Maternal Th1- and Th2-type reactivity to placental antigens in normal human pregnancy and unexplained recurrent spontaneous abortions

Spontaneous abortion is the most common complication of pregnancy, but the etiology of a significant proportion of abortions is still unknown. We have examined the production of Th1- and Th2-type cytokines by women with unexplained recurrent spontaneous abortion (RSA) since it appears that successful murine pregnancy occurs in a Th2-dominant situation and that Th1-type immunity is associated with pregnancy failure. We have compared maternal reactivity toward placental antigens in women with a history of successful pregnancy with that in women with a history of RSA. This was done by coculturing maternal peripheral blood mononuclear cells (PBMC) with autologous placental cells and also by stimulating maternal PBMC with antigens from a choriocarcinoma cell line of trophoblastic origin. We detected significantly greater levels of the Th2 cytokines IL-6 and IL-10 in normal pregnancy compared to unexplained RSA and significantly higher levels of the Th1 cytokine IFN-gamma in RSA compared to normal pregnancy. These results suggest that women with normal pregnancy have a higher Th2 bias, while women with a history of RSA evince a bias toward Th1-type reactivity.

The kinetics of beta-methyl-substituted labelled fatty acids in ischaemic myocardium: an analysis in man and with a blood-perfused isolated heart model

beta-Methyl-substituted free fatty acids (FFAs) have been developed for myocardial single-photon emission tomography (SPET) imaging, but little is known about their kinetics in ischaemic conditions. The aim of this study was to determine the changes in the myocardial kinetics of a beta-methyl-branched FFA, [123I]16-iodo-3-methyl-hexadecanoic acid (MIHA), under ischaemic conditions. The kinetics of MIHA were analysed: (a) using a blood-perfused isolated heart model subjected to moderate ischaemia (50% flow reduction) and (b) in patients who had an exercise thallium-201 SPET defect corresponding to either necrotic (n = 13) or chronically ischaemic and viable (n = 15) myocardium, and who underwent two consecutive SPET studies after MIHA injection. In animals, the myocardial early retention fraction of MIHA, but not its clearance rate, was dependent on coronary flow, the early retention fraction being higher in ischaemic than in normoxic conditions (0.24 +/- 0.10 vs 0.14 +/- 0.04, P = 0.004). In the patient SPET studies, the uptake of MIHA calculated in ischaemic and viable areas (G1: 74% +/- 9% of maximal left ventricular value) was different from that calculated in necrotic (G2: 59% +/- 7%, P < 0.001) or normal (G3: 88 +/- 6%, P < 0.001) areas. By contrast, MIHA-clearance calculated between the two consecutive SPET studies was not different in G1, G2 and G3. Unlike in the case of other FFAs, the myocardial clearance of MIHA is not decreased by ischaemia. However, the early retention of MIHA is increased in the case of a moderate reduction in coronary flow, a property which might help in the detection of viability in chronically ischaemic myocardium.

Monoclonal antibody Adnab-9 defines a preneoplastic marker in epithelium at risk for adenocarcinoma of the small intestine

Unlike colorectal cancer, risk markers for adenocarcinoma of the small intestine (ASI) have not been identified. Because the demographic and pathological features of both of these diseases are similar, immunohistochemistry was performed using monoclonal antibodies for three colonic premalignant markers, Adnab-9 (recognizes a colonic adenoma epitope), CaCo3/61, and FBB2/29 (small intestine proteoglycans expressed ectopically in colonic neoplasms), in normal and neoplastic small intestinal epithelium, and the results were compared with normal controls. Adnab-9 was also examined in 20 familial adenomatous polyposis (FAP) patients, a population known to be at an increased risk for ASI. Immunohistochemistry in normal and neoplastic tissue (adenoma, adenocarcinoma) from 18 patients with primary adenocarcinoma of the small intestine was compared with normal small intestine from 10 nonneoplastic controls. Four of 10 (40%) cases of normal small intestinal epithelium from controls were mildly positive in less than 10% of crypts, versus strong staining (>50% of crypts) in 16 of 18 (89%) patients with adenocarcinoma, and in 17 of 20 (85%) patients with FAP (P<.05). Adnab-9 predominantly stained Paneth cells as well as rare crypt and basal villous goblet cells. Adenomatous epithelium from the adenocarcinoma cases and adenomas from the FAP patients showed staining of Adnab-9 in 63% and 78% of cases, respectively. Only 17% of adenocarcinomas were positive for Adnab-9. In contrast, neither CaCo3/61 nor FBB2/29 showed any significant differences in the degree of staining in normal small intestinal epithelium in patients with adenocarcinoma compared with controls. Enhanced Adnab-9 staining in normal small intestinal epithelium from patients who harbor adenocarcinoma, and in FAP patients, supports its role as a risk marker of small intestinal neoplasia.

Home parenteral nutrition. 25 years later

After 25 years, there is enough clinical outcome experience to determine appropriate use of home parenteral nutrition in different disease states and age groups. Information regarding how to avoid complications and how patients and families can find necessary psychosocial support is provided in this article. Currently, small bowel transplantation is not a safer choice, unless there is severe liver disease caused by home parenteral nutrition or lack of central intervenous access.

Effect of vegetable extracts on immunoglobulin production by mesenteric lymph node lymphocytes of Sprague-Dawley rats

To clarify the immunoglobulin production-regulating activity of vegetable extracts, mesenteric lymph node lymphocytes of Sprague-Dawley rats were cultured in the presence of 25 different vegetable extracts. The immunoglobulin content in the culture medium determined by ELISA indicated that the lily family (Liliaceae) vegetables most strongly enhanced the production of IgA and IgG, whereas they suppressed IgE production.

Tetracycline sclerotherapy for testicular hydroceles in renal transplant recipients

OBJECTIVES

To study the efficacy of tetracycline sclerotherapy in renal transplant recipients with symptomatic hydroceles.

METHODS

A total of 21 patients with symptomatic hydroceles following renal transplantation underwent aspiration of hydrocele and injection of tetracycline hydrochloride. Sclerosant solution was prepared by dissolving 1 g tetracycline hydrochloride powder in 10 mL 1% lidocaine. The amount of sclerosant used depended on the volume of the sac: 5 mL for a sac containing up to 100 mL and 2.5 mL of sclerosant was added for each increase of 100 mL in sac volume.

RESULTS

Twelve patients (57%) required only one treatment and 9 patients (43%) had up to 3 injections. The larger the hydrocele, the more treatments were required. The resolution of hydrocele was complete in 12 patients (57%) and partial in 7 (33%) with 2 (10%) failures. Pain at injection was observed in one third of the patients. No major complications (fever, hematoma, infections, abscess, or scrotal necrosis) occurred in any patient. No changes in the structure or size of the testicles were found by ultrasound during an average follow-up period of 35 months.

CONCLUSIONS

Tetracycline sclerotherapy is a safe, effective, and economical form of out-patient therapy that can be recommended as primary treatment for hydroceles in patients who have undergone renal transplantation.

Study of live donor kidney transplantation outcome in recipients with renal amyloidosis

We studied the results of renal transplantation in 16 patients with renal amyloidosis and in 46 controls with primary glomerulonephritis. Amyloidosis was primary in five and secondary to familial Mediterranean fever (FMF) in 11. All patients received live related donor kidneys and the majority had one-haplotype HLA match. One- and 5-year graft and patient survival rates were comparable in both groups. Moreover, the frequency of acute rejection episodes and the mean serum creatinine values were not significantly different between members of the two groups. Significant gastrointestinal symptoms in the form of nausea, vomiting, abdominal pains, and diarrhoea occurred in seven of the patients with amyloidosis (43.7%) and in only one of the controls (2%) (P = 0.001). All seven recipients with amyloidosis who developed the gastrointestinal manifestations were receiving cyclosporin and six had FMF. Maintenance colchicine treatment prevented recurrence of FMF symptoms. In one patient discontinuation of colchicine was followed by recurrence of FMF symptoms. Recurrence of renal amyloidosis was not observed in five patients subjected to Trucut graft biopsies 1, 2, 3, 18 and 72 months post-transplantation. It is concluded that live-related donor kidney transplantation is a safe procedure in patients with amyloidosis and follows a course similar to glomerulonephritis patients.

A threshold level of coupled G-proteins is required to transduce neutrophil responses

Chemoattractant-induced activation of human polymorphonuclear leukocytes involves receptor coupling to guanine nucleotide binding proteins (G-proteins). Treatment of polymorphonuclear leukocytes with pertussis toxin, which ADP-ribosylates neutrophil G-proteins and uncouples G-proteins from receptors, causes a conversion of cells from responders to nonresponders rather than a gradual decrease in the ability of all cells to respond (Omann, G. M., and J. M. Harter. 1991. Cytometry 12:252; Omann, G. M., and M. M. Porasik-Lowes. 1991. J. Immunol. 146:1303). Flow-cytometric methods were used to measure N-formylpeptide-induced cytosolic Ca2+ elevation and actin polymerization over a wide range of ADP-ribosylation levels and showed that although the percentage of responding cells varied markedly, the responding cells were stimulated equivalent to controls. The conditions of pertussis toxin (PT) treatment did not interfere with non-G-protein-mediated pathways as assessed by measurement of phagocytosis, a complex process involving the cytoskeleton. We tested the explanation that the all-or-none effect may have been due to heterogeneous insertion of the catalytic subunit of PT into the cells such that responders had no ADP-ribosylation and nonresponders were completely ADP-ribosylated. Measurement of the binding of fluorescent N-formylpeptides to permeabilized cells, which allows the distinction between completely ribosylated and normal cells, showed that all cells treated with a submaximal concentration of PT had intermediate levels of receptor-coupled G-proteins. Thus, partial ADP-ribosylation had occurred in all cells and the all-or-none insertion of the catalytic subunit of PT was ruled out. Thus, there is a threshold of coupled G-proteins required to transduce responses. The ability of PT to inhibit N-formylpeptide-induced actin polymerization and cytosolic calcium elevation was compared and showed that both responses have essentially the same threshold of G-proteins required to transduce the responses. Thus, the pathways regulating actin polymerization and calcium elevation appear to be coupled with equal efficiency to the G-proteins.

A threshold level of coupled G-proteins is required to transduce neutrophil responses

Chemoattractant-induced activation of human polymorphonuclear leukocytes involves receptor coupling to guanine nucleotide binding proteins (G-proteins). Treatment of polymorphonuclear leukocytes with pertussis toxin, which ADP-ribosylates neutrophil G-proteins and uncouples G-proteins from receptors, causes a conversion of cells from responders to nonresponders rather than a gradual decrease in the ability of all cells to respond (Omann, G. M., and J. M. Harter. 1991. Cytometry 12:252; Omann, G. M., and M. M. Porasik-Lowes. 1991. J. Immunol. 146:1303). Flow-cytometric methods were used to measure N-formylpeptide-induced cytosolic Ca2+ elevation and actin polymerization over a wide range of ADP-ribosylation levels and showed that although the percentage of responding cells varied markedly, the responding cells were stimulated equivalent to controls. The conditions of pertussis toxin (PT) treatment did not interfere with non-G-protein-mediated pathways as assessed by measurement of phagocytosis, a complex process involving the cytoskeleton. We tested the explanation that the all-or-none effect may have been due to heterogeneous insertion of the catalytic subunit of PT into the cells such that responders had no ADP-ribosylation and nonresponders were completely ADP-ribosylated. Measurement of the binding of fluorescent N-formylpeptides to permeabilized cells, which allows the distinction between completely ribosylated and normal cells, showed that all cells treated with a submaximal concentration of PT had intermediate levels of receptor-coupled G-proteins. Thus, partial ADP-ribosylation had occurred in all cells and the all-or-none insertion of the catalytic subunit of PT was ruled out. Thus, there is a threshold of coupled G-proteins required to transduce responses. The ability of PT to inhibit N-formylpeptide-induced actin polymerization and cytosolic calcium elevation was compared and showed that both responses have essentially the same threshold of G-proteins required to transduce the responses. Thus, the pathways regulating actin polymerization and calcium elevation appear to be coupled with equal efficiency to the G-proteins.

The adenylate cyclase system and prostaglandin production in human decidua parietalis

We studied the beta-adrenergic system in the human decidua and its effect on prostaglandin E2 and F2a release from dispersed decidual cells in culture. Beta-adrenergic receptors in decidual membranes were partially characterized using (+)[125I]HYP. Specific binding was demonstrated with maximum binding capacity (Bmax) of 70 +/- 10.6 fmol/mg and an affinity (KD) of 20.85 +/- 1.86 pmol. cAMP dependent phosphoproteins in decidual cytosol were also identified. Two phosphoproteins of M(r) 42,000 and 22,000 were seen in all preparations. Three others (M(r) 39,000, 23,000 and 21,000) were identified in only some of the preparations. Phosphoproteins of similar M(r) to those seen in cytosol prepared from decidual homogenates were also identified in cytosol of cultured decidual cells. Phosphorylation of the 42,000 M(r) and 22,000 M(r) proteins was maximal (3.04 +/- 0.35-fold and 5.7 +/- 0.68-fold) with 10(-6) M cAMP. Cultured decidual cells produced prostaglandin E2 and F2a which increased in a dose-dependent manner in response to dbcAMP, forskolin or isoproterenol. The decidua contains an intact beta-adrenergic system that, when activated, is capable of phosphorylating specific proteins and modulating prostaglandin release.

Bile canalicular alterations in hepatocyte nodules induced by 3'-methyl-4-dimethylaminoazobenzene in the rat: morphological clues on their pathogenesis and relevance to the neoplastic process

One characteristic change of hepatocyte plasma membrane in chemically induced nodules of rat liver is the spreading over on the whole cell surface of proteins normally associated with the canalicular domain. However, these proteins may present comparable altered patterns of membrane distribution in non-neoplastic situations, e.g. in cholestatic states. Consequently, the significance of an abnormal membrane distribution of canalicular proteins in hepatocyte nodules and its possible relevance to the neoplastic process remain to be clarified. We have therefore performed an ultrastructural study of bile canalicular alterations in the hepatocyte nodules induced by 3'-methyl-4-dimethylaminoazobenzene (3'-Me-DAB), in an attempt to gain some insight on their pathogenesis. We actually observed frequent bile canalicular changes in hepatocyte nodules from 10 to 16 weeks after the beginning of 3'-Me-DAB administration. These changes correlated with the rearrangements in hepatocyte architecture occurring at this stage of the neoplastic process, corresponding to the so-called pseudo-acinar structures and disorganized plates. In pseudo-acinar structures, hepatocytes were arranged in a tubular manner around dilated bile canaliculi. In this situation, bile canaliculi have lost many of their normal features and closely resemble ductular lumina. In disorganized plates, hepatocyte plates were thickened and irregularly branched. In this situation, bile canaliculi presented striking deviations from the normal, including: (i) dilatation and distortion, (ii) lesions of canalicular membrane (loss of microvilli, formation of blebs) and (iii) alterations in the pericanalicular cytoskeletal network. Most of these morphological abnormalities closely resembled those found in cholestatic states. Two pathogenetic mechanisms may be postulated to explain the cholestatic-like effect of 3'-Me-DAB: (i) a direct cellular injury caused by the carcinogen or (ii) an indirect consequence of the tissular rearrangements characteristic of disorganized plates. Our morphological results suggest that the phenotypic alterations of bile canaliculi induced by 3'-Me-DAB are not specific for the neoplastic process. They are likely to correspond to an impairment in the biogenesis of the canalicular membrane and/or in the maintenance of its integrity.

Detection of a biliary cell membrane glycoprotein in the serum of cholangiocarcinoma-bearing rats. Possible relevance to the membrane proteins used as serum tumor markers in humans

Certain markers used in the diagnosis and monitoring of human adenocarcinomas, such as carcinoembryonic antigen are membrane glycoproteins normally absent from the serum. How those proteins may reach the blood after the neoplastic transformation remains debated. In this work, we show that cholangiocarcinoma induced by 3'-methyl-4-dimethylaminoazobenzene in the rat provides some insight into the mechanisms implicated in this process. We observed that the extracellular matrix of all cholangiocarcinomas tested contained large amounts of a glycoprotein identified by a monoclonal antibody termed B10, and previously characterized as an integral membrane protein normally restricted to the apical domain of epithelial cell plasma membrane. The extracellular deposition of the B10-binding glycoprotein in cholangiocarcinomas was associated with the appearance of detectable levels of the protein in the serum, and an abnormal membrane expression of the protein, which was detected on both apical and basal plasma membrane domains of neoplastic biliary cells. We postulate that neoplastic transformation of biliary cells leads to an inappropriate membrane expression of the B10-binding protein, which in turn, results in the extracellular release of the protein and in its diffusion into the blood. The characteristic desmoplastic stroma of cholangiocarcinoma offers the opportunity to easily visualize the release process. A comparable mechanism is likely to explain how certain membrane glycoproteins used as serum markers in human malignancy may reach the blood.

Double-blind comparison of single doses of DS103-282, baclofen and placebo for suppression of spasticity

Twelve spastic patients received single oral doses of a new anti-spastic drug DS103-282 (Sandoz) 6 mg, baclofen 20 mg, and placebo on three separate days. Passive stretch responses were measured before administration and for four hours afterwards. DS103-282 was more effective than baclofen, and both drugs were more effective than placebo. Analysis of the recordings confirmed that DS103-282 had a specific effect upon stretch reflexes independent of its effect on resting muscle tone. Its action appeared at 30 to 45 minutes after ingestion, with maximum activity at 60-90 minutes. Unwanted effects of DS103-282 were drowsiness and (in one case) potentiation of antihypertensive therapy.