Comparison of the primary and secondary antiphospholipid syndrome: a European Multicenter Study of 114 patients

PURPOSE

To determine whether the features of the antiphospholipid syndrome (APS) are in any way influenced by the presence or absence of systemic lupus erythematosus (SLE). We followed up patients with 'primary' APS (PAPS) and APS secondary to SLE (APS plus SLE) with the objective of comparing laboratory and clinical events and of determining whether patients with PAPS would have evolution to SLE.

PATIENTS AND METHODS

A total of 114 patients from 3 European referral centers were included in this study. Fifty-six had APS plus SLE and 58 had PAPS. Laboratory and clinical data were collected during an average 2-year period.

RESULTS

Patients with PAPS and patients with APS plus SLE had similar clinical and laboratory profiles, with the exceptions of autoimmune hemolytic anemia, endocardial valve disease, neutropenia, and low C4 levels, all of which occurred more frequently in patients with APS plus SLE (p values: < 0.05, < 0.005, < 0.01, and < 0.001, respectively). On follow-up, 10 thrombotic episodes occurred in 10 patients, 8 of whom were receiving anticoagulant therapy. No patient with PAPS had either anti-DNA or anti-extractable nuclear antigen antibodies, and these patients had a significantly lower prevalence of antinuclear antibodies (41%) than patients with APS plus SLE (89%).

CONCLUSIONS

Patients with APS plus SLE and PAPS have similar clinical profiles, although heart valve disease, hemolytic anemia, low C4 levels, and neutropenia seem to be more common in patients with APS plus SLE. Patients with APS may develop further thrombotic events despite anticoagulation therapy.

[A new polyvalent vaccine against enteral infections in newborn calves]

The most frequent microbial causative agents of massive diarrheas in new-born calves kept on large cattle farms in the CSSR are rotaviruses, coronaviruses and enterotoxigenic strains of E. coli, manifesting themselves as complicated virus-bacterial infections. An inactivated polyvalent adjuvant vaccine has been developed for the prevention and specific prophylaxis of these enteral infections; the vaccine contains bovine rotavirus, bovine coronavirus and three enterotoxigenic serotypes of E. coli with protective antigen K 99. The rotavirus and coronavirus are propagated on the stable cellular line MDBK and inactivated with 0.2% formalin, the Escherichia strains are submersed in the MINCA culture medium during their cultivation and inactivated with 0.5% formalin. The vaccine was prepared as a blend of the same amounts of rotavirus and coronavirus and of such an amount of bacterin so that 1 ml of the vaccine will contain 10(9) bacteria. One part of oil adjuvant was added to five parts of the virus-bacterial blend and the blend was homogenized in the Ultraturax apparatus. The vaccine is to be used for immunization of pregnant cows and heifers; in these animals it induces the production of specific antibodies to all antigens contained in the vaccine. Its immunogenic effects were checked in 32 calves and 38 cows in the herds with the occurrence of diarrheas caused by both enteropathogenic viruses and enterotoxigenic escherichia. It was demonstrated that the inactivation did not influence in either of the viruses the process of inducing the production of specific antibodies, and the antibody response of the calves and heifers after application of 2 ml of complete inactivated vaccine was equally strong as after application of live vaccine containing only rotavirus and coronavirus. The level of the rotavirus antibodies increased on the average 30 times and 200 times, coronavirus antibodies twice and four times. The antibody response to coronavirus was negatively influenced by the relatively high levels of antibodies before vaccination. The antibody response to antigen K 99 was expressive in all cases.

The production of 99mTc-labeled conjugated antibodies using a cyclam-based bifunctional chelating agent

A bifunctional chelating agent (BFCA) based on a macrocyclic amine, cyclam, was used to form specifically 99mTc labeled rabbit-anti-HSA-antibodies. This study demonstrates the feasibility of forming a highly stable cyclam-based 99mTc-BFCA with its subsequent conjugation to antibodies.

Labeling of antibodies with 64Cu using a conjugate containing a macrocyclic amine chelating agent

The conjugation of a model antibody (rabbit-anti-HSA-IgG) with a functionalized derivative of cyclam (1-(3-aminopropyl)-4-methyl-1,4,8,11-tetraazacyclotetradecane) is reported. Coupling of this derivative to the antibodies was accomplished using commercially available heterobifunctional coupling agents. The conjugation technique produced minimal effects on the antibody binding activity. 64Cu complexes with this cyclam derivative have excellent stability in human serum and aqueous solutions containing 1 mM EDTA. The high stability of these Cu-complexes suggests that this system, or other analogous systems, may be useful for production of stable 67Cu-immunotherapeutic agents.

[Photoacoustic spectroscopy as a new approach to the determination of the skin penetration of locally applied drugs. Preliminary communication]

Photoacoustic-spectroscopic investigations of the penetration of topically applied drugs into the horny layer of the human skin are reported. By this technique the light absorption of the horny layer and its change due to drug diffusion can be determined in vivo in dependence on depth. Measurements have been performed on a sunscreening agent and on an UVA-absorbing systemic drug after topical application to the forearm.

[Radioimmunologic detection of antibodies to bovine leukemia virus]

The radioimmunologic assay (RIA) was elaborated for a demonstration of serum antibodies to bovine leukosis virus. The procedure makes use of the viral antigen bond to the fixed phase of a polystyrene carrier. The method was compared with the ELISA method and pseudoneutralizing and immunodiffusion tests. High congruence of the results of the RIA and ELISA methods was achieved, making 95%. The RIA method is more sensitive than the immunodiffusion test.

[Differential diagnosis of viral diarrheas in calves]

There is a description of the enzymoimmunologic method (ELISA), which was used for demonstration of rotaviruses and coronaviruses in the samples of excrements of the calves suffering from diarrheas. It is shown by a comparison with the results obtained by electron microscopy that the ELISA method provides by up to 50% higher capture rate and the reaction is highly specific. The method can also be applied to a detection of human rotavirus in the children's stool.

[Experimental and natural infection with the enzootic leukosis virus of cattle]

A trial was performed with heifers at the age of six to seven months. The animals were experimentally infected with the lymphocytes of a virus-productive donor. Infection was produced in all the nine cases, as demonstrated by means of the positive syncytial test. As indicated by the results of the trial, the antibodies to the enzootic bovine leucosis virus (BLV) were produced soon after experimental infection. A high sensitivity of the serum-neutralization test and the ELISA method was demonstrated in this connection: by these methods, the antibodies were identified already two to three weeks after experimental infection whereas by the immunodiffusion test they could be detected only after five weeks. Twenty-four animals were exposed to natural contact infection. Within 270 days of the trial, the disease after contact was recorded only in one heifer out of the four that were in close contact with the experimentally infected animals. In this case, as compared with experimental infection, the antibodies were produced much later--after 85 to 93 days. Leucosis was recorded in none of the remaining animals. The reasons why such a favourable result was obtained were the thorough disinfection of the stables after blood collections and the strict observance of the aseptic conditions. The results of experimental infection in three cows were identical with those obtained in young cattle. In the experimentally infected dairy cows, antibodies in milk were determined by the ELISA method. As found, in milk the antibodies to BLV appear two to three weeks later than they do in serum. The ELISA method of BLV antibody detection can be used for the identification of infected animals in herds where enzootic bovine leucosis occurs.