T-cell lymphoma revealed by a peripheral neuropathy. A report of two cases with an immunohistologic study on lymph node and nerve biopsies

In two patients a peripheral neuropathy was the presenting symptom of a noncutaneous peripheral T-cell lymphoma. In the first patient, the neuropathy had a relapsing and remitting course, the symptoms improved under corticosteroid therapy. The second patient suffered from a relentless neuropathy. In both cases the lymphoma infiltrated the peroneal nerve with an angiocentric and perivascular pattern resembling that observed in central nervous system lymphomas. The characterization of T-cell subsets in the lymph node showed cells with the helper/inducer and suppressor/cytotoxic phenotype in the first case and a predominance of cells with the helper/inducer phenotype in the second case. In the nerve, lymphocytes beard the helper/inducer phenotype antigen. A typical paraneoplastic vasculitis of nerve showed clearly different immunologic features.

Sjögren-like syndrome after drug-induced toxic epidermal necrolysis

7 of 9 patients recovering from a drug-induced toxic epidermal necrolysis (TEN) which they had had 2 months to 4 years before had xerostomia, or keratoconjunctivitis sicca, or both. 5 patients had symptoms; 2 had severe visual impairment. In 5 cases there was lymphocytic infiltration of small salivary glands; in 2 patients this was identical to that of Sjögren syndrome. None of the patients had antinuclear antibody. TEN may occur during acute graft-versus-host disease (GVHD) and these observations are reminiscent of the sicca syndromes reported during chronic GVHD. They suggest that autoimmune mechanisms may be involved in drug-induced TEN and that Sjögren syndrome may occur as the result of a drug reaction.

Agonist mediated conformational changes of solubilized calf forebrain muscarinic acetylcholine receptors

Muscarinic receptors in calf forebrain membranes can be identified by the specific binding of the radiolabelled antagonist [3H]dexetimide. These receptors (2.8 pM/mg protein) comprise two non-interconvertible subpopulations with respectively high and low agonist affinity but with the same antagonist affinity. For all the agonists tested the low affinity sites represent 85 +/- 5% of the total receptor population. 0.5% Digitonin solubilized extracts contain 0.8 pM muscarinic receptor/mg protein. In contrast with the membranes, these extracts contain only sites with low agonist affinity. The alkylating reagent N-ethylmaleimide causes an increase of the acetylcholine affinity for the low affinity sites in membranes as well as for the solubilized sites. This effect is time dependent until a maximal 3-fold increase in affinity is attained. The rate of N-ethylmaleimide action is enhanced by the concomitant presence of agonists. In contrast, N-ethylmaleimide does not affect antagonist binding. This suggests that agonists mediate a conformational change of both the membrane bound low affinity muscarinic sites and of the solubilized sites, resulting in their increased susceptibility towards NEM alkylation.

Phenotype study of fresh and cultured hairy cells with the use of immunologic markers and electron microscopy

The phenotype of fresh and cultured leukemic cells from patients with hairy cell leukemia was studied using a panel of monoclonal antibodies in addition to the detection of peroxidase activity under electron microscopy. In fresh samples, the leukemic cells from 11 patients displayed predominantly a B phenotype, as judged by their reactivity with the B1 monoclonal antibody and surface immunoglobulin expression. Ultrastructural peroxidase activity, characteristic of hairy cells, was observed in all cases studied. When hairy cells were cultured in the presence of phytohemagglutinin and irradiated T cells, their phenotype converted from surface Ig+, B1+, OKT3-, OKT11- to surface Ig-, B1+, OKT3-, OKT11+. In contrast, the peroxidase activity remained unchanged. Some hairy cells were also OKM1+, but no conclusion could be made about the MO2 antigen, a more specific marker of monocytes. The variability of the phenotype in vivo and in vitro indicates that reliable markers are required for identifying hairy cells. When studied together, the staining by B1 monoclonal antibody and the ultrastructural detection of peroxidase, enable the identification of hairy cells with certainty.

Toxicity and QSAR of chlorophenols on Lebistes reticulatus

The 24-h toxicity of 20 substituted chlorophenols upon Lebistes reticulatus has been determined. The biological results have been tentatively connected with several of the following six parameters: logarithm of the octanol-water partition coefficient (log P); index of molecular connectivity (1 chi v); molecular refraction (RM); perimeter of the efficient section of the molecule (sigma D); constants of HAMMET (sigma); and melting point (F). A correlation is achieved using sigma D and sigma D2 with a correlation coefficient of 0.943.

A new anti-liver-kidney microsome antibody (anti-LKM2) in tienilic acid-induced hepatitis

The sera of 131 patients with anti-liver-kidney microsome antibodies (anti-LKM) detected between 1973 and 1979 in two different laboratories were re-examined. (1) Eighty-six anti-LKM corresponded to the description given by Rizzetto, Swana & Doniach (1973), with a pattern of fluorescence predominating on the 3rd portion of the proximal tubules (P3). This group comprised 45 cases of idiopathic chronic hepatitis or idiopathic cirrhosis and one case of halothane-induced hepatitis. (2) Forty-five anti-LKM gave a different pattern on male mouse liver and male rat kidney: (a) fluorescence was greater on centrolobular than on periportal hepatocytes; (b) the first and second portions of proximal tubules (P1 and P2) predominated over P3; (c) P1 fluorescence was equally intense as P2 and (d) P3 cells were heterogeneous with one cell out of 20 more positive than the rest. Absorption tests confirmed that the corresponding antigen was also present in the liver microsomal fraction. A retrospective clinical study discovered tienilic acid-induced hepatitis in all cases. We suggest naming this new antibody 'anti-LKM2'.

Adult T-cell lymphoma leukemia in Western countries

A new T-cell disorder has recently emerged: the so-called adult T-cell lymphoma leukemia (ATLL) initially described in Japan. Subsequently, ATLL cases were recognized in patients from the Caribbean. We summarize the clinical and hematological features of 19 published cases from Western countries, in addition to a new case we encountered. The leukemic cells display characteristic morphological features and a T3+T4+T8-T6- surface antigenic phenotype. Overall survival is of short duration, but remission could be obtained in our case despite a subsequent relapse in skin and CNS. Geographic clusters of ATLL cases have led to the discovery of the possible role of a new retrovirus, HTLV, in the genesis of this rare malignancy.

Phenotype study with monoclonal antibodies of T lymphocyte colonies in normal individuals and in patients with chronic OKT8+ lymphocytic leukaemia

The lymphocyte colony forming capacity of peripheral blood mononuclear cells from normal controls and from two patients with chronic OKT8+ lymphocytic leukaemia was determined in agar culture under PHA stimulation. The number and size of the colonies in patients were reduced compared to normal. The lymphocytic phenotype of colony cells was studied with monoclonal antibodies in colonies harvested from agar culture and in colonies expanded in liquid culture in the presence of TCGF. This study was performed in individual colonies and in pooled colonies. Colonies from normal controls contained a mixture of the OKT4+ and OKT8+ lymphocyte subsets. In contrast, colonies from the two patients contained essentially OKT4+ lymphocytes. The data indicate that, in the patients, progenitors of the OKT8+ subset are unresponsive to normal proliferative and/or differentiative stimuli under the present culture conditions.

Evidence for anaphylactic reactions in peptic ulcer and varioliform gastritis

The theory of an allergic participation in the pathogenesis of gastric erosions occurring in varioliform gastritis and in peptic ulcer was tested in humans. Biopsies were obtained from the edges of gastric and duodenal ulcers and from the erosion edges of varioliform gastritis as well as from surrounding duodenal, antral and fundic mucosae. Intracellular immunofluorescence staining was used to identify mucosal plasma cells. The lesion edges were characterized by a marked increase of IgE cells. These features justify new therapeutic orientations.

Plasma exchange in pemphigus. Uncontrolled study of ten patients

Plasma exchange, together with oral immunosuppressive drugs and various doses of adrenal steroids, were used in the treatment of ten patients with pemphigus. Initially plasma exchange decreased the intercellular antibody (IC Ab) level in all patients and induced a clinical improvement in the conditions of eight of ten patients. This improvement was sustained for the six patients who received simultaneously 0.5 mg/kg/day or more of prednisone. Among the eight patients, four previously corticoresistant patients had perfect control of their disease. Conversely the other four patients, treated with low doses of prednisone, experienced a posttreatment rebound in IC Ab level and showed no or only transient clinical improvement. Plasma exchange may be useful in bringing corticoresistant pemphigus under control but it is not to be used without accompanying high doses of adrenal steroids.

Expression of an accessory cell phenotype by hairy cells during lymphocyte colony formation in agar culture

Human T lymphocytes require the cooperation of accessory cells to generate lymphocyte colonies in agar culture under PHA stimulation. Various hairy cell enriched fractions, as well as normal monocytes, have been found to be able to initiate colony formation by normal lymphocytes. Leukemic monocytes from CMML patients were also effective, but not the leukemic lymphocytes from CLL patients. The phenotype expressed by HC in agar colonies was further studied using cell surface and enzymatic markers. We have concluded that HC in agar culture in the presence of both normal T lymphocytes and PHA lose the B phenotype that they express in vivo and function like an accessory cell in contrast to normal or leukemic B lymphocytes.

Dual effect of N-ethylmaleimide on agonist-mediated conformational changes of beta-adrenergic receptors

Beta-Adrenergic agonists cause adenylate cyclase activation via a conformational change of their receptor. This was earlier revealed by the use of N-ethylmaleimide as a structural probe: agonist-bound receptors are rapidly inactivated by 0.1 mM N-ethylmaleimide while free and antagonist-bound receptors remain unaffected. Furthermore, the beta-adrenergic receptors only change conformation when coupled to the guanine nucleotide regulatory component of the adenylate cyclase system. It is shown in this report that treatment of turkey erythrocyte membranes with the sulphydryl-specific agent 2,2'-dinitro-5,5'-dithiodibenzoic acid and elevated concentrations of N-ethylmaleimide (1-10 mM) do not affect the total receptor number, but prevent the ability of beta-adrenergic agonists to mediate conformational changes. This effect is mimicked by GTP. These three compounds cause also a two- to four-fold decrease in agonist affinity. Both phenomena may be explained by the ability of the reagents to prevent, and of GTP to reverse, the functional coupling between the receptors and the regulatory component of the adenylate cyclase system. Removal of Mg2+ from the incubation medium (i.e. presence of 1 mM EDTA) produces a similar decrease in agonist affinity, but does not impair the ability of agonist/N-ethylmaleimide to inactivate the receptors. This suggests that Mg2+ increases the agonist affinity for the receptor-regulatory component complex, but is not required for its formation.

Assessment of appropriate laboratory measurements to supplement the Crohn's disease activity index

The ability of 11 laboratory parameters to reflect the degree of activity of Crohn's disease, using a clinical index as reference point was compared by means of multiple stepwise regression analysis. Activity was best defined in decreasing order by orosomucoid, sedimentation rate, C reactive protein, alpha-1-antitrypsin, albumin, haematocrit, IgM, circulating immune complexes, serum iron, IgG, and IgA. The haematocrit, the only laboratory measurement in the Crohn's disease activity index developed by the National Cooperative Study Group in the USA, is less discriminant than acute phase reactants. Only three parameters-namely, orosomucoid, sedimentation rate, and C reactive protein-have a significant weight and should be complementary to a simple clinical index.

Nephrotic syndrome associated with T-cell lymphoma

Glomerulopathies associated with non-Hodgkin's malignant lymphomas have been observed rarely. Previous reports have never determined the cell type of the lymphoproliferative disorder. This report documents a case of nephrotic syndrome in a patient with T-cell derived non-Hodgkin's lymphoma. The neoplastic cell was studied in terms of cell-surface markers, cytochemical staining, and ultrastructural morphology. Nephrotic syndrome occurred shortly after the apparent onset of the lymphoma. The kidney biopsy specimen was examined by light, fluorescence, and electron microscopy. Histologic findings were consistent with the diagnosis of mild focal and segmental glomerulosclerosis. Such an association, reported here for the first time, may support the hypothesis of a pathogenetic link between acquired T-cell abnormalities and glomerular diseases with minimal histologic injury.

Relationships between the extent of ileal lesion of resection and vitamin B12, bile salt and fat absorption

Vitamin B12 Urinary excretion, stool weight, fecal fat excretion, fecal 14C glycocholate excretion and 14CO2 output after I-14C glycocholate ingestion, were measured in 13 patients with non-operated ileal Crohn's disease (NOC), 14 patients with ileal resection for ileal Crohn's disease, with or without right colectomy (RC), and 11 patients with ileal resection with or without right colectomy for pathology other than Crohn's disease (RNC). A positive linear relationship was found between stool weight and 14C glycocholate fecal excretion. The logs of fecal fat and 14C glycocholate excretions were related to the extent of the ileal lesion of resection; a similar but negative relationship was observed for vitamin B12 urinary excretion. Fecal fat excretion and respiratory 14CO2 output were significantly higher in patients with right colectomy.

Anti-alprenolol anti-idiotypic antibodies bind to beta-adrenergic receptors and modulate catecholamine-sensitive adenylate cyclase

Rabbit antibodies induced against alprenolol, a potent beta-adrenergic antagonist, bind to other antagonists, and, with less avidity, to catecholamine agonists. Anti-idiotypic antibodies were raised against the anti-alprenolol immunoglobulins. The anti-idiotypic antibodies specifically bind and agglutinate turkey erythrocytes; this is not observed for human agglutinate turkey erythrocytes; this is not observed for human or sheep erythrocytes, which are devoid of beta-adrenergic receptors. The anti-idiotypic antibodies compete with (--)-[3H]-dihydroalprenolol for binding on the beta-adrenergic receptors on purified turkey erythrocyte membranes. The binding to the membrane-bound receptors is prevented by preincubation of the anti-idiotypic antibodies with their immunogen, the antialprenolol immunoglobulins. The binding to the receptor is not merely passive: the anti-idiotypic antibodies stimulate basal adenylate cyclase activity [ATP pyrophosphate-lyase (cyclizing), EC 4.6.1.1] and enhance adenylate cyclase activation by catecholamine. These observations support the notion that antiidiotypic antibodies may constitute an "internal image" of the original antigen and may mimic its biological effects.

Interaction between beta-adrenergic receptors and guanine nucleotide sites in turkey erythrocyte membranes

beta 1-Adrenergic receptors from turkey erythrocyte membranes have been identified by specific binding of the radiolabeled antagonist (-)-[3H]dihydroalprenolol. These receptors are inactivated by the alkylating agent N-ethylmaleimide when occupied by beta-adrenergic agonists but not when occupied by antagonists or when unoccupied. A time-dependent decrease of the number of receptor sites is observed. Inactivation affects 45-60% of the sites, regardless of the agonist or N-ethylmaleimide concentration. The guanine nucleotides GTP and 5'-guanylyl imidodiphosphate effectively protect the receptors against agonist-mediated inactivation by N-ethylmaleimide. Protection by ATP necessitates a 100-fold higher concentration; 10 mM NaF is ineffective. The guanine nucleotide effect is reversible and occurs via interaction with N-ethylmaleimide-insensitive sites. These observations establish that guanine nucleotide sites interact with and caused structural modification of the agonist-occupied beta-adrenergic receptors in turkey erythrocyte membranes.

Measurement of glycoprotein content and cell kinetics in preulcerous gastric mucosa

In an attempt to evaluate the role of gastric mucosal defense factors in ulcerogenesis, we measured the levels of glycoproteins in the mucosa as well as mucosal cell turnover in the preulcerous phase and compared these parameters to the normal mucosa in the same animal. Ovalbumin-presensitized Praomys (Mastomys) natalensis were challenged in the gastric wall with ovalbumin and a gastric ulcer developed at the challenge site 3 days later as a result of a mucosal anaphylactic reaction. This model enabled us to study the events occurring at the site of a future ulceration. Gas-liquid chromatographic determination of mucosal glycoproteins showed that the normal and preulcerous mucosae had similar levels. Cell turnover, determined by [3H]thymidine incorporation, was stimulated as a result of the preulcerous anaphylactic reaction at 24 hours postchallenge whereas at 48 hours the values were not different from those obtained in controls. These results suggest that the pathogenesis of anaphylactic gastric ulcer involves a change in cell turnover but no changes in the production of gastric mucus.

A monoclonal macroglobulin with antinuclear activity

Serum containing a monoclonal IgM protein from a patient with Waldenstroms' macroglobulinaemia gave intense immunofluorescent staining of kidney nuclei. The Fab mu fragments of this immunoglobulin were obtained. The IgM and Fab fragments reacted in vitro with kidney nuclei using unfixed cryostat sections of rat or mouse kidney. After treatment of the patient with chemotherapy, the monoclonal IgM disappeared, and no more antinuclear activity could be detected in the serum. The results strongly suggest that this IgM protein had antinuclear activity.

Prevention of experimental anaphylactic ulcer by antigen prefeeding

Studies were performed in animals to establish whether antigen prefeeding could present homocytotropic antibody synthesis and the induction of gastric ulcer resulting from mucosal anaphylaxis. A single digestive exposure to 1 or 10 mg ovalbumin induced a state of specific immunologic tolerance. Inhibition of the formation of specific reagins was shown by the study of mast cell degranulation. Tolerant animals presented a reduced incidence of gastric ulcer after subsequent mucosal challenge. These results are important for the development of methods of prevention and treatment of allergic diseases.

Study of human T and B lymphocytes with heterologous antisera. III. Immunofluorescence studies on tonsil sections

Lymphoid cells from human palatine tonsils were identified on tissue sections by membrane or intracellular immunofluorescence (IF) staining. Used in an indirect technique, an anti-IgM and an anti-HTLA (human T lymphocyte antigen) antiserum gave complementary patterns of membrane IF, characteristic of the follicular organization. When serial sections were stained for each of the five classes, immunoglobulin-containing cells from all classes were found. Their relative frequencies were, in decreasing order: IgG: 61.6%; IgA: 17.3%; IgM: 12%; IgE: 7.5%; IgD: 1.6%. These differed from those of the gut-associated lymphoid tissue (IgA greater than IgG greater than IgM) and of the peripheral lymph nodes (IgG greater than IgM greater than IgA), but were close to those of mesenteric nodes. The absence of secretory component in tonsil was an additional difference from gut-associated lymphoid tissue and the relatively high proportion of IgE-containing cells, in the absence of recognized atopy, is another feature in common with mesenteric lymph nodes. Finally, slight differences between these results and those obtained on tonsil cell suspensions suggest that some degree of selection probably occurs during the isolation procedure.

A random blood sugar diabetes detection survey

In a co-operative study undertaken between various groups in the community, 3212 persons were screened at the Agricultural and Pastoral Summer Show in Christchurch. The mean glucose value was 88.4 mg/dl (4.9mmol/l) which roughly equates to 91 mg/dl (5.1mmol/l) plasma value. There was a standard deviation of 19.5mg/dl (1.08mmol/l) the 22.5 percentile was 63mg (3.5mmol/l), the 97.5 percentile was 125 (6.5mmol/l). One hundred and twenty persons of the total of 3212 were advised to contact their family doctors as a result of higher than normal blood sugar levels on the day. Twenty-five probable diabetics were diagnosed.