501
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502
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Selective immunoreaction as an adaptive trait. Behav Brain Sci 1985. [DOI: 10.1017/s0140525x00001199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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503
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Is the H-Y antigen a malefactor? Behav Brain Sci 1985. [DOI: 10.1017/s0140525x00001102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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504
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505
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The Y chromosome message. Behav Brain Sci 1985. [DOI: 10.1017/s0140525x00001229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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506
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A reproductive immunologist's view on the role of H-Y antigen in neurological disorders. Behav Brain Sci 1985. [DOI: 10.1017/s0140525x00001187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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507
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Hafler DA, Fox DA, Manning ME, Schlossman SF, Reinherz EL, Weiner HL. In vivo activated T lymphocytes in the peripheral blood and cerebrospinal fluid of patients with multiple sclerosis. N Engl J Med 1985; 312:1405-11. [PMID: 2985995 DOI: 10.1056/nejm198505303122201] [Citation(s) in RCA: 258] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
We found an increase in peripheral-blood lymphocytes bearing the T-cell-specific activation antigen Ta1 in 20 of 35 patients with progressive multiple sclerosis, 4 of 18 patients with stable or improving multiple sclerosis, 1 of 17 patients with other neurologic diseases, and 1 of 14 normal controls (P less than 0.0002, Fisher's exact test). No increases in two other markers of T-cell activation, T113 and the interleukin-2 receptor, were found. In the cerebrospinal fluid, patients with progressive multiple sclerosis (pleocytosis, 3.9 +/- 1.6 cells per cubic millimeter) had 42 +/- 3.0 per cent Ta1+ cells. In contrast, patients with other inflammatory central nervous system diseases (36 +/- 13 cells per cubic millimeter) had 9.6 +/- 1.8 per cent Ta1+ cells (P less than 0.01). In patients with other neurologic diseases without inflammation (0.7 +/- 0.16 cells per cubic millimeter), the percentage of Ta1+ cells was equivalent to that in patients with multiple sclerosis (39 +/- 5.4 per cent), although the absolute number was lower. There was a positive correlation between the presence of Ta1+ cells in the spinal fluid and blood of patients with other neurologic diseases, but not patients with multiple sclerosis. Less than 1 per cent of lymphocytes from the spinal fluid of patients with multiple sclerosis expressed interleukin-2 receptors, as compared with 9.8 per cent of cells from subjects with other inflammatory neurologic diseases (P less than 0.01). These results suggest that the T cells in the spinal fluid of patients with multiple sclerosis may be activated by a different mechanism or in a different temporal sequence from that in patients with other nervous system diseases. Furthermore, the increase in Ta1+ cells in the peripheral blood of patients with multiple sclerosis demonstrates systemic immune activation in the disease; monitoring such cells may provide an objective measure of abnormal immunologic activity.
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508
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Abstract
Multiple sclerosis manifests itself in a number of ways, affecting many body functions and systems. It is not possible to change the pathologic course of multiple sclerosis at this time, but this does not mean that physicians cannot improve the quality of life for patients with this disease. By participating in regular exercise, patients can maintain their strength and mobility. Spasticity may be controlled with medications, and urologic problems, which not only are often overlooked but also have a major bearing on patients' social and vocational life, should be controlled to the greatest extent possible.
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509
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Halperin EC. Total lymphoid irradiation as an immunosuppressive agent for transplantation and the treatment of 'autoimmune' disease: a review. Clin Radiol 1985; 36:125-30. [PMID: 3933886 DOI: 10.1016/s0009-9260(85)80094-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Total lymphoid irradiation (TLI) is a powerful immunosuppressive agent. This immunosuppression has the potential for clinical application in certain selected situations. In this review, the immunological changes produced by TLI and its potential applications in organ transplantation and the treatment of certain 'autoimmune' diseases are discussed.
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510
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Gordon PA, Carroll DJ, Etches WS, Jeffrey V, Marsh L, Morrice BL, Olmstead D, Warren KG. A double-blind controlled pilot study of plasma exchange versus sham apheresis in chronic progressive multiple sclerosis. Neurol Sci 1985; 12:39-44. [PMID: 3884114 DOI: 10.1017/s0317167100046564] [Citation(s) in RCA: 30] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Twenty patients with chronically progressive multiple sclerosis (MS) were randomised in a double-blind controlled study to assess the efficacy of plasma exchange therapy. All patients were immunosuppressed with prednisone and azathioprine and underwent either plasma exchange or sham apheresis. The 10 patients in each group were similar in age, sex, duration of disease and degree of disability. Clinical and laboratory responses were assessed immediately following the course of exchange or sham therapy, and 3 to 6 months later, by individuals blinded to the type of therapy administered. Although modest improvement was suggested on clinical examination in 7 of 10 patients exchanged and 3 of the 10 sham treated group, this was transient and was not accompanied by any change in disability status scores. No differences in abnormal laboratory investigations were demonstrable between the two patient groups following therapy. We conclude that plasma exchange therapy using this protocol is unlikely to be of clinical benefit as an adjunct in the management of chronically progressive M.S.
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511
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Zabriskie JB, Mayer L, Fu SM, Yeadon C, Cam V, Plank C. T-cell subsets in multiple sclerosis: lack of correlation between helper and suppressor T cells and the clinical state. J Clin Immunol 1985; 5:7-12. [PMID: 3156873 DOI: 10.1007/bf00915162] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Peripheral blood T-lymphocyte subsets were investigated in a group of 26 multiple sclerosis (MS) patients of different clinical categories and compared to those of 15 normal controls and 7 other patients with known immunoregulatory disorders. In addition 17 well-documented acute relapses in 11 MS patients were also studied, some of whom were tested serially prior to, during, and after the acute attack. Using three different commercial preparations of monoclonal antibodies directed against human T3, T4, and T8 lymphocyte markers, none of the MS patients irrespective of disease category exhibited any changes in the absolute numbers of T-cell subsets or ratios thereof; this was true during either quiescent or active stages of the disease. In contrast, several patients with known immunoregulatory disorders exhibited clear changes in T4/T8 ratios. Factors such as type of patient studied, sampling error, and methods of isolation of mononuclear cells, as well as source of monoclonal antibody, failed to explain the lack of change in T-cell subsets in these patients. Thus, our data fail to confirm the previous reports of a decrease in the absolute numbers of T8 cells or the increase in the T4/T8 ratios in active or quiescent MS patients. These negative findings underscore the need for further studies relating these markers to meaningful functional properties of these cells and their interaction with the relevant target organs.
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512
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Shen TY. Chemistry and Biological Profile of Immunosuppressants. Pharmacology 1985. [DOI: 10.1007/978-1-4615-9406-2_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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513
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Weiner HL, Hauser SL, Hafler DA, Fallis RJ, Lehrich JR, Dawson DM. The use of cyclophosphamide in the treatment of multiple sclerosis. Ann N Y Acad Sci 1984; 436:373-81. [PMID: 6099707 DOI: 10.1111/j.1749-6632.1984.tb14808.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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514
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Moser HW, Moser AE, Singh I, O'Neill BP. Adrenoleukodystrophy: survey of 303 cases: biochemistry, diagnosis, and therapy. Ann Neurol 1984; 16:628-41. [PMID: 6524872 DOI: 10.1002/ana.410160603] [Citation(s) in RCA: 214] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Adrenoleukodystrophy (ALD) is a genetically determined disorder associated with progressive central demyelination and adrenal cortical insufficiency. All affected persons show increased levels of saturated unbranched very-long-chain fatty acids, particularly hexacosanoate (C26:0), because of impaired capacity to degrade these acids. This degradation normally takes place in a subcellular organelle called the peroxisome, and ALD, together with Zellweger's cerebrohepatorenal syndrome, is now considered to belong to the newly formed category of peroxisomal disorders. Biochemical assays permit prenatal diagnosis, as well as identification of most heterozygotes. We have identified 303 patients with ALD in 217 kindreds. These patients show a wide phenotypic variation. Sixty percent of patients had childhood ALD and 17% adrenomyeloneuropathy, both of which are X-linked, with the gene mapped to Xq28. Neonatal ALD, a distinct entity with autosomal recessive inheritance and points of resemblance to Zellweger's syndrome, accounted for 7% of the cases. Although excess C26:0 in the brain of patients with ALD is partially of dietary origin, dietary C26:0 restriction did not produce clear benefit. Bone marrow transplant lowered the plasma C26:0 level but failed to arrest neurological progression.
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515
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516
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517
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518
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Eldridge R, Anayiotos CP, Schlesinger S, Cowen D, Bever C, Patronas N, McFarland H. Hereditary adult-onset leukodystrophy simulating chronic progressive multiple sclerosis. N Engl J Med 1984; 311:948-53. [PMID: 6472420 DOI: 10.1056/nejm198410113111504] [Citation(s) in RCA: 86] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
We studied a large kindred with a chronic progressive neurologic disorder affecting at least 10 men and 11 women in four generations in a pattern compatible with autosomal dominant inheritance. In 20 of the affected subjects, evaluated before the availability of computerized tomography and without regard to family history, the diagnosis was multiple sclerosis. Symptoms of the neurologic disorder begin in the fourth and fifth decades and include cerebellar, pyramidal, and autonomic abnormalities. The autonomic symptoms, which involve bowel and bladder regulation and orthostatic hypotension, may be the earliest changes but are frequently disregarded. Survival for 20 years after onset is common. The CT scan is striking and shows a symmetrical decrease in white-matter density, beginning in the frontal lobes but extending to all of the centrum ovale and the cerebellar white matter. Limited pathological observation reveals gross white-matter degeneration with microscopic vacuolation, preservation of U fibers and cortical structures, and no inflammatory changes or reactive gliosis. Because of its hereditary basis, the disorder should be susceptible to genetic definition and ultimately to treatment or prevention.
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519
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520
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521
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Abstract
Therapeutic apheresis is a relatively new modality. Its absolute indications are few and include hyperviscosity syndrome, cryoglobulinemia, thrombotic thrombocytopenic purpura, Goodpasture's syndrome, and life-threatening complications of immunologic disorders refractory to conventional management. The use of apheresis in most of the other disorders discussed in this monograph is experimental and should not be employed unless all the mitigating therapeutic considerations clearly suggest an overwhelming advantage of apheresis. The promise of apheresis is much greater than its current use, and the research applications of specific component separation and antibody removal are of great importance. It is hoped that these new developments will shortly make current devices obsolete and improve the clinical management of patients as well as increase our knowledge of disease etiopathogenesis.
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522
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Weiner HL, Hafler DA, Fallis RJ, Johnson D, Ault KA, Hauser SL. Altered blood T-cell subsets in patients with multiple sclerosis. J Neuroimmunol 1984; 6:115-21. [PMID: 6373819 DOI: 10.1016/0165-5728(84)90032-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
We have found an alteration in T-cell subsets in patients with active multiple sclerosis, specifically an increase in the T4:T8 ratio. These findings have been reproducibly obtained over the past four years, occurring in the majority of acute patients tested early in the course of an attack and in between 25 and 40% of chronic progressive patients, depending on their stage of illness. These changes correlate with pleocytosis in spinal fluid and with other abnormalities of immune function, such as spontaneous immunoglobulin production. They have been helpful in assessing disease activity in patients being treated on a variety of protocols and as part of research studies of immunoregulatory abnormality in multiple sclerosis, but have not been helpful as a diagnostic test for multiple sclerosis. The decrease of these cells in the peripheral blood of patients with active disease may be secondary to migration of these cells to the central nervous system, where they are sequestered.
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523
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524
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Miescher PA, Beris P. Immunosuppressive therapy in the treatment of autoimmune diseases. SPRINGER SEMINARS IN IMMUNOPATHOLOGY 1984; 7:69-90. [PMID: 6377542 DOI: 10.1007/bf01891781] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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525
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Schwartz RS. Twenty-five years of immunosuppression. SPRINGER SEMINARS IN IMMUNOPATHOLOGY 1984; 7:3-7. [PMID: 6330918 DOI: 10.1007/bf01891774] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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526
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Abstract
Immunosuppressive treatment of multiple sclerosis (MS) is based on the autoimmune hypothesis for which the main evidence is the close histological similarity between the human disease and chronic relapsing EAE. Although controlled trials indicate that ACTH is effective in accelerating recovery from relapses, long term ACTH or oral steroids are ineffective. Two controlled trials have suggested a beneficial effect of azathioprine, but neither was conducted "blind" and neither was sufficiently convincing to cause the widespread adoption of azathioprine by neurologists. One controlled trial, also not blind, reported a beneficial effect of an intensive course of cyclophosphamide, but this hazardous treatment will not be widely adopted unless other trials confirm this result. The converse hypothesis that MS is due to a deficient immune response to a virus has led to trials of immunostimulation. Interferon and levamisole have proven ineffective so far, but transfer factor slowed disease progression in one well conducted trial.
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527
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528
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529
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Whitehouse JM. Cytotoxic drugs for non-neoplastic disease. BMJ : BRITISH MEDICAL JOURNAL 1983; 287:79-80. [PMID: 6407713 PMCID: PMC1548391 DOI: 10.1136/bmj.287.6385.79] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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530
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531
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