Effect of acetylsalicylic acid on renal function in systemic lupus erythematosus

Glomerular filtration rate (GFR; 51Cr-EDTA clearance), serum creatinine concentration and urinary excretion of prostaglandins were measured in 8 patients with systemic lupus erythematosus (SLE) before and after 2 weeks of treatment with acetylsalicylic acid (ASA). ASA 65 mg/kg or up to 4 g/daily was given as a sustained release preparation. The serum salicylate concentration ranged from 0.3 to 1.6 mmol/l. Serum creatinine after 1 and 2 weeks and GFR after 2 weeks of ASA treatment showed no significant changes. There was a clearcut decrease in urinary excretion of prostaglandins PGE2 and PGF2 alpha, by 44% and 50%, respectively. It is concluded that therapeutic doses of ASA do not cause deterioration of GFR in patients with SLE and normal or moderately reduced renal function.

Influence of extradural morphine on the adrenocortical and hyperglycaemic response to surgery

Plasma cortisol and glucose concentrations were measured repeatedly from before the induction of anaesthesia until 9 h after skin incision in 36 patients undergoing abdominal hysterectomy. Twelve patients received general anaesthesia (halothane), and systemic opiates for postoperative pain; a further 12 patients underwent continuous extradural analgesia with a local anaesthetic agent (bupivacaine) and in the remaining 12 patients general anaesthesia (halothane) plus extradural morphine (4mg before skin incision and an additional 4mg at skin closure) were used. Patients receiving extradural morphine or bupivacaine were free of pain. The physiological cortisol and glucose response to surgery was blocked by the extradural analgesia with bupivacaine. Extradural morphine did not modify the initial increase in plasma cortisol and glucose concentrations during surgery, but suppressed the hyperglycaemic and cortisol response following surgery when compared with the general anaesthesia group receiving systemic opiates. However, cortisol and glucose concentrations were greater after operation in patients receiving extradural morphine compared with extradural bupivacaine, suggesting that the endocrine metabolic response to surgery is predominantly released by neurogenic stimuli other than pain stimuli involving opiate receptor-dependent nociceptive pathways.

Low levels of antibodies to surface antigens of group B streptococci in commercial IgG preparations

53 different batches of commercial IgG were tested for antibodies to group B streptococci (GBS) types Ia, Ib, II and III. The levels of antibodies varied widely. Comparison of the anti-GBS antibody levels in these preparations with those found in normal blood donor sera showed that the commercial IgG contained approximately 2.6 times less type-specific antibodies. We conclude that the commercial IgG now available is not optimal for passive immunization against GBS infections in neonates.

Prostaglandins, catecholamines, renin and aldosterone during hypertensive and normotensive pregnancy

Urinary excretion of prostaglandin E2 (PGE2) and F2 alpha (PGF2 alpha), plasma concentrations of renin (PRC), aldosterone (PAC), noradrenaline (PNA) and adrenaline (PA) were determined in the third trimester of pregnancy, 5 days and 3 months after delivery in preeclampsia and normotensive pregnant and non-pregnant control subjects. PGE2 was higher in pregnant control subjects than in non-pregnant subjects, but reduced to non-pregnant level in preeclampsia. PGF2 alpha was the same in preeclampsia and normotensive pregnancy but higher than in the non-pregnant group. PRC and PAC were increased during pregnancy, but considerably lesser in preeclampsia than during normotensive pregnancy. PNA and PA were the same in all three groups. All parameters were normal 3 months after delivery. There were no correlations between any of the hormones and blood pressure in any of the groups. PGE2 was positively correlated to PRC. The lack of renal PGE2 in preeclampsia might be responsible for the decrease in renal blood flow and sodium excretion, and the changes in PRC and PAC are supposed to be secondary to changes in PGE2. It is hypothesised that preeclampsia is a state of prostaglandin deficiency.

Isolation and some properties of an IgG Fc-binding protein from group A streptococci type 15

An IgG Fc-binding protein was isolated from alkaline extracts of group A streptococci type 15 by ion-exchange chromatography and immunosorption on an IgG column. Ample use of protease inhibitors was necessary to achieve successful isolation. 600 micrograms protein was obtained from 60 g bacteria (wet weight). The protein appeared homogeneous on agarose gel and sodium dodecyl sulfate polyacrylamide gel electrophoresis and had an apparent molecular weight of 29,500. It contained appreciable amounts of the amino acids glutamic acid, alanine, leucine, aspartic acid and lysine, but little or no tyrosine, phenylalanine, proline, glucosamine or galactosamine. It precipitated human monoclonal IgG of all four sub-classes in agarose gels as well as polyclonal IgG, IgG Fc and normal human serum. It did not precipitate IgG Fab, IgA, IgM, IgD or free kappa or lambda chains.

Mothers of infants with neonatal group B streptococcal septicemia are poor responders to bacterial carbohydrate antigens

Serum antibodies against various carbohydrate antigens were studied in 16 mothers of infants with serious infections caused by group B streptococci (GBS) (the study group), and compared with a control group of 29 urogenital carriers of GBS who gave birth to neonatally healthy infants. Using a radioimmunoassay for the determination of antibodies to GBS types Ia, Ib, II and III, it was found that the study group had significantly lower levels of IgG antibodies to each of the 4 GBS types than the control group. The IgG levels against Salmonella BO and DO, Yersinia enterocolitica 03, Francisella tularense and Streptococcus pneumonia types 3, 6, 9, 19 and 23 purified carbohydrate antigens were determined using an ELISA technique. Significantly more individuals in the study group than in the control group had low levels of IgG antibodies against 8 of 9 carbohydrate antigens. No difference was found in IgM levels against 3 of 4 antigens studied, while the study group showed significantly more IgM antibodies against Salmonella DO than the controls. These results indicate that mothers of GBS-infected infants might be poor IgG antibody responders to bacterial carbohydrate antigens in general.

On the relationship between urinary PGE2 and PGF2 alpha excretion rates and urine flow, osmolar excretion rate and urinary osmolality in anesthetized rats

A strong inverse relationship was found between the excretion rates of the prostaglandins PGE2 and PGF2 alpha and urine flow (and osmolar excretion rate) over a range of urine flow rates from 1.5 to 40 microliters . min-1 . g kidney weight-1, covering spontaneous variations and isotonic saline diuresis. These results suggest the operation of a negative feedback mechanism by which the diuretic action of the prostaglandins, as part of a defence system, counteracts excessive oliguria. PGE2 excretion did not correlate with either urinary kallikrein excretion or plasma renin concentration. When the concentrating mechanism was interfered with by reducing renal perfusion pressure to, or below 65 mmHg, and vasopressin was given i.v. PGE2 excretion rate roughly parallelled urine--and probably medullary interstitial osmolar activity. However, in hydropenic rats there was no correlation between urine osmolality (Uosm) and PGE2 excretion over a range of osmolalities from 500 to 2 500 mOsm . kg-1, nor any relationship between delta Uosm and delta PGE2 excretion. Thus, a high interstitial osmolar activity appears to be a prerequisite for the activation of PG-synthesis in the renal medulla, but another (other) yet undefined factor(s) play the major role as (a) determinant(s) for PG-excretion in vivo.

Interaction between prostaglandins of the E-type with a urinary component from halothane anesthetized rats

Prostaglandins of the E-type (PGE's) were found to react or combine with a urinary metabolite of Halothane yielding products which were left unrecovered during the purification procedure preceding specific radioimmunoassay of PGE2. The products were retained on sephadex LH-20 columns, and showed on thin layer silica gel plates (TLC) Rf values lower than those of the parent PGE-compounds. The product formation is supposed to involve the beta-hydroxyketone system of PGE, since PG's of the F and A type were unaffected. The product formation could be avoided by inducing anaesthesia with Hexobarbitone and maintaining the anaesthesia with Halothane-nitrous oxide or it could be reversed by adding barbiturates to urine samples obtained from animals anaesthetized with Halothane-nitrous oxide alone. The barbiturates effectively competed with PGE for the metabolite leaving PGE to behave normally on sephadex LH-20 and TLC, thus enabling us to evaluate correctly the PGE2 content by RIA.

IgG-Fc-receptors in T-type 12 group A streptococci from clinical specimens: absence from M-type 12 and presence in M-type 22

Eighty-eight T-type 12 group A streptococcal strains were randomly selected from routine specimens in two epidemiologically unrelated districts. All of 26 M-type 12 strains lacked IgA and IgG Fc-receptors, whereas all 32 M-type 22 strains had IgG Fc-receptors and 20 of them also receptors for IgA Fc. The remaining strains were not further M-typed but 18 of these 30 strains exhibited receptors for IgG and 13 for IgA.

A study of the effect of stimulated endogenous prostaglandin synthesis on urine flow, osmolar excretion rate, and renin release in hydropenic and saline loaded, anesthetized rats

The purpose of the study was to investigate the effects on urine flow and osmolar excretion of arachidonic acid (C20:4) infused in the renal artery of anaesthetized rats under conditions in which indomethacin previously was found to reduce urine flow and to prevent the development of a moderate saline diuresis. C20:4 caused a reversible increase in the urinary excretion rates of PGE2 and PGF2 alpha both in hydropenic rats and in rats during a saline diuresis. Renal venous plasma concentration of PGE2 increased significantly while the increase in PGF2 alpha was insignificant. C20:4 infusion was followed by an increase in urine flow and osmolar excretion rate in hydropenic rats, and it augmented urine flow (but not solute excretion) in saline-loaded rats. This latter effect was blunted by indomethacin treatment and inactin anaesthesia. Increased endogenous PG-levels were associated with only a modest (insignificant) increase in renin release under the present conditions. Saline loading acutely depressed PGE2 and PGF2 alpha urinary excretion rates and plasma renin concentration (PRC). The fall in PRC was unaffected by indomethacin. The main conclusions are that endogenous renal PG's have a diuretic effect in the amytal anaesthetized rat, while an effect on osmolar excretion rate is apparent only under hydropenic conditions. Acute saline loading depresses renal PG-synthesis, but this depression is not the only cause of the fall in PRC following saline loading. The saline diuresis is caused by a mechanism(s) not involving prostaglandins.

Obstetrical care in future pregnancies after fetal loss in group B streptococcal septicemia. A prevention program based on bacteriological and immunological follow-up

Among 22 mothers of infants infected with group B streptococci (GBS), 19 showed markedly low levels of antibodies against the infecting type. Three of the patients with low antibody levels went through a new pregnancy within 1 yr after they had lost an infant (2 patients) or experienced fetal death due to GBS (1 patient). They were still urogenital carriers of the type of GBS causing the previous infection, and their serum levels of type-specific antibodies remained low. All three went through a successful pregnancy following a prevention program comprising antibiotic treatment from the 28th wk of pregnancy.

Quantitation of antibodies against group B streptococci, Types Ia, Ib and III in sera from different groups of individuals: high antibody levels in sera from venereal disease clinic patients

Sera from 3 groups of individuals were investigated for antibodies to group B streptococci (GBS) types Ia, Ib and III using radiolabelled protein A: 45 girls, aged 1 to 12 years; 123 non-pregnant gynecological outpatients, aged 15 to 42 years; and 96 female venereological disease (VD) clinic patients, aged 15 to 54 years. The two groups of adults had higher antibody levels against type Ia than the girls, while no difference was found between the two adult groups in this respect. On the other hand, the VD patients had higher levels of antibodies against type Ib than the girls and the gynecological patients; the gynecological patients did not differ from the girls as regards anti-Ib antibodies. The antibody levels against type III were higher among the VD clinic patients than among the gynecological patients, who in turn had higher levels than the girls. Thus, the adults showed higher levels of antibodies against 2 of the 3 GBS types than did the girls. Furthermore, the VD clinic patients had higher levels against 2 of the 3 GBS types than the gynecological patients.

IgG F(ab')2 of rabbit anti-M sera but not the unfractionated sera are bactericidal for some group A streptococci with IgG Fc-receptor activity. Opsonic effect ascribable to anti-IgG

We have earlier reported on a group A streptococcal strain, type M12, which upon serial mouse passage acquired IgG Fc-receptor activity but lost the M-antigen. The passaged strain, 12P, was highly virulent for mice and grew well in normal human blood. The present study particularly concerns the opsonic effect on 12P of rabbit anti-M3, anti-M12 and anti-12P sera, as well as the corresponding IgG F(ab')2. Indirect bactericidal tests showed that the homologous anti-12P seum and IgG F(ab')2 were opsonic. The anti-M3 and anti-M12 had no effect on 12P; surprisingly, however, IgG F(ab')2 isolated from these sera displayed a clearcut opsonic activity. Data are presented which indicate that these "paradoxical" results can be explained by the binding of IgG F(ab')2 with anti-IgG specificity to human IgG, linked to the streptococcal surface through Fc-receptors. Only anti-12P serum, or IgG F(ab')2, were protective for mice on challenge with strain 12P.

New method that uses binding of immunoglobulin A to group A streptococcal immunoglobulin A Fc receptors for demonstration of microbial immunoglobulin A protease activity

A new method is described for the detection of bacterial immunoglobulin A (IgA) protease which splits IgA into Fab and Fc fragments. The method takes advantage of a recent finding that receptors for IgA fragments occur commonly among type 4 group A streptococci. The bacterial preparation to be tested for protease activity was first incubated with radiolabeled purified IgA1 myeloma protein, and the proportion of radioactivity bound to a standard suspension of the streptococci was then measured. Since isolated Fab fragments do not bind to streptococcal IgA receptors, a decrease in the amount of radioactivity bound to the streptococci, as compared with the amount before digestion, indicates the presence of protease in the test preparation. Using this method, protease activity was detected in Neisseria gonorrhoeae, Neisseria meningitidis, Haemophilus influenzae, Streptococcus pneumoniae, and Streptococcus sanguis, but not in Escherichia coli or Branhamella catarrhalis.

Binding of aggregated IgG in the presence of fresh serum: strong association with type 12 group A streptococci

Highly selected group A streptococci, 108 strains isolated from different groups of individuals, were tested for binding of aggregated human IgG which had been pre-incubated in fresh human serum. All strains displayed resistance to phagocytosis typical of M-producing strains. Among 73 strains isolated from sporadic cases of acute glomerulo-nephritis (AGN), 34 (47 per cent) bound the aggregates. All of 26 type 12 group A streptococci but none of 15 type 49 strains proved positive in the test system. Furthermore, one type 1 and one type 18 strain were positive. All 9 type 49 strains isolated in a minor epidemic of AGN proved negative. Twenty-six strains of type 12 group A streptococci were isolated during three different prospective studies in which no cases of AGN had occurred; all these strains bound aggregates in the presence of fresh serum. Thus, it was found that the capacity to bind aggregates in the presence of fresh serum was strongly associated with--though not limited to--group A streptococci carrying the type 12 antigen. However, this characteristic is not common to all nephritogenic strains, since all type 49 group A streptococci were negative in the test system.

Colonization of newborns with group B streptococci: relation to maternal urogenital carriage

Urethral and cervical specimens were obtained from 786 parturients during labour. 126 women (16%) were found to be urogenital carriers of group B streptococci (GBS). Bacteriological specimens were also obtained from the throat, umbilicus and external auditory canal of their 786 infants immediately after birth, and from 671 of the infants staying at the maternity unit 4 days later. 51% (64/126) of the infants born to GBS carriers were culture-positive for GBS immediately after birth. Only 27% (6/22) of the infants born to women who were GBS culture-positive in the urethra but not in the cervix contracted GBS at the delivery, in contrast to 59% (58/85) of the infants born to combined urethral and cervical carriers (P less than 0.05). This difference in colonization rate was not related to differences in levels of antibodies to the type of GBS carried by the individual parturient. On day 4, 13% (90/671) of the infants in the maternity unit were colonized with GBS. 39% of them were colonized at birth from their mother, 12% were culture negative at birth but had become colonized by day 4 with the same type of GBS as that isolated from the urogenital tract of the mother, and 37% were GBS positive on day 4 but culture-negative at birth and the mother's specimens did not reveal GBS. The distribution of serotypes among these infants was identical with that found among the other colonized infants, indicating that they might have contracted their GBS from the other infants in the maternity unit.

Relation between maternal urogenital carriage of group B streptococci and postmaturity and intrauterine asphyxia during delivery

The obstetrical significance of maternal urogenital carriage of group B streptococci (GBS) was investigated in a prospective study comprising 799 parturients and their infants. 128 mothers were GBS carriers. Fetal heart rate recording showing abnormal baseline frequency and concomitant late decelerations during delivery were found in 6 infants born of GBS carriers (5%) and in 7 (1%) of non-carriers (P < 0.01). The pH of fetal blood was determined in 14 (11%) GBS carriers and in 53 (8%) non-carriers. 6/14 (43%) infants of GBS carriers had pH values below 7.20, in contrast to 4/53 (8%) of the non-carrier group (P < 0.01). Mothers of infants showing signs of intrauterine asphyxia had the same amount of antibodies to GBS as mothers of infants without signs of asphyxia. Among the GBS carriers, 11/128 (9%) were delivered later than the 42nd week of pregnancy. A smaller proportion of non-carriers, 21/671 (3%), were delivered postterm (P < 0.01).

Quantitation of M antigen in Lancefield extracts of group A streptococci type 12 using electro-immuno assay

Anti-type 12 serum incorporated in agarose-polyethylene glycol gel in a concentration of 1.5% (vol/vol) was found to enable a distinct "rocket" precipitate in electro-immuno assay using hot hydrochloric acid extract of type 12 group A streptococci. This precipitate was removed by trypsin treatment of the extract and on addition of anti-M12 typing serum but not of five other typing sera to the extract. The streptococcal component responsible for this precipitate was eluted from a CM-cellulose ion exchange column at pH 6.5. These findings demonstrated that the precipitate was caused by the M12 antigen. Crossed immuno-electrophoresis of hot hydrochloric acid extracts of three different type 12 group A streptococci showed that the electrophoretic mobility of the M12 antigens was similar in the three extracts. A linear correlation was obtained between the concentration of the M12-antigen and the height of the precipitate obtained in the electro-immuno assay using different dilutions of a standard type 12 extract. M12 antigen could thus be quantitated by the electro-immuno assay. In quantitation experiments, uniformly prepared extracts of five randomly selected, freshly-isolated type 12 strains were found to contain from 130 to 1850% of M12 antigen, respectively (expressed in % of the content of the standard type 12 extract).

High isolation rate of Branhamella catarrhalis from the nasopharynx in adults with acute laryngitis

Branhamella catarrhalis was isolated from the nasopharynx in 55% of 40 noncompromised adult patients suffering from acute laryngitis. Diplococcus pneumoniae and haemophilus influenzae were found in another 5 and 8%, respectively; one patient had group A streptococci in the throat specimen. In 90% of the patients the laryngitis complaints were preceded by symptoms of an acute respiratory tract infection. Two of the patients with B. catarrhalis showed a significant titre conversion against influenza B and parainfluenza type e virus, respectively. Attempts to isolate virus failed in all cases. The results indicate that B. catarrhalis, known to cause acute otitis media in small children and respiratory tract infections in adult compromised hosts, may be involved in the etiology of acute laryngitis in otherwise healthy adults.

Relations of bone mineral content, ash weight and bone mass: implication for correction of bone mineral content for bone size

Bone mineral content (BMC) was measured by photon absorptiometry in fresh bone specimens: 35 iliac crest and 39 forearms were used. BMC was related to ash weight, fat-free weight and the amount of bone determined by quantitative histologic methods. Ninety-five per cent of the variation in bone mineral concentration (BMC') in the iliac crest could be explained by variation in ash weight, and 88% of the variation in BMC in the forearm could be explained by variation in the amount of bone determined histologically. The total cross-sectional bone area of radius and ulna could be calculated from the width of the structures measured on the photon absorption curves. Using this parameter and the relation between BMC and ash weight, the actual in-vivo bone mineral content in the forearm could be expressed in terms of ash-weight in grams per cm3 of total bone.

Changes in virulence, M protein and IgG Fc receptor activity in a type 12 group A streptococcal strain during mouse passages

A type 12 group A strain (1800) was passaged serially through mice 25 times. The ability to servive in normal human blood dropped from a growth index of 52 after the first passage to 1 after four passages. After 14 passages the growth index increased again and stabilized above 30. The virulence for mice increased from a LD100 of 10(8) colony forming units (CFU) to 10-100 CFU after 7 passages and then remained constant. The Mqw antigen disappeared after 4 passages as tested by immunodiffusion, electroimmunoassay and indirect bactericidal tests. Three antisera, raised in rabbits against strains originally belonging to types M3, M12 and M46 but devoid of type antigens after mouse passages showed high bactericidal indices against the 1800 strain after 14 or more passages on mice. Anti-type M1 serum was also found bactericidal for the passaged strains. The IgG Fc-receptor activity of the strain isolated after each mouse passage was tested in hemagglutination experiments with human red blood cells coated with "incomplete" anti-Rh and hot hydrochloric acid extracts of the strains. The capacity to agglutinate "Ripley"-coated cells increased gradually during the first 12 passages and subsequently the titres of the extracts stabilized between 1:160 and 1:320. The HUN coat, useful for detection of the G3m (5) maraker gave titraes increasing with the number of passages while the titres for IgG1 coats kept at 1:4 or below. On background of these results, the possible role of the IgG Fc-receptor as a virulence factor is discussed.