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Biomedical subjects

R Ullrich

Publications and source records attributed to R Ullrich.

At least 19 recordsLinked to original sources

Identification of a pathogenic epitope involved in initiation of Heymann nephritis.

Heymann nephritis is an experimental autoimmune disease model for human membranous nephropathy. We have recently identified a pathogenic epitope, clone 14 (C14), responsible for formation and deposition of glomerular immune complexes that is contained within the small subunit of the Heymann nephritis antigenic complex (HNAC). HNAC is a heterodimer composed of a large subunit designated gp330 and a smaller (44 kDa) subunit, which is immunologically identical to the receptor-associated protein. In this study, we prepared antibodies to fusion proteins with C-terminal deletions in the C14 sequence and assessed their ability to promote formation of immune deposits (IDs). When IgG specific for the shortest truncated fusion protein (C14/delta 3; 86 amino acids) was injected into rats, small IDs developed. In contrast, when IgG raised against the full-length C14 sequence was depleted of its reactivity toward the C14/delta 3 fusion protein (C14/delta 3-fp), no IDs could be detected. These data indicate that at least one pathogenic epitope is contained within the N-terminal 86 amino acids of C14. Since the IDs induced with the C14/delta 3-fp-specific IgG are smaller than those induced with the poly-epitope-specific anti-gp330 antibodies, it is likely that other epitopes in addition to those expressed by the C14/delta 3-fp are required for formation and growth of immune complexes.

Animals

T cell differentiation antigens on lymphocytes in the human intestinal lamina propria.

Recently, T cell subpopulations presumably representing memory T lymphocytes have been described in vitro. Intestinal lamina propria T cells (LP-T) have characteristics resembling those of memory cells. We therefore investigated the expression of surface Ag associated with memory phenotype in vitro on lamina propria lymphocytes (LPL) and PBL and on the T cell subpopulations defined by the bright expression of CD45R0 by flow cytometric analysis of isolated cell populations. LPL had significantly increased percentages of CD45R0 and CD58 positive cells compared with PBL. Whereas PBL showed bimodal expression profiles of CD45R0, CD58, and CD2, the vast majority of LPL was bright for these Ag. Expression of CD45RA was significantly reduced in both frequency and intensity in LPL, and LPL had significantly reduced percentages of CD11a/CD18 and CD29 positive cells compared with PBL. The CD45R0 bright T cell subpopulations of both PBL and LPL were characterized by a lack of CD45RA. CD45R0 bright T cells from the peripheral blood (PB-T) were predominantly bright for CD2, CD58, CD29, and CD11a/CD18 whereas CD45R0 dim PB-T had bimodal expression profiles and CD45R0 negative PB-T were dim or even negative for these Ag. CD45R0 bright LP-T were also bright for CD2 and CD58 but had significantly reduced surface densities of CD11a/CD18 and CD29 compared with CD45R0 bright PB-T. The surface density of CD29 on CD45R0 bright LP-T corresponded to that of CD45R0 negative PB-T, and a significant proportion of CD45R0 bright LP-T was even negative for CD11a/CD18 and CD29. Additionally, CD45R0 bright LP-T in contrast to PB-T were characterized by a lack of 1-selectin and the expression of CDw49a and the mucosa-specific T cell Ag HML-1 on high percentages of cells. Our results show that the phenotype of CD45R0 bright T cells from the lamina propria clearly deviates from that of memory T cells in vitro and of CD45R0 bright T cells in the peripheral blood. We conclude that memory T cell populations in vivo undergo specific differentiation depending on their tissue localization, leading to unique phenotypic and presumably functional features.

Adult

Mesh tube--constricted varicose veins used as bypass grafts for infrainguinal arterial reconstruction.

Varicose veins are generally deemed inappropriate graft material for arterial reconstructions despite their physiologic flow surface because of their large and irregular caliber. Size reduction by threading such veins in constricting tubes may create bypass grafts of suitable caliber as long as redundant wall material does not cause stenoses. Sixteen human varicose veins (mean +/- SD, 13 +/- 3 mm diameter) obtained after stripping operations were inserted into Dacron mesh tubes of 6 mm internal diameter. Paraffin casts of the distended veins showed a size reduction of 6.9 +/- 2.6 mm. Wall material formed folds in only two veins. In both cases, diameter reduction was more than 10 mm. However, the folds did not result in significant stenoses. Mesh-constricted varicose veins were used as bypass material in 11 infrainguinal arterial reconstructions. All externally supported segments showed satisfactory size reduction without stenoses or folds. One graft occluded 2 months after surgery. Two patients had to undergo reoperation after 2 and 16 months, respectively. None of the complications could be attributed to the constriction of veins. The remaining grafts are patent and functional after a mean of 17 months (range, 6 to 42 months). Considerable size reduction by external wrapping of varicose veins is possible without adverse side effects. Such constricted veins were used successfully as bypass grafts for infrainguinal arterial reconstructions.

Aged

Erb:YAG and Hol:YAG laser ablation of meniscus and intervertebral discs.

Erb:YAG and Hol:YAG laser ablation rates of fibrocartilage and nucleus pulposus were measured in vitro simulating clinical conditions. After ablation macroscopic and microscopic appearance of the ablation site was investigated. Hol:YAG and Erb:YAG laser mean ablation rates increased almost linearly with rising energies, showing higher total ablation rates for the Hol:YAG laser due to its higher achievable energy density. At comparable energy densities the Erb:YAG laser appears to be more effective with respect to the corresponding ablation rates. Consequently, the ablational threshold proved to be lower for the Erb:YAG laser. Whereas during Hol:YAG laser ablation, some smoke formation and considerable tissue shrinking occurred, these effects could not be observed during Erb:YAG laser ablation. Consequently macroscopic and microscopic inspection showed some thermal damage after Hol:YAG and only minimal alterations after Erb:YAG laser ablation. Adjacent thermal damage was determined and proved to be lower for the Erb:YAG laser. In our opinion the characteristics of each laser system provide certain advantages for special clinical indications.

Aluminum Silicates

Effects of zidovudine treatment on the small intestinal mucosa in patients infected with the human immunodeficiency virus.

Zidovudine is associated with hematologic toxicity and may also impair the rapidly proliferating intestinal epithelium. However, patients with human immunodeficiency virus (HIV) infection receiving zidovudine gain body weight, indicating improved absorptive function. In the present study, 33 HIV-infected patients with gastrointestinal symptoms who were undergoing duodenoscopy and who had no detectable secondary intestinal pathogens were investigated; 12 of them received zidovudine. HIV antigen p24 was detected in duodenal biopsy specimens by immunohistology in 3 of 12 patients with zidovudine treatment and in 10 of 21 patients without zidovudine treatment. Morphometry of duodenal specimens showed reduced villus surface area (P less than 0.05) without crypt hyperplasia independent of zidovudine therapy and reduced numbers of crypt mitoses in patients with mucosal HIV infection (P less than 0.001) compared with controls. In the duodenal brush border, patients with mucosal HIV infection (P = 0.006) and patients without zidovudine treatment (P = 0.009) had absent lactase/beta-glucosidase activity more frequently than controls, and all HIV-infected patients (P less than 0.025) except zidovudine recipients had decreased alkaline phosphatase activity compared with controls. These findings show a hyporegenerative atrophy of the small intestine and enterocyte dysmaturation associated with mucosal HIV infection. Improved enterocyte maturation, indicated by increased brush border enzyme activity, may contribute to the clinical benefit of HIV-infected patients from zidovudine therapy.

Adult

Enteric immunologic abnormalities in human immunodeficiency virus infection.

The intestinal mucosa is an important portal of entry of HIV, and HIV-infected mononuclear cells are found in the intestinal lamina propria of 30 to 50% of HIV-infected patients even at early stages of the disease. HIV infection of epithelial cells has not consistently been detected and is still controversial. Intestinal T cells are phenotypically and functionally distinct from circulating T cells, especially in their state of activation and differentiation, which both affect the replication and cytopathicity of HIV. An increase in CD8+ cells and variable decreases in CD4+ cells have been found in the intestinal lamina propria by immunohistologic studies, resulting in a decreased CD4 to CD8 ratio; in addition, CD25 expression is reduced. Changes in intraepithelial lymphocytes are unclear. B-cell differentiation seems to be disturbed because IgA plasma cells and IgA2 secretion are reduced. Depletion or functional impairment of activated mucosal lamina propria lymphocytes by HIV infection could explain the breakdown of the mucosal immune barrier leading to opportunistic diseases; in addition, due to the interrelationship between mucosal immune system and epithelium, these changes might be responsible for the partial bowel atrophy and maturational defects in enterocytes of HIV-infected patients.

Acquired Immunodeficiency Syndrome

The use of mesh-tube-constricted dilated or varicose veins as arterial bypass conduit.

In general, dilated and varicose veins are not used as arterial bypass grafts despite their physiological endothelial lining. A uniform small diameter may be achieved by inserting such veins into mesh tubes. To test the degree to which dilated veins can be constricted without forming folds, in-vitro and experimental investigations were performed before such composites were used for clinical reconstructive surgery. Ovine jugular veins with a diameter of 15 mm were inserted into 6 mm tubes. After casting in paraffin wax none of the specimens showed folds on the flow surface. In 12 sheep pairs of mesh-constricted jugular veins and native femoral veins were implanted as femoropopliteal bypass grafts. Six animals were killed at 6 months and 6 at one year. All bypasses remained patent and none showed signs of obstruction caused by folds or anastomotic hyperplasia at angiographic control. Intimal hyperplasia was significantly reduced from 416 +/- 143 microns in the midportion of native vein grafts to 231 +/- 76 microns (p = 0.0001 paired t-test) in constricted veins as well as at the anastomoses (358 +/- 256 microns vs. 180 +/- 73 microns; p = 0.008). Partially or totally mesh-tube-constricted varicose veins were used for infrainguinal reconstructions in 19 patients and for coronary revascularization in 3. All grafts showed an even calibration at control angiography. As constriction does not lead to internal folds, varicose or dilated veins may be used successfully as bypass grafts after insertion into mesh tubes. The external reinforcement reduces the intimal hyperplasia within the graft and also reduces anastomotic hyperplasia.

Aged

Gastrointestinal symptoms in patients infected with human immunodeficiency virus: relevance of infective agents isolated from gastrointestinal tract.

The correlation of gastrointestinal symptoms and infections in 186 consecutive patients with human immunodeficiency virus (HIV) infection undergoing diagnostic endoscopy (oesophagogastroduodenoscopy, n = 124; colonoscopy, n = 37; both, n = 25) was investigated. Biopsy and stool samples were examined for infective agents. Only weight loss (p = 0.003) and dysphagia (p = 0.027) were more common in patients at stage CDC IV compared with earlier stages. In three of 27 patients at stage II/III and in 93 of 159 patients at stage IV an infective agent was identified in stool or gastrointestinal biopsy specimen (p < 0.001). Cytomegalovirus (n = 35), Candida sp (n = 28), M avium complex (n = 10), and Cryptosporidium (eight) were the most frequent agents detected. At stage IV, diarrhoea was more frequent in infected compared with non-infected patients (p = 0.006); however, an infective agent was also found in 39 of 82 patients at stage IV without diarrhoea. The frequency of gastrointestinal symptoms was not consistently increased in patients harbouring specific infective agents compared with non-infected patients. Our findings indicate that the pathogenic relevance of a gastrointestinal infection in HIV infected patients has to be verified and indirectly support the existence of an HIV associated enteropathy.

Adult

Aspergilloma in the frontal sinus expanding into the orbit.

A case of primary frontal sinus aspergilloma in a 79 year old non-immunocompromised woman, who presented with a right sided pyocele expanding into the orbit, is presented. The low susceptibility of the frontal sinus is probably related to the brachycephalic shape of the human skull which locates this sinus far anterosuperiorly to the nasal cavity. In human frontal sinus aspergillosis nasal symptoms are absent; the clinical manifestation of this rare disease is initiated by complications, especially orbital or intracranial invasion. Sinus opacity may raise early suspicion. Treatment consists of surgical debridement and re-aeration. Diagnosis is established by histological analysis of intraluminal contents.

Aged

[Procedure for production of leukocyte depleted erythrocyte and thrombocyte concentrates (PRP method) using top and bottom bags, Optipress automated separators and a computer controlled Cryofuge 6000].

PRP methods for production of WBC-poor red blood cell (RBCC) and platelet concentrates (PC) are investigated using top-and-bottom bags and Optipress separators. A standard centrifugation method (profile A) and 2 methods (profiles B and C) for a computer run centrifugation using 21 (profile B) or 19 (profile C) varying time segments and g numbers. An MS-DOS-compatible personal computer runs a Cryofuge 6000. 500 ml fresh whole blood are collected in triple and/or quadruple top-and-bottom blood bags. Samples of 163 blood donors, 163 RBCCs and 161 PCs are analyzed by a Coulter Counter T 540. Blood smears of 5 RBCCs made by profile B are evaluated. Mean WBC contamination of RBCCs produced by profiles A, B and C is found to be lower than 5 x 10(8)/RBCC. None of the 5 blood smears can be counted out completely. The full number of 100 WBCs is not detected. All WBCs found are polymorphous nuclear cells. Mononuclear cells (MNC) are not evident. PCs produced by profile B contain a mean platelet yield of (76.4 +/- 21.2) x 10(9)/PC and a WBC contamination of (1.2 +/- 0.7) x 10(7)/PC. The PCs of profile B differ significantly (p < 0.001) from those of profile A and profile C. The results show a high quality of RBCC and PC produced by PRP methods using top-and-bottom blood bags and Optipress separators. Employing a computer run centrifuge, PC and RBCC contain a similar WBC contamination compared with concentrates produced by buffy coat methods.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Component Removal

AIDS enteropathy.

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Acquired Immunodeficiency Syndrome

Intestinal microsporidiosis in a German patient with AIDS.

Since intestinal microsporidiosis might be of importance in the pathogenesis of gastrointestinal symptoms in patients infected with HIV, we examined duodenal biopsies of HIV-infected patients by electron microscopy. Enterocytozoon bieneusi infection of the small intestine was found in one of 23 patients studied, which gives a 95% confidence interval for the prevalence rate between 0.1% and 22%. The infected patient was a 24-year-old homosexual male with AIDS who underwent upper endoscopy because of acute epigastric pain, nausea, and vomiting. These symptoms were obviously due to mesenterial Kaposi's sarcoma obstructing the duodenal passage, as was later revealed at autopsy. However, microsporidiosis might have caused the patient's eight-month history of diarrhea and weight loss, since infected cells showed signs of degeneration, and no other pathogens were ever detected in stool or biopsy. Our finding of Enterocytozoon bieneusi infection in a German AIDS patient supports the concept of a worldwide distribution of this parasite; further studies are needed to define its exact prevalence in HIV-infected patients and its pathogenic relevance.

Acquired Immunodeficiency Syndrome

Phenotype and function of lamina propria T lymphocytes.

Lamina propria T cells have a low expression of the CD45RA antigen and a high expression of the CD45RO antigen. This phenotype is characteristic for memory T cells (table 2). In addition, T cells in the effector compartment of the mucosa bear surface antigens which are very rarely found in other sites of the immune system. Intestinal T cells also express functional IL-2 receptors and IL-2 receptor alpha chain mRNA, and are able to synthesize high amounts of IL-2. However, another marker of memory T cells, CD29, is not expressed in high density in the lamina propria indicating that lamina propria T cells differ from 'classical' memory T cells. This is supported by functional studies in nonhuman primates infected rectally with C. trachomatis which show that lamina propria T cells do not proliferate after stimulation with antigen but rather provide helper function for immunoglobulin synthesis (table 2). The intestinal lamina propria therefore contains highly specialized T cells which have a distinctive phenotype and are activated. Functionally these T cells can be characterized as differentiated effector lymphocytes which respond to triggering the antigen-specific T cell receptor by secreting helper factors for B cells. This concept is supported by recent studies showing that the pattern of lymphokines produced by lamina propria T cells and the responsiveness to certain lymphokines differ from those of other lymphocyte populations [25]. Lamina propria T cells thus represent a subset of memory T cells with a unique maturational state.

Animals