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Immunological factors and post coital test in unexplained infertility.

Twenty-four couples facing longstanding primary or secondary infertility underwent semen analysis, PCT, functional evaluation of menstrual cycle, hysterosalpingography and laparscopy. All clinical findings were normal with the exception of PCT which was positive in 13 and negative in 11. All the women underwent a multiple approach investigation of local and circulating antibodies production as well as cell-mediated immunity against live spermatozoa. Sperm Immobilization Test (SIT) and Spermatotoxicity Tests (STT) were performed in a single experimental design on cervical mucus and blood serum. Leucocyte Migration Inhibition Test in presence of sperms (LMIT) was done on peripheral leucocytes. Local antispermatic activity in the cervical mucus was negative in all PCT positive cases, and positive in six out of 11 PCT negative cases. SIT and STT were both positive in cervical mucus and in blood in one case only. No correlation could be found between PCT and serum SIT, STT or LMIT. The fertility pattern expressed by the number of pregnancies per years of exposure, already low in the whole group, was even lower in the sub-groups with positive immunological factors. Positive immunological factors do not exclude the possibility of conception but appear to be associated with a reduced rate of conception.

Cell Migration Inhibition

Relationship of causative factors in spontaneous regression of cancer to immunologic factors possibly effective in cancer.

In a book written by Everson and Cole (1966) on spontaneous regression 176 examples of the phenomenon were encountered in the medical literature from 1900 to 1964, supplemented by cases referred by friends. No common denominator of explanations were found. Various types of trauma (e.g., biopsy, incomplete excision), transfusions, infection, hormone changes, drugs, etc. were encountered as possible causative factors. Most significant of all factors was encountered in the 13 examples of spontaneous regression of the bladder; in this series regression of the tumor occurred in 10 after transplantation of the ureters out of the bladder. A consideration and discussion of various reactions in human beings associated with therapeutic regressions have been reviewed hoping to develop a correlation between the two types of regression. At the time of publication of our monograph 9 years ago we were unable to suggest any mechanisms which might explain the regressions. However, since that time so many advances have been made in immunology that it appears now that a stimulation of the immune process might explain most of the regressions. We are just beginning to learn a few methods of stimulating the immune process. Use of BCG is one of the best examples of this stimulating process; other bacterial agents, or fractions, are known to have this action. No doubt there are innumerable others unknown, some of which might explain spontaneous regressions. It would appear that hormonal changes might be responsible for many of the regressions but this author doubts it explains many. More is known at the present time about cellular immunity than humoral immunity, but greater possibilities surely lie in humoral immunity. The blocking and unblocking activities developed by the Hellströms and associates are no doubt important. Immunoglobulins exert a very important role in the immune process; antibodies may consist of immunoglobulins but much more needs to be known before this relationship can be understood. The recent report (Amery, 1975) that levamisole (given at the time of resection of the lung for carcinoma) improves patient survival is exciting. Amery believes the drug may prevent the hematogenous spread of the tumor during surgery and/or may decrease the immunosuppression caused by a major operation.

Adult

Immunologic factors affecting the in-vivo and in-vitro survival of the Legionnaires' disease bacterium.

Immunologic factors affecting viability of the Legionnaires' disease (LD) bacterium were studied in vitro and in vivo in mice and guinea pigs. In bactericidal tests, fresh human serum quickly killed LD cells. Heating fresh serum to 56 degrees C for 30 min destroyed bactericidal activity; absorbing it with bentonite had little effect. Fresh normal human serum was more effective than guinea pig serum. Adding LD cells to fresh normal human serum caused a greater than 50% depletion in functional complement activity, apparently by activating the classic C-142 pathway, because human serum deficient in C4 was not bactericidal. Antibodies to the Knoxville 1 LD strain in guinea pigs showed enhanced complement-mediated bactericidal activity. Without complement, immune guinea pig or human sera prolonged in-vitro LD cell survival. Antibodies to Knoxville 1 in mice depressed in-vitro bactericidal activity of human complement against Knoxville 1. In-vitro bactericidal tests support in-vivo studies in subcutaneous chambers. Complement-deficient mice immunized with Knoxville 1 were (P less than 0.01) less resistant to homologous challenge than nonimmunized mice. Immunized guinea pigs had a greater than 80-fold increase in resistance to subcutaneous-chamber infection.

Animals

Immunologic factors determining survival of cadaver-kidney transplants. The effect of HLA serotyping, cytotoxic antibodies and blood transfusions on graft survival.

We assessed immunologic factors determining graft survival in 510 recipients of primary cadaver allografts at one center. The degree of HLA match grade did not directly affect graft survival (54 per cent in no-antigen match, and 42 per cent in three-antigen match, at two years). There was no correlation between the HLA match grade and the degree of stimulation of the mixed lymphocyte culture. Patients receiving more than five blood transfusions had a significantly better graft survival than nontransfused recipients (52 versus 23 per cent, respectively, at two years, P less than 0.001). The beneficial effect of transfusions was noted whether or not lymphocytotoxic antibodies were produced, provided adequate screening was performed before transplantation. Transfusions did not alter the degree of stimulation in the mixed lymphocyte culture. More liberal use of transfusions and frequent screening for cytotoxic antibodies would probably result in more effective cadaver-kidney transplantation.

Blood Transfusion

A study of the role of immunological factors in the pathogenesis of the anaemia of acute malaria.

Children with acute Plasmodium falciparum malaria and anemia were investigated to see if immunological factors could be implicated in the pathogenesis of their anaemia. Direct Coombs tests using an anti-whole immunoglobulin antiserum were negative in all 12 children tested but two had positive tests with antisera to C3b and C3d. Low plasma levels of C3 and C4 were found but these were not significantly different from values found in a group of children with acute malaria who were not anaemic. Serum levels of immune complexes were normal at the time of their presentation at hospital with anaemia but were elevated one month later. Incubation of group O rhesus-negative red cells in a serum pool obtained from children with acute malaria and anaemia did not cause enhanced haemolysis or reduce their survival time on injection into mice. Splenic uptake of red cells was, however, significantly enhanced. We conclude that the anaemia of acute malaria is due mainly to destruction of red cells by malaria parasites and to enhanced erythrophagocytosis of normal cells.

Acute Disease

[Immunologic factors and platelet vessel wall interactions (author's transl)].

Platelet subendothelium interaction is an essential step in thrombosis and hemostasis which can be modulated by immunoglobulins, immune complexes, complement, and leukocytes. Antiplatelet antibodies can induce thrombocytopenia which is accompanied by a reduced vascular wall thickness and an increased fenestration. Antigen-antibody complexes can activate platelets inducing platelet release and aggregation. This reaction is amplified by the first component of complement C1q. Cytotoxic antibodies directed against endothelial cells have been observed in transplantation. These antibodies can be directed against HL-A antigens or specific endothelial antigens. Anticollagen antibodies have been detected in patients with leprosy. The C1q component can inhibit adhesion of platelets to collagen and platelet aggregation induced by collagen. The association of acquired or congenital C1q deficiency and vasculitis has been reported. C3a is taken up by endothelial cells and metabolized. C3a and C5a can modify vessel wall permeability and activate granulocytes which can become toxic for endothelial cells. Leukocyte cationic protein can reduce platelet aggregation. An anti-von Willebrand antibody could be the origin of hemostatic abnormalities and endothelial lesions. The involvement of immunologic factors in platelet vessel wall interactions is complex. Immune complexes and some antibodies seem capable of promoting thrombosis, while a component of complement (C1q) may also have an antithrombotic role.

Antibodies

Platelet-associated coagulation factors: immunological detection and the effect of calcium.

Normal platelets were examined by conventional coagulation methods and specific immunological techniques for the presence of platelet-associated coagulation factors. Platelets washed in buffer containing calcium chloride gave different results form those washed in the absence of calcium. Factor XI was not detected in washed platelets by any technique. Factor II and factor X were removed from platelets by washing in calcium-free buffer but not by calcium-containing buffer. Procoagulant factor VIII was readily removed or inactivated by washing in the presence or absence of calcium, but factor VIII related antigen was consistently demonstrated after multiple washes in either buffer. Factor V activity and antigen was detected in platelet suspensions after multiple washes although the presence of calcium in the washing buffer gave higher factor V assays and stronger immunological reactions than when calcium-free buffer was used. The results are consistent with the presence of calcium dependent binding sites in platelets which may have a role in the enhancement of factor V and phospholipid reactions.

Blood Coagulation

Ascitic versus solid growth of Ehrlich ascites tumor influenced by immunological factors.

A certain number of CBA mice injected intraperitoneally with 1 X 10(6) or fewer Ehrlich ascites tumor (EAT) cells did not develop ascites tumors but solid tumors at the inoculation site. The incidence of solid tumors proved dependent on the level of immunological reactivity of recipients, being increased in mice with increased immunological potency and absent in mice in which this potency was reduced. Mice bearing solid tumors had increased level of cytotoxic antitumor antibodies in serum. Possible reasons for a greater immune resistance of cells growing in subcutaneous tissue, than in the abdominal cavity, are discussed.

Animals

Surgery for coccidioidomycosis in 52 diabetic patients with special reference to related immunologic factors.

Fifty-two diabetic patients who underwent pulmonary surgery for coccidioiodmycosis were evaluated by a retrospective study which included classification by stage of disease, status of insulin dependency, and reaction to coccidioidin skin test. The insulin-dependent diabetic patient had a fourfold increase in the incidence of more severe (progressive) disease. Perioperative therapy with amphotericin B may be of value in the adult surgical candidate with progressive disease but is not necessary or desirable in the juvenile diabetic patient. Coccidioidomycosis is a disease of relative immunocompromise, and a negative skin test should herald such compromise and support a decision for surgery. Such surgery in the progressive stages should be totally extirpative. The presence of inadequately resected disease may adversely affect subsequent immunologic resistance of the host.

Adult

Immunologic factors influencing the intra-tumor localization of ADCC effector cells.

The role of cellular and humoral immunity in the localization of blood-borne, bone marrow-derived ADCC effector cells into the T1699 mammary adenocarcinoma was investigated. Administration of ALG before tumor inoculation caused total immunosuppression and resulted in minimal in situ inflammation. ALG treatment started at the time of tumor inoculation suppressed the delayed hypersensitivity response below a detectable level but permitted a significant antibody response. Under these circumstances, the localization of ADCC effector cells into the tumors appeared normal. Similarly, administration of ALG at later stages of tumor growth, where ALG acts as an anti-inflammatory agent, did not interfere with the normal infiltration of ADCC effector cells in situ, although the delayed hypersensitivity response was totally suppressed. When melphalan treatment was used to produce tumor-bearing mice with an intact delayed hypersensitivity response but devoid of a significant antibody response, the drug-treated animals were found to have high levels of ADCC effector cells in situ. These results demonstrate that although the in situ inflammatory reaction appears to be immunologically inflammatory reaction appears to be immunologically dependent, neither the delayed hypersensitivity nor the antibody response is solely responsible for the localization of ADCC effector cells in the T1699 mammary tumor.

Adenocarcinoma

Significant immunologic factors in male infertility.

A number of patients who suffer from involuntary infertility showed a sperm antibody in the blood serum as detected by 2 different methods of sperm agglutination. These techniques are the Kibrick method (gelatin agglutination test) and the F-D method (tube-slide agglutination test). With the former technique 9% of men and 18% of women from infertile couples had a positive result, while the latter technique revealed 5% of men and 15% of women with positive results. Such cases are termed immunological infertility. Several cases of necrospermia also showed sperm antibody activity. In vasectomized men it has been shown that 50 to 60% have sperm antibody during the first year postoperatively. To develop new methods for treatment of infertility immunosuppression by means of corticosteroid medication was applied. A 7-day regimen of 96 mg. per day methylprednisolone was studied. A drastic decrease of antibody level could be seen in some cases and the wives became pregnant. There has been approximately a 30% success rate in a group of 15 such couples.

Antibodies

Tissue-specific stimulation of ornithine decarboxylase activity by pituitary factors immunologically related to growth hormone.

Ornithine decarboxylase (L-ornithine carboxylase, EC 4.1.1.17) is an important enzyme in polyamine synthesis. Its activity is influenced by several peptides hormones, including growth hormones, which have physiological significance in various growth situations. A crude ovine pituitary growth hormone preparation (NIH-GH-S10) was subjected to gel exclusion chromatography (Sephadex G-100) and two major fractions were obtained. One of these corresponded to dimeric growth hormone (GH). The other fraction was excluded by the gel matrix, suggesting a material of higher molecular weight than GH. This was confirmed by polyacrylamide gel electrophoresis in the presence of sodium dodecyl sulfate. Analysis of a high molecular weight fraction by radioimmunoassay (antisera prepared against GH) and by bioassay (weight gain in hypophysectomized rats) gave apparent GH contents of 19% and 6%, respectively. On a weight basis, the high molecular weight fraction was more effective than GH in stimulating the activity of hepatic and adrenal ornithine decarboxylase, but GH was more effective in stimulating renal ornithine decarboxylase activity. Subfractionation of the high molecular weight fraction using a high porosity gel (Sephadex G-200) gave four fractions, which were shown by amino acid analysis and by polyacrylamide gel electrophoresis in the presence of sodium dodecyl sulfate to be distinct from GH and heterogenous. These subfractions had different potencies for stimulating renal and hepatic ornithine decarboxylase activity. The ability of crude growth hormone preparations to stimulate ornithine decarboxylase activity in some tissues may be a function of pituitary factors, in addition to GH, which have minimal growth promoting activity.

Adrenal Glands

The role of immunological factors in the treatment of cancer.

Evidence has accumulated in the last 15 years that many experimentally-induced tumours in animals carry a tumour-specific transplantation-type antigen (TSTA) in their plasma membrane and that the tumour-bearing host responds to the TSTAs with the production of antibodies and cytotoxic mononuclear cells. In man the situation is not yet clear but there are indications that a similar situation may apply in many human malignancies. These findings have led to a resurgence in interest in the role of immunotherapy in the treatment of malignant disease, but as yet there is no clear evidence from properly controlled clinical trials that immunotherapy is the treatment of choice for any tumour. At present clinical immunotherapy constitutes a field for careful investigation but it cannot be considered a proven modality of treatment. At present its use must be confined to controlled studies in which benefit or possible harm can be determined. When giving immunotherapy it is necessary to monitor carefully the specific immune reaction of the host against the tumour. Further progress in immunotherapy requires a better understanding of why tumour cells succeed in vivo to escape destruction by the immune responses of the host. This review summarizes the current state of knowledge concerning the nature of TSTAs, the effect of the immune response to TSTAs on metastatic spread and the mechanisms of escape with special reference to the role which circulating soluble TSTA plays in 'neutralizing' the action of cytotoxic cells and antibodies. It is stressed that there is no support for the hypothesis of a 'blocking antibody'. Finally the different types of immunotherapy which have been developed in animal systems are described and possible clinical applications are discussed.

Animals