[Deficiencies in humoral immunity]

B cell immune deficiencies are characterized by inadequate production of antibodies and/or low levels of one or more classes of immune globulins (IgG, IgA, IgM) or IgG sub-classes. They include: 1) severe deficiencies involving all the immune globulins (Bruton agammaglobulinemia, variable hypogammaglobulinemia); 2) selective deficiencies in immune globulins (IgA deficiency, IgM deficiency, deficiencies in IgG sub-classes, dysgammaglobulinemias); 3) transient infantile hypogammaglobulinemia; 4) B cell immune deficiencies with normal gammaglobulin levels. Symptoms of B cell immune deficiencies are variable but respiratory manifestations are usually more prominent than the other features that include digestive disorders, fungal infections, autoimmune conditions, joint manifestations, and severe bacterial or viral infections (pneumococcus, meningococcus, enterovirus). Management of IgM and IgA deficiencies rests on antimicrobial agents and non-specific measures. The prognosis of the other B cell immune deficiencies has improved dramatically since effective replacement immune globulin therapy has become available; this treatment combined with antimicrobial therapy and chest physiotherapy can usually prevent development of bronchiectases. The main risk is chronic enteroviral neuromeningeal infection.

Immunobiology in otolaryngology

Immunologic aspects of otolaryngologic diseases are appearing in our literature, and clinical applications of these concepts are becoming available. The significance of these advances is obscured by the confusing terminology usually employed; however, the terminology can be mastered without much difficulty. The humoral and cellular divisions of the immune system have long been recognized. The humoral division of the immune system appears to play a major role in the prevention of infection, autoimmune disease, and atopic disease. The cellular division is probably most important in the prevention of neoplastic disease. There is overlap and the systems do interact. Future manipulations of the immune system may assist in the diagnosis and treatment of diseases such as chronic secretory otitis media, allergic rhinitis, and cancer of the head and neck.

Complement activation by interaction of polyanions and polycations

Interactions between heparin and protamine in normal human serum previously were found to activate the primary complement pathway and deplete the early-acting complement components. In the present investigation, the role of heparin-protamine complexes, immunoglobulins, C1q and C1-INH in this interaction was studied. Heparin and protamine, like antibody and antigen, were found to combine in multiple proportions; those proportions which resulted in optimal precipitation also induced maximal C consumption. Complexes formed in serum contained C1q and IgG, but the amount of C1q was insufficient to account for the total depletion of C1 haemolytic activity, and immunoglobulins were not required for activation of complement to occur: maximal consumption was observed in immunoabsorbed hypogammaglobulinaemic sera in which IgG, IgM and IgA were undetectable (less than 5, less than 10 and less than 7 mug/ml, respectively). Purified C1q aggregated heparin-protamine complexes formed or forming in the presence or absence of serum. The ability to induce maximal C consumption was rapidly lost as heparin and protamine interacted, and complexes preformed either in serum or buffer, or supernates thereof, were relatively ineffective in complement consumption. Thus, the consumption of complement seems to occur via transient reactivity with C1,probably at the level of C1q. It seems to be limited by the ability of free heparin to potentiate the activity of C1-INH, and perhaps also by its direct effect upon the early acting C components. These experiments support the concept that complement activation by interactions between polyelectrolytes such as heparin and protamine, like interactions between the antibodies and antigens, may have a role in the initiation of inflammatory reactions by direct activation of the complement system.