Effect of continued feeding of cows' milk on asymptomatic infants with milk protein sensitive enteropathy

The clinical response and the histological changes in the mucosa of the small bowel in response to continued feeding with cows' milk protein were assessed over a period of 2-6 weeks in 24 infants who had shown histological changes without immediate clinical symptoms after challenge with a diet containing cows' milk protein. Twenty of the 24 infants (83%) thrived well on cows' milk protein. Jejunal biopsy specimens taken six to eight weeks after the initial biopsy showed histological improvement in all 20 infants compared with biopsy specimens taken soon after the challenge, which had shown mucosal damage. The mucosa had returned to normal in 12, was mildly abnormal in seven, and moderately abnormal in one. Corresponding improvements in the activities of mucosal enzymes were seen. In four of the 24 infants (17%) symptoms developed between three and six weeks. Histological examination of the jejunal biopsy specimens showed that mucosal damage had progressed in two, and remained the same in two; moreover, the disaccharidase activities remained depressed. The present study shows that most infants with enteropathy caused by sensitivity to cows' milk protein but without clinical symptoms develop tolerance to the protein and the mucosa returns to normal despite continued feeding with cows' milk protein.

Effect of soy protein on the small bowel mucosa of young infants recovering from acute gastroenteritis

The effect of soy protein on the small bowel mucosa of 18 infants with acute gastroenteritis was studied. The infants were maintained on a protein hydrolysate formula for 6-8 weeks, following which they were readmitted for soy protein challenge studies. Jejunal biopsy was performed before and 24 h after challenge. On the basis of the clinical and histological reaction to soy protein challenge, three groups were identified. Group 1 consisted of three infants who had clinical and histological reaction. There was associated depletion of mucosal enzymes, lactase, sucrase, malatase, alkaline phosphatase, and blood xylose levels. Group 2 consisted of seven infants who had histological reaction but no clinical symptoms. Two of these seven infants, however, developed clinical reaction when rechallenged with soy protein 2 and 90 days later. Following challenge, mucosal enzymes and blood xylose levels were depressed in five of the seven infants tested. Group 3 consisted of eight infants who did not have either a clinical or a histological reaction. The mucosal enzymes and blood xylose levels were not depressed in four infants tested. The present study shows that the small bowel mucosa of some young infants recovering from acute gastroenteritis remains sensitive to soy protein for a variable period of time. The feeding of soy protein to these infants may result in the persistence of mucosal damage and perpetuation of diarrhea.(ABSTRACT TRUNCATED AT 250 WORDS)

Isolation and partial characterization of the extracellular polysaccharides and lipopolysaccharides from fast-growing Rhizobium japonicum USDA 205 and its Nod- mutant, HC205, which lacks the symbiotic plasmid

The extracellular polysaccharides and lipopolysaccharides (LPSs) from two fast-growing Rhizobium japonicum strains, USDA 205 and HC205, were isolated and partially characterized. Strain HC205 is a Nod- mutant of USDA 205 which lacks the symbiotic plasmid. The extracellular polysaccharides from both strains are very similar in composition, having galactose, glucose, glucuronic acid, and acyl groups. The extracellular polysaccharides do not contain detectable levels of pyruvate. Methylation analysis shows that the extracellular polysaccharides from both strains have the same glycosyl linkages. The LPSs were purified by a modified phenol-water extraction procedure and gel filtration chromatography. The LPSs from USDA 205 and HC205 elute as broad peaks from the gel filtration column and contain 2-keto-3-deoxyoctonic acid as one of the major sugar components. Each broad 2-keto-3-deoxyoctonic acid-containing peak has a distinct shoulder on its leading edge. The shoulder and the remainder of the broad peak are separated and labeled LPSI and LPSII, respectively. Glucose (and 2-keto-3-deoxyoctonic acid) is a major sugar in the LPSI fractions. Both the LPSII fractions contain 2-keto-3-deoxyoctonic acid as the major sugar (about 20% of the mass). There are a number of quantitative differences in these LPS fractions between strain USDA 205 and HC205. Polyacrylamide gel electrophoresis shows that the LPSs are heterogeneous molecules but less heterogeneous than the LPSs from Salmonella minnesota or Rhizobium leguminosarum. The LPSI fractions from both USDA 205 and HC205 show a single lower-molecular-weight band and a higher-molecular-weight banding region which contains several bands. No bands are observed for the LPSII fractions from either USDA 205 or HC205.

Nasopharyngeal carcinoma in Malaysians under the age of 20 years

A total of 52 cases of NPC were found in a five-year survey from 1978 to 1982 in Malaysia. The annual rate of occurrence was 3.4, 3.0, 2.4 and 1.8 for Chinese, Malays, Kadazans and Sarawakians, respectively. The age-specific incidence rates per 100 000 were highest for Kadazans (2.34 to 7.59) in comparison to the other races (0.11 to 1.24). The proportion of NPC in young Malaysians formed 1.2% in Chinese, 7.2% in Malays and 6.9% for others. A sexual bias was present in Chinese (male:female = 2.2) and Sarawakians (1.7) but not in Kadazans and Malays (0.9). In most Chinese, the primary tumour histologically is of the poorly differentiated characteristic and this type is the predominant tumour in the country. The Kadazans presented with well differentiated primary tumour and the Malays with all three histological types i.e. well-, poorly- and undifferentiated. At first examination enlarged lymph nodes were found in 95.7% of the patients and 65.2% had epistaxis and growth in the postnasal space. Antibodies to IgA anti-VCA were present in half of the 6 patients serologically studied.

Malaria antibody levels in patients with nasopharyngeal carcinoma

The antibody titres to P. falciparum and Epstein-Barr Virus-associated antigens were assayed in 22 patients with NPC and 43 controls. All, but one patient had antimalarial titres; 14 had titres greater than 80 and 4 patients greater than 640. Compared to controls the mean anti-malarial titre for most age groups were higher in the patients. Those patients with high anti-malarial titres also had high IgA anti-VCA titre, an antibody which has been demonstrated to be diagnostic for NPC. The peak anti-VCA (IgG) and anti-EA (IgG) antibody titres were associated with anti-falciparum titres of 320-640 and 80-160, respectively. The results are discussed in relation to the possible association between malarial infection and etiology of NPC.

Adoptive transfer of immunity to Plasmodium berghei with spleen cells from drug cured mice

Plasmodium berghei infection gives rise to a fatal fulminating parasitaemia in mice. Resistance to the infection can be achieved if the mice are allowed to recover from the blood-induced infection by administration of chloroquine. In CBA/Caj, one cycle and in Balb/c mice, at least, two cycles of infection, alternating with drug-cure were necessary for the establishment of immunity. No parasitaemia was seen following further challenges after the third infection. Adoptive transfer of spleen cells from the immune mice showed that immunity could be transferred by 50 to 70 x 10(6) cells. On challenge the recipients develop high parasitaemia which was cleared in less than 5 weeks. Recipient mice given low number of spleen cells did not survive. The transfer of immune spleen cells depleted of either T or B lymphocytes abrogated the protective effect. Comparatively T lymphocytes were less effective in transferring protection than B lymphocytes. The study suggests that both humoral and cell-mediated effector mechanisms are needed for the maintenance of immunity in drug-cured immune mice.

Egg-protein-induced villous atrophy

The effect of egg protein on the small bowel mucosa of a 9-month-old infant with a history of intolerance to egg protein was studied. Within 24 h of ingestion of egg protein marked villous atrophy, depletion of mucosal oligosaccharidases, impaired absorption of xylose, and depressed serum complement levels were observed. The study demonstrates that egg protein is yet another cause of flat mucosa of the small intestine in infants.

Elevated IgG and decreased complement component C3 and factor B in B-thalassaemia major

Serum immunoglobulins, complements C3 and C4 and factor B were assayed in the sera of children with B-thalassaemia major, siblings and matched controls in an attempt to resolve the controversy surrounding the conflicting results reported in the literature. Significantly elevated IgG and decreased C3 and factor B levels were observed in thalassaemic patients who also had a high incidence of HBS hepatitis and other infections. The controversial results probably reflect differences in the incidence of infection, and the presence of circulating immune complexes due to blood transfusions, in the various communities. The alterations in immunoglobulin and complement levels represent a secondary rather than a primary immune disorder.

In vitro diagnosis of cow's milk protein sensitive enteropathy by organ culture method

The criteria that are used at present to diagnose cow's milk protein sensitive enteropathy (CMPSE) are based on an in vivo milk challenge which can be hazardous and life threatening. We have used an organ culture model to determine the usefulness of this technique in establishing the diagnosis of CMPSE on the basis of a single biopsy with in vitro milk challenge. Fourteen infants with diarrhoea clinically suspected to have CMPSE were studied prospectively. On the basis of milk challenge studies seven infants had CMPSE. They had clinical reaction to cow's milk with associated histological changes and depression of alkaline phosphatase levels in the jejunal mucosa. In all seven cases parallel changes in alkaline phosphatase levels were noted in the organ culture specimens of initial biopsy subjected to in vitro challenge. The seven control infants tolerated cow's milk and did not have histological changes. The alkaline phosphatase levels were moderately increased in the jejunal mucosa in five of the seven infants. The alkaline phosphatase levels in the organ culture specimens of initial biopsy were increased after in vitro challenge in all seven infants. This study suggests that organ culture methods may be useful in the vitro diagnosis of CMPSE, and also obviate the need for in vivo oral milk challenges and repeated biopsies.

Immunological studies in cows' milk protein-sensitive enteropathy

55 infants, aged between 1 and 13 months, who presented with persistent diarrhoea were placed on a diet free of cows' milk protein. The clinical condition of the infants improved and 6-8 weeks later each was challenged with low-lactose cows' milk. The following investigations were performed before and 24 hours after provocation: jejunal biopsy, serum and duodenal juice levels of complement C3 and C4, C3-activator, and immunoglobulins A, G, M, and D. Three groups were recognised on postchallenge clinical symptoms together with histological changes in the jejunal mucosa: group 1 (n=10 infants) with no clinical or mucosal abnormality, group 2 (n=18 infants) with mucosal abnormalities but lacking clinical symptoms, and group 3 (n=27 infants) with mucosal abnormalities and clinical symptoms; but in group 3 symptoms were delayed for over 24 hours in 7 infants, and in the remaining 20 infants symptoms appeared within 24 hours. After provocation the serum IgG levels were decreased in 3 infants in group 1, 12 in group 2, and 17 in group 3. The mean serum IgA and IgM levels were higher in group 1 compared with group 2 or 3; pre- and postchallenge mean serum immunoglobulin levels, complement, and complement activator levels were of equal magnitude in all three groups. A depletion of serum complement C3 level was observed in 4 (group 1), 4 (group 2), and 13 (group 3) infants 24 hours after provocation with cows' milk; the fall in serum IgG was often associated with depletion of complement in serum. This suggests the involvement in some infants of IgG-mediated complement-consuming immune reactions in the development of the damage in the intestinal mucosa. After challenge, exudation of IgG and IgA occurred irrespective of the presence or absence of mucosal damage and was not always associated with the decrease in serum IgG concentration. Because of the variable conditions present in the intestinal lumen it is suggested that the level of immunoglobulins in duodenal juice is not a reliable measure of the local immune response. Levels of complement and immunoglobulin in serum or duodenal juice fail to provide help in the diagnosis of cows' milk protein-sensitive enteropathy.

The pineal gland of equatorial mammals. I. The pinealocytes of the Malaysian Rat (Rattus sabanus)

The ultrastructure of the pinealocytes of the Malaysian rat (Rattus sabanus), a mammal inhabiting a zone near the equator where the annual variations of daylength are inconspicuous, was examined and compared with that of pinealocytes of other mammals. On the basis of the presence of granular vesicles, only one population of pinealocytes was found. A large number of granular vesicles and vesicle-crowned rodlets is characteristic of the pinealocytes of this equatorial species. Vesicle-crowned rodlets are especially numerous in the endings of the pinealocyte processes and; they most often found in direct topographical connection with the perivascular spaces. The physiological significance of the presence of such large amounts of vesicle-crowned rodlets and of the secretory process characterized by the formation of granular vesicles is discussed.

Acquired carbohydrate intolerance and cow milk protein-sensitive enteropathy in young infants

Sixty infants with acquired carbohydrate intolerance, 19 with protracted diarrhea, and 41 with features indistinguishable from acute infectious enteritis, were maintained on a lactose-free and cow milk protein-free formula for about eight weeks, after which jejunal biopsies were performed before and after oral provocation with cow milk protein. Following provocation, 43 infants showed mucocal abnormalities associated with marked reduction in the levels of all three disaccharidases. In one infant, mucosal change was unaccompanied by enzyme depletion. Six infants had enzyme depletion without visible mucosal changes. In ten infants the intestinal mucosa remained normal and there was no consistent pattern of change in the enzyme levels. The findings suggest that cow milk protein has a deleterious effect on the small bowel mucosa of young infants recovering from enteritis and may be an important contributing cause of acquired carbohydrate intolerance in these infants. In the management of young infants with acquired carbohydrate intolerance both the offending sugar and protein should be excluded.

Cows' milk protein-sensitive enteropathy: an important contributing cause of secondary sugar intolerance in young infants with acute infective enteritis

The effect of cows' milk protein (CMP) on the mucosal disaccharidases was investigated in 23 infants with acute infective enteritis. Jejunal biopsies performed before and after cows' milk provocation were subjected to histological examination and to mucosal disaccharidase enzyme (lactase, sucrase, and maltase) analyses. After milk challenge, changes in mucosal histology were observed in 18 infants, in 17 of them the levels of all 3 mucosal disaccharidases were much reduced. 10 of these infants developed diarrhoea and, in 6, the stools were positive for reducing sugar. It is concluded that CMP has a deleterious effect on the jejunal mucosa of young infants recovering from infective enteritis, so that in the management of young infants with sugar intolerance secondary to infective enteritis, CMP and lactose should be excluded from the diet.

Serum immunoglobulin levels in the Malaysian Orang Asli

Serum immunoglobulin G, A, M, D and E levels were determined in the forest-dwelling Orang Asli of age group 8 to 64 years. The levels are higher than observed for urban Malaysians and comparable to levels reported for populations residing in the tropics. There was no significant difference in serum levels of all the immunoglobulins studied in both sexes. The elevated serum immunoglobulins levels are discussed in terms of the nature of the immune defence developed in the Orang Asli to contend with the many parasites prevalent in their environment.

Cows' milk protein-sensitive enteropathy. An important factor in prolonging diarrhoea of acute infective enteritis in early infancy

The possible role of cows' milk protein in prolonging diarrhoea in very young infants with acute infective enteritis was studied in 14 infants, 9 under the age of 2 months and 5 older than 6 months. Bacterial pathogens were isolated from the stools of 4 infants from the younger age group. After appropriate initial treatment the infants were maintained on a cows' milk protein-free formula. 6 weeks later jejunal biopsies were performed before and 24 hours after challenge with a low lactose cows' milk protein formula. The immunoglobulin and complement levels in the serum and duodenal juice were also estimated at these times. Attempts to isolate bacterial and viral pathogens in stools were again made in all patients. The 5 older infants clinically tolerated cows' milk protein and their pre- and postchallenge jejunal biopsies were within normal limits. However, significant histological changes were observed in the postchallenge jejunal biopsies of all 9 infants under 2 months of age. In addition, 5 of these infants developed diarrhoea. This suggests that the jejunal mucosa of very young infants previously fed a cows' milk protein-based formula and who contract infective enteritis suffers damage when rechallenged with cows' milk protein.

Cows' milk protein-sensitive enteropathy. Combined clinical and histological criteria for diagnosis

Cows' milk protein enteropathy is recognised as a significant cause of persistent diarrhoea and malabsorption in young infants, but there are as yet no generally accepted diagnostic criteria. A combined clinical and histological approach to the diagnosis of cows' milk protein-sensitive enteropathy has been used in 15 patients, and the following set of criteria are proposed. (1) Clinical disease (diarrhoea with or without vomiting) while receiving cows' milk protein. (2) Clinical improvement on a diet free of cows' milk protein. (3) Normal or mildly abnormal histology of jejunal mucosa when taken 6-8 weeks after symptoms subside. (4) Histological relapse, with or without clinical relapse, after re-exposure to cows' milk protein.