Immune deficiency: evaluation, diagnosis, and therapy

Adenosine deaminase activity in recipients of bone marrow from immunodeficient mice homozygous for the wasted mutation

Mice homozygous for the mutation wasted (wst/wst) have been postulated to be a model for the form of human severe combined immunodeficiency disease (SCID) that is secondary to a genetic deficiency of adenosine deaminase (ADA). To test this hypothesis more critically, we transplanted marrow from wst/wst and littermate control mice into lethally irradiated normal recipients. The Vmax and Km values for ADA in recipient's hematologic and non-hematologic tissues did not differ significantly. These results indicate that the wasted mouse is not a model for ADA deficiency and SCID.

Immunodeficiency in pediatric otolaryngology

The relationship between the individual's aerodigestive tract and the external environment is a delicate balance maintained by a competent immune system. An understanding of the immune system and the various immune defects thus enables the practitioner to diagnose and treat an otherwise unrecognized cause of recurrent respiratory and ear infections. In this article a review of the immune system is presented. The structure and function of cell mediated and humoral immunity as well as the corresponding deficiency states are discussed. Specific emphasis is placed on immunity as it relates to the air and food passages and the ear. All charts of patients with immune deficiency seen at the Children's Hospital of Philadelphia were reviewed. Thirty patients were found to be immunodeficient. Hypogammaglobulinemias accounted for 50.0 per cent, IgA deficiency accounted for 33.3 per cent, and chemotactic defects occurred in 13.3 per cent. All patients exhibited some type of otolaryngologic disease, characterized by frequent infections of the middle ear, upper respiratory tract, paranasal sinuses, or lungs. Because of this pattern of presentation, the otolaryngologist should be aware of these disorders and participate in their diagnosis and treatment.

Chronic cytomegalovirus infection, immunodeficiency, and monoclonal gammopathy-antigen-driven malignancy?

An infant with severe combined immunodeficiency had normal numbers of lymphocytes which bore E rosette and surface Ig markers in an appropriate distribution. However, only minimal responsivity to in vitro stimulation by mitogens and allogenic cells, and none to antigens could be elicited; functional antibody responses were also nil, except to cytomegalovirus. Intrauterine-acquired cytomegalovirus may have caused his immune dysfunction, although the possibility of a postnatal infection cannot be excluded. Therapy with transfer factor and thymus transplantation was unsucessful in restoring immunity and may have aggravated a pre-existing monoclonal gammopathy. It is possible that the monoclonal protein was derived from B-cells transplacentally received from the patients mother.

Demonstration of an intrathymic defect in a case of severe combined immunodeficiency disease

An in vitro system has been developed to elucidate the nature of the cellular defect in primary immunodeficiency diseases. Incubation, on human thymic epithelial monolayer cultures, of peripheral blood lymphocytes and bone-marrow cells from a child with documented severe combined immunodeficiency disease resulted in the appearance of a population of cells that formed rosettes with sheep erythrocytes. The same cell preparation permitted the synthesis of antigen-specific, complement-dependent antibodies after in vitro education, as demonstrated in a plaque assay system. In addition, thymic tissue from the same child gave morphologic and functional evidence of maturation when cultured in vitro. The experimental results suggest that in this case, lymphoid precursor cells were present in the bone marrow but failed to differentiate to functional maturity due to a defect in maturation of thymic tissue.