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Functional abolition of monocyte HLA-DR by aldehyde treatment. A novel approach to studies of class II restriction elements in antigen presentation.

The effect of low concentration aldehyde treatment (0.0012 to 0.005%) on the expression of HLA-DR Ag by human monocytes was investigated. This treatment was shown to selectively abolish the expression of HLA-DR determinants defined by a monomorphic mAb (YE2.36) in a rosette assay. The expression of class I MHC Ag and Fc gamma R remained unaffected. As a result, the presentation of the recall Ag tetanus toxoid and streptokinase-streptodornase (SK-SD) to freshly isolated autologous T cells and T cell clones was completely inhibited. Increasing the concentration of aldehyde to 0.05% consistently produced partial restoration of Ag-presenting capacity. Low dose aldehyde treatment did not affect monocyte viability or membrane turnover. Thus, aldehyde-treated monocytes produced a second generation of HLA-DR and expression was almost completely restored to normal after 24 h of culture. The presentation of monocyte class II Ag as alloantigens was also inhibited by low dose aldehyde treatment but inhibition was much less marked when monocytes were aldehyde treated at 2 h rather than at 24 h of culture. This is consistent with the reexpression of HLA-DR which occurred readily in the first 24 h of culture and much less readily thereafter. Low dose aldehyde treatment did not affect Ag uptake and processing. However, monocytes which had been pulsed with Ag, aldehyde-treated to abolish HLA-DR, and then cultured to allow regeneration of HLA-DR could present Ag only when given a second Ag pulse, suggesting that once the association between microbial Ag and HLA-DR had formed the Ag was not then free to reassociate with novel HLA-DR. Low dose aldehyde treatment did not affect monocyte IL-1 production, neither did it inhibit the detection of HLA-DR by soluble mAb in FACS analysis. These results are consistent with the view that low dose aldehyde treatment disrupts the tertiary structure of human Ia molecules such that allostimulatory determinants and restriction elements for exogenous Ag are rendered inaccessible to T lymphocyte receptors and to cell-bound anti-DR mAb in the rosette assay, although DR determinants may remain accessible to soluble mAb.

Aldehydes↗

Blocking plasma factors of migration inhibition factor production in patients with cervical carcinoma. A possible role in vivo.

The blocking activity was studied of plasma from patients with cervical carcinoma in a model of migration inhibition factor (MIF) production by normal human leukocytes. At the same time, the patients' in vivo (intradermal reactivity) and in vitro (MIF assay) responses were studied with two common antigens (streptokinase-streptodornase and purified protein derivative). The plasma of 15 of 27 patients with carcinoma was capable of blocking the MIF test of human normal leukocytes. Twelve of 15 patients with blocking factor in their plasma had no or only a slight in vivo response, although they had a good in vitor response. Two patients had blocking factor without any in vivo or in vitro response. Six patients who had in vitro responses and slight or no in vivo responses had no plasma blocking activity. Three patients had neither in vivo nor in vitro responses and lacked blocking activity in their plasma.

Cell Migration Inhibition↗

In vitro proliferation of lymphocytes from human volunteers vaccinated with armadillo-derived, killed M. leprae.

A killed, armadillo-derived Mycobacterium leprae vaccine was examined for its ability to induce cell-mediated responsiveness in purified protein derivative (PPD)-positive volunteers residing in a nonendemic country using the lymphocyte transformation test (LTT). A marked increase in the proliferative responses to a M. leprae-soluble antigen preparation was observed in the two groups which were vaccinated with the highest doses of the vaccine, i.e., 1.5 X 10(8) and 5 X 10(8) bacilli. This increase was observed in both groups 3 months after vaccination, and persisted for the study period of 1 year. The in vitro proliferative responses to whole bacilli, of both armadillo and human origin, showed a similar but smaller increase 3 months after vaccination. Some enhancement of responses to cross-reactive antigens, such as PPD, and to unrelated antigens such as streptokinase-streptodornase, tetanus toxoid and diphtheria toxoid, was also observed. Thus, the LTT revealed that while the killed M. leprae vaccine induced a specific cell-mediated response to M. leprae, it was also responsible for a nonspecific immune-enhancement effect in healthy volunteers.

Adult↗

Abnormal cutaneous reactions in dermatitis herpetiformis.

In 94% of the patients with dermatitis herpetiformis, a locally applied ointment with an ester of nicotinic acid (Trafuril) induced an abnormal reaction with erythema, edema, papules, and often vesicles. The appearance of the reaction to Trafuril is similar to DH lesions. It differs markedly from the reactions to iodide where, as a rule, only one large blister results. The reaction is most pronounced 12-24 hours after application of Trafuril. The reactivity is strongest in the predilection areas for dermatitis herpetiformis. Strongly increased reactivity to Trafuril in DH is induced by pretreatment with streptokinase, streptokinase-streptodornase, or urokinase. Diminished reactivity to Trafuril is seen after pretreatment with injections of Compound 48/80, tranexamic acid, cromoglycate, or application of fluocinolone-acetonide, as well as after stroking the skin.

Adult↗

Lymphocyte response to phytohemagglutinin in atopic dermatitis.

Studies of patients with atopic dermatitis (AD) have demonstrated several clinical and laboratory indications of immunity defects, but with frequently contradictory results. We have recently shown that many patients with negative cutaneous delayed type hypersensitivity to candidin and streptokinase-streptodornase may have normal in vitro lymphocyte transformation to the same antigens. We hypothesized that this represents recovery of immunocompetent cells when they are isolated in vitro. This report describes phytohemagglutinin-induced transformation of lymphocytes immediately after isolation and after four days in culture (precultured). Responses of lymphocytes from patients with AD were initially subnormal, but increased to normal levels after the preculture period. Our results suggest that defective immune function in AD is not due to a permanent intrinsic lymphocyte defect, but is more likely due to factors associated with disease activity and severity.

Adolescent↗

Defective cell-mediated immunity in carcinoma of the prostate.

Cell-mediated immunity was assayed in 18 patients with a histologic diagnosis of carcinoma of the prostate and in 10 control patients with benign prostatic hypertrophy. In vivo cell-mediated response was assayed by intradermal skin testing to a battery of five delayed hypersensitivity antigens. In vitro cell-mediated immunity was studied by lymphocyte transformation using both heterologous and autologous "serums" and nonimmune rosette formation. Lymphocyte transformation studies were carried out using both specific antigens (Dermatophyton and streptokinase-streptodornase) and a nonspecific mitogen (phytohemagglutinin). Nonimmune rosette formation was performed under numerous temperature ranges. A defect in cell-mediated immunity was found in patients with carcinoma of the prostate. Skin tests demonstrated a significantly increased incidence of energy in cancer patients. Mitogen-induced lymphocyte transformation was significantly depressed when autologous serum from patients with carcinoma of the prostate was utilized in the procedure. It is concluded that defect in cell-mediated immunity does exist in patients with carcinoma of the prostate. This defect is expressed in vivo and in vitro and seems to be mediated by a serum factor.

Aged↗

Histoplasma meningitis with common variable hypogammaglobulinemia.

Histoplasma meningitis (HM) has been reported to occur primarily in association with disseminated histoplasmosis (DH). We report a case of histoplasma meningitis occurring in a patient with common variable hypogammaglobulinemia (CVH) in which no manifestations of DH were observed. L. L., a 66-year-old Caucasian male, clerical worker, developed occasional episodes of dizziness and tinnitus in mid-1971. During 1972, increasing frequency of these episodes and gradually progressive confusion were noted. In January 1973, vomiting, forther confusion, obnubilation, and a left central facial paresis developed and he was hospitalized. Physical examination revealed no pulmonary abnormalities, lymphadenopathy or hepatosplenomegaly. Over the ensuing 6-week evaluation, there was occasional fever to 38.5 degrees C. Chest roentgenogram was normal. Cerebral angiography suggested a mass in the left cerebellar hemisphere. EEG was diffusely slow. Multiple CSF examinations revealed: Glucose 7-18 mg/with a normal blood glucose, protein 109-256 mg/and cells 66-140 (95 + % mononuclear). Histoplasma capsulatum was cultured from CSF but not from sputum, urine, blood or bone marrow. Skin tests for PPD, histoplasmosis, coccidiodomycosis, blastomycosis, mumps, dinitrochlorobenzene and streptokinase-streptodornase were negative then and 6 months later. Histoplasma serum antibody was absent. Immunoglobulin analysis revealed IgG 430 mg %, IgA 46 mg %, and IgM 35 mg %, which with the history and skin test results suggested CVH. Treatment with 2.51 gm of amphotericin B given intravenously over a 3-month period resulted in complete reversal of all neurologic signs and clearing of the confusion. The remission has been maintained for two years. This case represents a primary infection of the CNS by histoplasma. The relationship between the HM and the CVH will be discussed.

Agammaglobulinemia↗

Modulation of the host response in human schistosomiasis. IV. Parasite antigen induces release of histamine that inhibits lymphocyte responsiveness in vitro.

Several mechanisms underlying the suppression of in vitro lymphocyte transformation responses to parasite antigens in human schistosomiasis have been previously described, but the role that immediate hypersensitivity reactions may have in regulating these lymphocyte transformation responses has been little explored. Using Hypaque-Ficoll-separated peripheral blood mononuclear cells (PBMC) from patients with schistosome infections, we found that histamine release could be demonstrated routinely in lymphocyte cultures challenged with adult worm, egg, or cercarial antigens. Release occurred within 1 hr of stimulation, and histamine persisted in the cultures for 6 days at levels of 10(-6) to 10(-7) M. That such concentrations were capable of suppressing LT responses in vitro was shown by the addition of exogenous histamine to modified PBMC culture systems from 10 normal individuals and eight patients with Schistosoma mansoni or Schistosoma mekongi infections. Responses to phytohemagglutinin, streptokinase-streptodornase, and tetanus were equivalently suppressed in both groups (50.8 +/- 6% in normals and 55.9 +/- 6.2% in patients), and the doses required for maximal suppression were similar. Passage of PBMC from infected patients over nylon wool, in addition to removing adherent suppressor cells, also markedly reduced the number of histamine-containing basophils (74 +/- 4.5% removed). The enhanced responsiveness to parasite antigen by PBMC depleted by nylon wool passage was abrogated by the addition of exogenous histamine to the cultures. These results indicate that in routine PBMC cultures 'nonspecific' lymphocyte suppression by histamine liberated from basophils in an antigen-specific fashion may help to account for the specific suppression of lymphocyte responses to parasite antigens so characteristic of patients with schistosome and other helminth infections.

Antigens↗

Antigen-specific lymphocyte transformation in patients with recent yersiniosis.

Lymphocyte transformation in patients with recent yersiniosis was studied. A micromethod using washed blood cells and Yersinia enterocolitica antigen was employed. The washed blood cells were incubated in the presence of various dilutions of heat-treated whole bacteria; these proved as antigen superior to gentamicin- or formalin-treated bacteria. Patients with recent yersiniosis had a significantly higher response against Yersinia antigen as compared to 20 healthy controls, who had either no response or a low response. No difference could be observed in responses against PPD or streptokinase-streptodornase, or in the mitogen responses between these two groups. A marked cross-reaction was observed between Yersinia and Escherichia coli antigen. The results show that patients with recent yersiniosis develop lymphocyte transformation response against Yersinia. Lymphocyte transformation test can be used in the study of host responses against infecting Yersinia in patients with different clinical pictures of yersiniosis.

Antigens, Bacterial↗

Subcorneal pustular dermatosis--an unusual course.

In a patient with subcorneal pustular dermatosis (SPD) the appearance of new pustular lesions characteristic of the disease was triggered by two episodes of drug eruption (induced by dapsone and quinidine sulphate respectively) and by the intra-dermal injection of the recall antigens Candida and streptokinase-streptodornase, performed for evaluation of delayed hypersensitivity. Both episodes of drug eruption were probably the result of an immediate-type hypersensitivity reaction towards the offending drugs, as indicated by positive mast cell degranulation tests.

Aged↗

Autologous and allogeneic suppressor lymphocyte inhibition of human erythroid colony forming unit proliferation.

Certain in vitro and in vivo animal studies have supported the concept that lymphocyte-derived microenvironmental factors are important in erythroid proliferation. Considerable controversy has developed regarding the applicability of these concepts to human erythroid proliferation. We, therefore, evaluated the role of lymphocytes on human erythroid colony forming unit (CFUE) proliferation in the plasma clot system. Bone marrow (BM) was obtained from normal donors and cocultured with the following cell populations: a) cultured (6 day) lymphocytes autologous or allogeneic to BM; b) cultured lymphocytes stimulated with conconavalin A (Con A), allogeneic lymphocytes or streptokinase streptodornase (SKSD). In general, unstimulated cultured lymphocytes enhanced CFUE proliferation. In contrast, lymphocytes stimulated with Con A. SKSD, or allogeneic lymphocytes suppressed lymphocyte proliferation. The suppressor cell was concentrated in the T-cell fraction obtained by sheep red blood cell rosetting followed by ficoll-Hypaque centrifugation. Both allogeneic and autologous stimulated T-cells suppressed CFUE. Moreover, supernatants from stimulated lymphocyte cultures suppressed CFUE proliferation although the cell of origin and characteristics of the suppressive factors have not been defined. These data support the concept that lymphocytes may play an important role in modulating the human BM erythroid microenvironment.

Bone Marrow Cells↗

Abnormalities of lymphocyte transformations in women with condylomata acuminata.

The cellular immunity of 16 women with recalcitrant condylomata acuminata was investigated with an in vitro assay of antigen-induced lymphocyte transformations. Results were compared to those of 24 age-matched controls. Lymphocyte transformation responses (in counts per minute) for women with condylomata were much lower than controls for phytohemagglutinin-P, 32,285 and 60,015, (P less than .001); for concanavallin A, 28,664 and 58,605, (P less than .001); and for pokeweed mitogen, 34,941 and 73,394 (P less than .0001). No significant differences in lymphocyte transformations were noted between the 2 groups to Candida or streptokinase-streptodornase antigens. Immunosuppressive diseases, recurrent infections, and intraepithelial neoplasms of the genital tract were more frequent in the group of women with condylomata, and this seems to clinically substantiate the depressions noted in their in vitro cellular immunity. A refractory course of condyloma acuminatum in some women may be a reflection of an underlying state of immunosuppression.

Adolescent↗

Suppressor T cell numbers and function in atopic patients with high serum IgE levels.

Suppressor T cell function and the sensitivity of lymphocyte transformation to histamine has been studied in 9 atopic patients with high serum IgE levels and in 14 controls. The effect of concanavalin A (Con A) induced suppressor T cells on the proliferative response of fresh lymphocytes to mitogens and antigens was measured; in atopic subjects the median suppression to 5.0 micrograms/ml Con A was 80% to 1.0 microgram/ml Phytohaemagglutinin (PHA) was 73%, to Dermatophagoides pteronyssinus extract was 45% and to streptokinase--streptodornase was 24%. Indomethacin increased lymphocyte proliferation to mitogens, but to a variable degree, in both groups. Histamine suppressed lymphocyte transformation to PHA and Con A (median suppression in normal subjects 38 and 46%, and in atopics 51 and 60%) and to D. Pteronyssinus extract. There was no significant difference between normal subjects and atopics in any of these functional assays. The relative and absolute numbers of total T cells, helper T cells and suppressor T cells measured by monoclonal antibodies and the helper to suppressor T cell ratio were normal in the atopic group. These results show that the activity of Con A induced suppressor T cells and the effect of histamine and indomethacin on lymphocyte proliferation is normal in highly atopic subjects. No suppressor T cell defect has been identified using these assays.

Adolescent↗

Atopic dermatitis, impaired cellular immunity, and molluscum contagiosum.

A substantial elevation in the level of serum IgE (7,000 to 19,000 ng/ml) was noted in a man with atopic dermatitis and chronic molluscum contagiosum. Cell-mediated immunity (CMI) was depressed in vivo (cutaneous anergy), whereas in vitro tests showed normal numbers of "T" rosette-forming lymphocytes, a normal phytohemagglutinin-P-elicited lymphocyte transformation response, and lymphocyte transformation reactivity to the antigens streptokinase-streptodornase and purified protein derivative. Accumulated evidence suggests that patients with atopic dermatitis may have, associated with an elevated serum IgE level, a functional defect(s) in CMI that is greater in vivo than in vitro. This functional defect may impair host defense and account for the chronic molluscum contagiosum infection present in this patient.

Adult↗

Differentiation-associated alteration in human monocyte-macrophage accessory cell function.

Human monocyte (Mo) to macrophage (Mx) differentiation is associated with marked and well studied changes in morphology, biochemical parameters, and effector cell function. Nevertheless, the comparative accessory cell (AC) function of blood Mo and differentiated Mx has not been carefully studied. We, therefore, examined the kinetics and mechanisms of change in AC function during in vitro Mo to Mx differentiation. The system utilized has two distinctive features: blood Mo and resultant cultured Mx represent a cohort of cells derived from the bone marrow within a 12-hr period. Moreover, the in vitro derived Mx utilized herein have been characterized extensively and are functionally and biochemically similar to pulmonary macrophages (PMx). In the experiments reported, AC functions of blood Mo, Mx derived from Mo after 1 to 6 days of culture, and PMx was compared. AC were cultured with nylon wool column-purified autologous T cells and were stimulated with concanavalin A (Con A) or streptokinase-streptodornase (SKSD). Blood T cell proliferation to Con A or SKSD was inhibited greater than 90% by the removal of Mo and was reconstituted by 20% Mo. Mx derived from Mo by culture for 1 to 3 days exhibited the same (or better) AC function as Mo when T cells were stimulated with either SKSD or Con A. In marked contrast, Mx derived from 6-day cultures exhibited less than or equal to 15% of Mo (i.e., control) capacity to support T cell proliferative response to SKSD. Six-day Mx support T cell proliferation to Con A was somewhat variable. Similar to 6-day cultured Mx, PMx failed to function as AC. The mechanism of loss of AC function was examined: a) cultured Mx maintained Ia antigen positivity for greater than 8 days; b) mixing experiments with Mo + 6-day cultured Mx or Mo + PMx demonstrated no T cell suppression; c) the normal capacity of most 6-day cultured Mx to support Con A but not SKSD induced T cell proliferation, apparently ruled out the loss of the ability to deliver a nonspecific "second signal" as the involved mechanism; d) inhibition of Mo to Mx differentiation by dexamethasone preserved AC activity. Thus, human culture-derived Mx and PMx exhibit deficit AC function through loss of an undefined mechanism. However, loss of AC antigen processing or presentation may occur.

5'-Nucleotidase↗

Coccidioidomycosis: early immunologic findings.

T and B lymphocyte number and lymphocyte response to phytohemagglutinin, pokeweed mitogen, concanavalin A, coccidioidin and streptokinase-streptodornase (SKSD), plus monocyte ingestion of coccidioidin- and IgG-coated chicken erythrocytes were measured in 5 patients with coccidioidal meningitis, 11 with nonmeningeal extrapulmonary cocidioidomycosis and 5 with localized pulmonary infections. These cases were evaluated within six months of the onset of infection. Lymphocytic responses to phytohemagglutinin, pokeweed mitogen, concanavalin A, SKSD and coccidioidin and monocytic ingestion of coccidioidin- and IgG-coated chicken erythrocytes were severely decreased in patients with meningeal and nonmeningeal, extrapulmonary coccidioidomycosis but not in patients with localized pulmonary infections. T and B cell numbers, however, were normal in all groups. Thus, defects in cellular immunity are involved in the pathogenesis of extrapulmonary coccidioidomycosis and measurements of lymphocytic and monocytic function may identify patients prone to extrapulmonary infection.

Adult↗

Immunosuppression in Kenyan visceral leishmaniasis.

Cell-mediated immune responses were evaluated in 15 patients with active visceral leishmaniasis from Masinga location in eastern Kenya where the disease is endemic. Age and sex matched controls were selected from a village school in the same area. In vivo studies were carried out by skin testing with leishmanin, tuberculin, streptococcal and candida antigens. Lymphocyte blastogenic transformation to the mitogens phytohaemagglutinin (PHA) and concanavalin A (Con A) and the antigens purified protein derivative (PPD), streptokinase-streptodornase (SKSD) and leishmanial antigen (LA) was studied in vitro. The results showed that immunosuppression in visceral leishmaniasis in Kenya was both specific and non-specific. In the majority of patients there was complete anergy to all antigens in vivo and in vitro. The suppression of responses to mitogens was less marked. Recovery of non-specific responses preceded the development of specific immunity. In a small number of patients (23%) immune unresponsiveness to leishmanial antigens persisted 1 year after parasitological cure.

Adolescent↗

Delayed hypersensitivity skin testing: response rates in a surgical population.

The results of this study indicate that skin test responses should be measured at both 24 and 48 hours post-injection and considered reactive or positive if induration of greater than or equal to 5 mm. is noted at either time. The practice of measuring responses at 48 hours only is neither appropriate nor recommended as it may produce a large percentage of false negative results. Erythema without induration was noted in a small percentage of patients. Future studies should evaluate the efficacy of erythema greater than or equal to 15 mm. in the absence of induration as a reactive response to mumps antigen. The validity of data interpretation must ultimately be based on correlations with morbidity and mortality. Streptokinase-streptodornase, mumps, and trichophyton were the three antigens with highest response rates, and this battery detected 94% of the reactive or positive responses to the five-antigen battery.

Adolescent↗