The antibody response in rabbits to previously tolerated antigens

Can drugs cause autoimmune thrombocytopenic purpura?

A wide range of medications can cause life-threatening immune thrombocytopenia (ITP), hemolytic anemia, or neutropenia in sensitive individuals. The antibodies associated with these conditions usually require soluble drug to be present in order to react with the cell membrane glycoproteins for which they are specific. However, some patients make drug-independent antibodies (autoantibodies) as well. Occasionally, only autoantibodies are produced following exposure to a drug. Although drugs and other small molecules can become conjugated to proteins in vivo, which may induce an immune response, only fragmentary information is available to explain how exogenous substances sometimes perturb the immune system in such a way that antibodies capable of causing immune cytopenia are produced. Platelets are affected by drug-induced antibodies more often than any other blood element. For many drug-induced thrombocytopenias, the targeted membrane glycoproteins are readily accessible for laboratory investigation and methods for detecting the responsible antibodies are well developed. Techniques for studying cellular aspects of the immune response induced by drugs through in vitro manipulation of T and B lymphocytes are also advancing rapidly. Studies of drug-induced ITP may provide clues to the general mechanisms whereby drugs and other xenobiotics induce immune diseases. Clinicians should consider the possibility of an exogenous trigger in patients who present with apparent autoimmune thrombocytopenia.

Reticuloendothelial cell function in alpha-methyldopa-induced hemolytic anemia

2 patients having alpha-methyldopa-induced hemolytic anemia were followed sequentially using an in vitro assay of autologous monocyte-macrophage activity to determine if their reticuloendothelial system (RES) function was abnormal and thus could be related to the mechanism of lysis. RES function was evaluated while the patients were actively hemolyzing and during remission, following discontinuance of the drug. The results indicated that RES activity is normal in patients having hemolytic anemia due to alpha-methyldopa administration. Also, following cessation of drug therapy, the patients' IgG-coated red cells interacted significantly for a prolonged period (4-5 months) with autologous or normal allogeneic monocyte-macrophages. This was associated with a concurrent reticulocytosis and indicates a persistent low-level hemolytic phase throughout this period, even though hemoglobin and hematocrit values remained within the normal ranges. Although levels of IgG sensitizing the patients' red cells were essentially constant during the hemolytic phase and when the patients were in complete remission, significant monocyte-macrophage activity was only evident during the hemolytic period. In an attempt to explain this phenomenon, it is postulated that hemolysis in patients receiving alpha-methyldopa is related to the interaction of drug with red cell membrane proteins which results in a variably expressed 'altered' antigen which is recognized by 'autoantibody'. The proper expression of the Fc portion of the immunoglobin molecule to result in specific recognition by receptors on monocyte-macrophages depends upon the extent of the antigen alteration by alpha-methyldopa. If the drug does not result in appropriate antigen alteration, then, although 'autoantibody' may still bind to the red blood cell, its Fc region is not readily recognized by monocyte-macrophages and little or no erythrophagocytosis occurs.

Experimentally induced autoantibody to heat-stable alkaline phosphatase in the baboon

Experimental evidence has been collected which signifies that autoantibody has been induced against lung heat-stable alkaline phosphatase which represented 60% of the total alkaline phosphatase of that tissue. Immunization of a male baboon with highly purified human placental alkaline phosphatase (heat-stable and cross-reactive with the baboon heat-stable enzyme) resulted in production of a precipitating factor in the immune serum which reacted with the heat-stable enzyme of both the human and baboon but not the heat-labile form of alkaline phosphatase of either species. This precipitating factor is a baboon autoantibody because 1) it had a gamma mobility on immunoelectrophoresis and retarded the electrophoretic mobility of the heat-stable enzyme from both normal and immunized baboons; 2) its titer increased as more booster injections were administered; 3) it formed a well-defined precipitin rocket with the baboon heat-stable enzyme in the Lurell's antigen-antibody crossed electrophoresis; 4) in immunodiffusion it formed a discrete precipitin line with the baboon heat-stable enzyme, which fused partially with the precipitin line of human placental alkaline phosphatase (immunogen).

Antibodies to rabbit cytochrome c arising in rabbits

Antibodies reactive with rabbit cytochrome c have been observed in rabbits immunized with several heterologous cytochromes. Such antibodies have also been observed in rabbits immunized with rabbit cytochrome c conjugated to bovine gamma globulin. The serum of a rabbit immunized with human cyto chrome c reacted with the cytochrome c of the same rabbit.