HLA AW19, B12 in immunoproliferative small intestinal disease

A group of 21 patients with immunoproliferative small intestinal disease (IPSID), 10 with alpha heavy chain paraproteinaemia and 11 without it, were HLA typed. The results were compared with 35 disease controls and 120 normal controls. A significant increase of Aw19 and B12 antigens was noted among the patients compared with the control subjects. The high rate of association of both AW19 and B12 antigens in patients as compared with controls suggests a possible haplotype (Aw19, B12) association with IPSID.

Lymphocytes subpopulation in normal family members of patients with alpha-chain disease

Normal family members of eight diagnosed patients suffering from alpha-chain disease had been investigated by immunoelectrophoresis for abnormal alpha-chain protein in their serum. The pattern was demonstrated in four families only, of different members, but all are of the first-degree relationship. The aim of the study was to determine any possible hereditary defect of the immune system in such patients, as compared to the immune system of the normal members of the family who had abnormal protein in their serum. It was found that in both patients and normal members, the proportion of circulating B-lymphocytes was much higher than normal, whereas that of T-lymphocytes was lower than normal. Neither could be sensitized to DNCB, and their skin tests to tuberculin were negative. From all these findings, it was concluded that the disease was a B-cell disease of IgA type transmitted by a hereditary factor associated with a low level of cellular immunity. Further studies are required to support this hypothesis.

[Splenic lympho-plasmocytic sarcomas discovered by exploratory laparotomy in 2 cases of cold agglutinin disease]

The 2 patients have cold agglutinin disease with lymphoid nodules in the bone marrow. A splenectomy was done because of the severity of the hemolytic anemia and because of the increasing splenomegaly. Tumoral nodules with the aspect of lymphoplasmocytic sarcoma or immunocytoma were discovered in the spleen. Those tumors can be considered either as a morphologic aspect of the cold agglutinin disease which is yet considered as a kind of chronic lymphoproliferative syndrom or as the proliferation of an other clone. In this hypothesis, the lymphoplasmocytic sarcoma habe the same signification that the Richter's syndrome in chronic lymphoid leukemia and that the sarcoma appearing in Waldenström's macroglobulinemia or in alpha heavy chain disease.

[Alpha chain disease. Report of a case (author's transl)]

A young patient, with alpha chain disease, is in good clinic condition, a little more than 4 years after the diagnosis. She received, during 1 year, antibiotics of tetracycline type, then antimitotics during 2 years. 9 months after antimitotics treatment was achieved, histologic signs remained unmodified, without evidence of degenerescence. Immunoelectrophoresis which was normal at the end of chemotherapy is always normal after 15 months without treatment.

Alpha heavy chain disease (report of 18 cases from Iraq)

The clinical and pathological features of 18 new patients with alpha heavy chain disease seen at two referral centres in Baghdad, Iraq, are described. The series included 14 males and four females ranging in age from 14 to 47 years. Almost all patients presented because of long-standing abdominal pain and diarrhoea. The tissue diagnosis and extent of the disease were established at laparotomy in most patients. Peroral jejunal biospy was used in a number of patients, mainly for follow-up. The serological abnormality was confirmed by immunoselection technique. Most of the patients had extensive thickening of the bowel wall and/or tumour masses of the small intestine and mesenteric nodes. Histopathological sections showed muscularis. Preliminary results of the treatment, including two long remissions, are reported. In general, our observations agree with those made by other authors, mostly from the Middle East and Africa. We believe that a high index of clinical suspicion, routine use of the immunoselection, and recognition of the early pathological changes may hopefully lead to the detection of more cases before the frank neoplastic phase of the disease.

Preparation and evaluation of an antiserum to the carboxymethylated Aalpha chain of human fibrinogen

Antiserum to the carboxymethylated Aalpha chain of human fibrinogen has been produced in rabbits and its reactions investigated in a double diffusion system. The antiserum reacts with the carboxymethylated Aalpha chains, but not with carboxymethylated gamma chains, nor with carboxymethylated Bbeta chains, provided that the antiserum had been absorbed with carboxymethylated Bbeta chains. The antiserum also reacts with Aalpha chains in the whole fibrinogen molecule, either in plasma or in the purified form, and spur formation was observed when intact fibrinogen was compared with high solubility fibrinogen, which contained little or no intact Aalpha chain.

[Alpha heavy chain disease]

Alpha chain disease is a fairly rare disease (less than 80 cases have been diagnosed to date) the diagnosis of which should be considered as a routine in France when a young arab or oriental jew presents with digestive symptoms such as chronic diarrhoea, abdominal pain of abdominal tumour. The diagnosis of the disease requires two examinations 1) serum immunoelectrophoresis with monospecific anti-IgA antiserum, which alone isolates in 100% of cases the paraprotein. 2) Exploratory laparatomy seems advisable in all cases, for it alone permits multiple lymph node and intestinal biopsies whict are necessary to determine the stage of the disease, the prognosis and treatment. 3) Generally speaking, heavy chain disease seems to represent like Burkitt's lymphoma, a model for experimental carcinoma.

Identifying immunoglobulin isotypes, allotypes and idiotypes by a hemolytic assay in gel

We developed a hemolytic radial immunodiffusion assay for identifying immunoglobulin (Ig) isotypes, allotypes and idiotypes by using gels containing erythrocytes coated with anti-Ig antibody or erythrocytes coated with Staphylococcal protein A. These indicator cells lysed specifically when treated sequentially with Ig antigen, the appropriate anti-Ig antiserum (developer) and complement. To identify these Ig subpopulations, we used monospecific indicator cells, e.g. erythrocytes coated with antibody specific for an Ig isotype, and developers with broader specificities ('multispecific'), e.g. antiserum to Fab. Alternatively, we used 'multispecific' indicator cells, e.g. erythrocytes coated with antibody to Fab and monospecific developers, e.g. antiserum to Ig idiotype. To identify Ig subpopulations specifically, either the indicator cells or the developer need to be monospecific. When both the indicator cells and the developer were monospecific, e.g. to allotype and to isotype, the specificity was determined by both reagents and ultimately restricted by the reagent with the narrower specificity, that is, reacting with the smallest Ig subpopulation. This sensitive hemolytic assay may be used to quantitate subpopulations of Ig molecules and may be modified into a reverse plaque forming cell assay to count lymphocytes secreting a given Ig class, type, allotype and idiotype.

"Mediterranean abdominal lymphoma" or immunoproliferative small intestinal disease. Part II: pathological aspects

The pathology of 25 cases of Mediterranean abdominal lymphoma, better designated as immunoproliferative small intestinal disease (IPSID), are reported from the American University of Beirut Hospital. The series includes nine cases with documented alpha heavy chain disease (alpha-HCD). The disease is characterized by the presence of a diffuse and compact bandlike lymphoplasmacytic infiltration of the proximal small intestinal mucosa. The presence of a concomitant malignant lymphoma in the intestine and/or mesenteric lymph nodes, and of alpha-heavy protein in the serum is commonly encountered. Two histopathologic variants of IPSID are present. The first is characterized by the diffuse infiltration of the mucosa, at sites away from tumoral masses, by either pure plasmacytic infiltration, or mixed lymphoplasmacytic infiltration. This variety is associated with the immunoblastic sarcoma type of malignant lymphoma, and with alpha chain disease (alpha-HCD). The second variant is characterized by a diffuse follicular lymphoid hyperplasia pattern in the small intestinal mucosa. The associated malignant lymphoma is diffuse and undifferentiated often having a starry-sky pattern. This variety is not associated with alpha-HCD. Both histologic variants share the same clinical antecedents. In five patients, mesenteric lymph nodes harbored immunoblastic sarcoma while the intestinal mucosae of the same patients were involved with a benign appearing lymphoplasmacytic infiltration. This finding stresses the need for staging laparatomy. Three patients, with alpha-HCD, had peripheral lymph node involvement with immunoblastic sarcoma. The disease apparently evolves in two stages: an immunoproliferative phase, probably reversible, and a later development of malignant lymphoma. The term immunoproliferative small intestinal disease accurately describes the nature of the entity.

[Specific antibodies bound to secretory IgA in the sera of patients with intestinal infections]

Specific IgA and sIgA antibodies were studied in the sera of patients suffering from various intestinal diseases (dysentery, salmonellosis, typhoid fever, chronic typhoid carrier state) and in the sera of healthy persons immunized by parenteral route with typhoid alcohol vaccine. The nature of antibodies was identified in Coombs' test, using monospecific antisera to alpha-chain and to the secretory component. IgA and sIgA antibodies were revealed most frequently in the sera of dysentery patients and of chronic typhoid carriers. No sIgA antibodies were found in the sera of subcutaneously immunized persons. The presence of specific sIgA antibodies in the serum reflects the participation of local immune mechanisms in the formation of systemic immunity in the intestinal infections.

Radiological characteristics of primary intestinal lymphoma of the "Mediterranean" type: observations on twelve cases

Radiological findings in 12 cases of "Mediterranean" lymphoma are analyzed, 4 of which are associated with gammapathy. These findings have not permitted differentiation of this type of lymphoma from those classically described, although there are two signs that strongly suggest this diagnosis: extension of the lesions along wide areas of the small intestine, almost always including the duodenum, and spiculation of the mucosal fold edges, representing massive plasmocyte infiltration of the lamina propria. The principal clinical, immunological, and pathological aspects are described, as well as the radiological differential diagnosis.

T and B lymphocytes in alpha-chain disease

The patients studied were diagnosed as suffering from alpha-chain disease by their clinicopathological features, malabsorption findings, X-ray, and presence of abnormal alpha-chain protein in their serum. The objective of the study was to determine any possible defect of the immune system in such patients. The rosette technique and surface immunofluorescence were used to enumerate the circulating T and B lymphocytes in these patients. They were also skin-tested with tuberculin and given sensitizing doses of dinitrochlorobenzene. Their serum immunoglobulins were also quantitated. It was found that the proportion of circulating B lymphocytes was much higher than normal, whereas that of T lymphocytes was lower than normal. Furthermore, they could not be sensitized to DNCB and their skin test to tuberculin was negative. It was concluded that the disease was a B-cell disease of IgA type, associated with low level of cellular immunity.

Paraproteinemia in normal family members of eight cases with primary intestinal lymphomas in Iraq

Normal family members of eight patients with paraproteinemia of the primary intestinal lymphoma, had been investigated by immunoelectrophoresis, for IgA heavy chain pattern. IgA heavy chain pattern was demonstrated in four families only, of different members, but all are of the first degree relationship. Detailed clinical, laboratory, radiological and histopathological findings of those eight cases were suggestive of malaborption. Out of the 129 normal family members of the 8 cases, 23 cases (17.8%) had abnormal immunoglobulin in their sera. These results may explain a hereditary factor which is responsible for production of alpha-chain diseases. Supports for this hypothesis need further research.

Further evidence for a role of secretory component (SC) and J chain in the glandular transport of IgA

These studies support the transport model depicted in Figure 3: Incorporation of J chains into dimeric IgA induces a configurational fit allowing complexing of IgA with SC available in the plasma membrane of serous secretory epithelial cells. This complexing on the surface of the cell stimulates pinocytosis, and the completed secretory IgA molecules are transported in cytoplasmic vesicles to the gland lumen. The same transport model can be applied for the external translocation of IgM.

An abnormal human IgA1 half-molecule

An IgA1 half-molecule, which is composed of a deleted alpha1 chain linked with a disulfide bond to an intact kappa chain, was detected in a patient (Cha). The molecular weights of the paraprotein and the isolated alpha1 chain were estimated to be 75 000 and 53 000, respectively. Identification of tyrosine as the C-terminal amino acid and the presence of idiotypic determinants in the abnormal alpha1 chain indicated that the molecule would have an intact N-terminal variable region and a C-terminal region. Furthermore, no cleavage of the abnormal protein into Fab and Fc by proteolytic enzyme isolated from Neisseria gonorrhoeae suggested the absence of a "hinge" region in the abnormal alpha1 chain.