Anti-laminin antibodies in inner ear diseases: a potential marker for infectious and post-infectious processes

Natural antibodies against laminin (ALA) have been detected recently in some acute and chronic infectious disorders. In our present study sera of a large number of patients with inner ear disorders of unknown etiology (n = 413) were tested for ALA. Control sera were taken from patients with diseases of known infectious etiology and patients with diseases of unknown etiology in which an infectious etiology was suggested. Patients with classical autoimmune diseases as well as healthy blood donors were also included in this study. The highest frequency of ALA was found in patients with sensorineural hearing loss (SNHL) (68%), whereas the incidence of ALA was comparatively uncommon in patients with Menière's disease (14%). In patients with chronic infectious diseases ALA were detected with almost the same frequency as in patients with SNHL. The elevation of the erythrocyte sedimentation rate and the association of ALA-positive SNHL with other chronic inflammatory disorders suggest that ALA might be stimulated by a persisting infectious process. These findings suggest that certain forms of inner ear disorders might have a chronic infectious etiology.

Sulfadoxine specific lymphocyte transformation in a patient with eosinophilic pneumonia induced by sulfadoxine-pyrimethamine (Fansidar)

A patient developed eosinophilic peripheral pulmonary infiltrates while receiving malaria prophylaxis with sulfadoxine-pyrimethamine (Fansidar). Withdrawal of Fansidar and treatment with corticosteroids led to rapid recovery. No exacerbation occurred after cessation of corticosteroids. Lymphocyte transformation testing gave a positive result in the presence of sulfadoxine but not pyrimethamine. It is concluded that drug hypersensitivity to sulfadoxine was the cause of the eosinophilic pneumonia in this patient.

[Demonstration by lymphocyte transformation test of the allergic genesis in a case of acute hepatitis]

After accidental re-exposure to metamizole a 50-year-old patient developed severe jaundice within five hours (total bilirubin 43.9 mg/dl) with a rise of GOT to 147, of GPT to 222, of gamma-GT to 380 and of alkaline phosphatase to 497 U/l. The allergic genesis of this reaction was demonstrated in the lymphocyte transformation test which, in the presence of the causative substance and its metabolites, was performed five times during a period of 232 days. The first three tests were positive with stimulation indices up to 2.3. Sensitization to the metabolite 4-aminoantipyrine was demonstrated: this is known to be the first of four metabolites formed within 1-1 1/2 hours and constituting 40% of the four metabolites in the blood.

[Prognostic significance of antimitochondrial antibody profiles A-D in primary biliary cirrhosis]

Sera from 550 patients with primary biliary cirrhosis were tested by ELISA and the complement-fixation test (CFT) for the antimitochondrial antibodies (AMA) anti-M2, anti-M4, anti-M8 and anti-M9. Four profiles were defined and correlated with morphological and biochemical criteria - A: only anti-M9 positive by ELISA; B: anti-M9 and (or) anti-M2 positive by ELISA; C: anti-M2, anti-M4 and (or) anti-M8 positive by ELISA; D: anti-M2, anti-M4 and (or) anti-M8 positive by ELISA; D: anti-M2, anti-M4 and (or) anti-M8 positive by ELISA and CFT. Liver biopsies were obtained in 385 patients. Analysis of histological stage at the time of first serological testing revealed PBC stages I/II or only nonspecific lesions in all group A patients and in 90% of group B patients, while 49% of patients in group C and 59% of those in group D had stage III/IV or had histological features of chronic active hepatitis or "mixed form". Levels of alkaline phosphatase and GPT were significantly higher in groups C/D than groups A/B patients (P less than 0.05), and bilirubin and IgG levels were more frequently elevated in the former groups of patients (P less than 0.05). It is concluded that classification of PBC into AMA profiles may help in identifying patients at high or low risk of progression of the disease.

Characterization of a new mitochondrial antigen-antibody system (M9/anti-M9) in patients with anti-M2 positive and anti-M2 negative primary biliary cirrhosis

A new antimitochondrial antibody (AMA) against an outer membrane associated antigen on liver mitochondria was detected by ELISA in sera from patients with primary biliary cirrhosis (PBC). This antibody was named anti-M9. There is evidence that it is a partial organ-specific antibody as shown by absorption studies using submitochondrial particles prepared from heart, liver and kidney. A purified M9-fraction was prepared by subjecting a 100,000 g supernatant from rat liver mitochondria to ion exchange chromatography. This fraction was devoid of the previously described M1-M8 antigens except for M4. Trypsin treatment of the fraction enabled a distinction to be made between M4 which was protease resistant, and M9 which was trypsin sensitive. Applying this M9-fraction in Western blotting anti-M9 positive sera recognized two proteins at a molecular weight of 98 kD and 59 kD. Anti-M9 antibodies were detected in 37% of 156 anti-M2 positive as well as in 82% of 22 anti-M2 negative patients with histologically proven PBC. It is concluded that anti-M9 is a new AMA type in PBC which may be helpful especially for the early diagnosis of PBC in patients who are still anti-M2 negative. As one of the earliest immunological signs in PBC further characterization of M9 could provide new insights into the etiopathogenesis of the disease.

[Cefotaxime-induced allergic agranulocytosis in an acute attack of serologically atypical primary biliary cirrhosis]

A 35-year-old woman developed pharyngitis with high fever and painful joint swellings. A severe cholestatic hepatitis occurred 40 days later with a rise of bilirubin to 32 mg/dl. "Nuclear dot" antibodies were demonstrated in the immunofluorescence test on cell cultures, confirming a diagnosis of primary biliary cirrhosis which had followed an atypical course. After nine days of cefotaxime administration, commenced because of persistent fever of 40 degrees C, an agranulocytosis was demonstrated, which regressed within a week of discontinuing the drug. The allergic genesis of the agranulocytosis was proven by repeated lymphocyte stimulation tests in the presence of cefotaxime. The autoimmune hepatitis was probably a predisposing factor in the genesis of the allergically induced agranulocytosis.

The antimitochondrial antibody anti-M9. A marker for the diagnosis of early primary biliary cirrhosis

The clinical relevance of a new antimitochondrial antibody, anti-M9, reacting with an outer membrane-associated antigen on liver mitochondria is described. Sera from 22 anti-M2-negative patients with histologically proven primary biliary cirrhosis (PBC) who had been followed for 5-15 years were tested for anti-M9 in the ELISA using a purified M9-fraction. 18 (82%) were anti-M9-positive, and 17 of them (94%) were in stage I/II. None of the 17 anti-M9-positive/anti-M2-negative patients with early PBC progressed to stage III/IV during the observation period of 5-15 years, and in all instances anti-M9 remained of the IgM-type. In one anti-M9-positive patient anti-M2 of the IgM type appeared 2 years after the first demonstration of anti-M9. Among 156 patients with anti-M2-positive PBC, 58 (37%) had anti-M9, and 39 of them (67%) were in stage I/II. 19 of these 39 stage I/II patients (49%) had anti-M9 exclusively of the IgM-type in contrast to none of the 19 stage III/IV patients. Using the purified M9-fraction in ELISA and Western blotting, anti-M9 antibodies were confined only to patients with PBC or overlap syndromes between PBC and autoimmune chronic active hepatitis (10% of 133 patients) and were not found in patients with other hepatic and non-hepatic disorders. We conclude that the determination of anti-M9 may be helpful for the diagnosis of early and asymptomatic PBC. From follow-up studies of anti-M9-positive but anti-M2-negative patients it emerges that this antibody type may be associated with a benign course of PBC.

The pathogenesis of cianidanol-induced fever

Recently, there has been a variety of reports of adverse drug reactions during therapy with the flavonoid Cianidanol (Ci), a cytoprotective radical scavenger, especially involving haemolytic anaemia and drug fever. To elucidate whether the fever was due to a direct, antigen-independent interaction of Ci with immune competent cells, its effect on macrophage (M phi) function and early biochemical events during lymphocyte activation has been examined. A direct interaction of Ci with M phi was demonstrated, resulting in increased secretion of interleukin-1 (IL-1). The influence of Ci on lymphocyte activation was assessed by measuring levels of cyclic AMP and GMP. At high concentrations of Ci, cAMP levels were increased, and at low Ci concentrations cGMP levels were elevated. Both findings are correlated with lymphocyte proliferation and function, which is increased at low and decreased at high concentrations of Ci. The synthesis of prostaglandin E2 by M phi, an important factor in M phi-mediated suppression, was reduced by increasing doses of Ci, which inhibited M phi-cyclooxygenase. Ci did not affect phospholipase A2 activity. These findings indicate that flavonoid-induced fever may be due to allergic as well as pseudo-allergic mechanisms, the latter probably caused by increased antigen-independent release of IL-1, the endogenous mediator of fever.

The specificity of the lymphocyte transformation test in a patient with hypersensitivity reactions to pyrazolone compounds. A 10-week follow-up study before and after rechallenge

To evaluate the specificity of the lymphocyte transformation test (LTT) in the diagnosis of drug allergy we studied over 71 days an atopic woman with a past history of frequent adverse reactions to pyrazolone drugs. Rechallenge with the incriminated substances aminophenazone (aminopyrine) and propyphenazone was carried out on Days 11 and 31 respectively. An immediate type of hypersensitivity reaction was seen after 100 mg aminophenazone, while 100 mg of propyphanozone led to a serum sickness-like syndrome. We found two specifically sensitized lymphocyte populations using either the pure substance or sera containing metabolite in cell cultures. Stimulatory responses with indices ranging between 3 and 6 were seen 3-4 days after exposure, and the tests remained positive in both instances for 3-4 weeks. Specific sensitization was proven by positive skin tests and by a small but distinct lymphocyte proliferative response before challenge. Several lymphocyte function tests were performed over a period of 53 days and revealed a large fall in pokeweed mitogen-induced immunoglobulin synthesis and an increase in suppressor cell activity after rechallenge with aminophenazone. We conclude that the proliferative response observed in the presence of the offending drug is due to the activation of T memory cells and therefore highly suggestive of a true allergic reaction.

Co-trimoxazole-induced hepatic injury--an analysis of cases with hypersensitivity-like reactions

Trimethoprim-sulfamethoxazole (co-trimoxazole) is used extensively for treatment of pulmonary and urinary tract infections. Side effects may affect skin, blood, bone marrow, kidney and the liver. Although a number of sulfonamides have been reported to have produced hepatic lesions, hepatitis following therapy with trimethoprim-sulfamethoxazole is a rather rare event. While trimethoprim has not yet been reported as a cause of hepatic disorders, sulfamethoxazole has occasionally been described as inducing hepatic injury. In some cases, these reactions are accompanied by symptoms indicative for allergic reactions such as fever, rash and eosinophilia. Seven well documented cases are analyzed and discussed with respect to the nature of side effects caused by co-trimoxazole.

Immunology of primary biliary cirrhosis

(1) The serological diagnosis of PBC is possible in almost 100% of cases when appropriate methods and specific antigen preparations are used such as the purified ATPase fraction by ELISA for the detection of anti-M2, sonicated mitochondria by immunodiffusion for the demonstration of precipitating antibodies against M-A or M-B, and cell cultures by immunofluorescence for the detection of antibodies against nuclear dots. (2) The establishment of AMA profiles obtained by ELISA and CFT seems to be a sensitive approach to a better definition of the natural course of PBC. A distinction between a rather benign and a more progressive course seems especially possible in the presence of the AMA profiles A and B (anti-M9 and/or anti-M2-positive only by ELISA) versus D (anti-M2-, anti-M4-, anti-M8-positive in the CFT). (3) The analysis of cellular immune reactions in vitro and in vivo suggests an activation of cytotoxic T cells as well as a defect in the function of T suppressor cells. (4) Although the aetiology of PBC is unknown, the detection of MHC Class II antigens on bile duct epithelial cells in liver biopsies of patients with PBC but not of normal individuals may imply that an infectious agent being exposed in association with these MHC structures may trigger the disease. The inability of the immune system in controlling this infectious process would then lead to an ongoing inflammatory reaction which is responsible for the continuous destruction of bile ducts within portal triads.

Prognostic relevance of serum inhibitory factors (SIF) in protracted and persistent hepatitis B

In a follow-up study of 3 years' duration, serum inhibitory factors (SIF) were analysed in 23 patients with a protracted course of viral hepatitis B (PVH) and 12 patients with chronic persistent hepatitis (CPH). Four patients showed a progressive course, developing chronic active hepatitis, and one died of liver failure. All 4 patients had high and persisting SIF activity. The other patients were either SIF negative or lost SIF during the observation period. The inhibitory moiety was isolated from an albumin-rich serum fraction, indicating that the factor was of the same nature as previously described in patients with acute viral hepatitis B. SIF was also demonstrated in other viral infections but was absent or of low activity in autoimmune, toxic or nutritive disorders. These results suggest that SIF may act as an immunoregulatory molecule protecting the liver from exaggerated immune response.

[Progressive inner ear diseases--sequelae of a secondary autoimmune process? Significance of antibodies to endoplasmic reticulum]

In sera from patients with different forms of inner ear diseases antibodies against endoplasmic reticulum (anti-ER) could be detected by ELISA in association with antisarcolemmal (ASA) and antiendothelial antibodies (AEA). 36% of 296 patients with sensorineural hearing loss (SNHL), 30% of 20 patients with tinnitus, 21% of 48 patients with sudden deafness and 20% of 49 patients with Menière's disease had ASA. 94% of these ASA positive patients were also positive for anti-ER. The overall frequency of anti-ER was 57% of patients with SNHL, 60% of patients with tinnitus, 46% of patients with sudden deafness and 22% of patients with Menière's disease. Analysing the clinical course in 5 anti-ER positive and 11 anti-ER negative patients with SNHL it was shown that all 5 patients either had a progressive course and/or a systemic manifestation in contrast to only 4 of the anti-ER negative patients. Anti-ER antibodies were also detected in 38-53% of patients with different chronic inflammatory disorders of unknown aetiology (polymyalgia rheumatica, vasculitis, sarcoidosis, ankylosing spondylitis etc.) while only 6% of patients with typical autoimmune disorders (collagen diseases, lupoid hepatitis, primary biliary cirrhosis) and 8% of blood donors had this antibody. Therefore it can be concluded that anti-ER antibodies have no apparent relevance for the diagnosis of SNHL. They may be, however, indicative of a secondary autoimmune process triggered by a persistent infectious agent.

Subtypes of antimitochondrial antibodies in primary biliary cirrhosis before and after orthotopic liver transplantation

Antimitochondrial antibodies are markers for primary biliary cirrhosis and probably reflect a specific defect in immunoregulation underlying this disease. Antimitochondrial antibodies and their primary biliary cirrhosis-specific subtypes were tested before and up to 6 years after orthotopic liver transplantation. Sera from 31 consecutive patients were tested, 15 patients had primary biliary cirrhosis and 16 non-primary biliary cirrhosis. Antimitochondrial antibodies were investigated under code by immunofluorescence, and primary biliary cirrhosis-specific subtypes were determined by radioimmunoassay (anti-p62, anti-p48) and complement fixation test (anti-M2, anti-M4, anti-M8). Before orthotopic liver transplantation, antimitochondrial antibodies were detected by immunofluorescence in 13 of 15 patients with primary biliary cirrhosis. Of these patients, 12 were positive for anti-p62 and 8 for anti-p48. Ten patients were positive for anti-M2, 4 patients for anti-M4 and 7 patients for anti-M8. Two primary biliary cirrhosis patients and all non-primary biliary cirrhosis patients were negative with all tests. One month after orthotopic liver transplantation, antimitochondrial antibodies titers declined or became negative by antimitochondrial antibodies immunofluorescence, 3 patients became negative by radioimmunoassay for anti-p62 and 1 for anti-p48. With complement fixation test, 4 patients became negative for anti-M2, 2 for anti-M4 and 4 for anti-M8. Antimitochondrial antibody titer reduction observed 1 month after orthotopic liver transplantation remained unchanged in most sera during the following years. A rise was observed in two patients after 4 and 5 years.(ABSTRACT TRUNCATED AT 250 WORDS)

A simple and sensitive fluorometric immunoassay for the measurement of immunoglobulins in culture medium of mitogen-stimulated lymphocytes

A sensitive fluorescent immunoassay (FIA) for the quantification of immunoglobulins (IgG, IgM) in culture supernatants of human lymphocytes has been developed and compared with an ELISA method. FIA, like the ELISA assay, detects nanogram amounts of immunoglobulin (Ig), and has a high degree of specificity and reproducibility. The intra-assay coefficient of variation was about 5% in both test systems; the inter-assay coefficient of variation was approximately 9% in FIA and 13% in ELISA. Quantification of supernatants of lymphocyte cultures by both systems showed a high degree of concordance (correlation coefficient r = 0.93). The advantages of the FIA procedure are the short assay time and the more direct acquisition of signal.

Mitochondrial antigens and autoantibodies: from anti-M1 to anti-M9

The specificity and clinical relevance of nine antimitochondrial antibodies (AMA) - anti-M1 to anti-M9 - are described. All nine AMA types react with antigens which are associated either with inner (M1, M2, M7) our outer mitochondrial membranes (M3, M4, M5, M6, M8, M9) derived from rat liver or beef heart mitochondria. These antigens can be clearly distinguished by their different physical and chemical properties. Anti-M1 to anti-M9 can be related to distinct clinical entities: anti-M1, anti-M5, and anti-M7 are found in nonhepatic disorders, such as syphilis (anti-M1), undefined collagen diseases (anti-M5), and some forms of cardiac diseases (anti-M7). Anti-M3 and anti-M6 are detected in drug-induced disorders, such as phenopyrazon-induced pseudolupus syndrome (PLE; anti-M3) and iproniazid-induced hepatitis (anti-M6). Anti-M2, anti-M4, anti-M8, and anti-M9 are confined to primary biliary cirrhosis (PBC). Anti-M2 is a specific marker for the diagnosis of PBC; 96% of PBC patients (n = 752) were anti-M2 positive. Anti-M4 and anti-M8 seem to reflect disease activity. Anti-M9 antibodies occur preferentially in early PBC. The clinical course of PBC was analyzed with respect to four different AMA profiles: profile A: only anti-M9 positive in the ELISA; profile B: anti-M9 and anti-M2 positive in the ELISA; profile C: anti-M2 positive in ELISA and complement fixation test (CFT), but anti-M4 and anti-M8 positive only in the ELISA; and profile D: anti-M2, anti-M4, anti-M8 positive in ELISA and CFT. Patients with profile A and B were found to have a rather benign course while those patients with profile C and D showed a rather progressive course when followed over a period of 6-15 years. Considering the similarities between bacterial and mitochondrial membranes, it is suggested that the formation of AMA of different specificities in PBC, especially of the anti-M2 type, may be induced by cross-reacting antigens.

[Autoantibody profile in collagen diseases. A clinical-serological study of 250 patients from Tuebingen clinics]

Sera from 250 patients with connective tissue diseases were tested for antinuclear antibodies by immunofluorescence (IFL) and immunodiffusion. In patients with systemic lupus erythematosus (SLE, n = 49), progressive systemic sclerosis (PSS, n = 30) and Sjögren's syndrome (n = 20), IFL showed antinuclear antibodies with a frequency of 70 to 100%. Patients with localized scleroderma (n = 16) and discoid LE (n = 38) had antinuclear antibodies in 31 and 21% of cases, respectively. In patients with vasculitis (n = 32), fluorescent antinuclear antibodies were only rarely detected (0-6%). In the immunodiffusion LE-specific anti-Sm antibodies were demonstrated in 10%, anti-nRNP nRNP antibodies in 20%, and anti-Ro antibodies in 37% of patients with SLE. In Sjögren's syndrome, anti-Ro antibodies were found in 45% and anti-La antibodies in 35% of patients. 57% of patients with PSS had the disease-specific anti-Scl-70 antibody, while only 19% had antinucleolar antibodies as detected by IFL. In patients with localized scleroderma, dermatomyositis (n = 6) or vasculitis, no precipitating antibodies were detectable. The demonstration by immunodiffusion of nuclear antibodies in patients with discoid LE could be connected with a transition to a systemic course of the disease.

Characterization and clinical relevance of a new complement-fixing antibody--anti-M8--in patients with primary biliary cirrhosis

A new complement-fixing antimitochondrial antibody--anti-M8--was detected in patients with primary biliary cirrhosis. Anti-M8 was only found in association with anti-M2, however, not all anti-M2 positive patients had anti-M8. Thus, among 66 anti-M2 positive patients, 29 were also positive for anti-M8, whereas sera from patients who had the complement-fixing anti-M2 and anti-M4 antibodies in parallel always strongly reacted with the M8 antigen. This group was previously described as mixed form. The M8 antigen was isolated either from human liver mitochondria or pig kidney microsomes and could be clearly distinguished from the M4 antigen. In contrast to M4, M8 was trypsin sensitive and banded at sucrose densities from 1.16 to 1.24, while M4 was found at densities from 1.08 to 1.14. Like M4, the M8 antigen also co-purified with outer mitochondrial membranes. Fifty-three patients with primary biliary cirrhosis have been followed over a period of up to 16 years and were classified according to their complement-fixing antimitochondrial antibody profile. At the time of the first diagnosis, 95% of 31 patients being anti-M2 positive, but anti-M8 negative (antimitochondrial antibody Profile I) were in Stage I or II. In contrast, only 61% of 13 patients being anti-M2 and anti-M8 positive (antimitochondrial antibody Profile II) and 44% of 9 patients with anti-M2, anti-M8 and anti-M4 in parallel (antimitochondrial antibody Profile III) belonged to Stage I or II.(ABSTRACT TRUNCATED AT 250 WORDS)

Indoprofen-induced aplastic anemia in active connective tissue disease detected by drug-specific lymphocyte transformation

In connective tissue diseases, the differentiation of disease-related hematological aberrations from drug-induced cytotoxic or allergic blood-cell dyscrasias is often difficult. In this paper we report on the positive identification of an indoprofen-induced severe pancytopenia in a multi-drug-treated patient with active systemic lupus erythematosus by use of a drug-specific lymphocyte transformation test.

Acute interstitial nephritis and non-oliguric renal failure after cefaclor treatment

A case of acute interstitial nephritis (AIN) developing after cefaclor treatment is reported. Diagnosis was proofed by kidney biopsy and lymphocyte transformation test. The clinical course of the patient with non-oliguric renal failure was favourable. Four weeks after discontinuation of cefaclor treatment the renal function was completely restored and remained stable over the ten-month follow-up period. It is concluded that cefaclor can cause hyperallergic AIN and acute renal failure.

Influence of cianidanol on specific and non-specific immune mechanisms

The influence of Cianidanol (Ci), a cytoprotective radical scavenger, on peripheral blood mononuclear cells (PBMC) was assessed with respect to its immunomodulatory function. In previous studies performed in our laboratory, a bidirectional influence of Ci on the immune response was observed, depending on its concentration. In order to elucidate this effect, the influence of Ci on macrophage (M phi) and B-cell function was investigated. A marked dose-dependent suppression of M phi phagocytosis by Ci could be detected. Furthermore, PGE2 synthesis of non-activated and PHA-activated PBMC was inhibited in the presence of Ci. This effect was shown to be due to an inhibition of M phi cyclooxygenase. It was also demonstrated that neither spontaneous nor Staphylococcus aureus Cowan I induced proliferation of highly purified B-cells was enhanced by Ci. Similar results were obtained by measuring the influence of Ci on immunoglobulin secretion of purified B-cells, exposed to Klebsiella membrane preparations. From these data it can be concluded that the previously described enhancing effect of Ci on immunoglobulin secretion is probably T-cell mediated.

[Immunoserologic differentiation of chronic cholestatic hepatitis. Significance of antimitochondrial antibodies and hepatic membrane antibodies]

In 22 of 45 patients with chronic cholestatic liver inflammation and humoral immune phenomena, followed over 15 years with at least one liver biopsy, there was the histological picture of primary biliary cirrhosis (PBC), stages I to IV, with constantly demonstrable antimitochondrial antibodies (AMA) of M2-type. In 12 patients there were signs of PBC and chronic active hepatitis (CAH) in the liver histology, and they were M2-positive. Six of them also had M4-antibodies and were thus classified as 'mixed form'. The other six were seropositive for liver-membrane antibodies (LMA) and (or) antinuclear antibodies (ANA) and thus demonstrated an overlap between PBC and autoimmune or lupoid CAH. In five patients there was autoimmune CAH of lupoid type, in four of them with LMA or ANA without M2- or M4-antibodies. The remaining six patients had pericholangitis with persisting ANA and increased serum concentrations of immunoglobulin M without M2- and M4-antibodies, as well as LMA. Clinically a nondestructive polyarthritis predominated without definite signs of collagenosis. The listed immunoserological parameters make it largely possible to differentiate classical PBC, mixed forms or overlap of PBC and CAH, autoimmune CAH and nonpurulent cholangitis of pericholangitic type.

Influence of TPA (12-O-tetradodecanoyl-phorbol-13-acetate) on human B lymphocyte function

The effect of the tumour-promoting agent TPA (12-0-tetra-dodecanoyl-phorbol-13-acetate) on the proliferation and Ig secretion response of blood and tonsil lymphocytes was investigated and compared to that of the T-cell-dependent polyclonal activators pokeweed mitogen (PWM) and group A streptococcal cell membranes (A-ScM) or the T-cell-independent B cell mitogen Staphylococcus aureus Cowan I (SAC) and a T-cell-independent B cell activator Klebsiella pneumoniae (Klebs M). In blood mononuclear cells (MNC), a rather weak, monocyte-dependent DNA synthetic response was observed after exposure to TPA, in comparison to PWM, A-ScM or SAC. Whereas highly purified B cells did not respond to TPA, purified T cells proliferated to a similar degree as unseparated MNC; moreover, the addition of T to B lymphocytes enhanced proliferation rates proportionally to the number of T cells added. This suggests that TPA acts as a polyclonal T cell activator (PTA) for human blood and tonsil cells. Similarly, TPA induced only small amounts of Ig secretion in blood and in tonsil MNC, as determined by an ELISA assay, and no significant Ig secretion in highly purified B cells. The rather weak B cell differentiation response was not due to a monocyte suppressor effect, since partially monocyte-depleted MNC or B cells responded similarly to the non-depleted cells. Thus, TPA cannot be considered as an alternative to other B cells stimulators, both with regard to DNA synthesis and Ig secretion.

Mitochondrial antibodies in primary biliary cirrhosis: species and nonspecies specific determinants of M2 antigen

Sera from patients with primary biliary cirrhosis reacted with four major bands in beef heart mitochondria and ATPase extract when analyzed by immunoblot after sodium dodecyl sulfate-polyacrylamide gel electrophoresis. These four immunologically reactive bands corresponded to protein bands with molecular weights of about (a) 80,000; (b) 63,000; (c) 56,000; and (d) 43,000 to 46,000. An additional immunoreactive band was found with some high-titered primary biliary cirrhosis sera at 36,000. No association with any ATPase subunits was found, except for band c which migrated between the alpha- and beta-subunit of ATPase. Most ATPase fractions did not contain this band c, indicating that M2 determinants, as defined by immunoblot, are not identical with any ATPase subunit. Species and nonspecies-specific determinants of M2 were identified using mitochondria from rat liver and human heart and liver. Antigenic bands a, c and d were nonspecies-specific. Band b and e occurred only in beef heart. An additional determinant at about 38,000 was detected using human heart and liver mitochondria. Primary biliary cirrhosis sera showed a typical reaction with two protein bands of Escherichia coli, one at about 85,000 to 90,000 and the other at 60,000. Antibodies against both determinants could be absorbed with submitochondrial particles of beef heart showing that E. coli shares cross-reacting determinants with mitochondria. Sera from 56 primary biliary cirrhosis patients were tested using beef heart mitochondria.(ABSTRACT TRUNCATED AT 250 WORDS)

An ELISA method for the detection of autoantibodies to adrenal cortex

An enzyme-linked immunosorbent assay (ELISA) is described for autoantibodies to adrenal cortex. Microsomes were prepared from fresh human adrenal glands, and microtitre ELISA plates were incubated at 4 degrees C overnight with 25 micrograms antigen/ml, the optimal concentration for the system. Optimal dilution of patient's serum was 1/500. Peroxidase-labelled anti-human IgG and IgM sera were used in separate tests and o-phenylenediamine and H2O2 served as substrate. Intra-assay variance of optical density units was 4.5%, and inter-assay variance was negligible when antigen preparations from 2 different adrenal glands were compared. All sera positive or negative at first test gave the same qualitative result in a second. Non-organ-specific binding of sera containing mitochondrial or ribosomal antibodies was eliminated by a blocking ELISA system where the antigen-coated plates were incubated with test sera, and in a second step, peroxidase-labelled IgG from an adrenal antibody-positive control serum was added. In this test, optimal antigen concentration for coating of plates was 6.25 micrograms/ml and optimal serum dilution 1/50. The ELISA proved more sensitive and reproducible than indirect immunofluorescence. Adrenal antibodies detected by ELISA were usually of IgG class alone and only 1 of the 30 positives also contained IgM specificity. 30 out of 38 sera (79%) from patients with 'idiopathic' Addison's disease were positive whereas immunofluorescence revealed only 23 (61%) at first testing and another 4 positives when sera were tested on different adrenal glands. The ELISA described is useful for both scientific work and clinical diagnosis of autoimmune adrenalitis.

Serum inhibitory factors (SIF) are of prognostic value in acute viral hepatitis

Serum inhibitory factors (SIF) were analysed in relation to the natural course of acute viral hepatitis in 81 patients followed over a period of 1 year. 63 patients recovered completely (group 1), and 18 had a protracted course of hepatitis (group 2) as shown by persistent transaminase activity 6 months after onset. 11 patients in group 2 still had signs of liver disease after 1 year. A gradual fall of SIF activity (in 47 patients) heralded resolving hepatitis, whereas persistence of SIF (in 8 patients) correlated with inflammatory activity and failure of hepatitis B viral antigen elimination. Absence of SIF activity was associated with either an uncomplicated or a chronic course of hepatitis in 23 and 3 patients, respectively. Repeated determination of SIF may help to predict the final outcome of hepatitis. Both excessive and failure of SIF production may result in the development of chronic liver disease.

Inhibition of the adenine nucleotide translocator by organ specific autoantibodies in primary biliary cirrhosis

Sera from 13 patients with proven primary biliary cirrhosis (PBC) were studied for the capacity to bind to the adenine nucleotide translocator (ANT) isolated from heart, kidney and liver mitochondria. Antibodies against the ANT from liver were detected in the serum of all PBC patients, while 10 of 13 sera were negative when tested with the ANT from heart. None of the sera showed a significant binding to the ANT from kidney. The specific binding and the organ specificity of the autoantibodies against the ANT from liver were also confirmed by immunoabsorption studies on the isolated proteins. To distinguish between antibody titre and antibody activity, we measured the ability of the antisera to inhibit the adenine nucleotide transport across inner mitochondrial membrane using isolated mitochondria from heart, kidney and liver. Six of 13 patient sera tested inhibited the adenine nucleotide transport from liver mitochondria, however, none of the sera inhibited the transport from heart or kidney mitochondria again indicating the organ specificity of the antigen and the autoantibodies.

Demonstration of organ specific antibodies against heart mitochondria (anti-M7) in sera from patients with some forms of heart diseases

Using submitochondrial particles (SMP) from beef heart, pig kidney and rat liver in the ELISA, we detected partial organ specific anti-mitochondrial antibodies (AMA) against heart and kidney SMP in sera from patients with different forms of cardiomyopathies. Serum samples from 50 of 159 patients with congestive or hypertrophic cardiomyopathy (31%) and from two of 15 patients with acute myocarditis (13%) were AMA positive. These AMA could be clearly differentiated from other known AMA (anti-M1-M6) and were therefore named anti-M7. Thirteen of the 52 sera (25%) reacted only with heart SMP (type a) and 39 showed a cross-reaction with kidney, lung and pancreas mitochondria (type b). However, using liver SMP, no positive reaction was found. The anti-M7 type a and b activity was abolished completely by absorption with heart SMP. The anti-M7 antibodies were directed against an antigen which co-purified with the inner mitochondrial membrane and had a molecular weight of 67,000-72,000. They seem to be confined to some forms of cardiomyopathies and myocarditis of unknown aetiology and were not detected in sera from patients with other diseases.

[Serum inhibition factor in acute viral hepatitis]

Sera from patients with acute viral hepatitis were found to inhibit the in vitro proliferation of normal lymphocytes induced by different mitogens and antigens. SIF interfered with the intermediate phase of mitogen induced lymphocyte activation which was defined by protein and RNA synthesis indicating that SIF acts as an antiactivator and may belong to immunoregulatory physiologic serum factors. The active moiety could be separated from immunoglobulins and other proteins by means of gel filtration, anion exchange and affinity chromatography. The major SIF activity always copurified with albumin. Evaluation of SIF in sera from patients with acute and protracted viral hepatitis may be helpful in determining the outcome of hepatitis. Thus, fall of SIF activity during acute viral hepatitis always indicated complete recovery while persistence of SIF correlated with ongoing inflammatory process and persistent viral infection.