire in this disease, B cells from four patients with Hashimoto's thyroiditis were immortalised and, after limiting dilution, screened for reactivity to thyroid antigens. After a second limiting dilution, one anti-thyroglobulin IgM-secreting clone from three patients, and four clones from one patient, were analysed. The Ig heavy and light chain genes from each clone were amplified using the polymerase chain reaction and sequenced. The resulting heavy and light chain sequences were heterogeneous, although the four clones from one patient and the clone from a second patient shared a germline VH sequence. All antibodies had similar functional affinity, comparable to serum IgG from Hashimoto's patients. The cross-reactivity of the antibodies was analysed against bovine and rat thyroglobulin, histones, cardiolipin and human skeletal muscle. The antibodies were polyreactive, indicating that they are probably natural autoantibodies of unknown pathogenic significance.

Amino Acid Sequence↗