Recognition of the alpha-1 and alpha-2 domains of H-2 molecules by allospecific cloned T cells

Previously we had shown that allospecific bulk cultures of cytolytic T lymphocytes lysed the products of cloned class I major histocompatibility genes expressed after DNA-mediated gene transfer. In these experiments, performed by using cloned allospecific T cell effectors, a T cell hybridoma, and recombinant DNA technology, we have been able to map determinants recognized by these T cell clones to the alpha-1 domain of H-2Dd and the alpha-2 domain of H-2Ld (four of eight clones). Target cells used were L cells (H-2k), expressing wild type or hybrid H-2 antigens of H-2d origin. Thus, for the first time determinants recognized by cloned T cells are found in the recombined alpha-1 and alpha-2 domains.

Recognition of the alpha-1 and alpha-2 domains of H-2 molecules by allospecific cloned T cells

Previously we had shown that allospecific bulk cultures of cytolytic T lymphocytes lysed the products of cloned class I major histocompatibility genes expressed after DNA-mediated gene transfer. In these experiments, performed by using cloned allospecific T cell effectors, a T cell hybridoma, and recombinant DNA technology, we have been able to map determinants recognized by these T cell clones to the alpha-1 domain of H-2Dd and the alpha-2 domain of H-2Ld (four of eight clones). Target cells used were L cells (H-2k), expressing wild type or hybrid H-2 antigens of H-2d origin. Thus, for the first time determinants recognized by cloned T cells are found in the recombined alpha-1 and alpha-2 domains.

Doppler diagnosis of valvular aortic stenosis in patients over 60 years of age

Twenty-five consecutive elderly patients with suspected aortic stenosis underwent continuous-wave Doppler echocardiography followed by cardiac catheterization. Doppler-derived calculations of peak and mean aortic valve gradients were compared with catheterization-derived values of peak-to-peak, peak and mean gradients. The best correlation was found between Doppler- and catheterization-derived mean gradients (r = 0.89). A Doppler-derived measure of the timing of peak aortic flow velocity (modified time-to-peak velocity/modified left ventricular ejection time) successfully separated those with gradients above or below 50 mm Hg and also helped to avoid over- or underestimation of aortic valve gradients by Doppler.

A subset of Ly-1 inducer T cell clones activates B cell proliferation but directly inhibits subsequent IgG secretion

We find that a fraction of Ly-1+2- inducer T cell clones inhibits differentiation of memory B cells into IgG-secreting plaque-forming cells. Inhibition of secondary antibody responses was not the result of induction of Ly-2+ T suppressors. Instead, inducer cells directly inactivated B cells, requiring an antigen bridge as well as identity at the major histocompatibility complex (I-A) locus. The interaction between the inducer T cell clone and hapten-specific B memory cells results in an early proliferative response and subsequent failure of B cells to secrete antibody in response to T helper cell signals. Possible mechanisms for this novel type of B cell inactivation are explored.

Serum aminotransferases and gamma-glutamyl transferase in protein energy malnutrition

Forty six children suffering from Protein Energy Malnutrition (PEM) were classified according to the Wellcome classification. Their aspartate aminotransferase, alanine aminotransferase and gamma-glutamyl transferase were measured. Aspartate aminotransferase was raised in 20 patients (43.5%) and alanine aminotransferase was raised in 12 patients (26%). Y-glutamyl transferase was raised in only one patient suffering from marasmic kwashiorkor, who, in contrast to the rest of the patients had a marked rise in aminotransferases. The aminotransferase elevation correlated positively with a Severity Index calculated from height and weight retardation and serum albumin levels. It is suggested that the moderate rise in aminotransferases found in PEM is not due to damage to the liver. However, marked enzyme elevations can occur in a small minority of patients, suggestive of liver injury, probably caused by hepatotoxins.

Binding of antigen in the absence of histocompatibility proteins by arsonate-reactive T-cell clones

Inducer T-cell clones reactive to the p-azobenzenearsonate (arsonate) hapten possess binding sites for radioactive arsanylated proteins, which are not present on clones with other antigen specificities. Binding occurred in the absence of histocompatibility proteins. Binding was specific for the p-azobenzenearsonate hapten, since unconjugated proteins and proteins conjugated to the nonactivating o-azobenzenearsonate hapten neither bound to the clones nor competed binding of radioactive antigen. One of the clones was studied in more detail, using a panel of structural analogs of arsonate conjugated to the carrier protein ovalbumin. All conjugates that activated the clone in the presence of antigen-presenting cells also competed binding of radioactive antigen in the absence of antigen-presenting cells. Nonactivating conjugates did not compete binding. Based on evidence in this and the succeeding paper (Rao et al., accompanying paper), we suggest that these arsonate-binding sites may include the physiological antigen receptors of arsonate-reactive T-cell clones.

Analogs that compete for antigen binding to an arsonate-reactive T-cell clone inhibit the functional response to arsonate

We have tested several structurally related haptens, conjugated to ovalbumin, for their effect on activation of an inducer T-cell clone reactive to the p-azobenzenearsonate (arsonate) hapten. Low concentrations of some analogs inhibited DNA synthesis and lympkokine production by the clone in response to arsanylated antigen, but not in response to the lectin concanavalin A. Inhibition was specific for this clone, since the response of clones reactive to other antigens was not blocked. Inhibition may result from competition of these analogs with arsonate at a site on the T cell. The effectiveness of blocking by arsonate analogs parallels their ability to bind to a previously described arsonate-binding site on the clone (Rao et al., accompanying paper). We suggest that the binding and blocking assays detect the same physiological arsonate-recognition site on the clone, and hence that the cell-surface arsonate-binding sites we have described mediate its physiological response to antigen.

Activation specificity of arsonate-reactive T cell clones. Structural requirements for hapten recognition and comparison with monoclonal antibodies

We describe clones of hapten-specific inducer T cells from (BALB/c X A/J)F1 mice that respond to the p-azobenzenearsonate hapten conjugated to carrier proteins or directly conjugated to antigen-presenting cells. Some of the clones are also activated by haptens structurally related to arsonate. All activating analogues are recognized by each clone in association with the same major histocompatibility complex (MHC) protein as is arsonate. Weakly activating and nonactivating analogues are immunogenic in D2.GD amd (BALB/c X A/J)F1 mice, since they can effectively activate primed lymph node cells or long-term hapten-reactive cell lines. Hence the specificities of these clones may reflect their intrinsic recognition of arsonate and its analogues, rather than more efficient presentation of certain analogues than of others by antigen-presenting cells, or differential recognition of associated MHC epitopes by the clones. We compare the activation specificities of the clones with the binding specificities of monoclonal antibodies to arsonate, and discuss structural features of the analogues that may be important for activation and binding. Our results suggest that a site (or subsite) on arsonate-reactive T cell clones may interact directly with hapten, and may be experimentally separable from the site (or subsite) for MHC determinants.

Carcinoma of the tonsillar area treated with external radiotherapy alone

Seventy patients with carcinoma of the tonsillar area were treated with radiation therapy alone, all with a minimum follow-up of 3 years. Seventeen patients with stages I and II developed six recurrences and three were salvaged by surgery. Fifty-three patients with stages III and IV developed 24 recurrences, and only three could be salvaged by surgery. We conclude that radiation therapy is adequate for stages I and II carcinoma of the tonsillar area. Local control rate is satisfactory and surgical salvage is acceptable. Patients with advanced disease, Stages III and IV, have a poor survival rate with radiotherapy alone. Local recurrence is high and surgical salvage is inadequate. We have decided to offer selected patients with stages III and IV tonsillar carcinoma planned combined radiotherapy and surgery, in an effort to improve the survival rate.

A study of urinary excretion of biogenic amine metabolites in epilepsy

Urinary total catecholamines, their metabolites, and a metabolite of serotonin have been investigated in 20 patients with epilepsy, and in 10 controls. The levels of total catecholamines, vanillyl mandelic acid and 5-hydroxyindole acetic acid in epileptics were not significantly different from the controls. However, the mean 3-methoxy-4-hydroxyphenylglycol, excretion in cases of epilepsy was significantly increased as compared to the control group. It is concluded that a central catecholaminergic disturbance is involved in the pathogenesis of epilepsy.

Urinary excretion of taurine in epilepsy

The level of urinary taurine and 17-hydroxycorticosteroids were estimated in 19 cases of epilepsy. These levels were then compared with those of normal healthy subjects. The urinary taurine levels were significantly higher in epilepsy and have diagnostic as well as prognostic significance.

Posterior fracture-dislocation of the distal part of the fibula. Mechanism and staging of injury

The Bosworth fracture, a fixed posterior fracture-dislocation of the distal part of the fibula due to external rotation of the supinated foot, is a rare injury. In this report we review the literature, present two new cases, and describe our cadaver studies, showing that the initial stages of the injury are identical to those of a Maisonneuve fracture. The final stages that are unique to this fracture-dislocation are the posterior dislocation and fracture of the fibula and the fracture of the medial malleolus or rupture of the deltoid ligament. The objectives of treatment are reduction of the dislocation, repair and stabilization of the tibiofibular syndesmosis, and restoration of the ankle mortise to its anatomical position.

Lysis of inducer T cell clones by activated macrophages and macrophage-like cell lines

We describe a sequence of reciprocal interactions between cloned inducer T cells and antigen-presenting cells (APC) that results in selective depletion of the antigen-reactive inducer cells. We show that corecognition of antigen and I-A by hapten-reactive inducer T cell clones results in (a) release of macrophage-activating factor (MAF) and other lymphokines, (b) expression of lytic activity by a subset of MAF-sensitized APC after triggering, and (3) lysis (mediated by the activated and triggered macrophage) of the inducer T cell clone and other cells in the vicinity. We suggest that this sequence of steps may limit the extent of macrophage-mediated tissue destruction by depleting the specific inducer T cell clones that initiate the response.

Disparate functional properties of two interleukin 1-responsive Ly-1+2- T cell clones: distinction of T cell growth factor and T cell-replacing factor activities

We describe the properties of two Ly-1+2- T cell clones (Ly-1.14 and Ly-1.21), which are maintained in long-term culture in the absence of other cell types. The clones require media containing a source of interleukin 1 as well as interleukin 2. They retain physiologic responses to interleukin 1, which is required for optimal production of T cell lymphokines by these clones in response to concanavalin A (Con A). The two Ly-1+2- T cell clones differ in their production of lymphokines after stimulation by Con A. The supernatant of clone Ly-1.21 promotes the proliferation of T cells maintained in long-term culture, induces antibody synthesis in cultures of B cells and antigen, and induces the differentiation of cytolytic cells in cultures of thymocytes and antigen; these assays define the properties of T cell growth factor (TCGF), T cell-replacing factor for B cells (TRF-B), and T cell-replacing factor for cytolytic cells (TRF-C), respectively. In contrast, the supernatant of clone Ly-1.14 contains only TCGF activity and does not promote antibody synthesis by B cells or differentiation of cytolytic cells from thymocytes. The results indicates that TCGF and TRF activities reside on independent, although perhaps related, molecules.

Disparate functional properties of two interleukin 1-responsive Ly-1+2- T cell clones: distinction of T cell growth factor and T cell-replacing factor activities

We describe the properties of two Ly-1+2- T cell clones (Ly-1.14 and Ly-1.21), which are maintained in long-term culture in the absence of other cell types. The clones require media containing a source of interleukin 1 as well as interleukin 2. They retain physiologic responses to interleukin 1, which is required for optimal production of T cell lymphokines by these clones in response to concanavalin A (Con A). The two Ly-1+2- T cell clones differ in their production of lymphokines after stimulation by Con A. The supernatant of clone Ly-1.21 promotes the proliferation of T cells maintained in long-term culture, induces antibody synthesis in cultures of B cells and antigen, and induces the differentiation of cytolytic cells in cultures of thymocytes and antigen; these assays define the properties of T cell growth factor (TCGF), T cell-replacing factor for B cells (TRF-B), and T cell-replacing factor for cytolytic cells (TRF-C), respectively. In contrast, the supernatant of clone Ly-1.14 contains only TCGF activity and does not promote antibody synthesis by B cells or differentiation of cytolytic cells from thymocytes. The results indicates that TCGF and TRF activities reside on independent, although perhaps related, molecules.

Alloreactive T-cell clones. Ly phenotypes predict both function and specificity for major histocompatibility complex products

We have studied the association of Ly phenotype with function and specificity for major histocompatibility complex (MHC) products by examining the properties of 21 T-cell clones derived from B10 anti-B10.D2 and B10.A anti-B10.D2 mixed lymphocyte cultures (MLC). T cells were selected after MLC solely on the basis of Ly phenotype, cloned by limiting dilution, and tested for stability of Ly phenotype, function and specificity for class I or class II MHC products. Sixteen Ly-1+2- and five Ly-1-2+ T-cell clones were tested. The clones selected for the Ly-1+2- phenotype maintained this phenotype, expressed helper but not lytic function, and recognized class II MHC products (I-Ad or I-Ed). All Ly-1-2+ clones maintained this phenotype, possessed cytolytic but not helper activity, and recognized class I MHC products (Dd and Ld). Our data therefore confirm at the clonal level the original observations of a remarkably consistent correlation between Ly markers, MHC specificity, and function. They suggest that the expression of Ly antigens on T-cell clones forms part of a genetic program for each of these specialized cells that also determines their function and MHC specificity.

Haemophilus influenzae meningitis in adults

Three cases of pyogenic Haemophilus influenzae meningitis in adults have been diagnosed within the Brisbane Metropolitan area in the last twelve months. This had been considered a very unusual cause of meningitis in adults which has not previously been recorded in the Australian literature, and should alert clinicians to a possible alteration in the age specificity of this disease. Two of the three isolates proved resistant to ampicillin; this emphasizes the need to exclude beta lactamase production in all Haemophilus isolates from critical infections. All three patients recovered without significant sequelae but the choice of primary antimicrobial in adult meningitis remains open to question.

The management of carcinoma of the nasal vestibule

Forty-two patients with squamous cell carcinoma of the nasal vestibule were reviewed. The patients were treated at either the Southern California Permanente Medical Group or the UCLA Medical Center. Thirty-eight patients (90%) had early lesions and 4 (10%) had late disease (involving the nodes or bone). The following conclusions were formed from this study: (1) Patients without bone destruction or lymph node metastases will do well with either irradiation or surgery. Those with bone destruction or lymph node metastases will do poorly in spite of radical treatment. (2) Early lesions can often be cured with either partial rhinectomy or irradiation. (3) A surgical recurrence following partial rhinectomy can be salvaged with irradiation. (4) A radiation recurrence of an early lesion can be salvaged with surgery. (5) The routine use of total rhinectomy for early carcinoma or radiation failure is unwarranted. (6) Other primary cancers are not uncommon when followup is extended to the 5- to 10-year interval.

Differential effects of methacholine and antigen challenge on gas exchange in allergic subjects

In order to better characterize the differential effects of nonspecific and specific (antigen) bronchial challenge on gas exchange, seven ragweed-sensitive subjects with a history of asthma underwent progressive inhalation challenge with methacholine and ragweed extract on two different days. For comparable severity of bronchospasm (mean specific airway conductance 0.05 sec-1cm-1H2O for methacholine and 0.06 sec-1cm-1H2O for ragweed), there was a greater decrease in mean arterial oxygen saturation after ragweed (4.7%) than after methacholine challenge (2.7%) (p less than 0.05). While this was not accompanied by differences in static lung volumes, the density-dependent index decreased by 19% after ragweed (p less than 0.001) but remained unchanged after methacholine challenge. These results suggest that a greater involvement of peripheral airways in the bronchospastic response is, at least in part, responsible for the greater decrease in arterial oxygen saturation after ragweed challenge.