Deficiency of interferon-alpha generating capacity is associated with susceptibility to opportunistic infections in patients with AIDS

Acquired immune deficiency syndrome (AIDS) is a newly described syndrome in which patients are susceptible to certain malignancies and opportunistic infections (OI) usually found only in immunosuppressed individuals. Patients with AIDS have been found to have deficiencies of virtually all of their host defense systems. In this report, the natural resistance systems have been discussed. Although a deficiency of NK-cell function has been found in many patients with AIDS, this deficiency failed to distinguish patients susceptible to OI or malignancy from male homosexual controls. A deficiency of interferon-alpha generation by mononuclear cells upon exposure to HSV-1 infected fibroblasts was the best correlate with susceptibility to OI in AIDS patients. This deficiency failed to correlate with serum levels of acid-labile interferon-alpha in these patients. Although the interferon generating deficiency may be caused by the infections in these patients, it is more likely that the deficiency lays the groundwork for the establishment of the opportunistic infections.

Contact tracing in the acquired immune deficiency syndrome (AIDS). Evidence for transmission of virus and disease by an asymptomatic carrier

The sexual contacts of a patient with acquired immune deficiency syndrome were traced, and clinical, immunological, and serological evidence was obtained and evaluated. It was determined that the patient acquired the disease from a homosexual man who had no symptoms, but in whom laboratory evidence of immunodeficiency and serological evidence of exposure to the AIDS-associated retrovirus was found.

A human monoclonal antibody to cytomegalovirus (CMV)

We report the development of a human monoclonal antibody to cytomegalovirus (CMV) produced from a human X human hybridoma. This hybrid was developed by fusion of an EBV-transformed cell line making antibody to CMV and a human lymphoblastoid cell line WI-L2. The antibody is directed to a CMV-specific antigen primarily in the nucleus of CMV-infected human fibroblasts. It cross-reacts with at least 10 different strains of CMV and may provide a method for the rapid in vitro diagnosis of CMV infections. The production of CMV-specific human man monoclonal antibodies from human-human hybridomas for future therapeutic use is now technically feasible with this specific method of production.

A human monoclonal antibody to cytomegalovirus (CMV)

We report the development of a human monoclonal antibody to cytomegalovirus (CMV) produced from a human X human hybridoma. This hybrid was developed by fusion of an EBV-transformed cell line making antibody to CMV and a human lymphoblastoid cell line WI-L2. The antibody is directed to a CMV-specific antigen primarily in the nucleus of CMV-infected human fibroblasts. It cross-reacts with at least 10 different strains of CMV and may provide a method for the rapid in vitro diagnosis of CMV infections. The production of CMV-specific human man monoclonal antibodies from human-human hybridomas for future therapeutic use is now technically feasible with this specific method of production.

HLA-A,B,C and DR antigen frequencies in acquired immunodeficiency syndrome (AIDS) patients with opportunistic infections

During the past three years, an epidemic of acquired immunodeficiency syndromes (AIDS) involving the presence of specific forms of cancer (notably Kaposi's sarcoma) and infection (e.g., pneumocystis carinii) ordinarily seen only in severely immunosuppressed hosts has occurred among active homosexuals, Haitian immigrants, drug users, and hemophiliacs in large cities in the United States and elsewhere. An as yet unidentified viral agent is presumably the cause of the initial immunodeficiency and host genetic factors may influence the subsequent development of different clinical symptoms in different patients. We have previously reported that the HLA antigens DR5 and DR2 are associated with susceptibility to Kaposi's sarcoma (KS) in different Caucasian subpopulations. We now have also noted that AIDS patients with opportunistic infections have a normal frequency of DR2 and DR5 and a significantly increased frequency of DR3 and that the ultimate clinical expression of AIDS in patients with unexplained lymphadenopathy may depend upon genetic factors associated with these particular DR types.

Experience with the colony-forming (stem cell) assay of in vitro chemosensitivity in the management of patients with advanced malignant melanoma

Twenty-two patients with advanced malignant melanoma had tumor nodules biopsied and tumor cell colonies established in vitro in the colony-forming assay in the presence of vindesine. The patients then received iv vindesine at a dose of 3 mg/m2/week for 6 weeks. In four patients, in vitro death of cells exposed to vindesine in vitro correlated with clinical response to therapy. In the remaining 18 patients, lack of both in vitro and clinical response was noted.

The active pivot shift: the role of the popliteus muscle

Ligament insufficiency due to athletic injury is widely recognized and reported as an etiological factor in knee joint instability. It was recognized that a patient presenting with knee joint instability due to past hockey injury to the anterior cruciate ligament, subsequently verified surgically, was able to voluntarily and actively perform the pivot shift maneuver with his knee as a result of his anterolateral rotatory instability. During a subsequent 6 month period, three other patients with similar anterior cruciate deficiencies presented with this same active pivot shift maneuver phenomenon. A study was designed to determine the active muscle or muscles involved in this abnormal active motion in the knee joint with anterolateral rotatory instability. Electromyographic studies with needle electrodes were conducted on a variety of muscles in four subjects presenting with the instability. Results indicated that the popliteus muscle plays a major role in the active performance of the pivot shift maneuver.

Bronchoalveolar lavage in the diagnosis of diffuse pulmonary infiltrates in the immunosuppressed host

The usefulness of bronchoalveolar lavage in the diagnosis of pulmonary infiltrates in the immunosuppressed patient was studied in 97 patients. In immunosuppressed patients, the available diagnostic procedures are often invasive and have variable yield and a potential for serious complications. Bronchoalveolar lavage had an overall diagnostic yield of 66% (61 of 92 diseases). It was most effective in the diagnosis of opportunistic infections, including infection with Pneumocystis carinii (18 of 22 cases), cytomegalovirus pneumonia (10 of 12 cases), fungal pneumonia (5 of 6 cases), and mycobacterial disease (4 of 5 cases). The technique was also helpful in suspected pulmonary hemorrhage (7 of 9 cases) but was less useful for diagnosing malignancy (10 of 22 cases) and drug-induced toxicity (6 of 15 cases). Findings of bronchoalveolar lavage could be combined with those of transbronchial biopsies, brushings, and washings in the diagnosis of most of the diseases. The procedure was safe, even in thrombocytopenic patients and those requiring mechanical ventilatory support. Bronchoalveolar lavage is a valuable procedure for evaluation of pulmonary disease in the immunosuppressed host.

A mouse model for delayed-type hypersensitivity skin changes in chronic renal failure

Cellular immunity in mice with chronic renal failure was assessed by delayed-type hypersensitivity (DTH) skin testing. Normal, sham-operated, and C57BL/6 mice with chronic renal failure were sensitized and challenged with oxazolone, a contact-sensitizing agent. The magnitude of the DTH response was determined by sequential measurements of ear thickness following local challenge. Consistently lower DTH responses were observed in mice with chronic renal failure. DTH responses in mice with renal failure were highest at 48 hr postchallenge (9.3 +/- 1.3) but still significantly lower (p less than 0.05) than those in both sham-operated (12.9 +/- 0.7) and normal mice (12.6 +/- 1.0). When compared with those of the other groups, DTH responses of sham-operated animals were brisker (24 hr), while those of normal mice were more sustained (72 hr). These results confirm previously reported observations in end-stage renal disease patients. The mouse, along with appropriate skin testing, appears to be a useful model for studying cellular immunity in chronic renal failure.

Surgery for abdominal aortic aneurysms. With special reference to high-risk patients

Between 1973 and 1980, 150 patients with an abdominal aneurysm underwent aneurysmectomy at St Vincent's Hospital, Sydney. Of these, 52 were high-risk patients with significant medical disease, including myocardial ischaemia, angina pectoris, obstructive airways disease, portal hypertension, and end-stage renal disease. The operative mortality for the 150 patients was 4.6%; it was 9.6% in the high-risk group. The predicted overall survival rate at seven years, with a minimum of two years' follow-up, was 55%, which compares favourably with that reported in other series, particularly in view of the advanced age of most of the patients--43% were in the eighth decade of their lives. The predicted survival rate of 26% for the high-risk group is nearly four times the survival rate predicted by Szilagyi for patients with untreated aneurysms. This increased life expectancy justifies the adoption of the widest possible selection criteria for elective aneurysmectomy.

Defective T-cell response to PHA and mitogenic monoclonal antibodies in male homosexuals with acquired immunodeficiency syndrome and its in vitro correction by interleukin 2

We studied the ability of phytohemagglutinin (PHA) and two anti-T-cell monoclonal antibodies OKT3 and Pan T2, to induce proliferation and interleukin 2 (IL2) production in peripheral blood lymphocytes (PBL) from 21 homosexual patients: 12 with Kaposi's sarcoma (KS), 4 with reactive lymphadenopathy, and 5 with opportunistic infections. All patients with KS and opportunistic infections had significantly lower mitogen-stimulated DNA synthesis, as compared to the controls, irrespective of the mitogen used (P less than 0.01). The patients with lymphadenopathy exhibited significantly lower responses only in the OKT3 assay as compared to normals (P = 0.009). The production of endogenous IL2 was significantly lower in PBL cultures from patients with KS and with opportunistic infections, irrespective of the mitogen used, as compared to healthy male controls, and also significantly lower in the Pan T2-stimulated cultures from patients with lymphadenopathy. The addition of highly purified IL2 was able to restore partially lymphocyte proliferation in vitro in the presence of these mitogens in all patients. Our studies demonstrate (1) that male homosexuals even without clinical manifestations of immunodeficiency frequently exhibit a proliferative T-cell defect when anti-T-cell monoclonal antibodies rather than PHA are used as mitogens, (2) that this proliferative defect is associated with defective IL2 production, and (3) that this defect is at least in part correctable in vitro by highly purified IL2.

A prospective study of complications of pulmonary artery catheterizations in 500 consecutive patients

Five hundred twenty-eight pulmonary artery catheters were inserted in 500 patients at the New York University Medical Center between May and November, 1981. Complications occurred in 126 of 528 catheterizations. Serious complications occurred in only 23 of these 528 catheterizations (4.4 percent). These complications, while serious, did not contribute directly to any of 31 deaths seen in these patients. Pulmonary artery catheters were reported by clinicians to have been of benefit in the management of 80 percent of these patients. We conclude, in view of this experience, that the wide use of these catheters is justified, but only if there is a probability that the catheters will significantly contribute to the management of the individual patient.

Opportunistic infection in previously healthy women. Initial manifestations of a community-acquired cellular immunodeficiency

Opportunistic infections and unusual tumors have been reported in an unprecedented outbreak of community-acquired cellular immune deficiency among homosexual and drug-abusing men. We report five women with the same syndrome. The women were residents of metropolitan New York City closely associated with drug abuse either by personal use (our patients) or close sexual contact with an abuser (one patient). One patient was bisexual. All five patients developed Pneumocystis carinii pneumonia as well as combinations of other opportunistic infections including oral candida, disseminated mycobacteria, and ulcerative herpes simplex infections. All patients had marked depression of cellular immune function. Three patients died. The appearance of this syndrome in women has important implications with regard to the epidemiology and etiology of this emerging syndrome.

Hypoxemia reflexly increases secretion from tracheal submucosal glands in dogs

We anesthetized dogs, ventilated their lungs via the lower trachea, and exposed the epithelial surface of the upper trachea and coated it with powdered tantalum. Secretions from submucosal gland ducts formed elevations (hillocks) in the tantalum layer; we counted the number of hillocks that appeared in a 1.2-cm2 field. In 12 dogs, during normoxemia, 12 +/- 2 hillocks/cm2 formed in 90 s; during severe hypoxemia [fractional inspired O2 concentration (FIO2) = 0.05], 40 +/- 4 hillocks/cm2 formed in 90 s. Injections of sodium cyanide (25-75 micrograms) into the arterial supply to the carotid body also stimulated tracheal submucosal gland secretion. Secretory response to hypoxemia was suppressed by 1) section of both carotid sinus body nerves in six dogs and 2) section of both superior laryngeal nerves and vagus nerves in six other dogs. During mild hypoxemia (FIO2 = 0.10 or 0.15) tracheal submucosal gland secretion still increased. We conclude that hypoxemia increases secretion from submucosal glands in canine trachea by a carotid body chemoreflex.

Microenvironmental immunoregulation: possible role of contrasuppressor cells in maintaining immune responses in gut-associated lymphoid tissues

The addition of Peyer's patch T cells from most strains of mice to spleen cells in primary Mishell-Dutton cultures either has no effect or augments the spleen cells' response to sheep erythrocytes. However, if the Peyer's patch T cells are treated with an anti-I-J antiserum and complement to remove contrasuppressor-inducer cells, the remaining Ly-2 cells (T cells that express Ly-2 but not Ly-1) are highly suppressive. This "latent" suppressor cell activity also can be revealed by removing contrasuppressor-acceptor (transducer) cells from the splenic assay population with either an anti-I-J or anti-Ly-2 antiserum. These findings, taken together with previous work showing that orally administered antigen leads to systemic tolerance, give experimental support to the notion that contrasuppression may be important in allowing microenvironmental immune responses (in this case the gut-associated lymphoid tissue) to take place while systemic immunity is suppressed.