Development of a monoclonal antibody specifically reactive to gastrointestinal goblet cells

A mouse monoclonal antibody (7E6A5) of IgG isotype, reacting specifically with mucin-producing goblet cells of the human gastrointestinal tract, has been developed. 7E6A5 reacts by an ELISA with colonic protein eluted from a DEAE column. A screening by immunoperoxidase assay of 76 specimens from 19 different human tissues showed that the immunoreactivity of 7E6A5 was confined exclusively in the globules of goblet cells in the colon, the appendix, and the small intestine. Nongoblet small and large intestinal epithelial cells did not react. Immunoelectron microscopy demonstrated the reactivity with mucin droplets in a homogeneous granular pattern inside the globules of goblet cells. Mucus-secreting cells from remaining parts of the gastrointestinal tract and other mucus-secreting organs such as respiratory, genitourinary tracts, salivary and mammary glands did not show any reactivity to 7E6A5. These findings indicate that the antigen recognized by 7E6A5 is shared by the goblet cells of both the small and large intestines and is unique to them. The monoclonal antibody may be useful in the study of function of mucus-secreting goblet cells and may represent an important tool in the evaluation of diseases such as ulcerative colitis, colon cancer, and intestinal metaplasia in gastric mucosa that are associated with quantitative changes in goblet cell numbers or with qualitative differences in mucin secretion.

Nutritional status, function of the small intestine and jejunal morphology after total gastrectomy for carcinoma of the stomach

We studied the nutritional status and the prevalence of malabsorption in 12 patients one to three years after total gastrectomy (TG) for gastric neoplasm. The Roux-en Y technique was used for reconstruction. A correct dietary regimen according to the recommended daily allowance was suggested and patients were seen quarterly on an out patient basis. The nutritional status was evaluated by measuring serum albumin levels, total iron binding capacity, cholinesterase, area muscular circumference, triceps skinfold and delayed hypersensitivity response. Work-up studies for the small intestine included: stool fat, D-xylose and glucose tolerance tests, Schilling test (phase II and III), serum iron levels, serum vitamin B12 levels and biopsy of the jejunum. Malnutrition, defined as the occurrence of two or more abnormal nutritional parameters, was observed in one patient; glucose and D-xylose tolerance tests were normal in all. A mild degree of steatorrhea was observed in four patients. The second phase of the Schilling test was abnormal in eight patients, but urinary excretion of vitamin B12 increased in three of four patients after use of antibiotics. Low serum vitamin B12 levels were common after the twentieth postoperative month. Serum iron levels were initially low and returned to normal six months after TG. All patients had normal jejunal histologic findings. These data indicate that malnutrition after TG is not common if an adequate dietary intake is maintained. Malabsorption, possibly due to bacterial overgrowth, is not a major clinical problem.

A freeze-fracture study of the enteropathy associated with dermatitis herpetiformis: a comparative investigation with coeliac disease

Jejunal biopsies from patients with either dermatitis herpetiformis or coeliac disease were freeze-fractured and compared with normal jejunal biopsies. The intestinal mucosa of the normal biopsies showed a normal structure, with well-developed and tightly packed microvilli; in dermatitis herpetiformis and coeliac disease degenerative changes of the intestinal mucosa occurred. These changes appeared to be segmental in dermatitis herpetiformis and diffuse in coeliac disease. Emphasis is placed on changes in the tight junctional net at the base of the microvilli, which could represent cellular damage related to increased intestinal permeability to macromolecules in these diseases. An interpretative hypothesis for these observations is presented.

Biliary cystadenoma: an uncommon cause of recurrent cholestatic jaundice

The clinical history of a patient with intermittent jaundice is presented. The diagnostic work up, including ultrasound, laparoscopy, and endoscopic retrograde cholangiography, revealed a multiloculated cystic mass in the left lobe of the liver. At laparotomy, a multicystic lesion invading the left hepatic duct and protruding into the common bile duct was found. Histological examination revealed a biliary cystadenoma. Complete excision is the treatment of choice of such lesions.

In situ identification of immune competent cells in gastrointestinal mucosa: an evaluation by immunoelectronmicroscopy

The in situ identification of lymphocyte subpopulations by means of immunopathological techniques using specific monoclonal antibodies provides a tool for the study of the gastrointestinal-associated lymphoid tissue (GALT) in health and disease. In this field, monoclonal antibodies have been applied previously using light microscopy and either immunofluorescence or immunoperoxidase; however, these techniques are not sensitive enough to allow precise evaluation of localization of labelling. We describe an immunoelectronmicroscopic method, which defines labelling specificity, since it allows the identification of cells by immunophenotype labelling and ultrastructural markers simultaneously. This in turn allows a better evaluation of the labelled cells and of the relationship between labelled and unlabelled cells. The main features of the method are the use of fresh tissue samples, fixing in paraformaldehyde CaCl2, and the coupling of the immune reaction to an amplification system (avidin-biotin-peroxidase complex). The technique yields a good preservation of cellular ultrastructure, together with a strong and specific immunolabelling. Our results confirm the high specificity of monoclonal antibodies when applied to immunopathology techniques. We confirm the pattern of distribution of various lymphocyte subsets in the jejunal mucosa described by other authors by light microscopy.

Case-control study of hepatitis B virus infection in chronic liver disease and hepatocellular carcinoma

The prevalence of serum hepatitis B virus markers was studied in three groups of age- and sex-matched patients: a. 31 patients with liver cirrhosis and hepatocellular carcinoma (c-HCC); b. 31 patients with chronic liver disease (CLD) and c. 62 hospitalized control subjects. The overall exposure rate to the hepatitis B virus was 90% in c-HCC, 80% in CLD and 58% in control subjects. The prevalence of hepatitis B surface antigen (HBsAg) was 29%, 13% and 1.6% in the three groups, respectively. The prevalence of hepatitis B surface antibody was significantly lower in c-HCC (9.6%) than CLD (42%) and control subjects (40%). The serological evidence of continuous viral replication (HBsAg positivity or isolated high titre hepatitis B core antibody positivity) was more common in c-HCC (39%) than CLD (12%) and control subjects (1.6%). The prevalence and patterns of aggregation of serum hepatitis B virus markers were similar in the 31 patients with c-HCC and in 11 patients with HCC without concomitant liver cirrhosis (n-HCC). In conclusion, the overall exposure rate to the hepatitis B virus is similar in c-HCC and CLD. However, serological evidence of continuous viral replication is more common in the former group. A defective clearance of the hepatitis B virus in hepatocellular carcinoma is a possible explanation of the phenomenon. The strength of the association between hepatitis B virus infection and hepatocellular carcinoma appears to be similar in c-HCC and n-HCC.

Antibodies to gliadin in adult coeliac disease and dermatitis herpetiformis

Antibodies to gliadin, searched for by indirect immunofluorescence and a micro-ELISA, were detected in 16 (64%) of 25 sera from patients with adult coeliac disease and in 13 (45%) of 29 with dermatitis herpetiformis. Although the sensitivity of the two tests was relatively low in the whole groups, it increased when only cases with severe jejunum abnormalities were considered (93% for coeliac disease and 81% for dermatitis herpetiformis). A significant correlation was found between antigliadin antibodies and the severity of jejunum damage in both diseases. Moreover, most coeliac and dermatitis herpetiformis patients with antigliadin antibodies were on normal diet. The specificity of the tests was 100% for the immunofluorescence and fairly good for the micro-ELISA, as only 5 (11%) of the 46 disease control patients (Crohn's disease, ulcerative colitis) were positive for antigliadin antibodies. R1-reticulin antibody test was equally specific but less sensitive in both groups. We conclude that antigliadin antibodies are useful in the diagnosis of patients with active adult coeliac disease and dermatitis herpetiformis with gluten-sensitive enteropathy. Moreover, the two tests make it possible to monitor the compliance to gluten-free diet in both diseases.

Small-bowel involvement in dermatitis herpetiformis and in linear-IgA bullous dermatosis

In 23 patients with dermatitis herpetiformis (DH) and five patients with linear-IgA bullous dermatosis (BD), we evaluated the occurrence of histologic jejunal changes and small-bowel function abnormalities. None of the patients showed clinical signs or symptoms of malabsorption. Morphological jejunal changes consistent with gluten-sensitive enteropathy were found in 82% of DH patients and in 60% of BD patients. However, BD patients showed only mild jejunal histologic abnormalities, whereas more severe jejunal lesions were found in most patients with DH. Functional tests showed a rough correlation with the severity of the jejunal lesions, being almost completely normal in BD patients and DH patients with mild intestinal damage, whereas most of DH patients with subtotal or total villous atrophy showed abnormal d-xylose tests and folic acid assays. Lactose tolerance tests (H2 breath test and blood glucose after oral lactose load) showed no correlation with the degree of jejunal damage.

Diagnostic value of serum cholylglycine radioimmunoassay in chronic asymptomatic HBsAg carriers

The correlation between histological liver abnormalities and fasting serum cholylglycine levels was investigated in 75 chronic asymptomatic HBsAg carriers with normal conventional liver tests, to clarify whether serum CG radioimmunoassay could help in distinguishing the carriers with histological liver damage from those with normal histological findings. Mean (+/- SEM) fasting serum CG levels were 11.6 +/- 1.5 micrograms/dl in 56 carriers with normal liver histology, 14.6 +/- 4.2 micrograms/dl in 16 subjects with CPH and 95.6 +/- 54 micrograms/dl in three carriers with CAH. The incidence of abnormal values (greater than 40 micrograms/dl) among carriers with CAH (66%) was significantly higher than in the other two groups (1.8 and 12.5%, respectively). It is concluded that, among chronic asymptomatic HBsAg carriers with normal conventional liver tests, those who show abnormal serum CG levels are likely to have severe histological damage. This justifies the inclusion of CG radioimmunoassay in the routine follow-up of these subjects. The occurrence of false-positive and false-negative results must be considered if the test is used as an aid in the selection of patients for liver biopsy.

Sex-determinants and their distribution in various populations of Musca domestica L. of Western Europe

The distribution of sex-determinants in field populations ofMusca domestica domesticaL. was studied in 62 samples of flies collected at 53 sites (animal farms) between 1975 and 1981 in an area stretching North–South from Denmark (+ Iceland) to Sicily.

Karyological observations and genetic analyses demonstrated the existence of three types of population along a latitudinal cline. Populations of Northern Europe were of the standard type (XXfemales andXYmales) with theYchromosome determining sex. Those of Central and Southern Italy from sites below 100 m.a.s.l. (metres above sea level) were autosomal (XXfemales and males), sex in them being determined by autosomal sex-determinants for both femaleness and maleness. In the large intermediate zone the populations were mixed and had several karyotypes in both sexes. In this zone an altitudinal gradient was also observed, with autosomal determinants less common at higher altitudes. Genetic tests showed, in the autosomal and in the mixed populations, the presence of two autosomal male factors:MIII, the most common, on autosome III andMII, on autosome II.

The gradient in sex determinants found in flies of Western Europe appears to be a dynamic phenomenon of relatively recent origin. Both climatic influence and selective pressure with insecticides have probably contributed towards the micro-evolution of populations with different sex-determinants in the houseflies of the area studied.

Persistence of circulating HBsAg/IgM complexes in acute viral hepatitis, type B: an early marker of chronic evolution

Serial serum samples from 110 patients with acute viral hepatitis type B were tested for HBsAg/IgM complexes by a newly developed solid-phase radioimmunoassay. In 102 patients the infection resolved and they recovered from the disease. In these patients, HBsAg/IgM complexes were either absent from the outset of disappeared from serum within four weeks of admission, long before HBsAg had cleared or serum alanine aminotransferase had returned to normal, 8 patients progressed to chronic HBsAg carrier state and chronic liver disease. In these patients, HBsAg/IgM complexes were detectable in the serum on admission, and never disappeared. These results indicate that persistence of circulating complexes containing HBsAg and IgM after the early phase of acute viral hepatitis type B is a predictor of disease chronicity. As early as the fifth week of illness those in whom chronic liver disease developed could be distinguished from those who recovered.

[Prevalence of HBsAg and anti-HBs in hospital personnel]

The prevalence of serum HBsAg and Anti-HBs was studied in 201 staff members from two Renal Dialysis Units, one Medical and one Dermatological Division from two Hospitals in the Milano area. The overall prevalence of HBsAg was significantly greater among staff members (8.9%) as compared to controls (4.9%). On the contrary, the prevalence of Anti-HBs was only slightly higher in hospital personnel than in controls. Non-medical staff members (nurses, technicians) showed a prevalence of HBV markers (HBsAg and/or Anti-HBs) twice as high as medical staff members (46.1% vs 23.2%). When the prevalence of HBV markers was correlated to the duration of work in the hospital, a steady increase in the prevalence of Anti-HBs was observed. On the contrary, the prevalence of HBsAg rose in the first 3 years and remained constant thereafter. The prevalence of HBV markers was significantly higher among staff members from Renal Dialysis Units (HBsAg+ and/or Anti-HBs+:50%) than in the personnel from the Medical and Dermatological Divisions (32.4%). However, the difference was solely related to a higher prevalence of Anti-HBs in the former (42% vs 23%). This may reflect a higher risk of infection in Dialysis Units as compared to other Hospital Divisions. However, the difference might be magnified by the frequent use of HBIG in the Dialysis Units personnel.

Intrafamilial spread of hepatitis B virus infection. (Role of chronic hepatitis and of the hepatitis B e antigen)

Two hundred and forty household contacts of 85 chronic HBsAg carriers were studied to assess the relationship between liver histology and 'e' antigen or antibody positivity in the index carrier, and evidence of HBV infection within the family. Liver biopsy results were available in 54 index carriers. The prevalence of HBsAg and anti-HBs in the families of 29 carriers with chronic hepatitis and 25 carriers with either a normal liver or minimal inflammatory changes was not significantly different. Serum from 72 index carriers was available for HBeAg and anti-HBe testing. The prevalence of HBsAg and anti-HBs in the families of 5 HBeAg positive carriers, 59 anti-HBs positive subjects, and 8 carriers negative for both HBeAg and anti-HBe was again not significantly different. Infectivity of a carrier thus does not appear to correlate either with histological evidence of liver damage or with the 'e' antigen or antibody positivity of the carrier.

Chronic asymptomatic HBSAg carriers: histologic abnormalities and diagnostic and prognostic value of serologic markers of the HBV

Liver histology, the serum "e" antigen system, and DNA-polymerase activity were studied in 68 chronic asymptomatic HBSAg carriers with normal liver chemistries in order to assess the frequency of chronic hepatitis and the diagnostic and prognostic usefulness of serum HBV markers in these subjects. Liver histology was normal in 3 cases, showed nonspecific changes in 46, chronic-persistent hepatitis in 16, and moderate chronic active hepatitis in 3. The "e" antigen and DNA-polymerase activity were positive in 2 and 5 cases, respectively, and were associated with either minimal inflammatory changes or chronic-persistent hepatitis. The "e" antibody was found in 28, evenly distributed among the varios histologic categories; 2 out of 3 patients with chronic active hepatitis carried the "e" antibody. Sixty-four patients have been followed prospectively for 12-30 mo with serial liver tests. During follow-up, 1 patient, with minimal inflammatory changes on liver biopsy and negative for "e" antigen, antibody or DNA-polymerase activity, developed consistently abnormal transaminases, and showed progression to chronic active hepatitis on repeat biopsy. In another patient with chronic-persistent hepatitis, "e" antigen and DNA-polymerase activity reverted to entirely normal serologic status. In our large series, the frequency of chronic hepatitis among HBSAg carriers with normal liver chemistries was somewhat higher than previously reported. In these subjects, the "e" antigen status did not correlate closely with liver histology and did not seem to provide reliable short-term prognostic information.