Treatment of the immunodeficiency diseases — progress toward replacement therapy emphasizing cellular and macromolecular engineering

Assessing alcoholism as a risk factor for acquired immunodeficiency syndrome (AIDS)

Acquired Immunodeficiency Syndrome (AIDS) is characterized by a range of risk factors that determine susceptibility to HIV and the clinical expression of the disease. These include sexual practices, intravenous drug use, and blood exchange. Appropriate preventive measures have been formulated for these risk factors. This paper reviews alcohol abuse as a prominent feature of the homosexual experience, and suggests that it may merit consideration as a risk factor in relation to AIDS. The presumably high prevalence of alcohol abuse among homosexuals and the damaging effects of alcohol on the immune system are discussed as a basis for linking alcoholism, homosexuality, and AIDS. The implications of the potentiating effects of alcohol misuse as the human immunodeficiency virus infiltrates the heterosexual population are presented in terms of high risk populations and the need for additional preventive measures.

Metabolic defects in severe combined immunodeficiency in man and animals

Severe combined immunodeficiency (SCID) was originally thought to be one disease. Accumulating evidence indicates that SCID is a heterogeneous group of diseases that are clinically similar but are caused by quite different biochemical abnormalities. The best-studied form of SCID is that associated with an autosomal recessive inheritance pattern of adenosine deaminase (ADA) deficiency. Several biochemical mechanisms have been postulated to explain how a deficiency of ADA causes immune dysfunction. In forms of SCID not associated with ADA deficiency, other biochemical abnormalities have been detected. These abnormalities include deficiency in biotin-dependent carboxylases, alteration in lymphocyte surface membranes and irregularities in cytokine production. Two animal models for SCID now exist. Neither of these models is associated with ADA deficiency. Evidence for a possible defect in purine metabolism in one model has been demonstrated.

Parameters involved in the induction and abrogation of the lethal graft-versus-host reaction directed against non-H-2 antigens

The grafting of cells from donors incompatible for non-H-2 antigens alone can lead to GvHR mortality in up to 100% of lethally irradiated adult recipients. GvHR severity correlates with the number of mature immunocompetent cells present in the bone marrow inoculum. Histologic and clinical manifestations of GvHR observed in these mice differ from those seen when GvHR is induced across an H-2 barrier. The number of non-H-2 genes capable of influencing GvHR mortality is probably great, and their effects may vary as a function of sex. The non-H-2 genes influence GvHR mortality mainly via their interactions, the consequences of which are complex and can result in either cumulative or suppressive effects. GvHR mortality is considerably reduced by donor immunization, shortly before grafting, against host-specific non-H-2 antigens; and it is virtually abrogated by an additional immunization of the donors against nonspecific (foreign) H-2 antigens. Three weeks after grafting, these "protected" mice are easily distinguishable from those undergoing lethal GvHR, as assessed by both clinical appearance and histologic examination; in contrast, they are nearly indistinguishable from control mice grafted with syngeneic cells. However, depending upon the conditions used for the immunization, an additional immunization against nonspecific H-2 antigens can lead to acceleration rather than suppression of GvHR mortality; this phenomenon is not seen, under the same experimental conditions, after immunization against specific non-H-2 antigens alone. It is therefore suggested that a "second signal" provided by an additional nonspecific stimulus can potentiate either the establishment of specific suppression or the activation of a secondary ("positive") response. Suppressive effects of the specific and nonspecific immunizations are cumulative, and both treatments activate suppressor cells. The intensity of suppression induced by both specific and nonspecific immunizations is antigen dose-dependent. At equivalent antigen doses the specific immunization is considerably more effective than the nonspecific immunization, and is detectable after injection of as few as 2.5 X 10(5) cells. In both cases, irradiation of the immunizing cells abolishes the suppression induced by the lower cell doses tested, while it merely decreases the intensity of the suppression induced by the higher cell doses tested. The impairment of suppression after irradiation of the immunizing cells is not attributable to a modification of their homing pattern, but to the fact that proliferation of the immunizing cells, which leads to an augmentation of the antigen dose, is abolished by irradiation.(ABSTRACT TRUNCATED AT 400 WORDS)

Immunoreconstitution in severe combined immunodeficiency after transplantation of HLA-haploidentical, T-cell-depleted bone marrow

Immunological reconstitution by transplantation of HLA-haploidentical, paternal bone marrow was attempted in four infants with severe combined immunodeficiency who lacked HLA-identical donors. To prevent graft-versus-host disease, T lymphocytes were removed from the grafts by agglutination with soybean agglutinin and rosette formation with sheep red blood cells. None of the patients received conditioning treatment before transplantation. Normal, donor-derived cellular immune functions developed in all four patients within several months of transplantation. Threatening complications of graft-versus-host reactions were not seen. All four patients remain in excellent health 12-15 months after discharge home, with persisting normal T-cell functions.

Allogeneic marrow transplantation

After 15 years of clinical investigation, allogeneic marrow transplantation can be considered the treatment of choice for a variety of hematologic and immunologic diseases. This review has focused upon some of the principles, current results, problems, and future directions in allogeneic marrow grafting.

Altered immunity in male patients with alcoholic liver disease: evidence for defective immune regulation

We sought evidence for altered immunity in patients with alcoholic liver disease, and we correlated the observed immunologic abnormalities with the extent of histologically proven liver disease. Total circulating lymphocytes and the absolute number of T lymphocytes were decreased in alcoholics (p less than 0.01) compared to controls. Immunoglobulins G and A were elevated significantly (p less than 0.05) in alcoholic patients with hepatic fibrosis or cirrhosis compared to controls and alcoholics without liver histopathology. In alcoholics with fibrosis or cirrhosis at time of admission, IgE levels were also elevated (p less than 0.01) but decreased 50% during hospitalization. Forty-eight percent of the patients with alcoholic liver disease had antibodies to small bowel epithelium, and 33% had antibodies to fibroblast cytoplasm. In addition, we found that alcoholics immunized with polyvalent pneumococcal polysaccharide responded with significantly elevated (p less than 0.025) antibody titers compared to hospitalized controls. In aggregate, these findings in patients with alcoholic liver disease are consistent with a defect in immune regulation.

Association between pre-transplant natural kill and graft-versus-host disease after stem-cell transplantation

Natural killer activity against herpes simplex virus type 1 infected fibroblasts NK(HSV-1) was studied prospectively in patients undergoing allogenic bone-marrow or fetal-tissue stem-cell transplantation. Thirteen patients showed evidence of engraftment and survived long enough to develop graft-versus-host disease (GvHD). Of this group, all of the seven having normal NK(HSV-1) activity before transplantation acquired GvHD and the six having low NK(HSV-1) had no evidence of GvHD. These results were independent of mode of preparation of patients for transplantation, source of stem cells used, or cytomegalovirus infections, and they suggest that this assay reflects a host-determined function capable of stimulating GvHD.