Lyme arthritis: oligoclonal anti-Borrelia burgdorferi IgG antibodies occur in joint fluid and serum

The antibody response to Borrelia (B.) burgdorferi, and to measles virus as control antigen, was analysed by agarose isoelectric focusing (AIF) and immunoblot of joint fluid and serum from 10 patients with Lyme arthritis and 10 controls with rheumatoid arthritis. Among the Lyme arthritis patients, six had oligoclonal anti-B. burgdorferi IgG antibody bands in joint fluid and corresponding serum, one patient had oligoclonal antibody bands in joint fluid only and also an elevated B. burgdorferi-specific joint fluid to serum antibody ratio as evidence of intra-joint production of specific antibodies, and the remaining three patients were negative for oligoclonal-specific antibody bands. Absorption with B. burgdorferi antigen confirmed the specificity of the oligoclonal antibody bands. They comigrated only partially on AIF with oligoclonal bands of total IgG, and the specificity of most oligoclonal IgG in joint fluid and serum in Lyme arthritis remains undefined. Among the controls, no anti-B, burgdorferi IgG antibodies were detected by AIF and immunoblot. Instead, 9 of the 10 rheumatoid arthritis patients had oligoclonal anti-measles IgG antibody bands which were restricted to the joint fluid in three of them, indicating local production. We conclude that Lyme arthritis is often accompanied by an oligoclonal specific antibody response in joint fluid and serum simultaneously, and occasionally by intrasynovial synthesis of oligoclonal-specific antibodies.

Multiple sclerosis: cells secreting antibodies against myelin-associated glycoprotein are present in cerebrospinal fluid

We evaluated the B-cell response in cerebrospinal fluid (CSF) and blood by enumerating cells secreting antibodies to myelin-associated glycoprotein (MAG) and, for reference, to myelin basic protein (MBP), two myelin components which may constitute targets for autoimmune attack in multiple sclerosis (MS). Among 25 untreated MS patients, 12 had cells in CSF secreting anti-MAG IgG antibodies (mean value 1 per 1429 CSF cells) and three also had cells secreting anti-MAG antibodies of the IgM isotype but at lower levels. In CSF from 2 out of 10 MS patients examined, anti-MAG and anti-MBP IgG antibody-secreting cells were present concurrently. Antibody-secreting cells were less frequent in blood and bone marrow, reflecting compartmentalization to CSF. Anti-MAG antibody-secreting cells were found in CSF from only 1 out of 27 control patients. The intrathecal production of anti-MAG and anti-MBP antibodies may be important in the pathogenesis of MS.

Antibodies to myelin-associated glycoprotein are found in cerebrospinal fluid in polyneuropathy associated with monoclonal serum IgM

Antibodies to myelin-associated glycoprotein (MAG) have been demonstrated in the serum samples from about half the patients with polyneuropathy associated with serum IgM monoclonal component. We examined cerebrospinal fluid (CSF) and serum samples from 13 patients with this disease by enzyme-linked immunosorbent assay for anti-MAG IgM antibodies. We detected these antibodies in both CSF and serum samples in 10 of the patients; in three of them the antibodies were at higher levels in the CSF. The remaining three patients had anti-MAG IgM antibodies in the CSF only. Intrathecal production of anti-MAG IgM antibodies is thus common in polyneuropathy associated with IgM monoclonal component. In three patients, examined on two occasions from 1 to 7 years, high anti-MAG IgM antibody levels persisted in CSF and serum samples. Among 165 patients with other neurologic diseases, including 60 with multiple sclerosis and 60 control subjects with tension headache, anti-MAG IgM antibodies were detected in the CSF from three patients (two with multiple sclerosis, one with aseptic meningitis), and in the serum sample of one patient with multiple sclerosis. Whether the frequent occurrence of anti-MAG IgM antibodies in CSF and their intrathecal synthesis has pathogenetic relevance for the development of polyneuropathy associated with IgM monoclonal component is unsure.

Correlation between homologous and heterologous enzyme immunoassays for progesterone determinations in milk from cows

Two enzymeimmunoassays, homologous and heterologous, have been used for measuring progesterone in unextracted bovine milk using HRP as the enzyme label. Antibody raised by immunization of the rabbit against 11 alpha-hemisuccinate-BSA was used for the homologous system (EIA-11 alpha) and 7 alpha-carboxyethylthioether-BSA (EIA-7 alpha) for the heterologous. The progesterone derivatives used for the enzyme-hormone conjugates were 11 alpha-hemisuccinate and 6 beta-OH-hemisuccinate respectively. Milk progesterone in 60 samples measured by EIA-11 alpha and EIA-7 alpha were highly correlated (r = 0.93). Both systems were further compared with a conventional direct progesterone radioimmunoassay (RIA) in regular use for the same samples showing a good correlation. The sensitivity estimated was much higher in the EIA-7 alpha (0.5 pg/well) than in the EIA-11 alpha (32 pg/well).

Oligoclonal Borrelia burgdorferi-specific IgG antibodies in cerebrospinal fluid in Lyme neuroborreliosis

Cerebrospinal fluid (CSF) and serum from 45 patients with lymphocytic meningoradiculitis were examined by isoelectric focusing combined with immunoblotting to detect Borrelia burgdorferi-specific oligoclonal immunoglobulin G (IgG) bands. In pretreatment samples, 35 patients (78%) showed B. burgdorferi-specific oligoclonal IgG in CSF indicative of intrathecal antibody production. At 2, 3-6, and 6 weeks after onset, respectively, such bands were present in 5 (42%) of 12, 21 (88%) of 24, and in all of 9 patients (100%). Up to 1 year after therapy, specific oligoclonal bands in CSF tended to remain unchanged despite clinical recovery. B. burgdorferi-specific oligoclonal bands in serum were found in 7 patients. These bands had identical migration patterns as in CSF, but were fewer in number and in some patients showed a temporal evolution different from their CSF counterpart. Not all oligoclonal IgG in CSF reacted with B. burgdorferi. The 41-kDa flagellar antigen was shown to be a major antigen in the intrathecal immune response. The demonstration of B. burgdorferi-specific oligoclonal IgG in CSF is a sensitive and reliable indicator of Lyme neuroborreliosis.

Chronic progressive myelopathy associated with HTLV-I: oligoclonal IgG and anti-HTLV-I IgG antibodies in cerebrospinal fluid and serum

Among 22 patients with human T-lymphotropic virus type I (HTLV-I)-associated chronic progressive myelopathy, agarose isoelectric focusing (AIF) revealed oligoclonal IgG bands in 21: in 3 in CSF only; in 11 in CSF and to some extent in serum; and in 7, identical patterns in CSF and serum. By immunoblot after AIF of CSF and serum, we observed bands of anti-HTLV-I IgG antibodies in 19 patients: in 5 in CSF only; in 9 in CSF and partly in serum; and in 5, identical in CSF and serum. Oligoclonal anti-HTLV-I IgG antibody bands could only partly be traced to oligoclonal IgG bands. If, prior to AIF, serum and CSF were absorbed with HTLV-I antigen, practically all oligoclonal HTLV-I-specific IgG antibody activity was abolished, while the oligoclonal pattern of total IgG was affected only to a minor extent. Alongside with HTLV-I-specific oligoclonal B cell response, HTLV-I myelopathy is regularly accompanied by production of oligoclonal IgG of unknown antibody specificities.

[Diagnosis by DNA analysis in familial isolated growth hormone deficiency type I-A]

We show the autoradiograms of DNA from one child affected of familial isolated growth hormone deficiency type I-A. Restriction endonuclease analysis of DNA isolated from leukocytes was done using 32P-labeled human GH cDNA clone as a probe. DNA analysis using the restriction endonuclease Bam HI revealed that the 3.8 kb restriction fragment, which contain the normal hGH-N gene, was absent. Since these deletions preclude production of any GH-N protein, affected individuals tend to be immunologically intolerant to exogenous GH. The child was homozygote and after treatment with exogenous GH developed a high titre of antibodies to GH and growth arrest. This is the first case of this genetic disorder studied in Spain.

Operational studies on the control of Taenia solium taeniasis/cysticercosis in Ecuador

A large-scale study in Loja and El Oro Provinces, Ecuador, demonstrated that population-based treatment of human taeniasis with a low dose of praziquantel is feasible and effective for the short-term control of transmission of Taenia solium in hyperendemic areas. Chemotherapeutic intervention also effectively promoted local preventive measures and contributed greatly to the elaboration of a long-term control programme.

Epidemiologic survey on hepatitis B in Gypsy women

The determination of HBsAg in 3,404 pregnant women showed 84 positive cases (2.46%), which is above the average for the Spanish population. Notable risk factors were prior liver diseases, sexual promiscuity and spouse with liver disease. Other common, but less significant factors, were histories of transfusion or drug addiction. A very high proportion of the pregnant women were of the Gypsy race (12.1%), and these women showed a statistically higher (p less than 0.001) rate of chronic HBV infection (8.4%) than non-Gypsy population (1.4%). The Gypsy population showed a lower presence of known risk factors but a higher positivity for the e antigen. Our findings suggest that there is a higher prevalence of chronic HBV infection in pregnant Gypsy women and that the infection shows particular epidemiologic features.

Occurrence and isotype of antibodies against peripheral nerve myelin in serum from patients with peripheral neuropathy and healthy controls

Antibodies against peripheral nerve myelin have previously been demonstrated in serum from patients with peripheral neuropathy and IgM paraproteinaemia, and a causal relationship has been suggested. Using enzyme-linked immunosorbent assay (ELISA), anti-myelin antibodies were found in sera from eight of 16 patients with polyneuropathy and paraproteinaemia, but also in 17% of 109 patients with peripheral neuropathy lacking monoclonal immunoglobulin, including five of 10 patients with Charcot-Marie-Tooth disease, and in 16% of 142 blood donors. The antibodies were mostly of IgM class in the two neuropathy groups, while blood donors had mostly IgA antibodies, and a few subjects of each group had antimyelin antibodies of two different isotypes. Western blot confirmed the ELISA results in a majority of antibody positive sera and revealed a 25-30 kD myelin target antigen for sera from the three groups, and for some of the non-paraproteinaemic sera also a 100 kD myelin target antigen. Our results demonstrate that the presence of serum autoantibodies against peripheral nerve myelin does not necessarily indicate a pathological event.

Failure of maintained hyperprolactinemia to improve lactational performance in late puerperium

Although stimulation of PRL secretion in the early postpartum period has been found to improve lactational performance, the effect of chronic maintenance of elevated plasma PRL levels on milk production is not known. In a randomized design, 66 lactating women were assigned to receive either a placebo (n = 32) or the dopamine antagonist sulpiride (n = 34; 100 mg, three times daily), for 4 days, followed by 50 mg, three times daily, for a 90-day period). Their basal and 30 min postsuckling plasma PRL levels as well as the weights of their infants were measured 1, 4, 15, 30, 60, and 90 days postpartum. Forty-one women (20 sulpiride-treated and 21 placebo-treated) completed the study. Compared with the placebo group, which had the expected postpartum plasma PRL decline, the sulpiride-treated women maintained significantly elevated basal plasma PRL values up to the 90th postpartum day. In contrast, the postsuckling plasma PRL level was significantly diminished in the latter group, and on day 90 was practically absent. On day 15, weight gain was significantly greater in the infants whose mothers received sulpiride, but later, no differences were detectable between groups of infants despite the disparity in PRL levels in their mothers. We conclude that enhancement of PRL secretion in the early postpartum period may transiently increase milk production, but chronic hyperprolactinemia has no effect on lactational performance. The plasma PRL response to suckling is not essential for the maintenance of milk secretion. Instead, basal plasma PRL levels and neurogenic reflexes may be more instrumental in maintaining established lactation.

Update of the Wiskott-Aldrich syndrome. From a new case report

After presenting the case of a male patient who was diagnosed as suffering from the Wiskott-Aldrich syndrome at the age of 4 months, we review the main clinical (infections, bleeding and eczema), immunological (deficiency of IgM, normal IgG, elevated IgA and IgE, deficiency of total T lymphocytes, normal T4 levels, decreased levels of T8, diminished response to phytohemagglutinin and partial depletion of the lymphocyte population in biopsies of lymph nodes and spleen) and haematological (thrombocytopenia, dysmegakaryocytosis, decreased half-life and decreased granulation in the protoplasm of megakaryocytes) manifestations of this syndrome. In general, our aim is to carry out an up-to-date review of the syndrome, and to include comments on the diagnostic and therapeutic aspects.

Antinuclear antibodies in scleroderma, mixed connective tissue disease and "primary" Raynaud's phenomenon

The diversity of antibodies in patients with scleroderma, mixed connective tissue disease or "primary" Raynaud's phenomenon could be used as a laboratory aid in the clinical diagnosis. In serum samples of 75 patients we screened for antinuclear antibodies (HEp 2 cells), anti DNA, soluble nucleoprotein and extractable nuclear antigens (Sm, rRNP, U1-nRNP, SSA/Ro, SSB/La and Scl-70). Distinctive antinuclear antibodies pattern was identified in each group of patients. This immunologic profile is valuable for clinical diagnosis and the preferential association of certain autoantibodies with some diseases and not with others, suggest an antigen-driven stimulus for its production.

Immunoblot detection of oligoclonal anti-myelin basic protein IgG antibodies in cerebrospinal fluid in multiple sclerosis

Migration properties and occurrence of antibodies against myelin basic protein (MBP) in paired CSF and serum specimens from patients with multiple sclerosis (MS) were demonstrated after agarose isoelectric focusing, immunoblot transfer, and immunoperoxidase staining. Oligoclonal IgG antibody bands directed against MBP were found in the CSF of 9 of 28 patients with MS (32%), but not in the CSF of any of 34 patients with other neurologic diseases. No serum showed anti-MBP antibody bands. The CSF anti-MBP antibodies migrated to the anodal region of the IgG area in a different fashion from oligoclonal IgG and anti-measles IgG antibodies, which were detected in parallel. The anti-MBP bands were transient in three of seven patients whom we studied consecutively. Enzyme-linked immunosorbent assay (ELISA) of serum and CSF for detection of IgG reactivity against MBP showed absorbance values above 2 standard deviations of controls in 44% of the MS patients and in 21% of those with other neurologic diseases. Results of this assay correlated partly with those of the immunoblot assay. ELISA positive and immunoblot negative results might be due to a broad polyclonal anti-MBP antibody response.

High correlation between molecular alterations of the c-myc oncogene and carcinoma of the uterine cervix

We have examined 35 human tumors of the uterine cervix (carcinoma presenting the highest incidence in Mexico; about 34% of women's malignant tumors) for alterations of the cellular myc (c-myc) protooncogene. Elevated amplification and/or rearrangement of the c-myc oncogene were detected in most (approximately 90%) samples (48% showed amplification and 43% presented both alterations). Most tumors were stage II cervical carcinomas and for some of them we detected up to 60-fold amplification of c-myc. These results suggest an important role for c-myc oncogene in the development of tumors of the uterine cervix.

[Perinatal aspects of the children of heroin addicts]

Maternal, perinatal and neonatal factors of 27 newborns of heroin addicted mothers were reviewed between 1980 and 1984. Results were compared with a control group of 2,587 normal newborns. A progressive increase in number of cases was observed in the last years. Mean age of heroin-addicted mothers was significant lower than control group (p less than 0.001). Only 18.5% were under obstetrical control for at least 4 times (p less than 0.001) and 40.7% had antecedents previous abortions (p less than 0.025). Four cases of maternal syphilis were diagnosed and also four mother were positive to HBsAg; statistical difference in both cases was highly significant with respect to control group (p less than 0.001). A higher index of premature rupture of membranes (11.1%, p less than 0.001) and cesarean sections (25.9%, p less than 0.001) was appreciated. No significant difference was observed attending to fetal presentation, instrumental delivery, Apgar test scores and pH of umbilical artery (p greater than 0.05). A higher incidence of preterm (18.5%, p less than 0.01) and small for gestational age babies (44.4%, p less than 0.001) was ascertained. Pregnancy control and no smoking habit might influence birth weight (p less than 0.001). Neonatal withdrawal syndrome was present in 44.4% and was related to mother's last dose and secondary to degree of heroin abuse (p less than 0.025).