Air contamination during skin preparation and draping in joint replacement surgery

Despite the use of ultraclean air, there are still cases of infection in total joint arthroplasty. One possible route by which bacteria may enter the wound is indirectly by contamination of instruments during skin preparation and draping. We found that bacterial air counts were 4.4 times higher during preparation and draping for hip or knee arthroplasty using an unscrubbed, ungowned leg holder than during the operation itself. With the leg holder scrubbed and gowned during preparation and draping, the air counts were reduced but were still 2.4 fold greater than intraoperatively. On some occasions, the air counts during preparation and draping exceeded the standards for ultraclean air irrespective of the attire of the leg holder. We recommend that the leg is held by a scrubbed and gowned member of the team. More importantly, we consider that instrument packs should be opened only after skin preparation and draping have been completed.

The total chemical synthesis of monocyte chemotactic protein-1 (MCP-1)

The affinity-based N (alpha)-amino protecting group tetrabenzo[a,c,g,i]fluorenyl-17 methoxycarbonyl (Tbfmoc) has been utilized as a hydrophobic probe to allow the simple, quick and highly effective isolation of a 76 residue cysteine-containing protein (MCP-1). The base-labile Tbfmoc group can be removed under very mild conditions, which preserve the thiol-containing protein in the reduced state. Oxidative folding was then used to furnish the biologically active beta-chemokine MCP-1.

Chamber for testing metered-dose propellant-driven aerosols of immunologically relevant proteins

A small aerosol chamber was developed for testing and delivery of aerosols of immunologically important proteins to the respiratory tracts of rodents. The chamber was designed to accommodate the small aerosol volumes produced by metered-dose propellant-driven aerosol canisters. Metered bursts of protein aerosols released into the chamber could be sampled for their particle sizes or used to expose the noses of up to six mice to the aerosols. The chamber consisted of a polyethylene tank with two removable plexiglass end plates. One end plate accommodated the propellant-driven, metered-dose, aerosol vial. The other end of the tank was fitted with a plate accepting aerosol sampling devices or a plate containing mouse restrainers. Uniform concentrations of aerosolized proteins were obtained at different positions in the chamber when sampled for particles of respirable size. Respirable-sized protein particles produced by propellant-driven aerosols ranged from 5 to 50% of total aerosolized protein. Propellant-driven aerosols of proteins released in the chamber produced aerosol particles equivalent to 15-26 micrograms of total protein exposure to the respiratory tract of each mouse. The chamber permitted aerosol releases without risk of operator exposure. This aerosol chamber will permit the testing of protein aerosols for their immunologic consequences to the respiratory tract. Potential proteins for testing in this device include immunizing vaccine antigens, immunomodulating cytokine proteins, and passive antibody aerosol therapies against respiratory infections.

Propellant-driven aerosols of functional proteins as potential therapeutic agents in the respiratory tract

Aerosols of respirable-sized particles of functional proteins were delivered by volatile propellant from metered-dose aerosol canisters. The enzyme alkaline-phosphatase and a monoclonal antibody were lyophilized with surfactant and suspended in the aerosol propellant dimethylether. As much as 20 micrograms of functional protein, assessed by enzyme function or antibody binding activity, was delivered per 40 microliters of released propellant. Up to 25% of the protein was of respirable size (< or = 4 microns mass median aerodynamic diameter) when aerosolized proteins were sampled with a Casella cyclone. Respirable particles were derived from visible surfactant/protein complexes suspended in the liquified propellant and from propellant-soluble, nonsedimentable, surfactant/protein molecules that are probably reverse micelles. 10-14 days of propellant exposure in dimethylether increased protein solubility in the propellant, increased the total protein aerosolized and maintained or increased the quantity of respirable-sized protein molecules, as compared to the day aerosol vials were charged with propellant. Scanning electron microscopic studies of the respirable-sized protein/surfactant particles showed that they ranged in size from 0.07 to 3.25 microns in diameter, and they appeared to be chain aggregates of spherical subunits, 0.11 to 0.93 microns in diameter. This structural motif was common to both proteins. The possibility of delivering immunizing antigens, cytokines, passive antibodies and other therapeutic proteins to the respiratory tract using propellant-driven aerosols is discussed.

Pharmacokinetics and pharmacodynamics of a new cardiotonic vasodilator agent, 349U85, in normal subjects

OBJECTIVE

To assess the pharmacodynamics and pharmacokinetics of single oral doses of a new vasodilator-cardiotonic agent, 349U85 hydrochloride [6-piperidino-2(1H)-quinolinone hydrochloride], in healthy male subjects.

METHODS

This randomized, parallel, double-blind, placebo-controlled, dose escalation trial was conducted at a university-based clinical research center among 27 healthy male subjects. Data measurements used in the study included cardiac index, supine and standing blood pressure, 24-hour ambulatory electrocardiography, and 12-lead electrocardiography.

RESULTS

Doses from 2 mg to 250 mg were well tolerated. Cardiac index, supine heart rate, and orthostatic hypotension, indicators of inotropic, chronotropic, and vasodilator effects, respectively, correlated to plasma concentrations of 349U85 and of its metabolite, 661U88. Results suggest that 349U85 may be more responsible for inotropic effects, whereas 661U88 may be more responsible for vasodilatory and chronotropic effects. These results are consistent with the preclinical pharmacologic profile for these two compounds. Headache, orthostatic dizziness, and hypotension tended to occur more frequently at higher doses and were temporally related to drug administration. Pharmacokinetic analyses indicate nonlinearity of 349U85 and 661U88, suggestive of saturation of metabolism and large interindividual variability in maximum plasma drug concentration and area under the plasma concentration-time curve. The source of the variability is not known. The time to maximum distribution was approximately 0.7 hours for both 349U85 and 661U88; the terminal elimination half-life was 1 hour for 349U85 and 3 hours for 661U88. Holter monitoring revealed asymptomatic increases in ventricular and supraventricular ectopic activity in some volunteers; ectopy appeared to be related to the dose of 349U85 and generally occurred at higher doses.

Interscalene block for shoulder arthroscopy: comparison with general anesthesia

Arthroscopic shoulder surgery can be performed under regional or general anesthesia. The objective of this study was to demonstrate that regional anesthesia has several benefits over general anesthesia for this type of surgery, particularly in the ambulatory patient. Forty patients received general anesthesia and 63 an interscalene block. The regional block was found to be safe and effective, with a high degree of patient acceptance. It provided excellent intraoperative analgesia and muscle relaxation. Postoperatively, regional anesthesia resulted in fewer side effects, fewer hospital admissions, and a shorter hospital stay than did general anesthesia.

Laparoscopic management of acute small bowel obstruction

Acute small bowel obstruction is commonly due to band adhesions. In the past it has had an overall mortality rate of up to 11% for elderly patients. In this paper we report three cases of small bowel obstruction, treated by laparoscopic division of the causative bands. All patients recovered rapidly and were discharged within 5 days of surgery.

Stereoselective high-performance liquid chromatographic assay with fluorometric detection for the isomers of mivacurium in human plasma

A high-performance liquid chromatographic assay with fluorometric detection was developed for the analysis of the stereoisomers of mivacurium, a new short-acting neuromuscular blocker, in plasma. The isomers were isolated from plasma by solid-phase extraction with C18 and anion-exchange cartridges. The extracts were chromatographed on a LiChrosphere 60 RP Select B column (125 mm x 4.6 mm I.D.) using a mobile phase of acetonitrile-water (4:6, v/v) containing 0.005 M octanesulfonic acid. The fluorescence excitation and emission wavelengths were 202 and 320 nm, respectively. The accuracy and precision of the assay, expressed as the percentage deviation of measured values from true values and the percentage coefficient of variation, respectively, were less than or equal to 10% at all concentrations except for the percentage coefficient of variation at the lower limit of quantitation (5 ng/ml). The assay has been successfully used for the analysis of plasma samples from a pharmacokinetic study in human volunteers.

In situ detection of autoanti-idiotype antibody-forming cells induced by influenza virus infection

In situ immunocytochemical-staining methods combined with computer-aided image analysis were employed to examine autoanti-idiotype antibody-forming cell expansion in vivo. Autoanti-idiotype antibody-forming cells were demonstrated in the spleens of C57BL/6J (B6) strain mice intranasally infected with the influenza virus A/Hong Kong/168/(H3N2)[R] X-31. Autoanti-idiotype B cells were detected and elevated in spleen tissues after secondary influenza infections compared to normal B6 mice, and were specific for a dominant idiotype antibody called PY206 reactive with the influenza virus hemagglutinin. Influenza virus-infected BALB/c mice, which make little PY206 Id, did not have increased autoanti-Id against PY206 compared to normal mice. Results provide evidence for an idiotype network-mediated stimulation of autoanti-idiotype B cell production during influenza virus infection.

Expression of the intracisternal A particle endogenous retrovirus genes over the lifetime of mouse and Syrian hamster

Transcription of intracisternal A particle genes in several tissues has been examined throughout the lifespan of inbred C57BL/6J and outbred wild-type mice and golden Syrian hamster. In both rodent species, expression of the genes occurs at all ages and in all tissues. Also, in both species, RNA transcripts of heterogeneous lengths are found that correspond in size not only to the proviral genes previously characterized but also to genes larger than those reported. In hamster, the size heterogeneity is more extensive than in the mouse, where discrete size transcripts are detectable over the heterogeneous signal. Transcription of these genes throughout the lifespan is not peculiar to the hamster or inbred laboratory mouse strain (C57BL/6J) but also occurs in many tissues of outbred wild-type Mus musculus at each age examined. Lifelong transcription of intracisternal A particle retrovirus genes raises the suggestion that retrovirus proteins and cDNA are continuously produced and could facilitate cumulative genomic rearrangements. This could lead to improper gene regulation and thus contribute to the age-dependent increase of cancer and more generally to the aging process itself.

A dominant idiotype in the antibody response against the influenza virus hemagglutinin. Serum and in situ analyses

PY206 is an Id associated with a BALB/c murine mAb described as being specific for the influenza A virus hemagglutinin. However, production of this Id by BALB/c mice immunized with influenza is low. This report shows that the PY206 Id is a dominant component of the anti-influenza antibody response in C57BL/6J strain mice infected intranasally with the influenza A/Hong Kong/168/(H3N2)[R] X-31 virus. High PY206 Id expression was linked to the IgHb Ig allotype locus. PY206 Id+ antibody-forming cells were identified in situ in cryostat sections of lymphoid tissues and idiotypic heterogeneity was identified among PY206+ B cells. Uninfected adult C57BL/6J mice had PY206 Id in their serum that lacked influenza binding specificity. In situ analysis of prenatal and neonatal spleen of uninfected C57BL/6J mice showed that the expansion of PY206 Id+ B cells occurred early in development. PY206+ cells were demonstrated in the lungs of influenza-infected mice but not in normal mice, establishing the capability to study this B cell population in the lung. This model offers the opportunity to manipulate the anti-influenza A virus hemagglutinin B cell response and to study the proliferation and migration of influenza-specific B cells in their native tissue environments.

A dominant idiotype in the antibody response against the influenza virus hemagglutinin. Serum and in situ analyses

PY206 is an Id associated with a BALB/c murine mAb described as being specific for the influenza A virus hemagglutinin. However, production of this Id by BALB/c mice immunized with influenza is low. This report shows that the PY206 Id is a dominant component of the anti-influenza antibody response in C57BL/6J strain mice infected intranasally with the influenza A/Hong Kong/168/(H3N2)[R] X-31 virus. High PY206 Id expression was linked to the IgHb Ig allotype locus. PY206 Id+ antibody-forming cells were identified in situ in cryostat sections of lymphoid tissues and idiotypic heterogeneity was identified among PY206+ B cells. Uninfected adult C57BL/6J mice had PY206 Id in their serum that lacked influenza binding specificity. In situ analysis of prenatal and neonatal spleen of uninfected C57BL/6J mice showed that the expansion of PY206 Id+ B cells occurred early in development. PY206+ cells were demonstrated in the lungs of influenza-infected mice but not in normal mice, establishing the capability to study this B cell population in the lung. This model offers the opportunity to manipulate the anti-influenza A virus hemagglutinin B cell response and to study the proliferation and migration of influenza-specific B cells in their native tissue environments.

Tumor necrosis factor-alpha analyzed within individual macrophages by combined immunocytochemistry and computer-aided image analysis

Immunocytochemical staining procedures were combined with computer-aided image analysis to quantitate the relative intracellular production of tumor necrosis factor-alpha (TNF) within individual macrophages. Optimal conditions for time and methods for the activation of TNF production, fixation of cells for optimal immunocytochemical staining, and image analysis methods were determined. Thioglycolate elicited peritoneal macrophages were readily activated to significantly increased levels of intracellular TNF, as early as 1 hr after activation with lypopolysaccharide (LPS) + interferon-gamma: maximum intracellular TNF was evident after 2-3 hr. Both LPS and interferon-gamma was necessary to increase intracellular TNF. Normal alveolar macrophages also readily produced increased intracellular TNF, but normal peritoneal and splenic macrophages were poorly activated to TNF production. Acid stripping of receptor bound TNF allowed discrimination between intracellular TNF/integral membrane TNF, and TNF-receptor-bound TNF. Results stress the importance of studying these TNF forms early after activation. Applications for TNF quantitation by these means are discussed.

Prevalence of maternal HIV infection based on anonymous testing of neonates, Sydney 1989

The presence of antibody to human immunodeficiency virus (HIV) in post-partum women may be inferred by screening the blood of their newborn babies, since maternal IgG antibodies freely cross the placenta. We tested a sample of 10,217 newborns from 10 hospitals covering three areas in Sydney and other metropolitan centres in New South Wales from April to July, 1989. None of the specimens gave a positive test for antibody to HIV. Thus, the prevalence of HIV positive serology in this sample of newborns was found to be zero. It was estimated that the seroprevalence of antibody to HIV among all neonates in the study area was between zero and 0.045% (99% confidence interval). Because newborns are an accessible group for the study of HIV, and can act as surrogates for their mothers, anonymous testing of this sentinel group will remove some of the limitations generalizing the information in the present database of HIV infection in Australia. This study provides baseline data and suggests that there is not a widespread epidemic of HIV infection among heterosexual persons in Australia at the present time and that routine antenatal testing of women for antibody to HIV may not be cost-effective. However, it will be important to repeat this study at regular intervals to detect any increase in HIV seroprevalence.

Combined immunocytochemical staining and image analysis for the study of lymphocyte specificity and function in situ

Immunocytochemical staining methods were combined with computer-aided image analysis to quantitate relative intracytoplasmic and cell membrane products within single lymphoid cells. Lymphoid cells fixed to microscope slides were immunocytochemically stained and the densities of immunocytochemical stains for individual lymphoid cells were determined on video-camera-captured microscopic images to quantitate synthesized and fully assembled antibody molecules detected by an anti-idiotypic antibody. Similarly, expression of a lymphoid cell membrane molecule, Ly-1, was comparatively quantitated in individual lymphoid cells. Densitometric analysis of tissue sections was utilized to measure tissue areas and quantitate cell nuclei in tissues. Two-color immunocytochemical staining and sequential image analyzer-determined locations of individual cells in tissues allowed unambiguous identification of doubly stained cells in their native tissue environment. This analysis was applied to the in situ identification of antibody forming cells producing the CRIc idiotype of the BALB/c anti-arsonate response and a determination of the mu chain usage by those individual cells. Applications of combined immunocytochemistry and computerized image analysis to studies of in vivo immunologic functions are discussed.

Percutaneous control of a portacaval H-graft: description of a new device and its initial clinical application

A percutaneously-controlled inflatable cuff which can change the diameter of a portacaval H-graft has been developed and used in 10 patients. When inflated, the cuff narrows the H-graft to increase portal pressure and reduce shunting. Use of the cuff has been of clinical significance in 3 of 7 long-term surviving patients. Narrowing the shunt improved the clinical state in 2 patients with encephalopathy, and reopening a closed shunt improved ascites in the third patient. Duplex ultrasound and deep Doppler have demonstrated an alteration of hepatic portal blood flow following inflation of the cuff after 6 months. It is concluded that further development of this controlled portacaval H-graft is warranted.

In situ analysis of antibody-forming cells from the BALB/c CRIc idiotype family: idiotopic heterogeneity among clustered cells

Immunocytochemical staining methods were applied toward defining the in situ expansion of the BALB/c mouse antibody-forming cells (AFC) that express the CRIc idiotype (id) family associated with the antibody response against the p-azophenylarsonate (Ar) hapten. CRIc+ AFC dominated the early primary anti-Ar response but represented a decreased fraction of the anti-Ar AFC during secondary responses. Two subsets of the CRIc family, CRIc1 and CRIc2, differed in their relative expression, with CRIc1 more pronounced during primary responses and CRIc2 better expanded in secondary responses. Idiotopic differences among AFC in very close proximity suggested convergent migration among B cells having similar but not identical V regions or possibly V region mutations among clonally derived cells. The approach also allowed in situ idiotypic analysis of polyclonally activated B AFC.

Detection of antibody, idiotype, and anti-idiotype forming cells by in situ immunocytochemical staining

Methods are described for the immunocytochemical staining of cryostat sections of lymphoid tissue with enzyme conjugates of antigen, idiotype (Id) and anti-idiotype. Results established this as a useful approach, for simultaneously detecting Id and anti-Id antibody forming cells (AFC) in situ. As a model, the 5AF6 Id family associated with the BALB/c mouse antibody response against the p-azophenyl-arsonate (Ar) epitope was examined by two-color immunocytochemical staining, allowing the simultaneous detection of both Id+ and Id- anti-Ar AFC. Spleens from mice secondarily immunized with Ar antigen but not normal mice contained anti-Id AFC stained with the 5AF6 Id but not with another immunoglobulin of the same isotype. A sequential staining method was developed which allowed the detection of both Id and anti-Id AFC in the same tissue, thus providing a means of examining Id and anti-Id antibody networks in intact lymphoid tissues.

Newborn screening for cystic fibrosis using an enzyme linked immunoabsorbent assay (ELISA) technique

Neonatal screening for cystic fibrosis (CF) has been conducted using conventional radioimmunoassay. An alternative immunoassay approach has been developed and applied to screening 35,550 newborns. Seventeen confirmed CF infants were detected by both assays. This monoclonal antibody-based enzyme immunoassay using microtitre plate ELISA technology has proved effective in case finding and offers a number of advantages. A reduced labour component, ease of handling, use of nonradioactive reagents, long reagent shelf-life, greater specificity and a reduction in potential sample handling and transposition errors combine to make this technology appropriate for a large volume neonatal screening laboratory.

Two BALB/c anti-arsonate idiotype families: two heavy chain variable regions (Vh) shared with anti-DNP antibodies are used by one family while a Vh similar to anti-GAT antibodies is used by the other

Amino terminal amino acid sequences were obtained for both the heavy (H) and light (L) chains of seven BALB/c anti-arsonate (Ar) monoclonal antibodies representing the 5AF6 and 3C6 idiotype (id) families described in this strain. 5AF6 family H chains showed strong homology to the germ-line gene sequence for the A strain 36-60 family. However, four to five identical H chain sequence differences for two of these antibodies (5AF6 and 95B5), as well as two previously reported related sequences (92D5, 94B10), suggested they were encoded by a different Vh. The 36-60 family Vh genes have been shown to be identical to the Vh gene of the anti-DNP binding myeloma M460 [Dzierzak et al., J. Immun. 136, 1864-1870 (1986)]. H chains amino acid sequences derived from an id-460+ anti-DNP hybridoma and a germ-line gene differing from the 30-60-like Vh sequence [Dzierzak et al., J. Immun. 136, 1864-1870 (1986)] were found to be virtually identical to the 95B5 and 5AF6 Vh sequences. This suggests that the same two related H chains making up two subsets of the 5AF6 anti-Ar id family are also both used in two subsets of the id-460 anti-DNP response. 5AF6 family L chains were highly homologous to the other Vk2 L chains of the 36-60 family. 3C6 family H chains can be placed in the Vh l group, are unrelated to the described anti-Ar H chain families, and have been placed in a new anti-Ar Vh family, Ars-E. The 3C6 H is similar, however, to a Vh used by a BALB/c anti-GAT idiotype family of antibodies. 3C6 L chains were of the murine kappa chain group, Vk8 and most resembled an L chain from an A strain monoclonal anti-Ar having no defined idiotype.

Regulation of the BALB/c anti-p-azophenylarsonate antibody response by monoclonal anti-idiotype. I. Anti-idiotope fine specificity

Five monoclonal anti-idiotype antibodies were prepared against the IgG1 monoclonal antibody, 5AF6, the prototype molecule representing the BALB/c 5AF6 idiotype family of antibodies specific for the p-azophenylarsonate (Ar) hapten. Three were of BALB/c origin and two were derived from allotype congenic strain CB.20. All five anti-idiotopes (id) reacted with the 5AF6 immunogen but not with four other BALB/c anti-Ar sharing other id with 5AF6. Four of the five showed some reactivity with three monoclonal anti-Ar derived from A strain mice that represent a minor component of the anti-Ar from that strain. Reactivity patterns of these anti-id indicated that all five reacted with different id on the 5AF6 molecule, yet all five were sufficiently close to the Ar-binding site for their binding to be blocked by the Ar hapten alone. Furthermore, all five anti-id could compete with each other for binding to 5AF6, indicating that the five id detected by these anti-id were in close proximity. Four of the five anti-id reacted with id produced by conformations requiring both the appropriate heavy and light chains. The fifth anti-id reacted with a heavy chain id stabilized by the presence of any light chain. The implications of such a diverse anti-id response against a single antibody molecule on anti-id network interactions are discussed.

Regulation of the BALB/c anti-p-azophenylarsonate antibody response by monoclonal anti-idiotype. I. Anti-idiotope fine specificity

Five monoclonal anti-idiotype antibodies were prepared against the IgG1 monoclonal antibody, 5AF6, the prototype molecule representing the BALB/c 5AF6 idiotype family of antibodies specific for the p-azophenylarsonate (Ar) hapten. Three were of BALB/c origin and two were derived from allotype congenic strain CB.20. All five anti-idiotopes (id) reacted with the 5AF6 immunogen but not with four other BALB/c anti-Ar sharing other id with 5AF6. Four of the five showed some reactivity with three monoclonal anti-Ar derived from A strain mice that represent a minor component of the anti-Ar from that strain. Reactivity patterns of these anti-id indicated that all five reacted with different id on the 5AF6 molecule, yet all five were sufficiently close to the Ar-binding site for their binding to be blocked by the Ar hapten alone. Furthermore, all five anti-id could compete with each other for binding to 5AF6, indicating that the five id detected by these anti-id were in close proximity. Four of the five anti-id reacted with id produced by conformations requiring both the appropriate heavy and light chains. The fifth anti-id reacted with a heavy chain id stabilized by the presence of any light chain. The implications of such a diverse anti-id response against a single antibody molecule on anti-id network interactions are discussed.

Regulation of the BALB/c anti-p-azophenylarsonate antibody response by monoclonal anti-idiotype. II. Idiotope expression in serum and its regulation

Five murine monoclonal antibody (mAb) anti-idiotypes (id), shown in the accompanying report by binding studies to be reactive with five different id on a single member of the 5AF6 family of BALB/c antibodies against the p-azophenylarsonate (Ar) hapten, were used to examine the distribution of their recognized id among anti-Ar in BALB/c and other mouse strains immunized with keyhole limpet hemocyanin-Ar (KLH-Ar). Differences in id expression in BALB/c and other strains substantiate that all five monoclonal anti-id reacted with different id. This suggests that the anti-id repertoire for a single antibody molecule may be extensive. Two of the anti-id reacted with id that were found in virtually all KLH-Ar immunized BALB/c mice, but constituted only a subset (approximately 33%) of the antibodies representing the 5AF6 family. The other three anti-id reacted with id infrequently expressed among BALB/c anti-Ar. Other mouse strains producing 5AF6 family anti-Ar antibodies also produced antibodies recognized by mAb 2CB8 and 6BA1; however, the three id infrequently expressed in BALB/c mice were produced in higher quantities and in a greater percent of mice. Monoclonal anti-id were capable of suppressing a portion but not all of the 5AF6 family of anti-Ar antibodies. Four of the five anti-id suppressed a greater fraction of the 5AF6 family than that id represented in a normal immune response, suggesting that suppression was mediated via an id other than that recognized by these monoclonal anti-id. Overall, the results indicate that an extensive repertoire of anti-id can be produced against a single id antibody, but suppression induced by treatment with these anti-id in this model is presumably mediated via another as yet unidentified id determinant(s).

Regulation of the BALB/c anti-p-azophenylarsonate antibody response by monoclonal anti-idiotype. II. Idiotope expression in serum and its regulation

Five murine monoclonal antibody (mAb) anti-idiotypes (id), shown in the accompanying report by binding studies to be reactive with five different id on a single member of the 5AF6 family of BALB/c antibodies against the p-azophenylarsonate (Ar) hapten, were used to examine the distribution of their recognized id among anti-Ar in BALB/c and other mouse strains immunized with keyhole limpet hemocyanin-Ar (KLH-Ar). Differences in id expression in BALB/c and other strains substantiate that all five monoclonal anti-id reacted with different id. This suggests that the anti-id repertoire for a single antibody molecule may be extensive. Two of the anti-id reacted with id that were found in virtually all KLH-Ar immunized BALB/c mice, but constituted only a subset (approximately 33%) of the antibodies representing the 5AF6 family. The other three anti-id reacted with id infrequently expressed among BALB/c anti-Ar. Other mouse strains producing 5AF6 family anti-Ar antibodies also produced antibodies recognized by mAb 2CB8 and 6BA1; however, the three id infrequently expressed in BALB/c mice were produced in higher quantities and in a greater percent of mice. Monoclonal anti-id were capable of suppressing a portion but not all of the 5AF6 family of anti-Ar antibodies. Four of the five anti-id suppressed a greater fraction of the 5AF6 family than that id represented in a normal immune response, suggesting that suppression was mediated via an id other than that recognized by these monoclonal anti-id. Overall, the results indicate that an extensive repertoire of anti-id can be produced against a single id antibody, but suppression induced by treatment with these anti-id in this model is presumably mediated via another as yet unidentified id determinant(s).

Development of a protocol for newborn screening for disorders of the galactose metabolic pathway

The protocol evaluated in this paper employs an enzymatic assay of galactose metabolites, thin layer chromatography, and an assay of galactose-1-phosphate uridyl transferase on a single sample of blood collected routinely for newborn screening. Its effectiveness was tested by a retrospective study of known galactosemic blood samples, and also by a prospective study of 207,000 newborn samples from which 6 infants with severe transferase deficient galactosaemia and 2 infants with red cell epimerase deficiency were identified. The detection rate for severe transferase deficiency in the newborn population was 1:35,000. Advantages include low false positive rate, definitive diagnosis within 6 hours of sample receipt, and the use of technically simple and robust procedures. This protocol overcomes the difficulties encountered with previously described procedures.

Complete nucleotide sequence of an EcoRI-1.35-kb repeated element of mouse: homology with the cellular flanking region between two intracisternal A-particle genes

The complete DNA sequence (1369 bp) of an EcoRI-1.35-kb repeated element (ER-1) of the mouse BamHI family has been determined. Analysis of this sequence revealed that a portion of the 3' end (positions 1277-1369) of ER-1 was found to share 91% homology with the flanking cellular sequence between two adjacent intracisternal A-particle (IAP) genes, IAP-19A and IAP-19B.

Nucleotide sequences of murine intracisternal A-particle gene LTRs have extensive variability within the R region

Nucleotide sequences of the long terminal repeats (LTRs) of four murine intracisternal A-particle (IAP) genes IAP62, 19, 81 and 14 were determined. Each IAP LTR contains three sequence domains, 5'-U3-R-U5-3', and each is bound by 4 bp imperfect inverted repeats. The transcriptional regulatory sequences, CAAT and TATA, as well as the enhancer core sequence GTGGTAA are conserved and precisely positioned within the U3 region. In the R region, the sequence AATAAA is located twenty base pairs preceding the dinucleotide CA, the polyadenylation site. In IAP19 and IAP81, the 5' and 3' LTRs are flanked by a six nucleotide direct repeat of cellular sequences representing the possible integration sites for these IAP proviruses. Both the size and sequences of different IAP LTRs vary considerably, with the majority of the variation localized within the R regions. The size of R varies from 66 bp in IAP14 to 222 bp in IAP62; in contrast, the U3 and U5 regions are all similar in size. These extra sequences within the R region of large LTRs consist of several unusual directly repeating sequences which account for this variability.

BALB/c antiarsonate idiotypes: gene complementation necessary for expression

The expression of two idiotype (id) families (5AF6 and 3C6) associated with the BALB/c p-azophenylarsonate-specific antibody response was examined in 11 mouse strains. Eight strains produced some of one or the other of these two id families with the mean percent expression in the anti-Ar responses of id(+) strains ranging from 8 to 43% for the 5AF6 and from 2 to 10% for the 3C6 idiotype. Four strains of mice (C58, AKR, PL, and RF) thought to have Lyt-3.1-linked VL repertoire differences from other mouse strains (Lyt-3.2) were tested for their capacity to contribute to 5AF6 and 3C6 id expression. The RF strain was capable of producing 5AF6 id and small amounts of 3C6 id. Tests of Lyt-3.1 congenic strains C.AKR (AKR Lyt-3.1 on a BALB/c background) and C.C58 (C58 Lyt-3.1 on a BALB/c background) showed that C.AKR could produce 5AF6 id while C.C58 could not. 3C6 id expression was present but depressed in C.C58 mice compared with the high 3C6 id expression in C.AKR. Breeding studies mating C.C58 (bearing the required Igh-Ca-linked VH genes) to other 5AF6(-) strains showed that gene complementation could result in 5AF6 expression in F1 offspring. 5AF6(-) strains capable of complementation included CBA/J, C57BL/6J, AKR/J, and PL/J. C58/J (from which C.C58 were derived) was the only tested strain that failed to complement for 5AF6 id expression. Additional matings between C58/J[5AF6(-)] and CBA/J[5AF6(-)] showed F1 offspring could produce 5AF6 id, indicating that C58/J can contribute functional VH genes necessary for 5AF6 id expression. Depressed expression of 5AF6 and 3C6 id was noted in mice where the C58/J-derived Lyt-3.1 genotype was present. The possibility that the depression of 5AF6 and 3C6 id expression derived from C58/J mice was due to regulatory influences rather than a lack of the VL structural genes is discussed.

Expression and regulation of two idiotype families and subsets within an idiotype family among BALB/c antibodies against p-azophenylarsonate

The expression and regulation of the two different idiotype (id) families associated with the anti-p-azophenylarsonate (Ar) antibodies of BALB/c mice were examined. Both families ( 5AF6 and 3C6 ) represented cross-reactive idiotypes (CRI) expressed in the anti-Ar of most individual BALB/c mice. In response to keyhole limpet hemocyanin-Ar, an average of about 28% of BALB/c anti-Ar had 5AF6 family idiotopes, while 3C6 family was expressed on about 16% of BALB/c anti-Ar antibodies. Suppression induced by anti-idiotype treatment against one family did not suppress the expression of the other family, suggesting that the two families were regulated independently. However, the relative expression of one family could influence the expression of the other, because depression of the 5AF6 family tended to increase the expression of the 3C6 family of anti-Ar. Analysis of the 5AF6 family showed that a majority of BALB/c mice produced antibodies bearing most or all of the idiotopes associated with the family, but that a subset of about 35% of the antibodies synthesized lacked idiotopes associated with a monoclonal anti-Ar member of this family, 2.4. Treatment of mice with anti-idiotypes prepared against two different monoclonal anti-Ar of the 5AF6 family produced different effects: one enhanced while the other suppressed idiotype expression, suggesting that there are differences in the idiotopes associated with these two regulatory pathways. Additionally, results indicated that subsets of antibodies within the 5AF6 idiotype family could be regulated independently of each other.

Expression and regulation of two idiotype families and subsets within an idiotype family among BALB/c antibodies against p-azophenylarsonate

The expression and regulation of the two different idiotype (id) families associated with the anti-p-azophenylarsonate (Ar) antibodies of BALB/c mice were examined. Both families ( 5AF6 and 3C6 ) represented cross-reactive idiotypes (CRI) expressed in the anti-Ar of most individual BALB/c mice. In response to keyhole limpet hemocyanin-Ar, an average of about 28% of BALB/c anti-Ar had 5AF6 family idiotopes, while 3C6 family was expressed on about 16% of BALB/c anti-Ar antibodies. Suppression induced by anti-idiotype treatment against one family did not suppress the expression of the other family, suggesting that the two families were regulated independently. However, the relative expression of one family could influence the expression of the other, because depression of the 5AF6 family tended to increase the expression of the 3C6 family of anti-Ar. Analysis of the 5AF6 family showed that a majority of BALB/c mice produced antibodies bearing most or all of the idiotopes associated with the family, but that a subset of about 35% of the antibodies synthesized lacked idiotopes associated with a monoclonal anti-Ar member of this family, 2.4. Treatment of mice with anti-idiotypes prepared against two different monoclonal anti-Ar of the 5AF6 family produced different effects: one enhanced while the other suppressed idiotype expression, suggesting that there are differences in the idiotopes associated with these two regulatory pathways. Additionally, results indicated that subsets of antibodies within the 5AF6 idiotype family could be regulated independently of each other.

The use of a conical spacer after laryngectomy

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Independent regulation of serologically distinct idiotypes in F1 hybrid mice

We have investigated the regulation of expression of two distinct intrastrain cross-reactive idiotypes, CRIA and CRIC , characteristic of anti-p-azophenylarsonate (anti-Ar) antibodies of the A/J and BALB/c strains, respectively, in (BALB/c X A/J)F1 ( CAF1 ) mice. Such hybrid mice were found to synthesize antibodies with each idiotype when immunized against the Ar hapten group, although the expression of each was significantly reduced as compared with the parental strain. CAF1 mice were pretreated with idiotypic-specific antibody reagents and subsequently hyperimmunized against the Ar hapten. Analysis of the idiotypes present in immune sera showed that suppression of either CRI did not concomitantly suppress the expression of the other. Alteration of the expression of one idiotype was not, however, without influence on the other; the expression of CRIC was markedly enhanced in mice suppressed for CRIA.

Idiotypic relationships among anti-p-azophenylarsonate antibodies: shared public idiotopes among A-strain minor CRI and BALB/c CRIc

Four monoclonal antibodies, each previously categorized as a member of the minor cross-reactive idiotypes of the A/J anti-p-azophenylarsonate (Ar) response, have been subjected to a detailed study of their idiotopes. All four were found to share at least one common public idiotope, with other public idiotopes expressed on some and not others of these antibodies. These CRIm were compared with 7 monoclonal anti-Ar derived from BALB/c mice that have been previously found to bear idiotopes of the BALB/c CRIc. Considerable homology of public idiotopes was demonstrated between the 4 A/J CRIm and 5 of the BALB/c CRIc(+) anti-Ar referred to as the 5AF6 family. The implications of these findings with respect to the structural basis and regulation of these idiotypes are discussed.

Idiotypic heterogeneity of the cross-reactive idiotype associated with the anti-p-azophenylarsonate antibodies of BALB/c mice

The cross-reactive idiotype (CRI) associated with the BALB/c antibody response against the p-azophenylarsonate (Ar) hapten was studied by analyzing hybridoma anti-Ar derived from BALB/c mice. The BALB/c CRI (CRIc) was previously thought to be a single idiotype as defined by rabbit anti-idiotype. CRIc has been resolved into at least two separate families of anti-Ar antibodies that are unrelated idiotypically to each other. Analysis of the 5AF6 family revealed considerable idiotypic heterogeneity, including a number of public idiotopes that appeared to be primarily associated with combinatorial idiotopes (requiring H + L chains) or L chain-specific idiotopes.

Idiotypic heterogeneity of the cross-reactive idiotype associated with the anti-p-azophenylarsonate antibodies of BALB/c mice

The cross-reactive idiotype (CRI) associated with the BALB/c antibody response against the p-azophenylarsonate (Ar) hapten was studied by analyzing hybridoma anti-Ar derived from BALB/c mice. The BALB/c CRI (CRIc) was previously thought to be a single idiotype as defined by rabbit anti-idiotype. CRIc has been resolved into at least two separate families of anti-Ar antibodies that are unrelated idiotypically to each other. Analysis of the 5AF6 family revealed considerable idiotypic heterogeneity, including a number of public idiotopes that appeared to be primarily associated with combinatorial idiotopes (requiring H + L chains) or L chain-specific idiotopes.

Cystic fibrosis screening by dried blood spot trypsin assay: results in 75,000 newborn infants

Seventy-five thousand 5-day-old babies were screened for cystic fibrosis by blood spot immunoreactive trypsin (IRT) assay as part of a statewide screening program. IRT was elevated in 433 babies; retesting revealed persistent elevation in 38. Sweat testing confirmed cystic fibrosis in 35 babies and was normal in two babies, whose IRT remained elevated at the time of the test. Sweat testing was refused by one mother. Of the 35 babies with cystic fibrosis, 13 had meconium ileus or an already diagnosed affected sibling, but the diagnosis was unsuspected in 22, although all but four had some symptoms suggestive of cystic fibrosis. Stool trypsin activity at the time of the diagnostic screen was normal in nine and reduced in seven of the babies with cystic fibrosis. One baby did not have elevated IRT, and the cystic fibrosis was missed by the screening test. In a retrospective study of blood spot samples from 36 newborn infants, who were later diagnosed as having cystic fibrosis, all had IRT levels greater than in matched controls. Our study confirms that elevated IRT is characteristic of newborn babies with cystic fibrosis, and shows that this test is very specific and sensitive when used as a newborn screening test.

An intrastrain cross-reactive idiotype associated with anti-p-azophenylarsonate antibodies of BALB/c mice

This paper describes an intrastrain cross-reactive idiotype, associated with the anti-Ar antibodies of all BALB/c mice tested. The idiotype is present on 20 to 65% of the anti-Ar antibodies of individual BALB/c mice and is localized to the Fab fragment. Adsorption of anti-Ar antibody from an immune serum completely removes the idiotypic activity. Inheritance of the idiotype is linked to the Igh locus, as shown by results obtained with congenic mice. It is present in strains that are Igh-Ia but not in the allotypically related Igh-Ij strains. The idiotype is also present in certain strains belonging to other allotype linkage groups. Expression of the idiotype is suppressed by the administration of rabbit antiidiotypic antibodies before immunization. The BALB/c idiotype is cross-reactive with an idiotype present in a small proportion of anti-Ar antibodies of A/J mice.

Relationship of idiotypes of the anti-p-azophenylarsonate antibodies of A/J and BALB/c mice

It has previously been shown that A/J anti-Ar antibodies contain 2 different families of cross-reactive idiotypes, referred to as the major and minor idiotypes populations. The present report shows that the minor A/J idiotype is related to a major idiotype of BALB/c anti-Ar antibodies. Anti-idiotype directed against the minor A/J idiotype binds 5 to 10% of A/J anti-Ar but an average of about 40% of BALB/c anti-Ar. This BALB/c population corresponds to the major BALB/c anti-Ar idiotype. For individual BALB/c anti-Ar preparations the maximum percentages of antibody bound by anti-id directed to A/J or BALB/c anti-Ar are very similar. Anti-id reactive with the minor A/J idiotypic population suppressed the formation of the BALB/c major idiotype when injected into BALB/c mice. Adsorption experiments showed that only about one-third of the minor A/J population is related to the BALB/c idiotype and that the expression of this idiotype is highly variable in individual A/J sera. Several types of evidence, obtained with hybridoma products expressing the major A/J idiotype, revealed no detectable relationship between the major A/J and BALB/c anti-Ar idiotypes.

An intrastrain cross-reactive idiotype associated with anti-p-azophenylarsonate antibodies of BALB/c mice

This paper describes an intrastrain cross-reactive idiotype, associated with the anti-Ar antibodies of all BALB/c mice tested. The idiotype is present on 20 to 65% of the anti-Ar antibodies of individual BALB/c mice and is localized to the Fab fragment. Adsorption of anti-Ar antibody from an immune serum completely removes the idiotypic activity. Inheritance of the idiotype is linked to the Igh locus, as shown by results obtained with congenic mice. It is present in strains that are Igh-Ia but not in the allotypically related Igh-Ij strains. The idiotype is also present in certain strains belonging to other allotype linkage groups. Expression of the idiotype is suppressed by the administration of rabbit antiidiotypic antibodies before immunization. The BALB/c idiotype is cross-reactive with an idiotype present in a small proportion of anti-Ar antibodies of A/J mice.

Relationship of idiotypes of the anti-p-azophenylarsonate antibodies of A/J and BALB/c mice

It has previously been shown that A/J anti-Ar antibodies contain 2 different families of cross-reactive idiotypes, referred to as the major and minor idiotypes populations. The present report shows that the minor A/J idiotype is related to a major idiotype of BALB/c anti-Ar antibodies. Anti-idiotype directed against the minor A/J idiotype binds 5 to 10% of A/J anti-Ar but an average of about 40% of BALB/c anti-Ar. This BALB/c population corresponds to the major BALB/c anti-Ar idiotype. For individual BALB/c anti-Ar preparations the maximum percentages of antibody bound by anti-id directed to A/J or BALB/c anti-Ar are very similar. Anti-id reactive with the minor A/J idiotypic population suppressed the formation of the BALB/c major idiotype when injected into BALB/c mice. Adsorption experiments showed that only about one-third of the minor A/J population is related to the BALB/c idiotype and that the expression of this idiotype is highly variable in individual A/J sera. Several types of evidence, obtained with hybridoma products expressing the major A/J idiotype, revealed no detectable relationship between the major A/J and BALB/c anti-Ar idiotypes.

Properties of a minor cross-reactive idiotype associated with anti-p-azophenylarsonate antibodies of A/J mice

Experiments are described that further characterize an A/J anti-phenylarsonate (anti-Ar) antibody population, which is idiotypically cross-reactive within the strain but differs from the family of antibodies expressing the major cross-reactive idiotype (CRI). This population has been designated as expressing a "minor" cross-reactive idiotype. Chain recombination studies with hybridoma products (HP) revealed that 2 of 3 HP expressing minor idiotypic determinants contain L chains that are idiotypically closely related to L chains in anti-Ar antibodies bearing the major CRI. The results indicate the expression of the same or very similar L chains in antibodies that differ in idiotype. The minor idiotypic population in serum was investigated by separating antibodies with minor and major idiotypic determinants by use of an immunoadsorbent containing anti-idiotype directed to an HP expressing the major CRI. Studies with the nonadherent, minor idiotypic population showed that such molecules constitute about 8 to 10% of the anti-Ar antibodies in a pool of serum but that individual sera vary markedly in their content of anti-Ar antibodies bearing minor idiotypes. Preinoculation of mice with conventional anti-idiotypic antiserum before immunization with KLH-Ar was found to suppress the appearance of the minor idiotypes as well as the major CRI upon subsequent immunization. The suppression of the minor idiotypic population is presumably mediated by the small fraction of rabbit anti-id antibodies directed against such molecules.