Immunologic studies in allergen-induced late-phase asthmatic reactions

We have measured plasma histamine, serum neutrophil chemotactic activity (NCA) and complement (C3 and C4) over a 24-hour period in patients experiencing either early- and late-phase (dual) or single early asthmatic reactions to inhaled allergens. There was a significant biphasic elevation in plasma histamine, which paralleled the fall in forced expiratory volume in 1 sec in 10 patients with dual responses, whereas in seven subjects with single early reactions, only a single early increase in histamine concentrations was observed. In general, in the individual subjects, the changes in plasma histamine paralleled both the elevations in serum NCA and the decreases in forced expiratory volume in 1 sec. By gel filtration on Sephacryl S-400, anion exchange chromatography on DEAE Sephacel, and chromatofocusing with Polybuffer Exchanger 94, the major NCA of both the early and the late reactions was associated with proteins having an estimated molecular size of 600,000 daltons, an elution from DEAE Sephacel at 0.15M to 0.30M of NaCl (pH 8.1), and a pI of approximately 6.5. There were no appreciable changes in serum C3 and C4 up to 24 hr after challenge in subjects with late-phase responses. The patterns of asthmatic response were not related to either the total or allergen-specific serum IgE or IgG4 concentrations. These results support the view that mediators of hypersensitivity participate in late-phase as well as early asthmatic reactions.

Human T-cell leukemia virus-associated membrane antigens: identity of the major antigens recognized after virus infection

Specific antibodies to cell membrane antigens found on human T-cell leukemia virus (HTLV)-infected cells have been detected in Japanese patients with adult T-cell leukemia/lymphoma and in asymptomatic carriers, using a live cell-membrane immunofluorescence assay. Reactivity of the positive antisera was analyzed using radioimmunoprecipitation and NaDodSO4/PAGE with the HTLV-infected tumor cell line Hut 102 (clone B2). The major cell-associated antigens identified include two glycoproteins of approximately equal to 61 and 45 kDa, which appear to be the most immunogenic species in exposed people, a nonglycosylated species of 42 kDa, and four additional species that contain gag gene-encoded antigens with sizes ranging from 19 to 55 kDa. The two glycoproteins ( gp61 and gp45 ) are encoded, at least in part, by the env gene of HTLV as evidenced by amino acid sequence analysis.

Necrobacillosis: a forgotten disease

Over four years five previously healthy young adults developed necrobacillosis , a severe septicaemic illness caused by Fusobacterium necrophorum. The infections were characterised by sore throat followed by rigors and the formation of metastatic abscesses and all caused considerable diagnostic confusion.

Mediators in exercise-induced asthma

Circulating concentrations of the mast cell-associated mediators, histamine and neutrophil chemotactic factor (NCF) of high molecular weight, were measured in atopic and nonatopic asthmatics after treadmill exercise. Elevations in the concentrations of both mediators accompanied the development of exercise-induced asthma (EIA). Normal individuals did not release mediators or develop bronchoconstriction after an identical exercise. The elaboration of mediators was not due to the onset of airflow obstruction, the postexercise basophilia, or the exercise task per se. A treadmill exercise undertaken while inhaling fully conditioned air inhibited EIA and NCF release; in contrast the same exercise undertaken while breathing cold, dry air elicited EIA and the production of mediators. This suggests that the stimulus for EIA and mediator release may be identical. Late-phase asthmatic reactions occur 3 to 9 hr after exercise in some asthmatics and are accompanied by the appearance of circulating NCF, as previously reported in allergen-induced late responses. In addition to the contribution of mediators to the spasmogenic reaction in EIA, mediators may contribute to bronchial inflammation by activating circulating leukocytes. There was a kinetic increase in the expression of neutrophil C3b receptors in EIA (+) asthmatics for up to 60 min after treadmill exercise. The enhancement of C3b receptors, as evidence of neutrophil activation, was preceded by release of NCF and reductions in peak expiratory flow rates. The prior administration of cromolyn inhibited EIA, NCF release, and enhancement of C3b receptors. These changes were not observed in EIA (-) asthmatics after an identical exercise task. These findings support the view that mediators are released in EIA and may play an important role in its pathogenesis.

Immunologically induced generation of tetraene and pentaene leukotrienes in the peritoneal cavities of menhaden-fed rats

The generation of sulfidopeptide leukotrienes and leukotriene B (LTB) in response to an IgG-mediated immune complex reaction in the peritoneal cavities of rats fed either a menhaden oil-supplemented diet or a beef tallow-supplemented diet for 9 to 10 wk was determined with the combined techniques of radioimmunoassay (RIA) and reverse-phase high performance liquid chromatography. Rats on the fish fat diet (FFD) incorporated eicosapentaenoic acid (EPA) into pulmonary and splenic tissues with an EPA:arachidonic acid ratio of approximately 2:1, whereas rats on the beef fat diet (BFD) showed no detectable EPA. The estimated total quantities of immunoreactive sulfidopeptide leukotrienes generated by each group of rats were similar, ranging from 70 to 99 ng/ rat in the FFD groups and 65 to 109 ng/rat in the BFD groups; for rats on the FFD this total included the pentaene products LTC5, LTD5, and LTE5 in quantities ranging from 24 to 39 ng/rat. The total quantities of immunoreactive LTB generated in the two groups of rats were similar, being 6 to 29 ng LTB4/rat for the BFD groups and the sum of LTB4 and LTB5 of 8 to 36 ng/rat for the FFD groups. There was a two- to seven-fold preferential generation of immunoreactive LTB5 over LTB4 in the FFD rats. LTC5 was equipotent with LTC4 in contracting guinea pig pulmonary parenchymal strips and ileal tissues. In contrast, LTB5 was 1/30 to 1/60 as potent and did not reach the same maximum as LTB4 in eliciting neutrophil chemotaxis. The finding that FFD favors the immunologic generation of LTB5, which has attenuated biologic activity when compared to LTB4, suggests that EPA-enriched tissues may produce less pro-inflammatory activity than tissues that are EPA-poor.

Immunologically induced generation of tetraene and pentaene leukotrienes in the peritoneal cavities of menhaden-fed rats

The generation of sulfidopeptide leukotrienes and leukotriene B (LTB) in response to an IgG-mediated immune complex reaction in the peritoneal cavities of rats fed either a menhaden oil-supplemented diet or a beef tallow-supplemented diet for 9 to 10 wk was determined with the combined techniques of radioimmunoassay (RIA) and reverse-phase high performance liquid chromatography. Rats on the fish fat diet (FFD) incorporated eicosapentaenoic acid (EPA) into pulmonary and splenic tissues with an EPA:arachidonic acid ratio of approximately 2:1, whereas rats on the beef fat diet (BFD) showed no detectable EPA. The estimated total quantities of immunoreactive sulfidopeptide leukotrienes generated by each group of rats were similar, ranging from 70 to 99 ng/ rat in the FFD groups and 65 to 109 ng/rat in the BFD groups; for rats on the FFD this total included the pentaene products LTC5, LTD5, and LTE5 in quantities ranging from 24 to 39 ng/rat. The total quantities of immunoreactive LTB generated in the two groups of rats were similar, being 6 to 29 ng LTB4/rat for the BFD groups and the sum of LTB4 and LTB5 of 8 to 36 ng/rat for the FFD groups. There was a two- to seven-fold preferential generation of immunoreactive LTB5 over LTB4 in the FFD rats. LTC5 was equipotent with LTC4 in contracting guinea pig pulmonary parenchymal strips and ileal tissues. In contrast, LTB5 was 1/30 to 1/60 as potent and did not reach the same maximum as LTB4 in eliciting neutrophil chemotaxis. The finding that FFD favors the immunologic generation of LTB5, which has attenuated biologic activity when compared to LTB4, suggests that EPA-enriched tissues may produce less pro-inflammatory activity than tissues that are EPA-poor.

Neutrophil chemotactic activity and histamine in atopic and nonatopic subjects after exercise-induced asthma

Seven atopic and 6 nonatopic asthmatics with exercise-induced asthma were subjected to a treadmill exercise task. After this procedure, both groups had elevations in the concentrations of plasma histamine and serum high molecular weight neutrophil chemotactic activity (as assessed by Sephadex G-200 chromatography). These findings support the view that the release of mast-cell-associated mediators can be independent of the atopic state.

Characterization and biologic properties of 5,12-dihydroxy derivatives of eicosapentaenoic acid, including leukotriene B5 and the double lipoxygenase product

Leukotriene B5 (LTB5) and three stereoisomers were prepared biosynthetically from eicosapentaenoic acid and compared with the analogous derivatives of arachidonic acid for their chemotactic and aggregating effects on human neutrophilic polymorphonuclear leukocytes. Leukotriene B4 (LTB4), LTB5, and the 6-trans-diastereoisomers of each were generated by activating polymorphonuclear leukocytes with the calcium ionophore A23187 in the presence of 14C-labeled and unlabeled arachidonic acid or 14C-labeled and unlabeled eicosapentaenoic acid, respectively. The double lipoxygenase products, (5S,12S)-6-trans-8-cis-LTB4 and (5S,12S)-6-trans-8-cis-LTB5, were generated from 5S-hydroxyeicosatetraenoic acid and racemic 5-hydroxyeicosapentaenoic acid intermediates by incubation with platelet sonicates. The products of each reaction were isolated by reverse-phase-high performance liquid chromatography and identified by their retention times relative to the appropriate totally synthetic standards, ultraviolet absorption spectra, immunoreactivity in a radioimmunoassay for LTB4, and, for all but the double lipoxygenase products, by incorporation of radiolabel from the specific polyunsaturated fatty acid source. When the concentration of LTB5 eliciting maximum chemotactic response of human polymorphonuclear leukocytes, 50 ng/ml (1.5 X 10(-7) M), and that eliciting a maximum aggregation response, 20 ng/ml (5.9 X 10(-8) M), were compared with the interpolated values of LTB4 eliciting comparable effects, the potency of LTB5 relative to LTB4 was approximately 1:8 as a chemotactic agent and about 1:20 as an aggregating agent. The double lipoxygenase products and the resolved 6-trans-diastereoisomers of the pentaene and tetraene series were about 2 logs less active as chemotactic factors than LTB4 and only (5S,12S)-6-trans-8-cis-LTB4 had even minimal aggregating activity.

Antibody to human T-cell leukemia virus membrane antigens, beta 2-microglobulin levels, and thymosin alpha 1 levels in hemophiliacs and their spouses

Recently, antibodies to human T-cell leukemia virus membrane antigens (HTLV-MA) and elevated levels of beta 2-microglobulin and thymosin alpha 1 have been found with high frequency in patients with the acquired immunodeficiency syndrome. Prospective studies of asymptomatic persons at high risk for this syndrome will ascertain whether any of these findings is a predictive marker for the disease. In this study, antibodies to HTLV-MA, beta 2-microglobulin levels, and thymosin alpha 1 levels were determined for a group of asymptomatic adult hemophiliacs and their wives. Five of thirty-nine hemophiliacs had HTLV-MA antibody, compared with none of 21 wives tested. The mean beta 2-microglobulin level for hemophiliacs was significantly higher than the control value (p less than 0.001), whereas the wives had a normal mean value. The mean thymosin alpha 1 values were normal for hemophiliacs and their wives; however, 3 of 22 hemophiliacs and 1 of 16 wives had abnormally high levels. Whether any of these abnormalities correlate with subsequent development of the acquired immunodeficiency syndrome will be ascertained by longitudinal follow-up of this population.

Immunologic release of neutrophil chemotactic activity from human lung tissue

The release of heat-stable neutrophil chemotactic activity (NCA) has been detected after challenge of isolated human lung tissue with anti-IgE. The major NCA released (NCAL) had similar physicochemical properties to the NCA detected in the circulation of asthmatic subjects after bronchial challenge with specific antigen (NCAAG). NCAL and NCAAG (1) had molecular weights of approximately 600,000 daltons as estimated by Sephacryl S-300 gel-filtration chromatography; (2) both eluted from DEAE-Sephacel (pH 7.8) between 0.1 and 0.2 molar NaCl; (3) had isoelectric points of between 6.5 and 6.8 as determined by chromatofocusing on Polybuffer Exchanger 94. In contrast to NCAAG, lung-derived neutrophil chemotactic activity appeared to be more heterogeneous after gel-filtration and anion-exchange chromatography. The release of NCA was complete by 15 min and there was no evidence of further release up to 12 hr. These observations indicate that high-molecular-weight NCA released from human lung tissue has similar properties to NCAAG and would support the view that NCAAG originates from lung tissue after antigen bronchial challenge in asthmatic subjects.

IgG heavy-chain (Gm) allotypes and HLA-antigens in insulin-dependent diabetes mellitus in Korea

Eighty-eight patients with insulin-dependent diabetes mellitus (IDDM) and seventy-two unrelated normal controls in Korea were studied for Gm allotypes and HLA-antigens. Ten Gm phenotypes were found among the Korean population. The phenotype frequencies of Gm axg (1,2,21), Gm ag (1,21), Gm agb0b3b5st (1,21, 11,13,10,15,16) and Gm agfb0b1b3b4b5 (1,21,3,11,5,13,14,10) were higher than the other Gm allotypes, but there was no significant difference between patients and controls. HLA-BW54 was found in 15% of patients who had any of those Gm allotypes (Gm axg, Gm agb0b3b5st, Gm ab0b3b5st). However there was no significant difference in frequency as compared with controls.

Complement receptor enhancement as evidence of neutrophil activation after exercise-induced asthma

To determine whether neutrophils are activated after exercise-induced asthma, increases in neutrophil complement receptor numbers (complement receptor enhancement) were measured by the rosette technique. In twelve asthmatic patients there was a time-dependent rise in complement receptor numbers for up to 60 min after treadmill exercise. This enhancement of complement receptors was preceded by a rise in plasma neutrophil chemotactic activity and a reduction in the peak expiratory flow rate. These changes could be inhibited by prior administration of disodium cromoglycate. The changes were not observed in seven asthmatic patients in whom asthma was not induced by an identical exercise task. Complement receptor enhancement was also observed in vitro when partially purified neutrophil chemotactic activity from a patient with exercise-induced asthma was incubated with normal neutrophils. These findings suggest that inflammatory cells are activated after exercise-induced asthma, possibly as a result of the release of neutrophil chemotactic activity and other mast-cell-associated mediators.

Correction of intraoperative diastolic myocardial dysfunction with nifedipine

We report the case of a 62-year-old man with severe aortic stenosis and hypertrophic cardiomyopathy, who could not be weaned from cardiopulmonary bypass after aortic valve replacement until buccal administration of the calcium-blocking agent nifedipine led to achievement of adequate hemodynamics. These observations demonstrate the importance of diastolic dysfunction in patients with hypertrophic cardiomyopathy, and suggest an important peri- and intraoperative role for calcium-blocking agents in their management. Recent hemodynamic studies have shown the importance of diastolic myocardial dysfunction in patients with hypertrophic cardiomyopathy, and demonstrated that calcium-blocking agents may enhance myocardial performance by reducing this dysfunction (Goodwin, 1982; Lorell et al., 1980, 1982; Sanderson et al., 1977). Although this new class of drugs has been increasingly used as an adjunct to cardioplegia, there is little information thus far on their application as treatment of intraoperative diastolic abnormalities. We report the case of a 62-year-old man with severe aortic stenosis and hypertrophic cardiomyopathy, who could not be weaned from cardiopulmonary bypass after aortic valve replacement until buccal administration of the calcium-blocking agent nifedipine led to an increase in cardiac output and blood pressure.

Antibodies to human T cell leukaemia virus-associated membrane antigens in haemophiliacs: evidence for infection before 1980

Human T cell leukaemia virus (HTLV), HTLV proviral DNA, and antibodies to HTLV or a related agent have recently been detected in patients with acquired immunodeficiency syndrome (AIDS). Antibodies against HTLV-related antigens were assayed by means of indirect living cell immunofluorescence of HTLV-infected cells in sera recently collected from Georgia haemophiliacs and in sera collected between 1976 and 1981 from New York haemophiliacs. 5 of 45 Georgia haemophiliacs and 8 of 48 New York haemophiliacs had antibodies to HTLV-associated cell membrane antigen (HTLV-MA). None of the control Georgia patients on haemodialysis or with chronic hepatitis had detectable antibodies. The 5 haemophiliac patients from Georgia with HTLV-MA had significantly fewer T4 lymphocytes than similar HTLV-MA-negative patients. There were no other significant immunological differences between these groups. These data suggest that transfusions with blood products may expose haemophiliacs to a substantial risk of acquiring HTLV or a related virus.

Antibodies to human T-cell leukemia virus membrane antigens (HTLV-MA) in hemophiliacs

Along with homosexual men, Haitians, and intravenous drug abusers, hemophiliacs are at high risk of contracting acquired immunodeficiency syndrome (AIDS). An earlier study revealed that 36 percent of a group of the AIDS patients had antibodies to cell membrane antigens associated with the human T-cell leukemia virus (HTLV-MA), whereas only 1.2 percent of matched asymptomatic homosexual controls had these antibodies. In the present experiments, serum samples from 172 asymptomatic hemophiliacs were examined for the presence of antibodies to HTLV-MA. Such antibodies were detected in 5 to 19 percent of the hemophiliacs examined from four geographical locations, but in only 1 percent or less of laboratory workers, normal blood donors, donors on hemodialysis, or donors with chronic active hepatitis.

Effect of continuous systemic infusion of D-amphetamine on the sensitivity of nigral dopamine cells to apomorphine inhibition of firing rates

Using a single-unit recording technique, sensitivity of nigral dopamine neurons to the inhibitory effect of apomorphine was examined on various days after a 7-day pretreatment with osmotic minipumps containing D-amphetamine. Continuous systemic infusion of D-amphetamine produced a short-lasting subsensitivity of nigral neurons to apomorphine (0-2 days after D-amphetamine), followed by a supersensitivity on days 7, 8 and 9, post-amphetamine. The supersensitivity seems to persist at least for one week, suggesting one possible mechanism mediating long-term behavioral and biochemical changes following chronic high-dose amphetamine administration.

Neutrophil chemotactic factor in exercise- and hyperventilation-induced asthma

Elevated levels of the mast-cell-associated serum neutrophil chemotactic factor (NCF) and an increase in blood basophil counts were observed in 6 atopic asthmatics during exercise-induced asthma (EIA). These changes were not found when the same degree of airways obstruction was elicited in the same subjects by isocapnic hyperventilation (ISH) with cold air. The NCF was unlikely to be related to the basophilia alone, because asthmatics without EIA who underwent the same exercise task, produced a similar basophilia but significantly less NCF. These findings suggest that mast-cell-associated (as opposed to basophil-associated) mediators of hypersensitivity are detectable in the bloodstream during the bronchoconstriction induced by exercise, but not by ISH.

Neutrophil chemotactic activity in milk-induced asthma

Four subjects with clinical histories of milk-induced asthma were studied (three allergic to cow's milk; one to soya milk). In each instance, skin prick tests, RAST (IgE and IgG4), the basophil histamine release, and serum precipitins, using appropriate milk extracts, were negative. After the ingestion of milk all the subjects developed a reproducible and dose-dependent increase in airflow limitation. Three patients (two allergic to cow's milk; one to soya milk) gave a characteristic immediate-type reaction, which was maximal at 30 min after challenge. The fourth individual developed an isolated late-phase response, with maximal airways obstruction 3 hr after ingesting milk. In the three subjects who gave an early reaction, wheezing was accompanied by an elevation in circulating neutrophil chemotactic activity (NCA). This was not observed in the individual with the isolated late reaction. By Sephacryl S-400 gel-filtration chromatography it was shown that NCA of the early reactions eluted with proteins having an estimated molecular weight of 600,000 daltons. The immediate asthmatic response in peak expiratory flow rate and the elevation in NCA were inhibited by the prior oral administration of either disodium cromoglycate (DSCG) or oral beclomethasone dipropionate (BDP). In contrast, DSCG had no effect on airways obstruction in the subject with the isolated late asthmatic response, although inhibition was achieved by BDP.

Exercise-induced late asthmatic reactions with neutrophil chemotactic activity

Two adults and 13 children with exercise-induced asthma had both immediate and late reductions in forced expiratory volume in one second (FEV1) after treadmill exercise. The late reactions developed 4 to 10 hours after exercise and in each instance were associated with wheezing or chest tightness (or both). Increases in neutrophil chemotactic activity, measured in the 2 adults and in 11 of the children, accompanied the reductions in FEV1 in all these subjects. In contrast, four other adults with only an immediate fall in FEV1 after exercise had only an initial elevation in neutrophil chemotactic activity, with no subsequent increase for the remaining 24-hour period. The agent responsible for the neutrophil chemotactic activity released during exercise-induced late reactions appeared to be identical to that released during immediate reactions. These observations suggest that some patients with exercise-induced asthma have late reactions that, as in the case of antigen-induced bronchoconstriction, are accompanied by the release of neutrophil chemotactic activity.

Antibodies to cell membrane antigens associated with human T-cell leukemia virus in patients with AIDS

The acquired immune deficiency syndrome (AIDS), which has recently occurred at increasing rates in homosexual men, intravenous drug users, and others, is characterized by the development of Kaposi's sarcoma and several opportunistic infections including pneumonia caused by Pneumocystis carinii. Serum samples from patients with AIDS and from matched and unmatched control subjects were examined for the presence of antibodies to cell membrane antigens associated with human T-cell leukemia virus. Nineteen of 75 of the AIDS patients had antibodies directed to surface antigens of Hut 102, a reference T lymphoid cell line infected with leukemia virus, as did two of the 336 control subjects.

Budgerigar fancier's lung. The persistence of budgerigar precipitins and the recovery of lung function after cessation of avian exposure

Forty-eight budgerigar fanciers have been studied and twenty-five (52%) of these lost their serum budgerigar precipitins after cessation of avian exposure. Twenty (80%) subjects lost their precipitins within 2 years. The lung function was assessed serially in seventeen patients with allergic alveolitis and correlated with the persistence of their serum precipitins. There was no difference in the lung function at presentation or in the incidence of complete recovery between the ten subjects, whose precipitins persisted for longer than 2 years, and the seven individuals in whom the precipitins had disappeared within this time. These observations suggest that budgerigar precipitins do not have a major role to play in the continuing pathogenesis of allergic alveolitis.