Detection of bullous pemphigoid antibodies by means of synthetic peptides as antigenic epitopes

In an earlier study, the circulating autoantibodies in patients with bullous pemphigoid (BP) were demonstrated in higher frequencies by means of an immunoblot technique then via indirect immunofluorescence. In the present work with the help of Peptide Structure software, two matched antigenic epitopes were chosen and synthesized. The sera of 34 patients with BP were investigated in parallel by an immunoblot technique using a human epidermal extract, and by an ELISA technique with synthetic peptides. The sera of 16 healthy persons and 10 patients with other bullous diseases served as controls. Among the 34 patients with BP, 23 sera proved positive for at least one synthetic peptide. Positive reactions with the major BP antigen (230 kD) were found in 22 patients by immunoblot technique and in 16 patients by the ELISA technique with the synthetic peptide, whereas with the minor BP antigen (180 kD), positive reactions were found in 9 patients by the immunoblot technique and 18 patients by the ELISA technique using the synthetic antigenic epitope of the minor BP antigen. All control sera were negative for both antigens in ELISA investigations. In 3 patients with pemphigus vulgaris, characteristic bands against pemphigus vulgaris antigen were identified by means of the immunoblot technique, but all other cases were negative. It is suggested that the development of this technique may lead to an opportunity for the rapid and simple diagnosis of BP.

Human herpesvirus 8 in classic Kaposi sarcoma

Recent studies suggest the role of a new human herpesvirus (HHV8) in the pathogenesis of different forms of Kaposi sarcoma (KS). In the present work we investigated the presence of HHV8 sequences in KS tumour tissues from patient with classic KS. Since clear evidences point to the role of immune suppression in the development of AIDS-associated KS or patients receiving immunosuppressive therapy, immunological investigations were also performed. We could show a highly consequent association of HHV8 sequences with classic KS in the large series of patients supporting our previous findings that this virus might be in some way involved in the pathogenesis of this tumour. In addition immunological examination of the patients revealed a mild decrease in the CD4 positive cell number, a significantly reduced CD4/CD8 ratio, a diminished PHA reactivity and leukocyte migration factor production of lymphocytes. The changes observed in the present study are similar, but much less pronounced than those may be observed in HIV infection.

Alpha-melanocyte stimulating hormone induces collagenase/matrix metalloproteinase-1 in human dermal fibroblasts

Recent reports have suggested that alpha-melanocyte stimulating hormone (alpha-MSH) plays an important role in untraviolet (UV) irradiation mediated skin changes including pigmentation, inflammation and connective tissue damage. alpha-MSH synthesis has been found to be induced in human keratinocytes following UV irradiation. In order to test the hypothesis whether UV induced alpha-MSH - via a paracrine loop - regulates the synthesis and the activity of collagenase/MMP-1, we studied the effects of alpha-MSH on the expression of MMP-1 and its tissue inhibitor of matrix metalloproteinases (TIMP-1). Confluent human dermal fibroblast cultures from foreskin biopsies of healthy human donors were treated with 10(-5)M, 10(-8)M and 10(-11)M alpha-MSH for 30 min. As determined by Northern blot analysis 10(-5)M and 10(-8)M alpha-MSH dose- and time-dependently induced steady state levels of MMP-1 mRNA up to 9-fold compared to untreated controls. TIMP-1 mRNA steady state levels were also slightly induced, however, the increased MMP-1/TIMP-1 ratio when normalized to beta-actin reflected an unbalanced synthesis. MMP-1 protein expression was studied with an immunofluorescence technique using a monoclonal antibody against MMP-1. After alpha-MSH treatment an increased number of fibroblasts revealed an intense perinuclear staining pattern compared to the less intense staining of control fibroblasts. The overall collagenolytic activity of supernatants from alpha-MSH treated fibroblasts was increased by 35%. Our data support the view that UV induced alpha-MSH - by the stimulation of collagenase/MMP-1 - may contribute to the loss of interstitial collagen related to cutaneous photoaging.

[Effectiveness of immunoblotting in the diagnosis of blistering skin diseases]

Results obtained with the immunoblot technique and indirect immunofluorescence on the specific circulating autoantibodies in 20 patients with bullous pemphigoid and in 15 patients with pemphigus vulgaris were compared. In 17 of the 20 patients with bullous pemphigoid, autoantibodies against the 230 kD major antigen could be demonstrated, and in 9 of these 17 patients more specific autoantibodies against "salt-split" epidermis antigen (220, 180, 130, 100 and 75 kD) were shown. Indirect immunofluorescence were positive only on the sera of 5 of the 20 patients with bullous pemphigoid. The sera of 11 of the 15 patients with pemphigus vulgaris yielded autoantibodies against specific antigen (130 and 85 kD protein). To summarize the results, the immunoblot technique is an excellent method to demonstrate circulating autoantibodies in patients with autoimmune bullous skin diseases and its sensitivity is better than that of the indirect immunofluorescence, procedure. Moreover, it gives a possibility to differentiate among different clinical types.

Treatment of cold urticaria

BACKGROUND

The etiology of cold contact urticaria is unknown and the therapy is therefore usually rather disappointing.

METHODS

This study reports therapeutic data on 42 patients with cold urticaria treated with a combination of terbutaline (3 x 5 mg a week, later 3 x 2.5 mg) and aminophylline-containing drugs (3 x 150 mg).

RESULTS

Complete remission of the urticarial response was achieved in 37 of the 42 patients.

CONCLUSIONS

The therapy was tolerated relatively well and the results are promising.

The lymphocyte transformation test with sulphadiminidum and with prealbumin-sulphadiminidum complex in patients with drug allergy

Earlier results (the absence or a decreased level of prealbumin [PA] in the serum, a higher proportion of PA-bearing lymphocytes as antigen-binding cells, and the presence of PA in the eluate of lymphocytes in patients with drug allergy) permitted the conclusion that, besides its other relevant functions, PA may also behave as a hapten carrier protein. The lymphocyte transformation test (LTT) involving measurement of 3H-thymidine uptake was therefore carried out with sulphadiminidum (SA) alone, with the PA-SA complex, and with the albumin-SA complex in patients with proven (3 cases) or suspected (63 cases) sensitivity to SA. In all 3 cases with proven drug allergy to SA and in 5 of the 63 suspect cases, the LTT was positive in response to both the drug alone and to the PA-SA complex (The albumin-SA complex gave positivity in only one case). In 5 of the 63 suspect cases, the LTT was positive only in response to the PA-SA complex. It is suggested that the sensitivity of the LTT could be increased if the test could be run with a complex of a protein (hapten carrier?) and a drug.

Papillomavirus DNA typing analysis in condyloma acuminatum patients and their consorts

The present study demonstrated human papillomavirus (HPV) infection by means of an in situ HPV DNA hybridization screening test (BIOHIT) in 8 male patients with genital condyloma acuminatum, their asymptomatic female consorts and 6 female patients with vulval condyloma acuminatum. The investigations revealed that all but one of the female consorts were infected by HPV but did not show any clinical sign of papillomavirus infection. HPV DNA typing analyses with the most common HPVs present in the genital tract (HPV 6, 11, 16, 18, 31 and 33) revealed the same HPV types in the consorts as found in their partners. (HPV 6 and/or 11 were detected in 4 pairs, HPV 18 and 31 in one pair each, and HPV 18/31 and 16/31 double infections in one pair each.) All cytological specimens of female patients with condyloma acuminatum were HPV-infected, the most frequent type being HPV 31. In the one patient with vulval condyloma acuminatum and carcinoma epidermoides cornescens, the "high-risk" HPV 18 was identified in both condyloma and carcinoma tissues.

[A new method, based on in situ DNA hybridization, for the detection of papillomavirus in condyloma patients and their partners]

The detection and typing analysis of human papillomavirus (HPV) were carried out by means of BIOHIT in situ HPV DNA hybridization screening and typing kits in condyloma tissues of patients with genital condyloma acuminatum, in cytological smears of their asymptomatic female consorts, and in female patients with vulval condyloma acuminatum. "Low"-risk HPV 6 and HPV 11 were demonstrated most frequently in the condyloma tissues of the male patients. It is noteworthy that all but one female consorts carried similar HPV type(s) in their cervical smears to those of their sexual partners in condyloma tissues. "Medium" and "high"-risk HPV 18, 31 and 33 types (frequently associated with high-grade dysplastic lesions and carcinomas) were demonstrated more frequently in female condylomas than in male. These three HPV types were identified in both tissues in a female patient with condyloma acuminatum and carcinoma epidermoids cornescens.

[Detection of circulating antibodies in the blood and immune complex precipitates of patients with autoimmune diseases (preliminary report)]

Antibodies against ENA (Extractable Nuclear Antigens), SSA/Ro and SSB/La were investigated in parallel in the serum and the immune complex precipitates of 41 patients with autoimmune disease (10 systemic lupus erythematosus, 23 discoid lupus erythematosus, 3 subacute cutaneous lupus erythematosus, and 5 progressive systemic sclerosis). It was demonstrated that in some cases the autoantibody spectrum of the serum did not coincide with that of the immune complex precipitate. In the majority of patients the protein content of isolated immune complexes was increased and the increase was attributed to IgG solely. In some patients antibodies appeared not only in the serum but also in immune complex, even in 4 patients (2 systemic lupus erythematosus, 1 subacute cutaneous lupus erythematosus, and 1 progressive systemic sclerosis) antibodies were detected only in the immune complex precipitate.

Primary Sjögren's syndrome from the viewpoint of an internal physician

The characteristics of primary Sjögren's syndrome are described on the basis of the follow-up of 65 patients with extraglandular symptoms at the onset and during the disease. The mean age of the patients at onset was 41.8 years and at the time of definite diagnosis was 45.8 years. Articular (32 cases), lacrimal (30 cases) and salivary (30 cases) manifestations were the most frequent initial symptoms. In only 22 of the 65 patients could Sjögren's syndrome be diagnosed at the onset. In most cases, the articular symptoms observed observed in 56 patients during the course corresponded to true polyarthritis, as verified by joint scintigraphy. Most frequently the wrists and ankles were affected. Chronic atrophic gastritis was found in 35 patients. In the young patients (13 cases), both the antrum and the corpus were affected more frequently than in the controls. In middle-aged patients (21 cases), atrophy of the antrum, and in the elderly (10 cases) atrophy of the corpus was more frequent than in the controls. All three types of chronic atrophic gastritis occurred in the disease. The decreased gastric acid secretion was characteristic of types A and AB gastritis, but the hypergastrinaemia only of type A. It was verified that chronic duodenitis and jejunitis occur in the disease. The pancreatic lesions were mild. Renal involvement was detected in 15 patients, vascular symptoms in 22 and lower-airway changes in 21. The variety of the different symptoms proved that primary Sjögren's syndrome can involve many organs.

[Detection of antimitochondrial antibodies by immunodiffusion, ELISA and immunofluorescence methods]

Ouchterlony immunodiffusion and ELISA were used for the detection of antimitochondrial antibodies. The results were compared with those of immunofluorescence measurements. The occurrence of antimitochondrial antibodies was investigated in 20 patients with primary biliary cirrhosis, in 30 with autoimmune disease and in 28 with porphyria cutanea tarda. Sonicated rat liver mitochondria fractions were used as antigens. Among the patients with primary biliary cirrhosis, Ouchterlony immunodiffusion revealed antimitochondrial antibodies in 18 cases, whereas antibodies were not found in the other groups of patients, except for 1 case of systemic lupus erythematodes. ELISA demonstrated that in all 20 patients with primary biliary cirrhosis where immunofluorescence revealed antimitochondrial antibodies, there was an increase in the quantity of antibodies against mitochondrial inner membrane fractions, and in 7 cases even against the outer membrane fractions. These 7 were the most serious cases clinically. These methods allow the differentiation of antimitochondrial antibody subtypes and promote the establishment of the diagnosis.

Day hospital as an alternative to inpatient care for cancer patients: a random assignment trial

A stratified, random-assignment trial of 442 cancer patients was conducted to evaluate medical, psychosocial, and financial outcomes of day hospital treatment as an alternative to inpatient care for certain cancer patients. Eligible patients required: a 4- to 8-hour treatment plan, including chemotherapy and other long-term intravenous (i.v.) treatment; a stable cardiovascular status; mental competence; no skilled overnight nursing; and a helper to assist with home care. Patients were ineligible if standard outpatient treatment was possible. No statistically significant (p less than 0.05) differences were found between the Adult Day Hospital (ADH) and Inpatient care in medical or psychosocial outcomes over the 60-day study period. The major difference was in medical costs--approximately one-third lower for ADH patients (p less than 0.001) than for the Inpatient group. The study demonstrates that day hospital care of medical oncology patients is clinically equivalent to Inpatient care, causes no negative psychosocial effects, and costs less than Inpatient care. Findings support the trend toward dehospitalization of medical treatment.

On the Origin of Strain-Induced Crystallization

DSC measurements on stretched polybutadiene held at fixed length show two melting regions. The first is shifted a small amount to higher temperatures relative to the isotropic endotherms. The occurrence of two melting regions is considered to be evidence for an inhomogeneous deformation of the rubber. The melting point increases on stretching are taken to be due to entropy effects.

The role of possible membrane damage in porphyria cutanea tarda: a spin label study of rat liver cell membranes

Two groups of rats were made porphyric by treatment for a shorter or a longer time with hexachlorobenzene (HCB); a third group was subjected to chronic treatment with ethanol; the fourth group comprised untreated, control animals. Suspensions were prepared of hepatocytes isolated from the livers of the animals in the individual groups, and in these systems the cell membranes were studied by spin labeling. In all three chronically treated groups, the order parameter calculated from the ESR spectra was significantly lower than that of the control group. The order parameters ofr the first three treated groups, however, did not differ significantly from one another. If either HCB or ethanol was incorporated into the isolated hepatocytes of the healthy control animals, the fluidity of the hepatocyte membranes increased. The order parameter decrease (compared to the control) for the hepatocyte membranes of the animals treated chronically with HCB or ethanol can be ascribed to the direct membrane-fluidizing effect of HCB or ethanol, and also to the altered lipid metabolism. With regard to the difference in the mechanisms of action of HCB and ethanol, on the basis of the experimentally proved membrane-damaging effect of the porphyrinogenic HCB it is probable that, besides other factors, the membrane damage may play an important role in the pathogenesis of porphyria cutanea tarda.

Study of erythrocyte delta-aminolevulinic acid dehydratase activity in porphyria cutanea tarda

The erythrocyte delta-aminolevulinic acid dehydratase activity was studied in porphyria cutanea tarda patients, compared to healthy controls, in an attempt to resolve the contradictions in the relevant literature data. In an in vitro experimental system, a study was also made of how the erythrocyte delta-aminolevulinic acid dehydratase activity varies on the action of the activators -SH and Zn2+. It was found that, compared to the healthy controls, the erythrocyte delta-aminolevulinic acid dehydratase activity of porphyria cutanea tarda patients is significantly decreased, but it is restored to the original activity level on the addition of -SH and Zn2+. Since there is a general -SH requirement of delta-aminolevulinic acid dehydratase, the most obvious explanation for the decrease of the activity in the case of the patients is the shift of the natural redox systems of the erythrocytes, and the decrease of the reduced glutathione/oxidized glutathione ratio.