Rheumatoid, antinuclear, and antileukocyte cytotoxic factors in patients with burns

Major low-energy trauma results in non-specific immunoglobulin generation without evidence for specific autoantibody production: A prospective cohort study

Cellular debris resulting from large trauma might overwhelm the scavenger mechanisms and lead to autoimmune reactions. We analysed whether a major well-defined trauma in humans induces laboratory signs of transient autoimmunity in the months after the insult. We included 50 patients with pertrochanteric femur fracture undergoing intramedullary nail osteosynthesis in a prospective cohort study and followed them at 3-4 days, 6 weeks, 12 weeks and 12 months postoperatively. By standard techniques, we assessed levels of total immunoglobulins, anti-nuclear antibodies (ANA), anti-cardiolipin antibodies, anti-dsDNA antibodies and anti-C1q antibodies, as well as antibodies against cytomegalovirus (CMV) as a control. Blood leukocyte differential and lymphocyte subpopulations were determined at baseline and in the first two postoperative samples. The mean age of the patients reached 80.1 years, and 23 (46%) completed all visits. Serum concentrations of total IgG, IgM and IgA increased at all follow-up time points. The ANA fluorescence light intensity units increased at 12 weeks and 12 months postoperatively (p < 0.0001), but the proportion of ANA-positive patients did not change (35%). The values of anti-C1q mildly increased at all follow-up visits, but not the ratio to total IgG. Anti-dsDNA remained negative in all patients, and anti-cardiolipin IgG/IgM antibodies did not change. Anti-CMV IgG antibodies increased significantly at all follow-up visits, without change in the ratio to total IgG. Flow cytometry showed an increased proportion of B-cells 3-4 days postoperatively. In conclusion, major musculoskeletal trauma in elderly patients induces a generalized non-specific increase in immunoglobulin production without laboratory signs for enhanced systemic autoimmunity.

The origin of autoantibodies

Autoimmune diseases are characterized by the appearance of autoantibodies (autoAb) which may participate in their pathogenesis, but autoAb have also been found in normals with a variety of other conditions. The production of hybridomas from lymphocytes of unimmunized normal mice and healthy humans and analysis of the monoclonal autoAb (m-autoAb) obtained, showed that many had polyspecific autoAb reactivity, binding to many seemingly unrelated self-antigens, or to several organs. Most m-autoAb were of the IgM class and shared a common cross-reactive idiotype (CRI). Low levels of Ab with similar binding pattern and idiotype are continuously represented in the serum of mice and humans who have no evidence of autoimmune or other disease. Very similar Ab appear in autoimmune diseases. Studies of m-autoAb derived from lupus-prone mice and from patients with systemic lupus erythematosus (SLE) and other autoimmune diseases also revealed polyspecific binding, IgM isotype and CRI. Moreover, these CRI, which were almost identical with the idiotypes of natural autoAb in normals, may identify a group of pathogenic Ab in the lupus mice and SLE patients. Since the data clearly suggest that lymphocytes that make autoAb are common and are part of the normal B cell repertoire coded by widely dispersed germline genes, there remain the basic problems of the function of these autoAb in health, as well as the question of their regulation and activation in vivo. Several postulated functions and immunoregulatory mechanisms are discussed and the possible role of certain factors, especially viruses, in enhancing autoAb production and autoimmunity, is assessed.

Immunity of the burned patient. An overview

The study of mortality in severe burns shows very clearly that most patients die because of septic problems. Surgery and intensive care in burn patients are actually well established, but the fight against infection and septicemia is still difficult. The risk arises due to poor host defence, leading to an unfair struggle and very often ending in death. Today it has become necessary for every burn surgeon and plastic surgeon to understand why this immune depression occurs and how it can be prevented or treated.

Rheumatoid factors in the sera of patient with gastrointestinal carcinoma

One hundred and nineteen patients with gastrointestinal (GI) malignancy (80 colorectal, 25 gastric and 14 pancreatic carcinoma) were studied for rheumatoid factors (RF), antinuclear antibodies (ANA) and immunoglobulin levels and the findings correlated with size of tumor, stage of disease and survival. Twenty three (19.3%) of the patients were RF seropositive compared to 5.7% of 70 matched controls (P = 0.02). In two thirds of the seropositive patients RF were detected prior to the initiation of treatment. The proportion of RF seropositivity increased significantly in patients with tumors larger than 4 cm and in patients with Stage D disease. The authors found a high incidence of ANA in the patients: 32.4% compared to 8% in normal subjects (P less than 0.01), but the proportion of RF in this group was not significantly different. Survival distributions of the RF positive cases were different from that of the other patients (18 versus 25 months median survival); however, this was not statistically significant. These findings indicate that RF in GI cancer patients sera is not rare and can be related mainly to "tumor load," although not considerably affecting survival.

'Metabolic' factors in thermal injury: role of nucleic acids

We believe that toxic events observed after thermal injury may be caused by the release of normally intracellular substances into the circulation. We define these substances as 'metabolic' factors. Analysis of extracts prepared from normal and burned mouse skin indicates that the burned skin extract contains increased clot-promoting (Thromboplastin-like) substances and, perhaps, less RNA than normal skin extracts. Injection of RNA or its breakdown products into the burned site significantly increases the acute mortality in burned mice. No increase in mortality is observed when these substances are injected into a non-burned site on burned mice. We suggest that 'Thromboplastin-like substances and RNA or RNA breakdown products may be some of the 'metabolic' factors involved in acute burn toxicity. Upon being released from their intracellular residence after thermal injury, their combined activity contributes to the acute mortality observed.

DNA-synthesis in the rat thymus after focal thermolesions on abdominal organs

The changes in the DNA-synthesis of lymphocytes in the different zones of the rat thymus were autoradiographically studied with 3H-thymidine after focal thermonecroses (740 degrees C/4 sec) on abdominal organs and sham operation (laparotomy). A single thermolesion was performed in separate groups of rats on the liver and spleen, whereas a third group received multiple heat lesions (liver, kidney, stomach wall). A slight decrease of the labeling index occured during the first 36 h after the sham operation and was attributed to an unspecific stress effect leading to an increased release of corticosterones. The most remarkable and contrasting result was the observation that after thermonecroses a decrease of the labeling index of thymus-lymphocytes did not happen during the first 48 h but rather a marked increased with a maximum on the fifth day. It was concluded that the stimulated DNA-synthesis in the thymus might be related to a cell mediated immune response against thermocoagulated tissue components or to an immediate T-cell dysfunction, which is known to develop after burns. In both cases the thymus might react with an increased division and maturation of lymphocytes regulated through a feed-back mechanism.

The modifying effect of autologous serum on leukocyte migration inhibition by liver antigens in systemic lupus erythematosus

The leukocyte migration test was used to examine patients with systemic lupus erythematosus (SLE) for evidence of cell-mediated immunity to human liver microsomes and mitochondria. Testing of both these antigens with leukocytes from patients was carried out simultaneously in culture medium enriched by either 20% fetal bovine serum (the standard test) or substituted 20% autologous serum. Normal controls showed little or no reactivity in the standard test whereas the SLE group revealed a high incidence of significant leukocyte migration inhibition to both antigens which, however, was considerably reduced by the substitution of autologous serum. The results suggest that the sera of patients with SLE contain factor(s) capable of blocking the in vitro expression of cell-mediated immunity to human tissue antigens. These factor(s), if active in vivo, might have a role in controlling some of the auto-immune manfestations of the disease.