Cryoglobulinaemia in Henoch-Schönlein purpura

Sera from patients with Henoch-Schönlein purpura were examined for cryoglobulinaemia. Thirty patients had acute Henoch-Schönlein purpura, with or without renal diseas; 14 had chronic nephritis after a previous episode of purpura; and 17 were well, without urinary abnormalities, after recovering from Henoch-Schönlen purpura. Raised concentrations of cryoglobulins were present in 14 (47%) of those with acute purpura, nine (64%) of those with chronic nephritis, but none of those who had recovered completely from Henoch-Schönlein purpura. This suggests that acute Henoch-Schönlein purpura and the chronic nephritis that sometimes follows it have an immune-complex pathogenesis. IgA and properdin were found in several cryoglobulins, which suggested that complement had been activated via the alternative pathway, but isolated cryoglobulins capable of splitting C3 in vitro did so via the classical pathway.

Changes in humoral components of host defense following burn trauma

Serum opsonic activity for E. coli 075, conversion of C3 by inulin, total hemolytic complement (CH(50)), levels of native C3, factor B, C3b inactivator (KAF), properdin (P), and immunoglobulins (Ig) were determined in 14 patients with burns involving 13% to 91% body surface during 6 to 8 weeks postburn. In the 12 uninfected patients, levels of IgG and IgA were reduced during the first 10 days postburn, and decreased concentrations of P and IgM were demonstrated from three to 6 weeks postburn. C3 conversion was reduced from 10 days to 6 weeks postburn. Levels of C3, factor B, and KAF were normal or elevated for the entire study period. No difference in the occurrence of humoral abnormalities was noted in patients with burns caused by flame, immersion scald, or acid contact. Reduction in C3 conversion and P concentration were the only abnormalities which correlated with increasing burn size. Bacteremia and/or fungemia was documented in the other two patients. In one of these patients, reduction in CH(50) occurred during septicemia due to S. aureus, and in the other, reduction in all measurements of complement was associated with candidemia and Pseudomonas septicemia and occurred prior to the development of shock. Serum opsonic activity was only reduced significantly during sepsis, suggesting that this abnormality occurred as a result rather than a cause of infection. These results indicate that consumption of components of the classical and/or alternative pathways of complement activation may be an important mechanism by which infection is perpetuated in the burn patient. They also emphasize the importance of the clinical management of the burn patient in preventing the development of septic complications.

Quantitative measurement of properdin in normal human serum by electroimmunoassay and single radial immunodiffusion

Properdin in normal serum was measured by electroimmunoassay (EIA) and single radial immunodiffusion (SRID). Fresh sera gave much lower properdin values in SRID in gels containing Mg2+ ions. Storage of sera at 4 degrees C resulted in a gradual increase of the properdin values measured by SRID but not of those of the EIA. With 10 mM of EDTA in the gels no difference between the properdin values obtained by the different methods was found. Evidence is presented that immunodiffusion values of properdin might be affected by precipitation of a C3-properdin complex in gels containing Mg2+ ions after the activation of the properdin system by agarose.

[Properdin and the protein composition of lymph and blood following resuscitation]

It was shown in experiments on dogs that the terminal blood letting with the subsequent reanimation by intrabone autoblood force pumping caused regular redistribution of proteins between blood, lymph, and tissues. Properdine and alpha-globulin retention in interstitium not eliminable by reanimation measures, and also stress secretion of gamma-globulins from the lymph nodes was noted.

Risk of bladder tumors among benzidine workers and their serum properdin levels

Serum properdin levels were determined for 21 benzidine operators at 6-month intervals for 2 years after termination of exposure to this carcinogen. Of this group, 7 developed bladder cancers within a 4-month period prior to the initial assay, and all 7 showed properdin levels below the median for the group as a whole. Two of the 3 workers who had had a brief exposure previously to beta-naphthylamine developed benign bladder tumors but had no malignant neoplasms up to 13 years later. The properdin assays of these 3 men remained consistently at or above the median values. No man developed a bladder tumor who was exposed less than 6 years to benzidine, even though 2 of these men showed low properdin levels. Of the 4 whose properdin levels were initially above the median but dropped below in subsequent assays, 3 developed bladder cancers 0.5, 4, and 9 years later. Only 1 man whose properdin level remained high in 1958-59 developed a bladder cancer 7 years later, and his immunologic picture may have been complicated by recovery from a larynx tumor in 1954. Recurrence of bladder tumors among the original 9 cases has occurred only among the 5 whose properdin levels remained below the median. The 1 whose ranking fell most dramatically (from 13 to 19) has had 13 recurrences in 13 years.

Alternative pathway of complement in sickle cell disease

Thirty-one patients, 10 months to 20 years of age, were studied. A complement abnormality was not identified in sera from patients with sickle cell disease (SCD) by the methods employed in the present study. Concentrations of C3, factor B, total hemolytic activity (CH50), properdin, and C3b inactivator were similar in sera from patients and control subjects (Table 1 and Fig. 2). Although concentrations of C3b inactivator protein were below normal in a few patients, there was no evidence that these levels were low enough to alter the functions mediated by this protein. Initiation of the complement sequence via the alternative pathway by reaction with inulin was equal in patient and control sera when assessed by the activation of factor B, cleavage of C3 and the comsumption of hemolytic complement components (Table 1). Lysis of erythrocytes treated with reduced glutathione was similar in patient and control sera during alternative pathway activation (Fig. 3), indicating comparable formation of lytic complexes via this pathway. An abnormality of the alternative pathway was not detected when the serum from patients with sickle cell disease was reacted with inulin. Thus, this polysaccharide, although commonly empolyed to assess alternative pathway function, is not satisfactory for studying serum from these patients. In addition, activation of the alternative pathway by cobra venom factor was comparable with controls when assessed by the lysis of glutathione-treated erythrocytes.

Pathways of complement activation in chronic discoid lupus: serologic and immunofluorescence studies

To assess the relative roles of the classic and alternative pathways of complement activation in chronic discoid lupus erythematosus (CDLE), serum levels of properdin, C3, and C4, and deposition of these proteins in the dermal-epidermal junction (DEJ) of 20 CDLE patients were compared to the findings in patients with clinically active and inactive SLE. Properdin was demonstrated in the DEJ of 10 of 14 (71%) histologically typical skin lesions from patients with CDLE, usually in association with deposits of immunoglobulin, C3, and C4. Properdin levels in CDLE patients were significantly increased (137 +/- 34%) (P less than 0.05) when compared to normal controls (101 +/- 18%) or to patients with clinically active SLE (89 +/- 32%). C3, C4, DNA-binding, and antinuclear antibody tests in CDLE were indistinguishable from those in normals, but significantly different from patients with active SLE (P less than 0.05). The complement profiles of patients with clinically inactive SLE resembled those of CDLE patients more closely than those of active SLE patients.

Hereditary deficiency of the third component of complement in a child with fever, skin rash, and arthralgias: response to transfusion of whole blood

A previously well 34-month-old male presenting with fever, skin rash, and arthralgias was found to lack C3 by immunochemical (undetectable) and hemolytic (1% normal) assays. No infectious agent could be demonstrated. Protein levels of Clq. C4, C5, properdin, and C3b-INA and hemolytic activities of complement components C1 to C9 except C3 were normal or elevated; total hemolytic complement activity was 13% of normal and was reconstituted by purified C3. Properdin factor B was 702 (normal 175 to 275) mug/ml, and was not cleaver upon addition of zymosan or cobra venom factor. The serum had normal immune adherence activity, but was deficient in ability to opsonize Candida albicans for uptake and Escherichia coli for killing by neurophils, generate neutrophil chemotactic factors and inhibit the growth of E. coli; these activities were restored by purified C3. A transfusion of 320 ml 1-hour-old normal whole blood on the fifty-second day resulted in transitory elevation of the C3 level to 25 mg/dl with a fall-off (approximately 2 1/2% per hour) to undetectable levels by 69 hours; it was followed by disappearance of the skin rash and arthralgias and return to normal of the previously elevated temperature and CRP levels. C3 levels in family members (seven of 24 half-normal), lack of anti-C3 activity, normal C3b-INA levels and a normal rate of catabolism of transfused C3 indicated that the deficiency was inherited with autosomal codominance and involved decreased synthesis of C3. Thus, this child is a unique individual with inherited C3 deficiency presenting with absence of repeated infections, whose symptoms of fever, skin rash, and arthralgia were abated by whole blood transfusion.

Membranoproliferative glomerulonephritis with disruption of the glomerular basement membrane

Seven patients with a form of membranoproliferative glomerulonephritis distinct in its glomerular ultrastructure from other forms are described. The use of silver impregnated electron micrographs revealed contiguous subepithelial and subendothelial deposits associated with basement membrane disruption, replication and layering of lamina densalike material. By light and fluorescence microscopy the appearance was distinctive but not diagnostic. Immunohistology consistently showed abundant C3 and properdin in a granular pattern while immunoglobulins and Clq were variably present. Low serum C3 concentrations were observed at some time in each patient, often accompanied by low levels of properdin, whereas the concentrations of Clq and C4 were normal. The patients were indistinguishable in their clinical course from those with other types of MPGN.

Alternative pathway of complement: nonenzymatic, reversible transition of precursor to active properdin

A method for the purification of properdin in precursor state (pre-P) has been elaborated. Precursor properdin, in contrast to activated properdin (P), does not initiate the formation of a C3 convertase when added to properdin-depleted serum, rather it requires the presence of an activating substance such as zymosan for expression of its activity. Comparing the activities of pre-P and P it was found that some P preparations contained significant amounts of pre-P because they were fully active only in the presence of zymosan. This observation indicated that P can partly revert to pre-P. Comparison by immunoelectrophoresis and sodium dodecyl sulfate polyacrylamide gel electrophoresis revealed no charge or size differences between pre-P and P. Radiolabeled pre-P, when analyzed after its participation in the reactions of the pathway, displayed an unchanged subunit m.w. of 50,000. Taken together, these results strongly suggest that the transition of pre-P to P is due to a partly reversible change in the conformation of the protein rather than the result of proteolytic cleavage.

Properdin factor B (Bf) polymorphism in Norway

Bf phenotype distribution and Bf allele frequencies in samples of the Norwegian population and the Lappish minority of Norway are presented. Bfs in Norwegians was found to be 0.817, while it was 0.888 in Lapps. The difference is statistically significant. Possible explanations of this difference are discussed. It is noted that Bf allele frequencies of Norwegians are similar to those of Germans, while differing from frequencies found in US whites.

Measurement of complement components in systemic lupus erythematosus by radial immunodiffusion

Total hemolytic complement activity (CH50) and levels of C4, C5, and Factor B determined by commercially available radial immunodiffusion plates were compared in sera from patients with systemic lupus erythematosus. There was a significant correlation between CH50, C4 and C5, but no correlation between Factor B and any of the other indices of complement activity measured.

[Properties and the protein composition of lymph and blood in burns]

Experiments conducted on 25 dogs demonstrated that burn was accompanied by a regular redistribution of plasma proteins between the fluid media of the organism and an intensification of lymphogenic resorption. Properdin, albumin, and alpha2-globulin retardation in tissues in case of burn was demonstrated indirectly. The degree of burn proved to depend on the initial properdin level.

Consumptive opsoninopathy: possible pathogenesis in lethal and opportunistic infections

Serum levels of properdin, Factor B and C3 and the ability of these sera to opsonize E. coli 075 were measured in 17 patients with surgical infections ranging in severity from mild to fatal. There was good direct correlation between severity of infection, serum levels of properdin and C3, and the ability of the serum to support opsonization. The levels of Factor B were not significantly reduced when measured by radial immunodiffusion, but immunoelectrophoresis showed conversion. Restoration of full opsonic activity was accomplished only by the addition of a combination of C3, Factor B, and properdin in excess. The findings provide evidence that severe bacterial infection causes a consumption of opsonic proteins which may result in a reduced ability of the patient's serum to opsonize bacteria and thereby further increase susceptibility to infection.

Interaction of E. coli strains with human serum: lack of relationship to K1 antigen

Twenty-eight strains of E. coli isolated from infants were compared with respect to opsonic requirements, sensitivity to serum, and ability to activate serum chemotactic factors. Six of the strains were isolated from stools of healthy newborn infants; 22 were isolated from the cerebrospinal fluid or blood of infants with meningitis and/or septicemia. Eighteen of the strains had K1 polysaccharide antigen. Fourteen of the strains (seven with K1 antigen) activated complement via the alternative pathway and all of these strains were well opsonized in 4% pooled human serum. A higher concentration of serum was necessary to opsonize 12 of the 14 strains that did not activate the alternative pathway. A wide variation was also found in opsonic requirements of E. coli strains isolated from healthy and sick infants. There was no relationship of the K1 antigen to opsonic requirements, to capacity to activate complement via the alternative pathway, to generation of chemotactic factors, or to sensitivity to serum cidal activity. Therefore, the association of E. coli with K1 antigen and neonatal meningitis did not appear to be related to these bacteria-serum interactions.

[Polymorphism of factor B of the properdin system (C3PA, GBG, and Bf) and histocompatibility-complement linkage]

Several recent studies have shown that the genetic polymorphism of factor B of the Properdin system (GBG or Bf) is closely linked to the major histocompatibility complex (MHC). The genetic polymorphism of Bf, a component of the alternate pathway of complement activation, is revealed by "immunofixation" technique after prolonged high voltage agarose electrophoresis. In this report, we describe technique for the Bf grouping and give the results in two families showing the linkage between HL-A and Bf loci. The study of a family with a recombinant between the second HL-A locus (SD-2) and the major MLC locus (LD-1) provides evidence that the Bf locus is not located outside the MLC's because the Bf allele remains linked to the SD-2 allele. In this family, a crossover occurs between Bf and LD-1, and since crossovers between Bf and SD-2 have already been discovered, it is now possible to locate the Bf locus between SD-2 and LD-1. The Bf phenotypes were determined in the serum of 247 normal unrelated caucasian individuals from the area of Strasbourg. The calculated allele frequencies in this population are: BfS=0.757, BfF=0.219, BfS1=0.014, BfF1=0.010. These allele frequencies are intermediary between those found by ALPER and RITTNER. The linkage between MHC and the complement system is now even more evident after the discovery that genes involved in the synthesis of the second and fourth complement components also belong to the MHC on the chromosome 6. These linkages were demonstrated by the study of several families with hereditary C2 deficiency in the U.S.A., and one family with C4 deficiency discovered in Strasbourg. C2 deficiency was found to be associated with three kinds of HL-A haplotypes (HL-A 10, W18; HL-A 2, W18 and HL-A2, 4A2) and the LD-7a specificity. In the family with C4 deficiency, the C4 deficient gene is associated with the HL-A haplotype 2, T3, W10 and a new hitherto unknown MLC type "Re". The linkage between C4 and MHC has been demonstrated recently also in the mouse (the Ss protein in the complement C4 fraction in the mouse) and in the guinea pig. The significance of the genetic linkage between some important components of the complement system and MHC is still unknown. It appears necessary to study all the genetic markers located within or in the vicinity of the MHC region on the chromosome 6 in investigations of the relationship between "pathologic states and HL-A antigens".

Herpes gestations with identical lesions in the newborn. Passive transfer of the disease?

Cutaneous lesions of herpes gestation is developed in a newborn on the fifth day of life and disappeared spontaneously after three weeks. The immunologic phenomena were analogous in the mother and child. No circulating or in vivo-bound immunoglobulins were demonstrated, but components 3 and 4 of complement were present at the basement membrane zone. We discuss a possible passive transfer of the disease to the newborn, and a supposedly pathogenetic role of immunologic phenomena in herpes gestationis.