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Delayed cutaneous hypersensitivity and lymphocyte transformation: dissociation in atopic dermatitis.

Studies of cell mediated immunity (CMI) in atopic dermatitis have demonstrated various defects and frequently contradictory results. The true nature of immune dysfunction remains uncertain. We approached this question by concurrently examining two aspects of CMI: delayed cutaneous hypersensitivity and in vitro lymphocyte transformation. Responses were tested using the antigens Candida albicans and streptokinase-streptodornase (SKSD). Mean lymphocyte transformation was equal in atopic patients and controls, although a subgroup of severely dermatitic patients showed depressed responses. Cutaneous anergy was the rule in atopic patients (96% to candidin and 84% to SKSD). Although normal subjects showed good correlation between in vitro and cutaneous responses, atopic patients showed a significant lack of correlation. Many patients manifested cutaneous anergy in the face of normal lymphocyte transformation re sponses.

Adolescent↗

Effect of extracellular products of Streptococcus on macrophage Fc receptors for IgG.

The effect of the extracellular products of Streptococcus (EPS) on the receptors for Fc of IgG of dog alveolar macrophage (AM) was evaluated by the rosette test. The AM controls produced 80 per cent rosettes; those treated with EPS, a reduced number of rosettes, which was directly related with the concentration of EPS. The adhesion of EPS treated AM to glass was less than that of the AM controls. Incubation of AM with streptokinase-streptodornase did not modify the amount of rosettes. The data support the possibility that streptolysin-O is the substance which modifies, or destroys the Fc receptors, or the integrity of the cell membrane. Ouabain did not alter the capacity of the dog alveolar macrophages to form rosettes, suggesting that cellular energy is not required for the interaction between the Fc receptor and the IgG.

Animals↗

The skin inflammatory response of the badger (Meles meles).

Twenty-five badgers, captured in an area where they had been implicated in outbreaks of bovine tuberculosis, received intradermal inoculations of control medium, 150 micrograms phytohaemagglutinin (PHA), 40 units streptokinase/10 units streptodornase (SK/SD), 200 micrograms purified protein derivative of Mycobacterium bovis (PPD), Freund's incomplete adjuvant (IFA), and Freund's complete adjuvant (CFA), each in 0.1 ml of inoculum. The reactions were assessed by skinfold thickness and skin histology 30 min--7 days after inoculation. Control medium caused slight cellular reaction, mostly polymorphonuclear leucocytes (PMNs), but no significant increase in skinfold thickness. SK/SD provoked no reaction. PHA stimulated a marked increase in skinfold thickness; the cellular reaction was predominantly PMNs, with some macrophages occurring after several days. IFA and CFA promoted a long-lasting increase in skinfold thickness, and a mixed histological picture of PMNs and macrophages; later in the response, especially to CFA, giant cells and some lymphocytes occurred. PPD stimulated a small increase in skinfold thickness with a timing (2-3 days) consistent with delayed hypersensitivity (DTH); there was, however, no erythema or palpable oedema or induration. The histology was an initial multifocal reaction of PMNs with a later phase of lymphocytes and macrophages with some granuloma formation. Other cell types (eosinophils, basophils) were seen in varying proportions in all reaction sites. M. bovis was isolated from four badgers; the cellular reaction to PPD was stronger than in uninfected animals, but other aspects of the skin response were unaffected. This study shows the capacity of badgers for strong inflammatory responses, and is the first report of a DTH response to PPD in this species.

Animals↗

Humoral antibody responses of swine infected experimentally with group E streptococcus. II. Antistreptokinase and antistreptodornase responses.

Swine infected experimentally with group E Streptococcus (GES) produced significant antibody titers against streptokinase (streptococcal fibrinolysin, SK) and streptodornase (streptococcal deoxyribonuclease, SD). The antibodies directed against SK (antistreptokinase, ASK) appeared two to nine weeks postexposure and persisted for the duration of the experiment (nearly six months). The ASK inhibited SK produced by GES antigenic types III, IV, and V, by GES devoid of type specific antigen, and by a group P Streptococcus. Selected strains of GES serotypes I and II and group U Streptococcus did not produce detectable SK. The antibodies directed against SD (antistreptodornase, ASD) appeared two to three weeks postexposure, reached a peak about six weeks postexposure, and persisted at high levels for nearly six months (the duration of the experiment). The ASD inhibited SD produced by all known antigenic types of GES, by GES devoid of type specific antigen, and by strains of groups P and U Streptococcus. The antibodies failed to inhibit SD produced by group C Streptococcus. The potential utilization of ASK and ASD titers as serological means of identifying swine infected with GES (carrier swine) is discussed.

Animals↗

Random monocyte migration: an in vitro correlation with the delayed hypersensitivity skin reaction.

The in vitro random migration and chemotactic activity of peripheral blood monocytes and neutrophils was compared with the delayed hypersensitivity skin test to streptokinase-streptodornase in fourteen normal subjects. A significant positive correlation (P less than 0.001) was observed between the random migration of monocytes and the size of the skin test reaction. No significant correlation was found with random neutrophil migration or monocyte and neutrophil chemotactic responses. These results indicate that the in vitro random mobility of monocytes is related to the in vivo expression of a delayed-type hypersensitivity skin reaction.

Adult↗

A basophil-activating factor from human T lymphocytes.

Human T lymphocytes stimulated with phytohaemagglutinin (PHA) or streptokinase-streptodornase (SK-SD) generate an activity which elicits non-cytotoxic histamine release from human basophils. Filtration of the T lymphocyte-derived activity on columns of Sephadex G-100 and Fractogel 55F sequentially revealed one predominant basophil-activating factor of mol. wt. 70,000-90,000, that was designated BAF-T. BAF-T was composed of two acidic proteins of approximate pI 4.4 and 5.2-5.5, as assessed by isoelectric focusing. The distinction of BAF-T from IgE was confirmed by the failure of BAF-T to bind to an anti-IgE affinity column and the capacity of BAF-T to release histamine maximally from basophils desensitized to IgE-dependent stimuli. The inability of BAF-T to release histamine from human lung mast cells and dog cutaneous mastocytoma cells suggests target cell specificity. The source and activity of BAF-T are consistent with a specific contribution of this mediator to human cellular immune and hypersensitivity responses involving T lymphocytes and basophils.

Basophils↗

[Enzymatic debridement of wounds. Comparison of 2 commercial preparations].

In a randomized single-blind trial 44 patients of the Unfallchir. Klinik of Wiesbaden with purulent exudates and/or necrotic substrates in wounds had been enzymatically debrided with preparation A or B (22 patients each group). The solutions had been applied topically in a wet-to-dry technique. Dressings were changed two times a day, until the area became clean and showed granulations. In the group treated with preparation A excellent and good results could be obtained in 16 patients, in the comparison group in 14 patients. Three patients in the group treated with preparation A remained unchanged; in the comparison group five patients remained unchanged or showed deterioration. Due to inefficiency or to side effects treatment was interrupted in four patients of the preparation A-group and in eight patients of the comparison group. The more satisfactory results with preparation A can be interpreted in regard to the action of the enzymes: Fibrinolysin immediately attacks the fibrin of blood clots and fibrinous exudates. Desoxyribonuclease assails desoxyribonucleic acid structures. Streptokinase and streptodornase however are needing plasminogen for transforming it into the effective enzyme of plasmin, as they themselves are uneffective. And the amounts of plasminogen in the treated wounds possibly are not sufficient.

Clinical Trials as Topic↗

Characterization of human macrophage activation factor (MAF) prepared from antigen-stimulated lymphocytes.

Macrophage activation factor (MAF) and migration inhibitory factor (MIF) obtained from sensitized human lymphocytes stimulated by streptokinase-streptodornase (SK-SD) were characterized by gel filtration and isoelectric focusing (IEF) techniques. Twenty-four and 48 hr supernatants were chromatographed on Sephadex G-100 columns and the eluate pooled into 5 fractions: the void volume (Fr. I), the eluate containing molecules with a molecular weight ranging from 55-70,000 (Fr. II), 30-55,000 (Fr. III), 20-30,000 (Fr. IV) and 10-20,000 (Fr. V). The 24 hr supernatants contained MIF activity in Fraction IV and maximal MAF activity in Fractions I and II whereas the 48 hr supernatants contained MIF activity in Fractions II and IV and maximal MAF activity in Fractions II and III. When the supernatants were purified by IEF, the eluant was pooled into 5 fractions: Fraction I (pI 3.5-4), Fraction II (pI 4-4.5), Fraction III (pI 4.5-5), Fraction IV (pI 5-5.5) and Fraction V (pI 5.5-6). The 24 hr supernatants contained maximal MIF activity in Fractions III and IV and maximal MAF activity in Fraction III whereas the 48 hr supernatants contained both maximal MIF and MAF activity in Fractions I and IV. Thus, it appears that although human MAF can be differentiated from MIF in the 24 hr supernatants, MAF and MIF activity in the 48 hr supernatants are generally found in the same fractions when examined either by IEF or gel filtration techniques.

Chromatography, Gel↗

[Skin tests as immunologic parameters in cervical cancer].

Immunological skin-tests in 158 patients admitted at the 1st Department of Gynaecology and Obstetrics, University of Vienna, and in 25 healthy controls were done in a long-term prospective study. 123 examined patients were suffering from invasive cervical cancer stage I or Ii (group 1), 17 patients were suffering from preinvasive lesions of the cervix (group 2) and 18 patients were admitted for treatment of benign disorders (group 3). Recall-antigens--streptokinase-streptodornase (SKSD), purified protein derivate (PPD) and candida (CAND)--and a primary antigen (DNCB) were used testing cutaneous delayed hypersensitivity reactions. Preoperative total reactivity to recall-antigens calculated by a score was significantly reduced in cancer patients in comparison to other groups. Subdividing the cancer patients according to histological criteria of the malignancy we could find significantly differences in particular tests (SKSD and CAND) but not in total reactivity score. Comparing the preoperative reactivity of cancer patients with or without recurrence of malignancy within two years less pronounced differences were found. Reactivity to recall-antigens in all tests and in all patient groups were better three weeks after surgical treatment than preoperatively. The prior found differences between the groups remained significant (p less than 0,05). In contrast, cancer patients demonstrated severe anergy in postoperative DNCB sensitization test as only 1 of 33 patients exhibited normal hypersensitivity reaction. 113 out of 24 patients of group 2 and 3 (54%) demonstrated delayed hypersensitivity to DNCB in operative sensitization test.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenoma↗

Differential responses to mitogen stimulation in lymphocytes from normal individuals and Lesch-Nyhan patients: influence of the bicarbonate buffer system.

Three patients affected with the Lesch-Nyhan syndrome were found to have normal levels of immunoglobulins, normal numbers of circulating B and T cells and normal IgG secretion in vitro in response to polyclonal activators. However, when cultures were performed in the absence of a bicarbonate buffer system, the proliferative response to several T cell stimulants (phytohaemagglutinin, concanavalin A and streptokinase-streptodornase) was impaired in Lesch-Nyhan cells as judged from the incorporation of labelled thymidine, uridine and leucine. This situation could be abolished by incubation in a 5% CO2 atmosphere and even reversed by supplementation of bicarbonate to the culture medium. Blocking the de novo purine synthesis by Methotrexate resulted in a more pronounced inhibition of the mitogenic response in Lesch-Nyhan lymphocytes than in normal cells. The differences in proliferative response between normal and Lesch-Nyhan lymphocytes with regard to culture conditions point to the critical role of the de novo pathway in lymphocyte stimulation.

Adolescent↗

Enhanced delayed hypersensitivity skin test reactivity with serial testing in healthy volunteers.

Delayed hypersensitivity skin testing with multiple antigens is frequently used to evaluate immunopotentiation therapy in man. Since serial skin testing with a single antigen has been shown to augment the skin test response, the present study was undertaken to assess the effect of serial delayed hypersensitivity skin testing on skin test reactivity with multiple antigens. Each of twelve healthy volunteers received 0.1 ml of five antigens on two occassion, 6 weeks apart. The antigens used were streptokinase-streptodornase, Candida, Trichophyton, mumps and Mycobacterium tuberculosis (PPD). The results demonstrated enhancement of skin test reactivity in the majority of tests. Indeed, 38.9% of the tests which were negative with the first skin test ( less than 10 mm induration) converted to positive. Enhancement in reactivity was observed in the majority of test subjects with all antigens except PPD. Similar enhanced skin test reactivity was observed in fifteen additional subjects tested serially with Candida only. The observations in this study suggest that uncontrolled studies of immunopotentiation must be interpreted with caution since serial delayed hypersensitivity skin testing with single or multiple antigens results in enhanced skin test reactivity.

Adult↗

Perioperative suppression of the leukocyte migration inhibition assay in patients undergoing elective operations.

The effect of anesthesia and operation on immunity measured by leukocyte migration inhibition using streptokinase-streptodornase is reported in normal patients undergoing elective surgical procedures. Eight-five per cent of the patients exhibited postoperative immunosuppression, and this persisted for 60 days or longer in more than half of them. Despite this, no complication was encountered relating to wound healing or sepsis.

Adolescent↗

Delayed skin reactivity of patients with herpetic stromal keratitis.

Twenty-seven patients with chronic stromal keratitis due to herpes simplex virus were tested for delayed skin reactions, to investigate the non-specific immune reactivity in vivo. Skin tests were performed with five ordinary antigens-Candida, mumps, phytohemagglutinin-P (PHA-P), purified protein derivative of tubercle bacillus (PPD), and streptokinase-streptodornase (SK-SD). The reactivity of the patients was generally decreased, as compared to the age-matched 40 healthy controls. Especially, the reactivity of the patients to PHA-P was significantly decreased (p less than 0.007). The largest mean diameters of erythema at 24 or 48 hours in Candida and PHA-P were also significantly less in the patients than in the controls (Candida, p less than 0.02; PHA-P, p less than 0.05).

Adolescent↗

Evaluation of the activity of anti-inflammatory agents by means of skin tests (M.S.U., SK-SD): comparison with clinical results.

The anti-inflammatory effects of indoprofen were evaluated by skin tests with mono-sodium-urate (M.S.U.) and streptokinase-streptodornase antigen (SK-SD) in 15 patients suffering from inflammatory and degenerative arthropathies. A clear-cut correlation between the short-term response to the M.S.U. skin test and the clinical response was observed in 12 patients.

Anti-Inflammatory Agents↗

Effects of Varidase buccal tablets on the sputum.

Samples of sputum were collected from ten patients with chronic respiratory diseases following treatment with Varidase (streptodornase and streptokinase) buccal tablets, four tablets per day for a period of seven days, and were compared with specimens obtained before the therapy in terms of rheological and cytochemical parameters. The study revealed a tendency for the respiratory secretion to show a lowered yield point and a decrease in mucous fibers after the therapy, thus suggesting, to some extent, the efficacy of the drug as an expectorant.

Adult↗

Dichotomies in the reactivity to worm antigen in human schistosomiasis mansoni.

3H-thymidine incorporation was studied using peripheral blood mononuclear cells (PBMC) from 41 Egyptians with Schistosoma mansoni infection. The individuals were preselected to fall into 3 age-matched categories: asymptomatic with light and heavy infections and those with schistosomal hepatosplenomegaly. Seven uninfected individuals served as controls. PBMC from all groups were comparable in their responsiveness to phytohemagglutinin (PHA), streptokinase-streptodornase (SKSD), and the schistosome soluble egg antigen (SEA). However, DNA synthesis induced by soluble worm antigenic preparation (SWAP) differed significantly among these groups. The mean response to SWAP (delta cpm = experimental cpm minus control cpm +/- standard error) was markedly decreased in individuals with heavy infections (1,963 +/- 509) compared with those with light to moderate egg excretion (4,646 +/- 790; p less than 0.01). Moreover, 2 subgroups were discernible among patients with hepatosplenomegaly. Seven were unresponsive to SWAP (7659 +/- 231), whereas 13 had vigorous responses (14, 617 +/- 2263; p < 0.01). This is the first demonstration of an inverse relationship between specific immune responsiveness to adult worm antigens and intensity of infection in humans with schistosomiasis mansoni. The depressed lymphocyte reactivity in patients with heavy infection, whether cause or consequence of the parasite load, may perpetuate large worm burdens. Furthermore, the observations on patients with hepatosplenomegaly may reflect differing pathogenetic mechanisms.

Adolescent↗

Longitudinal studies of lymphocyte response to Toxoplasma antigen in humans infected with T. gondii.

Toxoplasma antigen-specific lymphocyte transformation was measured in subjects in whom the diagnosis of acute acquired Toxoplasma infection was documented and in whom the time of onset of clinical illness was carefully determined. Neither false positive nor false negative reactions to Toxoplasma antigen were seen in lymphocytes from uninfected subjects or subjects with chronic Toxoplasma infection. Lymphocytes from subjects in both of these control groups responded equally to a different antigen, streptokinase-streptodornase (SK/SD). On the initial determination, the lymphocytes of 7 of 24 subjects with acute Toxoplasma infection of less than 12 months' duration failed to transform to Toxoplasma antigen. Five of these 7 subjects were among a group of 14 who had developed clinical illness less than 3 months previously. To determine when lymphocyte transformation to Toxoplasma antigen developed, longitudinal studies were carried out in subjects with acute Toxoplasma infection whose lumphocytes failed to transform initially to Toxoplasma antigen. It was found that in all patients, lymphocytes transformed with Toxoplasma antigen eventually, though in two patients this occurred between 9 and 12 months after the initial infection.

Adolescent↗

Induction of resistance to Toxoplasma gondii in human macrophages by soluble lymphocyte products.

Autoradiography and light microscopy were used to study the effects of lymphocyte culture supernatants, prepared under a variety of conditions, on the course of intracellular Toxoplasma gondii infection in human monocyte-derived macrophages in vitro. Supernatants prepared by incubating lymphocytes of dye test- (DT) positive subjects with T. gondii lysate antigen (TLA), lymphocytes of DT/negative subjects with streptokinase-streptodornase (SK-SD), or both populations of lymphocytes with concanavalin A (Con A) were capable of activating macrophages to inhibit or kill intracellular T. gondii. Supernatants prepared with the homologous antigen (TLA) to the target organism appeared more active in conferring resistance to infection with T. gondii on macrophages than those prepared with a heterologous antigen (SK-SD) or mitogen (Con A). The number of lymphocytes was critical in preparing active supernatants. These results suggest that soluble lymphocyte mediators can activate human macrophages in vitro to inhibit or kill T. gondii.

Adolescent↗