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The detection of platelet isoantibodies by membrane immunofluorescence.

A membrane ummunofluorescence test for the detection of platelet isoantibodies is described. Gel filtration of the incubation mixture was incorporated in the procedure and proved effective for the removal of serum proteins from the platelet suspension. With this technique isoantibodies were found in the serum of 13 out of a group of 16 patients who had received multiple transfusions. The results were checked by measuring the uptake of 125I-labeled anti-IgG fraction by gel-filtered platelets. Subsequently the membrane immunofluorescence method was also compared with established techniques described for the detection of isoantibodies such as the microtest for lymphocytotoxicity and a complement-fixation method and the procedures based on the release of labeled serotonin, the phagocytosis of chromium-tagged platelets, the increase of platelet factor 3 activity, and on platelet aggregation. We had the opportunity to investigate the serum of one patient for the presence of isoantibodies against platelets from HLA identical siblings both before and after the administration of their platelets. On the basis of this experience it is concluded that the membrane immunofluorescence test for platelet isoantibodies is a relatively simple method with a high degree of specificity and adequate sensitivity.

Antibodies, Anti-Idiotypic

Characteristics of an antiluteinizing hormone isoantibody produced during gonadotropin induction of ovulation.

Production of an antihuman LH antibody was suspected in a woman with isolated LH deficiency who received human pituitary gonadotropin (hPG) to induce ovulation and who developed secondary drug failure associated with very high "serum LH' values. Binding of [125I]LH to various dilutions of the patient's serum was demonstrated by precipitation with polyethylene glycol or sheep antihuman immunoglobulin G (anti-IgG) but not by precipitation with sheep antihuman immunoglobulin M (anti-IgM). Unlabeled LH competitively displaced [125I]LH from a 1:200 final dilution of the patient's serum, and indicated a single class of binding sites with a binding affinity of 1.5 X 1011 M-1 and a binding capacity of 84 ng LH/ml serum. The isoantibody was reactive against antigenic determinants in hPG, LH, and hCG but not against human FSH. Further examination showed binding to the beta, but not the alpha, subunit of two LH preparations and to beta hCG. It is concluded that repeated administration of hPG to this patient with isolated LH deficiency evoked IgG isoantibody formation against the beta subunit of LH.

Adult

The management of dental extractions in cases of thrombasthenia complicated by the development of isoantibodies to donor platelets.

Two cases of thrombasthenia, a rare hereditary disorder of platelet function, are presented. The oral surgical and dental management of these cases is discussed in the light of the development of isoantibodies to transfused platelets in one of the cases and in another case encountered. The problems of obtaining donor platelets matched for platelet and HL-A antigens are discussed. Emphasis is placed on the use of local hemostatic measures and antifibrinolytic agents in the management of hemorrhage in this disorder and the avoidance of platelet transfusions as far as possible. Conservative dentistry and early preventive dental advice are considered desirable in order to avoid extractions.

Adolescent

Platelet aggregometry and anti-platelet isoantibodies.

102 sera from polytransfused patients have been screened in platelet aggregometry. Anti-human platelet isoantibodies, tested against 'responsive' human platelets in PRP, give in the aggregometer a decrease in optical density recorded as a sigmoidal curve. In the first step of reaction PF3 availability suggests that the primary action of antibody is to damage the platelet membrane. The second step might be a true aggregation (an ADP-mediated platelet clumping) or a platelet lysis, depending on the type and the potency of antibody, on the type of platelets (normal or thrombasthenic) and on some experimental conditions. These conclusions, confirmed by electron microscopy findings, suggest that aggregometry is a very rapid and simple method of detecting platelet antibodies.

Adenosine

Anti-glycosyl antibodies. Two sets of isoantibodies with specificity for different carbohydrate moieties of the same glycosyl antigen.

Two sets of anti-glycosyl antibodies have been isolated by affinity chromatography methods from the antisera of rabbits immunized with a vaccine of nonviable cells of Streptococcus faecalis, strain N. Both types of antibodies are directed against a dineteroglycan of glucose and galactose present in the cell wall of this organism. The members of one set, anti-galactose antibodies, combine with the terminal lactose residues of the glycan and the member of the other set, anti-lactose antibodies, combine with terminal lactose residues of the same glycan. Each set of antibodies is composed of multiprotein components. The electrofocusing method had been used to isolate the individual antibody proteins in homogeneous states as shown by both electrophoresis and ultracentrifugation techniques. Since the components of each set combine with the same structural unit of the antigen, they have been designated as isoantibodies. The sedimentation constants, electrophoretic properties, carbohydrate constituents, and amino acid compositions of the two sets of antibodies are recorded.

Amino Acids

Cutaneous hypersensitivity and isoantibody production in cattle injected with live or inactivated Anaplasma marginale in bovine and ovine erythrocytes.

Delayed cutaneous hypersensitivity and the production of isoagglutinins against normal bovine erythrocytes were measured in cattle inoculated with erythrocytic preparations containing live or inactivated Anaplasma marginale. The effect of blood group substances versus parasitic components on induction of delayed cutaneous hypersensitivity and isoimmunity was examined by using test antigens derived from normal and parasitized erythrocytes, virulent A marginale in bovine erythrocytes, and attenuated A marginale in ovine erythrocytes. The use of inactivated vaccine of bovine origin induced production of isoantibodies and cutaneous hypersensitivity to both bovine and ovine blood group factors, whereas a similar vaccine preparation of ovine origin stimulated antibodies and cutaneous reactivity only against ovine blood group factors.

Anaplasma

Evaluation of in vitro and in vivo activities of isoantibodies directed against idiotypes and recognition structures for transplantation antigens.

Anti-idiotype sera were prepared by injection of CBA anti-A/JAX serum with or without adjuvant into CBA mice. These sera were tested in allocluster inhibition and passive enhancement-facilitation. While the anti-idiotype sera inhibited allocluster formation, particularly when prepared with complete Freund's adjuvant, they had virtually no effect on enhancement of Sa I grafted in CBA mice except for a marginal prolongation of graft survival in one out of three experiments. Anti-RS serum was prepared by immunizing (CBA X A)F1 mice with CBA thymus or spleen cells. The sera were tested in local graft-versus-host inhibition and passive enhancement. F1 anti-CBA thymus serum inhibited the local graft-versus-host reaction but had no enhancing effect. F1 anti-CBA spleen serum was virtually ineffective in both tests although a slight tendency to graft-versus-host inhibition was noted. The relative contribution of anti-idiotype and/or anti-RS antibodies to transplantation reactions is discussed.

Animals

Isoantibodies to human exocrine pancreas and endothelium.

A cytoplasmic immunofluorescence of some human pancreatic exocrine cells was obtained in 19.2% of 270 patient undiluted sera and confirmed in 20.4% of 98 healthy controls. No relation was found with clinical disorders or autoantibodies. This reaction was always associated with human endothelial antibodies and both were clearly related to high titre "incomplete" IgG anti-A group isoagglutinins.

Endothelium

Isoantibodies to human serum proteins in children after blood and plasma transfusions.

The influence of blood and blood-product therapy was studied in two groups of children: 1) 90 children who had exchange transfusion after birth because of serologic incompatibility (aged 5 months to 5 years). In 7 children of this group isoprecipitins were detected. In 4 cases they reacted probably with lipoprotein group factors. One child had anti-Gm 2 antibodies. 2) 32 patients with various blood diseases, aged 18 months to 17 years, who had multiple transfusions of blood or plasma. In 12 children of this group (38%), precipitins were demonstrated. Two had antibodies to lipoprotein group factors. No anti-Gm antibodies were discovered in this group of children. The results of the study indicate an influence of transfusions of blood and blood products on the formation of antibodies to human proteins.

Adolescent

Factors related to host recognition of bacterial antigens which cause urinary infection.

Some gram-negative bacteria isolated from the urinary tract have on their surfaces antigens identical to or similar to those of human blood groups A, B, or (H) O. Human isoantibodies to these antigens appear to play some part in the immunologic response to urinary infections. It is postulated from this observation that human isoantibodies A and B persist because they are important segments in resistance to infections rather than reactions to other human tissues (as in transfusions or transplantation). To further assess the relationship between bacterial antigens similar to those of blood groups A or B and host isoantibody response we performed an in-depth study of this relationship in 13 patients with urinary infection of upper or lower tracts. Isoantibody of the immunoglobulin M class appeared to be the antibody which reacted with both bacteria and human erythrocytes. Patients with infections of the upper tracts had proportionately more cross-reacting anti-B antibody than those with lower tract infections, but the amounts of anti-A antibody were roughly equivalent in both types of infection. Response of a given host was genetically predetermined. Some deficiency in host recognition of bacterial antigens was noted since only 4 of 13 patients recognized bacterial A or B antigens while all normals did so. Study of the defined crossreactions between bacterial and blood group antigens offers further opportunities for definition of the genetic components of immunity to urinary infections.

Antibody Formation

Complement-dependence of platelet serotonin release test in polytransfused patients.

The research of platelet isoantibodies in patients with Cooley's anaemia was performed by simultaneous determination of the platelet-complement fixation test, platelet factor 3 availability assay and 14C-serotonin release test. In 93% of the examined patients we obtained positive results with the 5HT-release test, which appeared to be a complement-dependent reaction in most of the sera-containing isoantibodies, different from sera of patients affected by autoimmune thrombocytopenia.

Adolescent

[Laboratory tests applied to transfusion problems. Identification of dangerous universal donors and their frequency].

We studied 504 subjects, whose blood group wes O; they were periodic or occasional blood donors from Transfusional Center A.V.I.S., Policlinico "Umberto I", Roma. Our research was based on the principle stated by Gandini: he states that the natural isoagglutinin concentration equal or superior to 1:200 and the presence of hemolytic isoantibodies may make universal donors dangerous. Our results indicated that the percentage of this kind of donors is 27.75%. Sice 17.26% of our studied subjects showed hemolytic antibodies, we consider it is sufficient to identify dangerous donors through a dosage of hemolytic isoantibodies.

Blood Donors