Diabetic iris neovascularization

PURPOSE

To compare the validity of careful slit-lamp biomicroscopic examination of the pupillary margin to screening gonioscopic examination in the early detection and prevention of neovascular glaucoma in diabetic patients.

METHODS

We examined two patients with histories of diabetes mellitus.

RESULTS

Angle neovascularization developed before iris neovascularization in both patients.

CONCLUSION

We believe screening gonioscopic examination is valuable in patients with diabetes.

Bilateral central retinal vein occlusions in a patient with acquired immunodeficiency syndrome. Clinicopathologic correlation

Four patients with human immunodeficiency virus (HIV) infection and central retinal vein occlusion have been previously described in the literature. The pathologic findings in a fifth patient with this association are reported. The histopathologic findings were similar to ischemic central retinal vein occlusion in persons without HIV infections. There was no evidence of HIV in vascular endothelial cells using electron microscopy and in situ hybridization techniques. The failure to identify any structural or direct infectious cause for central retina vein occlusion in this setting suggests that other hemorheologic factors related to HIV infection are probably responsible for the predisposition to vascular thrombosis.

DNA supercoiling in a thermotolerant mutant of Escherichia coli

A spontaneously occurring, nalidixic acid-resistant (NalR), thermotolerant (T/r) mutant of Escherichia coli was isolated. Bacteriophage P1-mediated transduction showed that NalR mapped at or near gyr A, one of the two genes encoding DNA gyrase. Expression of gyrA+ from a plasmid rendered the mutant sensitive to nalidixic acid and to high temperature, the result expected for alleles mapping in gyrA. Plasmid linking number measurements, made with DNA from cells grown at 37 degrees C or shifted to 48 degrees C, revealed that supercoiling was about 12% less negative in the T/r mutant than in the parental strain. Each strain preferentially expressed two different proteins at 48 degrees C. The genetic and supercoiling data indicate that thermotolerance can arise from an alteration in DNA gyrase that lowers supercoiling. This eubacterial study, when coupled with those of archaebacteria, suggests that DNA relaxation is a general aspect of thermotolerance.

Human HLA-A0201-restricted cytotoxic T lymphocyte recognition of influenza A is dominated by T cells bearing the V beta 17 gene segment

The major histocompatibility complex class I-restricted cytotoxic T lymphocyte (CTL) response is important in the clearance of viral infections in humans. After influenza A infection, a peptide from the matrix protein, M58-66, is presented in the context of the MHC allele HLA-A0201 and the resulting CTL response is detectable in most HLA-A0201 subjects. An initial study suggested that M58-66-specific CTL clones show conserved T cell receptor (TCR) alpha and beta gene segments. We have addressed the significance of this observation by determining the expression of V beta 17 during the development of M58-66-specific CTL lines in 21 unrelated HLA-A0201 subjects, and analyzing TCR usage by M58-66-specific CTL clones. TCR V beta 17 was the dominant V beta segment used and CD8 V beta 17 expansion correlated with M58-66-specific lysis. Limiting dilution analysis from five subjects showed the M58-66 CTL precursor frequency to vary between 1/54,000 and less than 1/250,000, and that up to 85% of the matrix peptide (M58-66)-specific CTL used the V beta 17 gene segment. The M58-66 specific CTL response was dependent on previous viral exposure and specific V beta 17 expansion, as it was not found in cord blood, despite a readily expandable V beta 17+ CD8+ T cell subpopulation. Sequence analysis of 38 M58-66-specific V beta 17 transcripts from 13 subjects revealed extensive conservation in the CDR3 region including conservation of an arginine-serine motif. To test the dependence of this CTL response on the V beta 17 gene segment, peripheral blood lymphocytes were depleted of CD8+ TCR V beta 17+ cells, before the generation of M58-66-specific CTL. In most cases such depletion blocked or severely reduced the generation of the M58-66-specific response, and under limiting dilution conditions could abolish M58-66-specific CTL precursors. These studies reveal the dependence of this natural human immune response on a particular TCR gene segment.

Functional three-domain single-chain T-cell receptors

T-cell receptors (TCRs) are membrane anchored heterodimers structurally related to antibody molecules. Single-chain antibodies can be engineered by linking the two variable domains, which fold properly by themselves. However, proper assembly of the variable domains of a human TCR (V alpha and V beta) that recognize the HLA-DR2b/myelin basic protein-(85-99) peptide complex was critically dependent on the addition of a third domain, the constant region of the TCR beta chain (C beta), to the single-chain construct. Single-chain molecules with the three-domain design, but not those with the two-domain design, expressed in a eukaryotic cell as chimeric molecules linked either to glycosyl phosphatidylinositol or to the transmembrane/cytoplasmic domains of the CD3 zeta chain were recognized by a conformation-sensitive monoclonal antibody. The chimeric three-domain single-chain TCR linked to CD3 zeta chain signaled in response to both the specific HLA-DR/peptide and the HLA-DR/superantigen staphylococcal enterotoxin B complexes. Thus, by using this three-domain design, functional single-chain TCR molecules were expressed with high efficiency. The lipid-linked single-chain TCR was solubilized by enzymatic cleavage and purified by affinity chromatography. The apparent requirement of the constant domain for cooperative folding of the two TCR variable domains may reflect significant structural differences between TCR and antibody molecules.

CDR3 sequence motifs shared by oligoclonal rheumatoid arthritis synovial T cells. Evidence for an antigen-driven response

T lymphocytes reactive with as yet undefined joint-localized foreign or autoantigens may be important in the pathogenesis of RA. Molecular studies demonstrating skewed T cell antigen receptor (TCR) variable gene usage and selective expansion of particular T cell clones within the synovial compartment support this view. Based on our recent study documenting selective expansion of V beta 17+ T cells in RA, we have pursued the identification of T cells relevant to the disease process, in an informative patient, by combining molecular analysis of freshly explanted RA synovial tissue V beta 17 TCR transcripts with in vitro expansion of V beta 17+ synovial tissue T cell clones. Peripheral blood V beta 17 cDNA transcripts proved heterogeneous. In contrast, two closely related sequences, not found in the peripheral blood, dominated synovial tissue V beta 17 transcripts, suggesting selective localization and oligoclonal expansion at the site of pathology. CD4+, V beta 17+ synovial tissue-derived T cell clones, isolated and grown in vitro, were found to express TCR beta chain transcripts homologous to the dominant V beta 17 synovial tissue sequences. One clone shares with a dominant synovial tissue sequence a conserved cluster of 4/5 amino acids (IGQ-N) in the highly diverse antigen binding CDR3 region, suggesting that the T cells from which these transcripts derive may recognize the same antigen. These findings have permitted a complete characterization of the alpha/beta TCR expressed by putatively pathogenic T cell clones in RA. Functional analysis suggests that the conserved CDR3 sequence may confer specificity for, or restriction by, the MHC class II antigen, DR4.

Increased frequency of V beta 17-positive T cells in patients with rheumatoid arthritis

OBJECTIVE

To identify the T lymphocytes that mediate disease in rheumatoid arthritis (RA).

METHODS

A panel of monoclonal antibodies reactive with T cell receptor (TCR) V beta gene products was used to analyze the RA T cell repertoire.

RESULTS

Of 5 TCR V beta gene products studied, only V beta 17-positive T cells were increased in peripheral blood and synovial fluid (SF) from RA patients, compared with controls (P < 0.01 and P = 0.0006, respectively). Thirty-one percent of the 49 RA SF samples and none of the 19 non-RA SF samples contained > 10% V beta 17-positive T cells. Activated (Tac-positive) T cells were enriched among V beta 17-positive synovial T cells.

CONCLUSION

The selective increase of V beta 17-positive T cells suggests a role for those T cells in the pathogenesis of RA.

Experimental vitreous replacement with perfluorotri-n-propylamine

OBJECTIVE

To evaluate perfluorotri-n-propylamine, a perfluorocarbon oil, as a temporary vitreous replacement in rabbits.

METHODS

After undergoing gas compression vitrectomy, rabbits were injected with perfluorotri-n-propylamine for 24 hours or 2 weeks. The rabbits were evaluated clinically and with electroretinography. The globes were then enucleated and processed for histological evaluation.

RESULTS

Clinical results showed droplet dispersion in the 2-week but not in the 24-hour group. Histological evaluation showed no changes in the retinal pigment epithelium or photoreceptor outer segments. Foam cells were seen in the 2-week but not in the 24-hour group. There was a marked dampening of the electroretinographic response that normalized after the removal of the oil.

CONCLUSIONS

Perfluorotri-n-propylamine demonstrated no retinal toxic side effects in rabbits and is a promising liquid perfluorocarbon oil.

The apoptosis-1/Fas protein in human systemic lupus erythematosus

Three independent mutations involving the apoptosis-1 (APO-1)/Fas receptor or its putative ligand have led to lupuslike diseases associated with lymphadenopathy in different strains of mice. To determine whether humans with SLE also have a defect in this apotosis pathway, we analyzed the expression of APO-1 on freshly isolated blood mononuclear cells and on lymphocytes activated in vitro using flow cytometry and the monoclonal antibody anti-APO-1. Significantly higher level of APO-1 expression were detected on freshly isolated peripheral B cells and both CD4+ and CD8+ T lymphocyte populations obtained from lupus patients when compared with normal controls (P < 0.001). Almost 90% of the cells that stained positive for APO-1 also expressed the CD29 antigen, suggesting that APO-1 was upregulated after lymphocyte activation in vivo. No defect in APO-1 regulation was detected after activation of SLE T (with anti-CD3) or B (with Staphylococcus aureus Cowan 1) lymphocytes in the presence of IL-2 in vitro. Similarly, the anti-APO-1 antibody induced apoptosis in 74 +/- 5% of activated SLE T cells in vitro compared with 79 +/- 6% of the normal controls (P > 0.05). These results reveal that, while APO-1/Fas may play an important role in the regulation of lymphocyte survival in SLE, no consistent defect in the expression or function of the receptor could be detected in these studies.

Human T-cell responses to Mycoplasma arthritidis-derived superantigen

When injected into mice, Mycoplasma arthritidis causes a chronic arthritis that resembles rheumatoid arthritis, histologically. The organism produces a superantigen termed Mycoplasma arthritidis mitogen or MAM, that in humans preferentially expands T cells whose antigen receptors express V beta 17. T cells with this phenotype appear to be increased in rheumatoid synovial effusions. We describe a novel approach to isolating and characterizing human MAM-reactive T-cell lines and determining their T-cell receptor (TCR) V beta usage. Lines were prepared from T cells that clustered with dendritic cells during a 2-day exposure to MAM. Cluster and noncluster fractions of T cells were then expanded by using feeder cells and a polyclonal mitogen. Most of the MAM reactivity was found in dendritic T-cell clusters, as were most of the T cells expressing TCR V beta 17. After expansion, 76% of the cluster-derived T-cell lines were MAM reactive, while no reactivity was seen in cell lines derived from the noncluster fraction. Of the MAM-reactive lines, 49% expressed V beta 17 on some or all of the cells. Cell lines from both cluster and noncluster fractions were analyzed for TCR V beta mRNA expression by PCR amplification. Other V beta genes (5.1, 7, 8, 12, and 20) were found to be expressed by lines that were MAM reactive, although these were not a major component of the cluster-derived T cells. Some non-cluster-derived lines expressed V beta s 17, 12, and 7, but these proved to be nonreactive to MAM. Therefore, dendritic cells can be used to immunoselect and characterize T cells that express superantigen-reactive TCRs.

Interaction of Mycoplasma arthritidis superantigen with human T cells

To define the interaction site of T cell antigen receptors (TCRs) with the superantigen of Mycoplasma arthritidis (MAM), we characterized the TCRs of human MAM-reactive T cell lines and T cell clones. Most MAM-reactive T cells express the V beta 17 gene segment; however, other V beta may also be used and not all V beta 17+ TCRs are MAM-reactive. Alignment of MAM-reactive and MAM-nonreactive V beta sequences suggests that MAM does not interact with a single site encoded by a V beta segment but that several sites may be involved or that other TCR elements contribute to formation of the MAM recognition site.

Subretinal hemorrhage after grid laser photocoagulation for idiopathic juxtafoveolar retinal telangiectasis

A 56-year-old man had decreased vision secondary to bilateral idiopathic juxtafoveolar retinal telangiectasis. One month after grid laser photocoagulation for macular edema in the right eye, a subretinal hemorrhage developed. Over the next 2 months, the hemorrhage spontaneously resorbed and vision improved to 20/50. At 2-year follow up, without further treatment, vision was still 20/50.

Microbial superantigens as etiopathogenic agents in autoimmunity

A recently characterized group of immunologically active microbial products, termed superantigens, may provide the etiopathogenic link between antecedent infection and the subsequent development of autoimmunity in the genetically susceptible host. In this article, the authors review the cellular interactions that underlie autoimmune disease and emphasize the central role played by T lymphocytes. Based on the unique properties of the superantigen and data derived from experimental animal models and clinical studies of human autoimmune disease, a hypothesis that these molecules could trigger both systemic and organ-specific autoimmunity was developed.

Eosinophilia-myalgia syndrome in patients ingesting a single source of L-tryptophan

OBJECTIVE

To estimate the attack rate for eosinophilia-myalgia syndrome and to identify potential risk factors for illness among patients attending a New York City medical clinic, who purchased L-tryptophan containing products produced exclusively by Showa Denko K.K.

METHODS

A case-control design was used. Cases and controls purchased L-tryptophan containing products at the medical clinic from July 1, 1989--December 1, 1989. All case-patients identified with illness onset during the study period were included. Controls were selected by a systematic sample of the 683 purchasers of L-tryptophan attending the same clinic.

RESULTS

Twelve (2.2%) of an estimated 553 L-tryptophan users were case-patients. Multivariate analysis suggested that lot 2 use (adjusted odds ratio [OR] = 35.9), concomitant use of chromium (adjusted OR = 12.3), and concomitant use of pyridoxine (adjusted OR = 5.8) were associated with the development of illness. Chemical analysis of tablets corresponding to the 3 Showa Denko K.K. lots ingested by study participants showed that lot 2 had the highest concentration of ethylidenebis (L-tryptophan), a proposed causative agent or marker for a causative agent in the eosinophilia-myalgia syndrome.

CONCLUSIONS

Information from our study of persons exposed to implicated L-tryptophan supports the role for a contaminant as the causative agent in the eosinophilia-myalgia syndrome and identifies possible cofactors that deserve further study.

Human B cell differentiation induced by microbial superantigens: unselected peripheral blood lymphocytes secrete polyclonal immunoglobulin in response to Mycoplasma arthritidis mitogen

Microbial superantigens (SA) activate a significant portion of the T cell repertoire based on their dual avidity for MHC class II antigens and T cell receptor (TCR) epitopes common to products of one or several TCR beta chain variable gene families. While SA that induce massive T cell proliferation and cytokine secretion have been implicated in clinical syndromes characterized by shock and generalized immunosuppression, SA activation of a more restricted T cell response may also have significant, perhaps immunostimulatory, effects on the immune system. To investigate this issue, we measured 3H-thymidine incorporation and polyclonal IgM and IgG secretion by normal human peripheral blood mononuclear cells (PBMC) cultured with a panel of microbial SA, including the Staphylococcus aureus-derived SA, SEA, SEB, SEC-1, SEC-2, SEC-3, SEE, TSST-1, and the Mycoplasma arthritidis-derived SA, MAM. The S. aureus-derived SA induce vigorous proliferation by PBMC, while optimal MAM-induced proliferation is significantly lower in magnitude. In all 12 subjects tested, mitogenic concentrations of MAM reproducibly stimulate unselected PBMC to secrete polyclonal IgM and IgG. In contrast, the S. aureus-derived SA induce Ig production only in cultures containing isolated B cell populations and either very low numbers of untreated autologous T cells, larger numbers of X-irradiated autologous T cells, or very low concentrations of the SA. No difference in the activation of helper (CD4) versus suppressor/cytotoxic (CD8) T cells by MAM and the S. aureus-derived SA was noted. Taken together, these data suggest that MAM's capacity to induce B cell differentiation correlates with its induction of a relatively weak proliferative response by unselected human T cells. MAM-like SA, when encountered in vivo, may result in a significant perturbation of the human immune system and potentially contribute to clinical syndromes characterized by immunostimulation and hypergammaglobulinemia.

Ciliary sulcus fixation of a dislocated posterior chamber intraocular lens using liquid perfluorophenanthrene

A posterior chamber intraocular lens was transsclerally sutured to the ciliary sulcus with the aid of liquid perfluorophenanthrene (Vitreon). This vitreous substitute facilitates the procedure and reduces the possibility of damage to the retina.

A neonatal hepatitis B surveillance and vaccination program: New York City, 1987 to 1988

From July 1987 to June 1988, 1030 pregnant women with hepatitis B were reported to a New York City surveillance program. Among 832 infants under follow-up, the coverage rates for combined hepatitis B immune globulin and vaccine doses 1, 2, and 3 were 84%, 77%, and 59%, respectively. Infants covered by Medicaid and uninsured Black and Hispanic infants were significantly less likely to be completely vaccinated. An estimated 160 cases of chronic hepatitis B infection were prevented among infants enrolled in the program. Strategies are needed to improve vaccine coverage among hard-to-reach groups.

Diabetic retinopathy: newer therapies to prevent blindness

Diabetic retinopathy is a common cause of blindness in the adult population in the United States. Ophthalmologists now have laser and surgical treatment modalities available that can significantly decrease the risk of blindness in the diabetic population. The American Academy of Ophthalmology, through its Diabetes 2000 program, is making a national effort to educate all physicians who care for diabetic patients to recognize the problem and to be aware of the therapies available to prevent blindness.

Screening test for detection of metallic foreign objects in the orbit before magnetic resonance imaging

RATIONALE AND OBJECTIVES

A study was designed to determine whether plain films, used as a screening modality for magnetic resonance imaging (MRI), could reliably detect intraorbital metallic foreign objects.

METHODS

In the first experiment, 20 metal particles were placed in five human cadaver orbits. Routine orbital plain film series and computed tomography (CT) were obtained, randomized, and interpreted blinded by three experienced radiologists.

RESULTS

The threshold size of particle detection for CT (0.07 mm3) was lower than for plain films (0.12 mm3). Placing metal particles in artificial and true vitreous demonstrated that all particles moved under a magnetic field at 1.5 T. When human globes were exposed to industrial tools (grinder, bandsaw, air hose, etc.), no metal objects penetrated the sclera.

CONCLUSIONS

Plain films can be used as a low-cost, low-radiation screening procedure for high-risk patients with occupations involving metal work. CT should be used for patients with a history of eye trauma from other causes.

Distribution of the posterior ciliary arteries revealed after vascular occlusions. A case report

Recognized posterior ciliary artery occlusion combined with central retinal artery occlusion is relatively uncommon. Clinical and experimental evidence of combined occlusions appear to support a nasal and temporal distribution for the posterior ciliary arteries in most cases. A case involving a patient in whom the posterior ciliary arteries divided superiorly and inferiorly to supply the region of the macula is reported. Some of the more common variations in the distribution of the posterior ciliary arteries are discussed. Clinicians should be aware that the territorial divisions of the choroidal perfusion in the macula may be horizontally based.