A new human monoclonal cold agglutinin Sa recognizing terminal N-acetylneuraminyl groups on the cell surface

A human homogeneous IgM/K cold agglutinin (CA) Sa is described, whose corresponding antigen on erythrocytes (RBC) was abolished by neuraminidase. This indicated that the antigen was related to N-acetylneuraminic acid, similar to Pr and Gd antigens. In contrast, this antigen was only partially destroyed by proteases, whereas Pr antigens are completely destroyed and Gd antigens are not influenced by proteases. Sa antibody activity was inhibited by sialyllactose NeuAc (alpha 2 leads to 3) (alpha 2 leads to 6) Gal (beta, 1 leads to 4) Glc like anti-Gd but in contrast to anti-Pr. The corresponding antigen was associated with an RBC membrane glycoprotein fraction like Pr, Sa is one of a spectrum of human monoclonal CA against cell surface neuraminyl groups.

Lymphadenopathy associated with dysgammaglobulinemia

Conditions in which lymphadenopathy is associated with dysgammaglobulinemia may be divided into two groups: those in which etiologic factors and pathogenesis are well established, and those which are still a medical dilemma. Only a few belong to the former group: infections, immunizations, and drug-induced conditions being the best examples. Unfortunately, the great majority belong to the latter group. Interestingly enough, many conditions with lymphadenopathy and dysgammaglobulinemia share similar histologic features, such as infiltration with lymphocytes, immunoblasts, plasma cells, and histiocytes. This pleomorphic infiltration may appear together with prominent vascular proliferation. In animal experiments, angiogenesis was induced by administration of immunocompetent lymphocytes into the skin of unimmunized, irradiated mice. Therefore such lymphocyte-induced angiogenesis may be a manifestation of the graft-versus-host reaction. Recent developments in immunology, such as the discovery of many membranous markers and receptors on the lymphocyte membrane, the study of cytoplasmic structure and synthetic products, detection of enzymatic aberrations and chromosomal abnormalities, and refinement in histochemical techniques, have led to attempt to reclassify lymphoplasmacytic and leukemic disorders. Indeed, several classifications coming from different coutries and from various centers in the same country have been proposed, leading to a typical "Tower of Babel" phenomenon. It is obvious that more knowledge of etiologic factors and pathogenetic mechanisms is necessary to classify, cure, and eventually prevent the diseases described in this paper.

Plasma cell neoplasia with osteosclerotic lesions. A study of five cases and a review of the literature

Sixty-eight patients with plasmacytic neoplasia and osteosclerotic lesions were analyzed. Men predominated in this series. Mean age was 55.3 years and 26 patients were younger than 51 years at diagnosis. Early onset of disease was statistically different from multiple myeloma in general. Thirty patients had peripheral polyneuropathy and often neurological manifestations preceded other symptoms. Skeletal pain was less common, whereas hepatomegaly, splenomegaly, and lymphadenopathy were more common than in myeloma in general. Incidence of azotemia, hypercalcemia, high ESR, and anemia was lower than in myeloma. In one fourth of the patients, the number of skeletal lesions did not exceed three. Mean survival was less than 20 months from first symptom and 12 months from diagnosis. Mortality was related sometimes to polyneuropathy. Thus, in several aspects, plasmacytic neoplasia with osteosclerotic lesions is different from the classical multiple myeloma.

Cytotoxic activity of cerebrospinal fluids (CSF's) against lymphocytes and phagocytes: comparison of normal and systemic lupus erythematosus CSF's

Fifty cerebrospinal fluids (CSF), 24 normal, 26 from systemic lupus erythematosus (SLE) patients were tested for cytotoxic activity against human lymphocytes, granulocytes and monocytes. Normal and SLE CSF's frequently killed all 3 cell types. Lympho- and granulocytotoxins often reacted at both 4 degrees/24 degrees C, and at 37 degrees C. They were more active when no complement was added (p less than 0.01), whereas monocytotoxicity was complement-dependent (p less than 0.01). Normal CSF's more often contained cold-reacting lymphocytotoxins and SLE CSF's more often had warm-reacting monocytotoxins, but the differences were not significant (p = 0.03). Cytotoxins were easily absorbed to and eluted from lymphocytes and granulocytes, and when CSF's were toxic to both types of cells, the corresponding eluates usually retained this activity. Sometimes, only 1 type of cell was killed by the eluate, whereas cytotoxicity against another was retained by the corresponding supernatant. In SLE remarkable differences were noted between CSF cytotoxins and serum cytotoxins. The former were often more potent at 37 degrees C not requiring non-human complement. Preliminary characterization of CSF cytotoxins suggests they may be IgG, however, participation of non-Ig cytotoxic substances cannot be excluded.

Multiple myeloma (light chain disease) with rheumatoid-like amyloid arthropathy and mu-heavy chain fragment in the serum

A 52 year old man presented with multiple myeloma and widespread amyloidosis involving joints, bursae- carpal tunnels, lymph nodes and subcutaneous tissue. Osteolytic bone lesions and pathologic fracture of the neck of the left femur were found. Bone marrow was infiltrated with both plasmacytes and lymphocytes. The majority of plasma cells contained large cytoplasmic vacuoles. Free kappa II type light chains and mu-heavy chain fragment were detected in the serum, and kappa II type Bence Jones protein was found in the urine. The molecular weight of the mu-heavy chain fragment was found to be approximately 50,000 daltons. An immunofluorescence study, using the double labelling technic, showed that the majority of plasmacytes in bone marrow contained both mu and kappa antigenic determinants in the cytoplasm. A review of the 12 previously described patients with mu-heavy chain fragment in the serum showed a variable clinical picture, thus their natural history and therapeutic response are difficult to evaluate at the present time. It seems that mu-heavy chain fragment can be found in a variety of clinical conditions and that mu-heavy chain disease cannot yet be accepted as a separate clinical entity.

Release of lysosomal enzymes from human polymorphonuclear leukocytes by soluble intermediate immune complexes

The efficacy of soluble immune complexes (1C) of different sizes prepared in vitro or present in RA sera and synovial fluids to induce the release of beta-glucuronidase (BG) and neutral protease (NP) from PMN has been examined. Immune complexes of human HGG-rabbit anti-human HGG prepared in 5, 10 and 20 times excess of antigen equivalence were fractionated into three pools, PI (22S--13S), PII (13S--7S) and PIII (7S) using Sephadex G-200 column chromatography. NP and BG-releasing activity was mostly associated with PII. Similar fractions were obtained from RA sera and synovial fluids. BG-releasing activity was again predominantly associated with PII. PII fractions from normal sera and from 2 non-RA IC disease sera showed less BG-releasing activity than the RA PII fractions. Negligible NP release was observed with all three serum pools. Further investigation demonstrated the presence of NP inhibitor(s) in PI and PII from human sera.

Felty's syndrome. Clinical and serological analysis of 34 cases

Review of 34 cases of Felty's syndrome showed this to be a form of 'super' rheumatoid disease because of the severity of joint disease, the prominence of extra-articular features and the remarkable incidence of infection. The response to splenectomy in these 34 patients was shown by a return towards normal of peripheral blood abnormalities and a decrease in bone marrow granulopoiesis. Although some patients remained free of infection after splenectomy, others have continued to have infections despite the return of white blood cell counts to normal levels. Although splenectomy and subsequent increase in white blood cell levels may be beneficial, our experience suggests that other factors are important in the susceptibility to infection of Felty's syndrome patients. Moreover, we think that splenectomy may have been instrumental in the fatal infection of one of our patients.

Muramidase (lysozyme) in Crohn's disease and in ulcerative colitis

Estimation of lysozyme (LZM) activity in the serum was suggested as a valuable test to distinguish between Crohn's disease and ulcerative colitis. Subsequently several reports either supported or denied the original observation. Selection of patients and methodological differences were suggested as an explanation for the controversy. We estimated serum LZM in a large group of patients using the lysoplate method and human LZM as a standard. The conditions of the assay were strictly standardized. In 90 patients with Crohn's disease the LZM level was 8.3 +/- 2.1 (SD) microgram/ml, in 57 patients with ulcerative colitis was 7.4 +/- 2.0 (SD) microgram/ml, and in 40 healthy individuals it was 7.0 +/- 1.2 (SD) microgram/ml. Although the difference between the mean LZM levels in Crohn's disease and in ulcerative colitis was statistically significant, there was a definite overlapping of values between these two diseases. No significant correlation of LZM level to the duration or extent of the disease, activity, or treatment was found in Crohn's disease. In ulcerative colitis the LZM level was often a little higher in severe disease, especially when the whole colon was involved.

M components associated with lymphoma: a review of 62 cases

Sixty-two of 1242 patients with M components were found to have lymphoma. There were 33 patients with immunoglobulin M(IgM), 20 WITH IgG, 5 with IgA, and one patient with Bence Jones protein M components. Three patients had biclonal gammopathy. The types of lymphoma were: lymphocytic, 31; histiocytic, 12; mixed cell, 4; stem cell, 2; Burkitt's, 1; Hodgkin's disease, 9; and unclassified, 3. All patients were in stages III or IV of lymphoma, and the average duration of disease was 29.3 months when M components were detected. Anemia, abnormal peripheral blood lymphocytes, and lymphomatous involvement of the bone marrow were especially common among patients with IgM M components. Osteolytic lesions were found in 12 patients and osteosclerotic lesions in one. A second malignancy occurred in eight patients. The level of M component was below 1.0 gm/dl in 55 per cent of patients. Significant suppression of normal immunoglobulin levels in the serum was noted in 4 and 16 patients with IgG and IgM components, respectively. Bence Jones proteinuria was found in 19 per cent, cryoglobulinemia in 11 per cent, and cold agglutinins, all of anti-i specificity, in 10 per cent of the patients. Most of the M components decreased during therapy. Only two M components gradually increased. The mean survival of 39 patients who died was 10.4 months. The living patients have been followed for a mean period of 21.2 months. The presence of M components in lymphoma may suggest B cell origin of the tumor but the coexistence of plasma cell dyscrasia cannot be ruled out.

Polymyositis in a patient with multiple neoplasms

A 64 year old woman with a past history of panhysterectomy and oophorectomy for carcinoma of the body of the uterus (1950) and partial colectomy for carcinoma of the colon (1971), presented in 1972 with severe weakness of the proximal girdle muscles and histological evidence of polymyositis. A detailed search disclosed no tumor and she was treated with prednisone. Two years later, investigations for iron deficiency anemia revealed two polyps in the colon. Pathological examination of the resected colon disclosed two separate foci of adenocarcinoma and a number of adenomatous polyps. Three months later, further investigations for melena led to the discovery of a gastric carcinoma. Due to the extent of the tumor, she was subjected to gastrectomy. splenectomy, and excision of the tail of the pancreas, but died of postoperative complications. At autopsy, no residual cancer was detected, but a meningioma was found. The association of polymyositis with malignant tumors has been recognized for a long time, but only two previously reported patients have had more than one cancer. Although a causal relationship is difficult to establish, continued vigilance for neoplasms is advocated during the follow-up period.

Kappa and lambda light chain disease: survival rates and clinical manifestations

Ninety-seven patients with light chain disease (LCD) were studied. The median survival from diagnosis was 30 mo for 52 patients with kappa-LCD and 10 mo for 45 patients with lambda-LCD (p less than 0.0007). A lower proportion of kappa-LCD patients (15.7%) than lambda-LCD patients (42.2%) died within the first 6 mo after diagnosis. The survival of the remaining patients with kappa-LCD was still much longer than of those with lambda-LCD (p = 0.022). The shorter survival of lambda-LCD patients could not be ascribed to an increased incidence of recognized manifestations indicating a poor prognosis (e.g., anemia, hypercalcemia, azotemia, low albumin, the extent of osteolytic lesions, or proteinuria), the incidence of amyloidosis, the clinical stage of the disease at diagnosis, or the response to treatment, and remains unexplained. A comparison of the clinical manifestations of LCD with those of other myelomas revealed some differences. LCD patients were slightly younger than IgA and IgG patients but older than IgD patients. A 1:1 ratio of males to females was similar to the ratios in IgA and IgG myeloma, but differed from the 3:1 ratio reported for IgD myeloma. Plasma-cell leukemia developed in 7/97 LCD patients, an incidence that was higher than has been reported in other myelomas. The initial BUN was more than or equal to 30 mg/100 ml in 54 of 95 LCD patients, an incidence that was higher than has been reported for IgA and IgG myeloma, but lower than the incidence in IgD myeloma. The incidence of amyloidosis in LCD (23 of 97 patients) was similar to that reported for IgA and IgG myeloma, but less than the incidence in IgD myeloma.