Thymoma, myasthenia gravis, erythroblastopenic anemia and systemic lupus erythematosus in one patient

A 50-year-old woman who initially had myasthenia gravis subsequently presented with thymoma, erythroblastopenic anemia and systemic lupus erythematosus during 17 years of follow-up. In a review of the literature no similar documented cases were found, although 14 patients were reported with three of the above diseases, two also having positive LE cell tests. An association of several autoimmune disorders in one patient may be more frequent than was previously believed.

Immunological and physicochemical studies of IgA1 (delta) cryogelglobulinaemia

Cryogelglobulinaemia in a patient with multiple myeloma and hyperviscosity syndrome was caused by an IgA(λ) protein. The M component circulated mainly in the form of a monomer, although a small portion of the IgA molecules were in a polymeric form. It was found that both purified monomer and polymer gelled promptly when cooled, although the limiting concentration producing a gel with the polymer was approximately one-half that required for gelation of the monomer, It was also found that the isolated (Fab')₂ fragment gelled on cooling.

The property of cryogelation was reversibly abolished by high and low pH, high salt concentrations, high concentrations of urea, and was irreversibly abolished by mild reduction and alkylation. It seems to be the first case of IgA(λ) cryogelglobulinaemia in which gelation was definitely associated with monomeric IgA and the (Fab')₂ portion of the molecule.

Synovial fluid examination for the diagnosis of amyloidosis

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A human IgG myeloma protein crystallizing with rhombohedral symmetry

The M-component in the serum of a patient with multiple myeloma and hyperviscosity syndrome was found to be an immunoglobulin of the IgG-1(K) class which crystallized spontaneously from the serum. After purification, the protein crystallized readily under a variety of conditions. X-ray diffraction studies indicated a rhombohedral lattice with cell dimensions: aR = 170 ± 5 Å, αE = 109 ± 2°. Assuming a molecular weight of 1.5 × 105, the crystals have been calculated to contain 66 ± 3% solvent, and six molecules per unit cell.Screening of the protein for antibody-like activity against a wide range of antigens gave positive results in several instances, in particular when tested against gum Karaya. This reaction was inhibited by D-glucuronic acid.

Bacteriolytic and bactericidal activity of maternal and cord sera. Relationship to complement, lysozyme, transferrin, and immunoglobulin levels

Bacteriolytic activity and its relationship to the level of immunoglobulins, complement, lysozyme, and transferrin was measured in 20 pairs and bactericidal activity in 6 pairs of maternal and cord serum. Escherichia coli Lilly, an organism easily lysed by normal human serum and four other Gram-negative bacteria were used.Cord sera invariably had lower bacteriolytic and bactericidal activity than their corresponding maternal sera. No statistically significant relationship between these activities and the level of immunoglobulins, complement, lysozyme, or transferrin was detected. A higher level of lysozyme was unable to compensate for the lower levels of other factors in the cord sera.

Release of intracellular constituents from rabbit polymorphonuclear leukocytes exposed to soluble and insoluble immune complexes

Polymorphonuclear leukocytes (PMNL) obtained from peritoneal exudates of unimmunized rabbits consistently released several intracellular constituents into the suspending medium when incubated with equivalence precipitates, which were prepared with rabbit antiserum to bovine serum albumin (BSA). Identical concentrations (AbN) of soluble immune complexes in antigen excess were neither as potent nor as predictable in triggering these phenomena. Precipitates prepared from antisera at 4 weeks after immunization were slightly more potent than those prepared from 6, 8 or 10-week antisera. On the other hand, soluble complexes prepared from 10-week antisera proved more potent than those derived from antisera of earlier bleedings. When PMNL were harvested from rabbits immunized with BSA and then exposed to immune complexes containing autologous antibodies, the ‘immune’ PMNL appeared to be less responsive to these stimuli when compared to PMNL obtained from unimmunized animals.

Studies on Human Myeloma Proteins with Antibody-Like Activity

More than 500 human sera containing one or more M-components were screened for antibody-like activity, using both double diffusion in agarose and modified Farr binding studies. Antibody activity was detected in two IgG myeloma proteins and two IgM macroglobulins using a number of negatively charged, positively charged, and neutral haptens. We have at least one of these M-components growing in cell culture producing two different cell lines, and we have obtained small crystals with two of the M-components. Equilibrium dialysis of the purified M-components yielded K0 values with low affinity. We have isolated, using liquid isoelectric focusing, a homogeneous IgG(γG1, K) protein from a leukemic patient 2 months after a bone marrow transplant operation. The IgG was not directed against the histocompatibility antigens. We detected significant binding with this protein and 3H-hydrocortisone. (Supported by MRC grant MA-3001 and the Ontario Treatment and Research Foundation).

Physicochemical, Immunological and Structural Studies on Two M-Components from a Single Individual

Serum from a patient with multiple myeloma contained two elevated monoclonal IgG M-components which differed with respect to electrophoretic mobility. Prolonged melphalan therapy reduced the serum concentration of the slow component (γ-electrophoretic mobility, pI 7.1) to normal levels but had no effect on the fast component (β-electrophoretic mobility, pI 6.8). The two M-components were isolated by column chromatography, on DEAE-cellulose and Sephadex G-200, and by isoelectric focusing. Both isolated heavy chains belonged to γG1 subgroup (a-b-f+ allotypes), possessed glutamic acid as the N-terminal amino acid, and were indistinguishable by acid and alkali urea starch gel electrophoresis, amino acid analysis, peptide mapping, and amide content. The isolated light chains of both M-components were λ(III) [Oz (-), St (-) II], possessed tyrosine as the N-terminal amino acid and were indistinguishable by their initial N-terminal sequence [tyr, valleu, leu, thr], circular dichroism spectra (240 to 310 nm), amino acid analysis, and mobility in acid urea starch gel electrophoresis.

Anomalous urinary proteins in patients with serum M-components

Abnormal urinary proteins were investigated in 365 patients with serum M-components; 250 urines were available for study. All specimens were concentrated and processed by electrophoresis and immunoelectrophoresis. An overall frequency of Bence Jones proteinuria was found in 63%, whereas other M-components were detected in 18%. In patients with multiple myeloma, Bence Jones proteinuria occurred in 71%, while M-components in the form of whole molecules of immunoglobulins or as Fc and F'c fragments were observed in 20%. Bence Jones globulin was found in 60% of patients with IgG myeloma, 69% of those with IgA myeloma and 100% of patients with IgD myeloma and light chain disease. In regard to other diseases, Bence Jones proteinuria was found in 44% of patients with macroglobulinemia, in 60% of patients with nonplasmacytic neoplastic diseases and in 28% of patients with non-malignant conditions. Other M-components were detected in the urine of 13%, 14% and 6% respectively.The detection of abnormal urinary proteins in patients with M-components in the serum is an important diagnostic tool and may have prognostic significance.