Occlusion of 22Na+ and 86Rb+ in membrane-bound and soluble protomeric alpha beta-units of Na,K-ATPase

In this work, we examined occlusion of 22Na+ and 86Rb+ in membranous and detergent-solubilized Na,K-ATPase from outer renal medulla. Optimum conditions for occlusion of 22Na+ were provided by formation of the phosphorylated complex from the beta,gamma-bidentate complex of chromium (III) with ATP (CrATP). Release of occluded cations occurred at equally slow rates in soluble and membrane-bound Na,K-ATPase. Values of 22Na+ occlusion as high as 11 nmol/mg of protein were measured, corresponding to 1.8-2.7 mol of Na+/mol of phosphorylated Na,K-ATPase as determined by 32P incorporation from [gamma-32P]CrATP. Maximum capacity for phosphorylation from [gamma-32P]CrATP was 6 nmol/mg of protein and equal to capacities for binding of [48V]vanadate and [3H]ouabain. The stoichiometry for occlusion of Rb+ was close to 2 Rb+ ions/phosphorylation site. In an analytical ultracentrifuge, the soluble Na+- or Rb+-occluded complexes showed sedimentation velocities (S20,w = 6.8-7.4) consistent with monomeric alpha beta-units. The data show that soluble monomeric alpha beta-units of Na,K-ATPase can occlude Rb+ or Na+ with the same stoichiometry as the membrane-bound enzyme. The structural basis for occlusion of cations in Na,K-ATPase is suggested to be the formation of a cavity inside a monomeric alpha beta-unit constituting the minimum protein unit required for active Na,K-transport.

Purification of Ca2+-activated K+ channel protein on calmodulin affinity columns after detergent solubilization of luminal membranes from outer renal medulla

A method is developed for purification of the protein of the Ca2+-activated K+ channel from outer renal medulla of pig kidney. The response of this K+ channel to physiological concentrations of Ca2+ is important for regulation of transtubular NaCl transport. In reconstituted vesicles direct addition of calmodulin doubles Ca2+ activation with sufficient affinity (K1/2 0.1 nM) for chromatographic purification of the protein. For purification luminal plasma membrane vesicles are isolated on metrizamide density gradients and solubilized in CHAPS. The fraction of soluble protein retained on calmodulin-Sepharose 4B columns in the presence of Ca2+ and eluted by EGTA is 0.7%. The purified protein has high Ca2+-activated K+ channel activity after reconstitution into phospholipid vesicles. It distributes on two bands of 51 and 36 kDa after gel electrophoresis in SDS. The 36 kDa band is rapidly cleaved by trypsin and may be involved in Ca2+ stimulation of the channel. Phosphorylation from cAMP-dependent protein kinase strongly stimulates Ca2+-activated K+ channel activity and labels the 51 kDa band suggesting that this protein is involved in regulation of K+ channel opening.

Inhibition of T cell-dependent antibody production by D-penicillamine. Different requirements for Cu2+ in suppression of polyclonal and antigen-specific B cell responses

The effects of D-penicillamine (D-Pen) on the production of immunoglobulins (Ig) and anti-microbial antibodies (Ab) by human mononuclear cells (MNC) cultured in vitro were analysed by haemolytic plaque forming cell (PFC) assays. Polyclonal Ig and Ab production, induced by pokeweed mitogen (PWM), was not affected by D-Pen in pharmacologically relevant concentrations, unless Cu2+ was added. Likewise, D-Pen + Cu2+, but not D-Pen alone, affected polyclonal Ig production induced by Epstein-Barr virus. The production of interleukin-2 and B cell growth factor by phytohaemagglutinin-stimulated T cells was not inhibited by D-Pen; again D-Pen + Cu2+ markedly reduced the production of these cytokines. By contrast, D-Pen significantly reduced the antigen-induced antibody production without requirement of additional Cu2+. Addition of cytokine-containing supernatant to MNC treated with D-Pen + Cu2+ tended to increase the PWM-induced Ig responses, but had no effect on the antigen-induced Ab production of MNC cultured with D-Pen. Thus, the mechanisms by which D-Pen suppresses polyclonal and antigen-induced B lymphocyte responses are different.

Comparison of the electron spin polarized spectrum found in plant photosystem I and in iron-depleted bacterial reaction centers with time-resolved K-band EPR; evidence that the photosystem I acceptor A1 is a quinone

The suggestion that the electron acceptor A1 in plant photosystem I (PSI) is a quinone molecule is tested by comparisons with the bacterial photosystem. The electron spin polarized (ESP) EPR signal due to the oxidized donor and reduced quinone acceptor (P 870 (+) Q(-)) in iron-depleted bacterial reaction centers has similar spectral characteristics as the ESP EPR signal in PSI which is believed to be due to P 700 (+) A 1 (-) , the oxidized PSI donor and reduced A1. This is also true for better resolved spectra obtained at K-band (∼24 GHz). These same spectral characteristics can be simulated using a powder spectrum based on the known g-anisotropy of reduced quinones and with the same parameter set for Q(-) and A1 (-). The best resolution of the ESP EPR signal has been obtained for deuterated PSI particles at K-band. Simulation of the A1 (-) contribution based on g-anisotropy yields the same parameters as for bacterial Q(-) (except for an overall shift in the anisotropic g-factors, which have previously been determined for Q(-)). These results provide evidence that A1 is a quinone molecule. The electron spin polarized signal of P700 (+) is part of the better resolved spectrum from the deuterated PSI particles. The nature of the P700 (+) ESP is not clear; however, it appears that it does not exhibit the polarization pattern required by mechanisms which have been used so far to explain the ESP in PSI.

An epidemic of cirrhosis in Danish women revisited

Between 1944 and 1947 the mortality statistics for the Danish population show an epidemic increase of liver diseases: subacute necrosis and cirrhosis. The epidemic only affected female mortality rates. Mortality due to cirrhosis remained at a higher rate for women than men until 1970 as a result of an excess mortality in the cohort of women who in 1945 were over the age of 45. Up to 1981 this group showed an excess of 4,000 fatalities. A reevaluation of medico-statistical data shows that the disease cannot be explained by the epidemic hepatitis occurring in 1942-1944 or by increased consumption of alcohol. Possible causes could be pharmaceutical products or additives, perhaps hormone preparations.

Autoreactive lymphocytes in thyroid disorders. Quantitation of anti-thyroglobulin antibody formation by a specific haemolytic plaque forming cell (PFC) assay

Blood mononuclear cells (MNC) from 21 patients with autoimmune thyroiditis were assayed for secretion of immunoglobulins in vitro by a reverse haemolytic plaque forming cell (PFC) assay. An antigen-specific assay was employed to quantify anti-thyroglobulin antibody (TgAb) secreting cells. The sensitivities of the two PFC assays were similar. The antigen specificity of the Tg-PFC assay was demonstrated by the ability of free Tg to inhibit PFC formation. The number of spontaneous TgAb-secreting cells was low (median 3 IgG-Tg-PFC/10(6), range 0-35/10(6)); TgAb activity was found in 3% (range 0-11%) of total IgG-PFC. The number of spontaneous IgG-TgAb-secreting cells correlated positively to TgAb titres in serum. MNC from most patients secreted IgG-TgAb upon polyclonal stimulation in vitro for six days with pokeweed mitogen (52 IgG-Tg-PFC/10(6), range 0-478/10(6)); TgAb activity was found among 2% (range 0-8%) of total IgG-PFC. Again, pokeweed mitogen-induced TgAb secretion correlated positively to TgAb titres in serum. Finally, MNC from most patients secreted TgAb after culture with Tg. The Tg-induced response was about 1/3 of the pokeweed mitogen-induced TgAb response. Tg did not increase the production of total IgG indicating that Tg is not a polyclonal stimulus. Few TgAb-secreting MNC were discovered in euthyroid sex and age-matched control patients.

[Fluorosilicone oil heavier than water: a new aid in vitreoretinal surgery]

The specific gravity of fluorosilicone oil (trifluoropropylmethyl siloxane) is greater than that of water, and because of this it opens up new possibilities in vitreoretinal surgery: In cases of PVR detachment, retinal defects at the inferior margin or the posterior pole can be reliably tamponaded. If there is a peripheral retinal hole, the retina is reattached solely by injection of the oil - drainage is unnecessary, since the subretinal fluid is forced back into the vitreous cavity through the retinal defect. Retinal folds resulting from a giant tear will flatten out of their own accord. The present paper communicates initial clinical experience with fluorosilicone oil in 21 eyes (trauma and PVR detachment cases, some of which were considered hopeless). Even though the cases selected for surgery were extreme, reattachment was accomplished intraoperatively in all but one of them. Redetachment occurred in 4 out of 10 eyes following removal of the oil; this was rectified with low-density silicone oil. An immediate side-effect of the new oil was a transient iritis, seen in 5 out of 21 cases. A suspected side-effect after longer-term observation (mean 19 weeks) was that the oil promoted PVR. Out of 4 histologically studied membranes which proliferated under the oil, phagocytosis and foreign body reaction to the oil were found in one of the specimens. No retinal damage due to the oil could be detected by electroretinography. As an intraoperative aid, fluorosilicone oil is thoroughly to be recommended. If a long-term tamponade is essential, the fluorosilicone oil should be replaced with low-density silicone oil (dimethylsiloxane) after a few weeks.

Pokeweed mitogen-induced secretion of IgG- and IgM-rheumatoid factors by synovial fluid and blood B lymphocytes in rheumatoid arthritis

Lymphocytes from patients with rheumatoid arthritis (RA) were assayed for their ability to secrete Ig and rheumatoid factors (RF) upon polyclonal activation in vitro. B lymphocytes secreting IgM-RF and IgG-RF were enumerated using hemolytic plaque forming cell (PFC) assays. The sensitivity of RF-PFC formation was similar to that of a reverse PFC assay detecting all cells secreting Ig. Blood mononuclear cells from RA patients generated a median of 12 IgM-RF and 15 IgG-RF-secreting cells/10(6) after 6 days culture with pokeweed mitogen (PWM). Thus a median of approximately 0.5% of IgM- and IgG-secreting cells were identified as RF-PFC. Synovial fluid B lymphocytes co-cultured with autologous blood T lymphocytes in the presence of PWM generated higher numbers of RF-secreting cells; medians of 43 IgM-RF and 441 IgG-RF secreting cells/10(6) were found. Thus, 8-9% of IgM- and IgG-secreting cells from synovial fluid were identified as RF-PFC. In co-cultures containing synovial fluid T cells, PWM-induced RF secretion was low. The data indicate that both blood and SF B cells have the potential for RF secretion.

Functional capacities of T lymphocyte subsets from synovial fluid and blood in rheumatoid arthritis

A reverse haemolytic plaque forming cell (PFC) assay was employed to analyse the impact of T suppressor/cytotoxic and T helper cells on B cell function in 10 patients with rheumatoid arthritis (RA). In all cases T8-enriched cells from synovial fluid and blood suppressed the pokeweed mitogen (PWM) induced IgM, IgG, and IgA secretion by autologous lymphocytes to the same degree. The suppression was partly abolished by irradiation of T8-enriched cells. T4-enriched cells from blood increased the PWM induced Ig secretion by autologous blood B cells. In six of 10 patients responses 1.2 to four times higher were obtained with T4-enriched cells from synovial fluid, but in four of 10 patients synovial fluid T4-enriched cells did not increase the PWM responses of blood B cells. T4- and T8-enriched T cells from synovial fluid comprised more Ia+ cells than did T cells from blood (36% v 3% and 43% v 6%). Ia+ T helper and suppressor/cytotoxic cells may modulate in vivo activation of synovial B cells in RA.

Autoreactive lymphocytes in thyroid disorders. II. Comparison of anti-thyroglobulin antibody production by plaque-forming cell, radio-immunological and enzyme-linked immunosorbent assays

Blood mononuclear cells (MNC) from 9 randomly selected patients with autoimmune thyroiditis were stimulated in vitro with pokeweed mitogen (PWM), a polyclonal B lymphocyte activator. The secretion of immunoglobulins (Ig) and anti-thyroglobulin antibodies (TgAb) was assayed by means of haemolytic plaque-forming cell (PFC) assays, radio-immune assay (RIA) and enzyme-linked immunosorbent assays (ELISA). Total Ig and TgAb production was maximal using MNC cultured at 1.0 X 10(6)/ml as estimated by PFC, RIA and ELISA. The Ig and TgAb production as measured by RIA and ELISA was 1.5 - 3 times higher after 12 days' culture compared to 6 days' culture. Ig and TgAb production measured by PFC-assays at day 6 correlated positively to the results obtained by RIA and ELISA at day 12. PWM-induced TgAb secretion correlated positively to TgAb titres in serum. As judged by PFC, TgAb production was found in 8/9 patients; about 5% (range 0 - 7.9%) of the total PWM-stimulated IgG-secreting cells were involved in TgAb secretion. TgAb production as measured by ELISA and RIA was found in 6/9 patients. By reference to an affinity-purified human TgAb preparation, the TgAb secretion was about 0.7% (range 0 - 21.3%) of the total PWM-induced IgG secretion.

Chymotryptic cleavage of alpha-subunit in E1-forms of renal (Na+ + K+)-ATPase: effects on enzymatic properties, ligand binding and cation exchange

Chymotrypsin in NaCl medium at low ionic strength rapidly cleaves a bond in the N-terminal half of the alpha-subunit of pure membrane-bound (Na+ + K+)-ATPase from outer renal medulla. Secondary cleavage is very slow and the alpha-subunit can be converted almost quantitatively to a 78 kDa fragment. The sensitive bond is exposed to cleavage when the protein is stabilized in the E1 form by binding of Na+ or nucleotides. The bond is protected in medium containing KCl (E2K form), but it is exposed when ADP or ATP are added (E1KATP form). Fluorescence analysis and examination of ligand binding and enzymatic properties of the cleaved protein demonstrate that cleavage of the bond stabilizes the protein in the E1 form with sites for tight binding of nucleotides and cations exposed to the medium. About two 86Rb ions are bound per cleaved alpha-subunit with normal affinity (Kd = 9 microM). The bound Rb+ is not displaced by ATP or ADP. The nucleotide-potassium antagonism is abolished and ATP is bound with high affinity both in NaCl and in KCl media. Na+-dependent phosphorylation is quantitatively recovered in the 78 kDa fragment, but the affinity for binding of [48V]vanadate is very low after cleavage. ADP-ATP exchange is stimulated 4-5-fold by cleavage; while nucleotide dependent Na+-Na+, K+-K+, or Na+-K+ exchange are abolished. Cleavage with chymotrypsin in NaCl at the N-terminal side of the phosphorylated residue thus stabilizes the E1 form of the protein and abolishes cation exchange and conformational transitions in the protein although binding of cations, nucleotides and phosphate is preserved. In contrast, cleavage with trypsin in KCl at the C-terminal side of the phosphorylated residue does not interfere with E1-E2 transitions and Na+-Na+ or K+-K+ exchange. This data support the notion that cation exchange and E1-E2 transitions are thightly coupled.

Mutations that impair a posttranscriptional step in expression of HLA-A and -B antigens

Mutations can interfere with posttranscriptional expression of the HLA-A and -B genes. B-lymphoblastoid cells that contain one copy of the major histocompatibility complex (MHC) were subjected to mutagenesis and immunoselection for MHC antigen-loss mutants. Some mutations partially reduced surface expression of HLA-A and eliminated HLA-B expression concurrently, although the HLA-A and -B genes were present and transcribed. Antigen expression was fully restored in hybrids of these mutants with other B-lymphoblastoid cells. Therefore, normal cell surface expression of the HLA-A and -B antigens on B lymphoblasts requires (i) execution of at least one trans-active step in the production of the antigens after transcription of the HLA-A and -B genes or (ii) association of the class I antigens with other molecules. DNA analysis of one mutant suggests the possibility that a locus required for the normal expression of the HLA-A and -B antigens is located between the MHC complement genes and the HLA-DP alpha II locus.

Essential cryoglobulinaemia: a clinical course lasting 25 years

The clinical course of a patient is described whose primary manifestations of a circulating cryo IgGK were cutaneous symptoms of pain, vascular purpura and necrotic ulcerations, especially of the lower extremities. A biopsy specimen of skin lesions showed vasculitis and immune reactants in the vessel walls. The aetiology was not recognized. The effect of primary long-term therapy with prednisone was not essential. Combined therapy with cyclophosphamide and plasmapheresis allowed a satisfactory initial remission but had to be maintained repeatedly in order to reduce the periodic recurrence of clinical signs and symptoms. Renal failure terminated the clinical course at 25 years from onset of symptoms.

A critical appraisal of evidence for localized energy coupling. Kinetic studies on liposomes containing bacteriorhodopsin and ATP synthase

In intact systems (chloroplasts, mitochondria and bacteria) many experiments have been reported which are indicative of localized coupling between ATP synthase and electron transfer complexes. We have carried out similar experiments with a system in which we may assume that specific interactions between the proton pumps are absent: reconstituted vesicles containing bacteriorhodopsin and yeast mitochondrial ATP synthase. The only experiment that gives results which differ from those previously published for intact systems concerns the effect of uncouplers on the rate of ATP synthesis at different levels of inhibition of the ATP synthase. We propose that this type of experiment may discriminate between localized and delocalized coupling.

Testing of concentric visual field constriction by means of scotopic visually evoked potentials

Using scotopic visually evoked potentials (VEP), an objective test of concentric absolute field defects is presented. At 0.8 log units above the mean VEP threshold, the full field, the central area of 50 degrees diameter, and the complementary peripheral field were flash stimulated. In 13 normal subjects the peripheral VEP response was larger in amplitude and shorter in latency compared to the central response. In four cases of concentric field restriction due to hysteria and malingering, the same results were found. In three cases of retinitis pigmentosa and advanced glaucoma, the peripheral VEP sensitivity was worse than the central one or no response could be found. The amount of stray light was estimated as the difference of the thresholds for central and peripheral stimulation (1.6 to 1.8 log units) in a patient with a residual central field of 20 degrees.

Objective determination of dark adaptation: accuracy of the evoked potential method

The psychophysical threshold and the appearance of the visually evoked potential (VEP) were compared in the dark adapted state. Nineteen normal subjects and 11 persons with defective dark adaptation were studied. The VEP threshold was an average of 0.2 log units (standard deviation 0.2) above the subjective threshold in the normal group, and 0.4 log units above it in the night-blind subjects. In 7 normal subjects, the alpha-activity of the electroencephalogram interfered with the VEP recording and rendered the evaluation more difficult. The results indicate that the VEP can be used as an accurate method of objectively measuring dark adaptation.

Interleukin-1-like activities in synovial fluids of patients with rheumatoid arthritis and traumatic synovitis

Interleukin-1 (Il-1)-like activity in biological fluids was measured by their ability to rectify the Il-1-dependent lymphokine production of highly purified T lymphocytes to a recall antigen. Il-1-like activity was found in 9 of 11 synovial fluid (SF) specimens from patients with rheumatoid arthritis (RA) but only in 2 of 11 paired RA sera. In traumatic synovitis, low Il-1-like activity was recorded in 5 of 9 SF specimens, and a similar low activity was found in sera of 4 of these patients. The Il-1-like activity was partly absorbed by an anti-Il-1 antibody. The presence of Il-1 in the SF of patients with RA suggests in vivo activation of monocytes/macrophages.

Pharmacokinetics of intraperitoneal cefotaxime treatment of peritonitis in patients on continuous ambulatory peritoneal dialysis

The pharmacokinetics of intraperitoneal cefotaxime as the sole therapy in patients on continuous ambulatory peritoneal dialysis with peritonitis have been examined. The mean plasma concentrations achieved following 1 h of peritoneal instillation of 500 mg of cefotaxime were 5.0 +/- 1.6 micrograms ml-1. The average plasma concentration over 24 h was 6.9 +/- 0.4 micrograms ml-1 and was no different from that found following a further 9-11 days of successful treatment of the peritonitis. However, the mean dialysate effluent concentration of cefotaxime was increased following the resolution of the peritonitis, 165 +/- 22.7 mg per cycle on day 10 or 12 compared with 50.4 +/- 7.3 mg per cycle on day 1, suggesting enhanced peritoneal cefotaxime absorption during acute peritonitis. Nevertheless, during both periods, adequate concentrations of cefotaxime were achieved in dialysate to treat local complications, but plasma levels may be inadequate to treat systemic complications due to Staphylococcus albus.

Subclavian venous stenosis. A complication of subclavian dialysis

Subclavian hemodialysis catheters are widely employed for temporary hemodialysis access, but there are few reports of serious complications. We report three cases in which the prolonged (greater than 15 days) use of subclavian dialysis catheters ipsilateral to the permanent vascular access was associated with the development of subclavian vein (SCV) stenosis three to six months after the temporary catheter was removed. In one case, the use of the permanent access was severely limited by massive arm edema. We conclude that, in addition to the usual complications of SCV cannulation, long-term use of SCV hemodialysis catheters can be associated with major late obstructive complications that may compromise permanent vascular access. We recommend that, wherever possible, temporary dialysis catheters and other subclavian lines be placed contralateral to the permanent vascular access site in patients undergoing hemodialysis.

Secretion of immunoglobulins and IgM rheumatoid factor by pokeweed mitogen-induced blood lymphocytes: an evaluation by plaque forming cell assays

The numbers of pokeweed mitogen (PWM)-induced IgM-, IgG- and IgA-secreting cells (SC) in mononuclear cell cultures from patients with seropositive and seronegative rheumatoid arthritis (RA) were reduced compared to those of control persons. Significant numbers of IgM rheumatoid factor (RF)-SC were only found in PWM-induced cultures from patients with seropositive RA (median: 7 IgM RF-SC/10(6) and controls greater than or equal to 50 years (median: 6 IgM RF-SC/10(6). The ratio of IgM RF-SC to total IgM-SC (RF/IgM-SC ratio) was significantly higher in patients with seropositive RA (median: 0.6%) than in controls greater than or equal to 50 years (median: 0.1%). Patients with seropositive RA and RF/IgM-SC ratios above 0.5% had higher Waaler-Rose titers than those with ratios under 0.5%. Our results indicate that secretion of Ig by PWM-induced blood lymphocytes is suppressed in patients with RA compared to controls; in seropositive RA a higher fraction of in vitro activated IgM-SC secrete IgM RF as compared to controls and patients with seronegative RA.

Identification of a Na+,K+, Cl--cotransport protein of Mr 34 000 from kidney by photolabeling with [3H]bumethanide. The protein is associated with cytoskeleton components

A polypeptide of Mr 34 000 is photolabeled with [3H]bumethanide after binding of this drug to membranes from the outer renal medulla and irradiation at 345 nm, a wavelength where bumethanide has an absorption maximum. Our data show that the polypeptide of Mr 34 000 is a component of the Na+/K+/Cl--cotransport system. The [3H]bumethanide binding protein is not extracted by concentrations of the nonionic detergent C12E8 that solubilizes 67% of the protein of the membranes including (Na+ + K+)-ATPase. This step increases the capacity for binding of [3H]bumethanide to 681 pmol/mg protein. Extraction of the binding protein requires high ionic strength suggesting that the Na+/K+/Cl--cotransport protein is associated with cytoskeleton components. This association may be important for control of the entry of NaCl into the cytoplasm and for cellular regulation of the rate of active transport of NaCl across the tubule cells in the thick ascending limb of Henles loop.

Colony formation by subpopulations of human T lymphocytes. V. Helper and suppressor activity of cloned human T-cell lines

Twelve human T-cell lines were derived from cultures stimulated with phytohaemagglutinin (PHA) or with the recall antigen purified protein derivative (PPD), using the one-step agar colony method, followed by further expansion of individual T-cell colonies for at least 50 days. As judged by monoclonal antibodies, two of the PHA-derived T-cell lines carried the helper-inducer (H-I) phenotype and two the suppressor-cytotoxic (S-C) phenotype. Four PPD-derived cell lines displayed the H-I phenotype, and three of these proliferated specifically when challenged with the recall antigen, whereas the fourth did not. Four PPD-induced T-cell lines carried the S-C phenotype, and only one of these was antigen-specific. All cell lines with H-I phenotype displayed helper cell activity as determined by Ig secretion of B lymphocytes stimulated with a T-cell-dependent polyclonal B-cell activator. Cell lines with the S-C phenotype had no such helper activity and suppressed Ig responses in the presence of freshly isolated T cells. Thus, a good correlation between phenotypic markers and functions was found. T helper cells and T suppressor cells can be differentiated by means of both polyclonal and antigenic stimuli.

Production of leukocyte migration inhibitory factor (LIF) in human lymphocyte subsets exposed to polyclonal activators

Lymphocyte subsets separated on the basis of nylon-wool adherence and E and EA rosetting, and characterized for the presence of esterase-positive phagocytic cells were investigated for production of leukocyte migration inhibitory factor (LIF) in response to polyclonal T- and B-cell activators, PHA, ConA, PWM, and Epstein-Barr virus (EBV). In the nylon-passed population only the high avidity E+EA+ cells responded to ConA, PHA-induced LIF production in all E-rosetting subsets. The nylon-adherent E+ subset, which contains activated T cells, produced LIF spontaneously. B cells produced LIF when exposed to PWM or uv-inactivated EBV. In accordance with the known T-cell dependence of PWM activation, LIF was detected only in supernatants of reconstituted populations containing both B and T cells. In contrast, uv-inactivated EBV, devoid of transforming potential, elicited LIF production in the pure B-cell population. LIF production in response to polyclonal activators seemed to be independent of accessory cells since reconstitution with autologous macrophages or semipurified monokine, high-molecular-weight Interleukin 1 (IL-1), did not alter the results.

Spontaneous in vitro immunoglobulin secretion at the diagnosis of insulin-dependent diabetes

Blood mononuclear cells obtained from 17 newly diagnosed insulin-dependent diabetic (IDDM) patients treated with insulin for 5-7 days were assessed for the number of spontaneous and pokeweed mitogen (PWM)-stimulated immunoglobulin-secreting cells in a reverse haemolytic plaque assay. The spontaneous in vitro immunoglobulin secretion was evanescent and decreased in individual patients within 1-4 months of insulin treatment. Compared to matched controls, 53% (9/17) of the IDDM patients had an elevated spontaneous secretion of immunoglobulin, 41% (7/17) for IgG, 35% (6/17) for IgM, and 35% (6/17) for IgA. The quantities of PWM-stimulated IgG, IgM, or IgA secreting cells in IDDM were comparable to the controls. The IDDM patients with spontaneous immunoglobulin secreting cells had higher fasting C-peptide levels compared to the patients with immunoglobulin-producing cells within the normal range (P less than 0.05). The average titre of islet cell cytoplasmic antibodies was 1:26 in (9 out of 9 were positive) patients with, compared to 1:1 in patients (4 out of 8 were positive) without spontaneous secretion (P = 0.025). These results suggest that the clinical onset of IDDM is associated with a polyclonal B lymphocyte activation and that higher levels of fasting C-peptide islet cell antibodies are associated with this immunoregulatory abnormality.

Spontaneous and induced immunoglobulin secretion by synovial fluid B lymphocytes in rheumatoid arthritis

The functional properties of B lymphocytes in synovial fluid (SF) from patients with rheumatoid arthritis (RA) were analysed by means of a reverse haemolytic plaque forming cell (PFC) assay. SF mononuclear cells spontaneously secreted IgG, but little IgM or IgA. The SF cells failed to respond to the polyclonal B cell activators pokeweed mitogen (PWM) and Epstein-Barr virus. However, SF B cells cocultured with autologous T lymphocytes from the blood and stimulated with PWM secreted IgG but little IgM or IgA. The PFC responses of blood B cells cocultured with autologous SF T cells in the presence of PWM were low; irradiation of the T cells increased the blood B lymphocyte responses, but the differences were not statistically significant. It is concluded that suppressor SF T cells may be partly responsible for the poor response of SF B cells to PWM.

Synovial fluid and blood monocytes/macrophages in rheumatoid arthritis. Influence on polyclonal activation of autologous B lymphocytes

The regulatory role of synovial fluid monocytes/macrophages from patients with rheumatoid arthritis in terms of B lymphocyte activation was evaluated by a reverse haemolytic plaque-forming cell (PFC) assay. Macrophage-depleted blood mononuclear cells (BMC) failed to respond to pokeweed mitogen (PWM). With autologous synovial fluid macrophages added, the PFC responses of macrophage-depleted BMC increased, and optimal concentration for full restoration of the PFC responses ranged from 8 to 35%. Synovial fluid mononuclear cells (SMC) as well as macrophage-depleted SMC were not able to respond to PWM. Addition of irradiated autologous blood macrophages to SMC did not increase the SMC PFC responses. It is concluded that the regulatory properties of synovial fluid macrophages do not explain the low PFC response of SMC to PWM.

Inhibition of polyclonally induced immunoglobulin secretion by aurothiomalate

The influence of sodium aurothiomalate on the secretion of immunoglobulins by normal human lymphocytes in vitro was investigated by means of a reverse hemolytic plaque forming cell (PFC) assay. Aurothiomalate inhibited the PFC response induced by pokeweed mitogen (PWM) and by Epstein-Barr virus (EBV) in a dose dependent manner. The inhibition was irreversible, as pre-incubation for 2 h with the drug followed by extensive washing and further culture in gold salt-free medium still caused an inhibition of the PFC response to PWM and to EBV. Cell proliferation was not significantly affected, suggesting that the inhibition of PFC formation was not due to cytotoxicity. Pre-incubation of monocytes/macrophages (Mø's), T lymphocytes and B lymphocytes with the gold compound prior to culture with PWM showed that Mø's and B cells were highly sensitive, whereas T lymphocytes were resistant to the drug. The findings indicate that aurothiomalate inhibits the polyclonally induced PFC response by interfering with accessory Mø function and by affecting the B lymphocyte itself.

Role of monocytes/macrophages and interleukin 1 in antigen-induced human lymphokine production

The monocyte/macrophage (M phi)-dependency for antigen-induced production of the lymphokine, leukocyte migration inhibitory factor (LIF), was investigated using a M phi pulse-exposure technique. M phi-depleted, purified T lymphocytes did not elaborate LIF in response to the recall antigen, tuberculin (PPD). Addition of M phi's pulsed with PPD rectified the response. Exposure of the M phi's down to 3 min, even at 0 degree C, was efficacious. PPD-exposed M phi's, either killed or rendered incapable of protein synthesis, failed to activate the T cells. However, PPD-exposed, killed M phi's triggered LIF production if exogenous interleukin 1 (IL-1) was provided. We suggest that M phi "presentation" of antigen in this test system is a passive albeit necessary, process; the requirement for M phi metabolism being confined to the elaboration of IL-1. Judged by the results of kinetic experiments, the latter stimulus appears to be mediated most effectively from 2 to 4 hr after antigenic challenge.

Complement C3c and C3d in plasma and synovial fluid in rheumatoid arthritis

By means of recently developed immunochemical assays increased levels of the complement C3c and C3d split products were found in synovial fluids of patients with rheumatoid arthritis (RA) as compared with synovial fluids of patients with traumatic synovitis (TS). In plasma, only the C3d levels were significantly increased compared with plasma levels of patients with TS. Both split products were higher in RA synovial fluids (SF) than in RA plasma. A positive correlation between the C3d concentrations in plasma and the presence of IC in serum was found, and between the C3c levels and the concentration of polymorphonuclear cells in SF of RA patients. Due to differences in turn-over of C3c and C3d determination of plasma C3d levels may be a useful parameter for the evaluation of immunological activity in RA, while measurement of C3c in the synovial fluid may elucidate the actual inflammatory activity in the synovial membranes.

Immune complex glomerulonephritis and chronic anaerobic urinary infection--complications of filariasis

We describe a patient with chyluria due to abdominal Bancroftian filariasis. The patient showed two unusual complications, an immune complex glomerulonephritis and a chronic urinary infection. We also discuss the use of the CT whole body scanner in the diagnosis and delineation of the extent of the disease.

Colony formation by subpopulations of human T lymphocytes. III. Antigenic phenotype and function of colony-forming cells, colony cells, and their expanded progeny

The antigenic phenotype of individual PHA-induced T lymphocyte colonies was studied with a direct immunofluorescence technique using fluorescein-labeled anti-Leu-2a and anti-Leu-3a antibodies. Of the colonies grown from mononuclear peripheral blood cells 85% were Leu-3a+ (inducer/helper phenotype), 12% were Leu-2a+ (suppressor/cytotoxic phenotype), and 3% contained equal numbers of Leu-2a+ and Leu-3a+ cells. Fluorescence-activated cell sorter (FACS) separated T-cell subsets showed that Leu-2a+ cells and Leu-3a+ cells form exclusively Leu-2a+ and Leu-3a+ colonies, respectively. Leu-3a+ cells formed colonies in both the absence and presence of conditioned medium (PHA-CM), whereas colony formation by Leu-2a+ cells was absolutely dependent on PHA-CM. Mixing experiments with FACS-separated T-cell subsets showed that Leu-2a+ cells inhibit colony formation by Leu-3a+ cells in a cell dose-dependent manner both in the presence and absence of PHA-CM. Phenotype analysis of individual colonies from mixing experiments strongly suggested monoclonal proliferation in the present colony assay system. The majority of expanded T-cell colonies showed helper activity in a reverse hemolytic plaque-forming B-cell assay, although to a lesser degree as compared to that of freshly isolated T lymphocytes.

Chronic lymphocytic leukaemia of T cell origin. Clinical variation possibly due to involvement of different T lymphocyte subpopulations

Based on the literature and 2 patients studied, we suggest that at least 2 different clinical entities are included in the concept of T CLL: (i) a clinical variant characterized by a relatively benign course, splenomegaly without lymphadenopathy, low lymphocyte count and granulocytopenia; the proliferating lymphocyte is morphologically mature, of medium size and a cytoplasm with azurophilic granules staining positively for acid phosphatase and corresponding to parallel tubular arrays as demonstrated by electron microscopy. The cells form E-rosettes, have no surface-membrane-bound Ig, but Fc-receptors for IgG. With monoclonal antibodies, the phenotype is OKT3+, OKT4- and OKT8+, theoretically corresponding to the suppressor/cytotoxic T lymphocyte subset, but functionally the cells demonstrate killer cell (responsible for ADCC), but not natural or suppressor cell activity. (ii) another clinical variant with an aggressive course, massive hepato-splenomegaly, lymph node enlargement and very high lymphocyte counts; the lymphocytes are small without cytoplasmic granules; their immunological and functional characteristics have not been determined, but morphologically the cells correspond to the T helper/inducer lymphocyte subset. Thus, involvement of different T lymphocyte subsets may be the reason for the clinical variation in T CLL.

Diagnostic value of urinary N-acetyl-beta-D-glucosaminidase, its isoenzymes and the fractional excretion of sodium following renal transplantation

Daily total urine N-acetyl-beta-D-glucosaminidase activity, isoenzyme profile and fractional excretion of sodium were measured in 13 consecutive renal transplant patients. Rejection episodes were clinically diagnosed in 12 patients, 11 of whom (92%) showed an increased enzymuria either before or during the onset of clinical signs. The ratio of the two major isoenzymes (A/B) fell during 10 episodes (83%) and in six of these (50%) increased levels of the minor isoenzyme forms were observed. Increased fractional excretion of sodium was associated with nine (75%) of the episodes. Increased fractional excretion of sodium with a raised total enzymuria accompanied by a reduced A/B ratio and an increased proportion of the minor isoenzyme forms occurred in eight (67%) of the rejection episodes. The use of these measurements in the diagnosis of episodes of acute rejection in renal transplantation is discussed.

Femoral hypoplasia-unusual facies syndrome in infants of diabetic mothers

Three children with the femoral hypoplasia-unusual facies syndrome are described. Two had the characteristic facial pattern of upslanted palpebral fissures, long philtrum with thin upper lip, micrognathia, and hypoplastic alae nasi. The other, an infant girl who died within 24 hours after birth, had a cleft lip, which distorted some of the other features. She also had a cleft palate, as did one of the two older boys. All three children had ear defects, upper limb involvement, and rib, vertebral, lower extremity, and genitourinary tract abnormalities. The infant girl died of lung hypoplasia associated with dysplastic kidneys and widely patent ductus arteriosus. All three were infants of diabetic mothers, one mother having developed overt diabetes in the first trimester of pregnancy. A literature review of 36 reported cases of FH/UFS revealed 12 individuals who were IDMs, establishing a strong relationship of the syndrome with maternal diabetes. A multifactorial inheritance model fits with the reported patients, with the relationship to diabetes, and with the similarity of FH/UFS to caudal regression, another condition related to maternal diabetes.

Storage of protein A-conjugated sheep erythrocytes for use in plaque-forming cell (PFC) assays

Sheep red blood cells conjugated with protein A from Staphylococcus aureus were frozen in liquid nitrogen. After thawing these cells were used as indicator cells in a plaque-forming cell assay visualizing human B lymphocytes secreting IgG, IgM or IgA. The thawed erythrocytes performed as well in the assay as erythrocytes freshly conjugated with protein A. Recovery of conjugated erythrocytes after freezing and thawing averaged 66%. By the method described indicator cells for a number of PFC assays may be prepared in bulk, frozen in suitable portions and thawed when needed. This prevents possible batch-to-batch variations and saves time.