Leukocyte mitosis: suppression in vitro associated with acute infectious hepatitis

Picornavirus infection leading to immunosuppression

Viruses, such as HIV, hepatitis A, poliovirus, coxsackievirus B3 and foot-and-mouth disease virus, use a variety of mechanisms to suppress the human immune system in order to evade clearance by the host. Therefore, investigating how a few changes in the viral genome of a nonlethal virus can lead to an alteration in disease, from survivable to immunosuppression and death, would provide valuable information into viral pathogenesis. In addition, we propose that gaining a better insight into how these viruses suppress an antiviral immune response could lead to viral-based therapeutics to combat specifc autoimmune diseases such as multiple sclerosis and Type 1 diabetes.

Aplastic anaemia in a case of hepatitis B with a high titer of hepatitis B antigen

A high titer of hepatitis B antigen (HBsAg) was found in a patient with acute hepatitis B infection complicated by bone marrow aplasia. A possible antimitotic effect of HBsAg as an aetiological factor of the aplasia in this patient is discussed.

Hepatitis B viral markers in pregnant women and newborn infants in Korea

A study of the 5,284 pregnant women who delivered at St. Columban’s Hospital in Mokpo City between April 1, 1985 to June 30, 1987 was conducted to determine the presence of hepatitis B viral (HBV) markers in the mothers and infants and to evaluate their effects. Medical histories, physical examinations, liver function studies and the ELISA test for HBV markers were reviewed. The following results were obtained: 1. Of the 5,284 pregnant women, 448 (8.48%) were positive for HBsAg. Three hundred and thirty four women tested positive for HBsAg; 130 (38.92%) were HBeAg positive, 105 (31.44%) were HBeAg and anti-HBe negative, and 99 (29.64%) were anti-HBe positive. 2. Women positive for HBsAg exhibited a slight increase in toxemia (p<0.1), and no significant difference in postpartum hemorrhage (0.05< p <0.1) and the severity of hyper-emesis. 3. SGPT was significantly higher in HBeAg positive women than in HBeAg negative women (p<0.01), and it was significantly more elevated in both eclamptic and preeclamptic women than in normal pregnant women (p<0.005). 4. The frequency of congenital malformation, spontaneous abortion, infantile death and physiologic jaundice was increased in the newborns of chronic HBV carriers, while women with active hepatitis B experienced more premature births. 5. Mother to infant transmission of HBsAg and HBeAg was high in the HBeAg positive group (18.0%, 42.7%) respectively, but very low in the HBeAg negative group (7.8%, 0.0%). Mother to infant transmission of antibodies was in the order of anti-HBc (95.5%), anti-HBe (91.2%) and anti-HBs (75.0%). The effects of the HBV carrier state in pregnant women included increases in toxemia, postpartum hemorrhage, congenital malformations and premature births, however none of them were statistically significant. There was a significant difference in the elevation of SGPT between toxemic and normal pregnant women, and between HBeAg positive and HBeAg negative carrier women. The mother to infant transmission rate of HBeAg was more frequent than that of HBsAg.

Serum inhibitory factors (SIF) are of prognostic value in acute viral hepatitis

Serum inhibitory factors (SIF) were analysed in relation to the natural course of acute viral hepatitis in 81 patients followed over a period of 1 year. 63 patients recovered completely (group 1), and 18 had a protracted course of hepatitis (group 2) as shown by persistent transaminase activity 6 months after onset. 11 patients in group 2 still had signs of liver disease after 1 year. A gradual fall of SIF activity (in 47 patients) heralded resolving hepatitis, whereas persistence of SIF (in 8 patients) correlated with inflammatory activity and failure of hepatitis B viral antigen elimination. Absence of SIF activity was associated with either an uncomplicated or a chronic course of hepatitis in 23 and 3 patients, respectively. Repeated determination of SIF may help to predict the final outcome of hepatitis. Both excessive and failure of SIF production may result in the development of chronic liver disease.

Immunosuppressive serum factors in viral hepatitis. I. Characterization of serum inhibition factor(s) as lymphocyte antiactivator(s)

Sera from patients with acute viral hepatitis B were found to inhibit the in vitro proliferation of normal lymphocytes induced by different mitogens and antigens. In addition, an effect on concanavalin A-induced T suppressor cell activity and pokeweed mitogen-stimulated IgG and IgM synthesis was demonstrated. Studies concerning the kinetics of serum immunosuppressive effects indicated that serum immunosuppressive factor (SIF) interfered with the intermediate phase of mitogen-induced lymphocyte activation which was defined by protein and RNA synthesis. Thus, when SIF-positive sera were added to lymphocytes, which were already activated by phytohemagglutinin, for 8, 12, or 18 hr, the inhibitory effect decreased in relation to the duration of lymphocyte activation. No inhibition could be demonstrated when SIF-positive sera were added 24 hr after initiation of mitogen stimulation. Furthermore, similar inhibitory effects were found measuring either uptake of [3H]uridine (RNA synthesis) or [3H]leucine (protein synthesis) in a 24 hr culture of phytohemagglutinin-stimulated lymphocytes or [3H]thymidine uptake (DNA synthesis) after 48 hr. These results indicate that SIF act(s) like an antiactivator and may belong to immunoregulatory physiologic serum factors.

Azathioprine, a clastogen in human somatic cells? Analysis of chromosome damage and SCE in lymphocytes after exposure in vivo and in vitro

Chromosomal analyses in lymphocytes of 28 patients with multiple sclerosis were carried out before, during and after Azathioprine (Aza) therapy. Only a higher incidence of gaps was found in treated patients than in a group of healthy persons but not in comparison with untreated patients. Similarly, no significant clastogenic effect was observed in vitro after short-term and long-term treatment of unstimulated and stimulated lymphocytes with concentrations of 1--100 microgram Aza per ml. Treatment of cultures with 0.0001--4.0 microgram/ml did not yield increased SCE frequencies. The absence of any significant clastogenic effect of therapeutic doses of Aza on human somatic cells is deduced from an evaluation of previously published data and from the present results.

Lymphocyte proliferation to phytohemagglutinin (PHA) in hepatitis B antigen-positive and -negative hepatitis

Lymphocytes from patients with HBs-Ag-positive and -negative acute, chronic-persistent, and chronic-active hepatitis, from healthy controls and from patients with alcoholic liver cirrhosis were tested under standardized conditions. These included use of a single charge of Phytohemagglutinin (PHA-P) dissolved and diluted in one operation, of a single pool of homologous serum of the major blood group AB found free of HBs-Ag and cytotixic factor, and elaboration of PHA dose response curves in the presence of autologous and homologous serum in each case examined. During the early phase of acute virus hepatitis B and non-B, and in HBs-Ag-positive chronic persistent and active hepatitis, hyperresponsiveness of lymphocytes to PHA was observed independently of the source of the serum present in the culture. Lymphocyte responsiveness returned to normal in the later phase of acute hepatitis and depressed in alcoholic liver cirrhosis and in cases of HBs-Ag-positive chronic active hepatitis in which cirrhosis had developed. Although the cause of these alterations in lymphocyte responsiveness is not completely understood, the central role of a primary change of the lymphocytes themselves affecting their ability to react to PHA seems probable.

Chronic active hepatitis in patients with and without hepatitis B surface antigenemia

This study was designed to compare the clinical and immunological characteristics of the hepatitis B surface antigen (HBsAg)-positive and HBsAg-negative (cryptogenic) forms of chronic active hepatitis. The data of 48 patients with chronic active hepatitis, 24 with persistent HBs antigenemia and 24 without HBsAg, were analysed. HBsAg was detected by counter-immunoelectrophoresis and radioimmunoassay. The clinical features, biochemical liver function tests, immunoglobulins, complement C3, antoantibodies, and cell-mediated immunoreactivity of the two forms of the disease were compared. Cirrhosis was found to occur more frequently at the time of diagnosis in the HBsAg-negative group, and the serum alkaline phosphatase level was raised significantly compared to the HBsAg-positive form. The elevation of the IgG level was greater in the cryptogenic form, but the difference was not statistically significant compared to the HBsAg-positive patients. There was a marked difference in the frequency of the mitochondrial antibodies, but not of the antinuclear factor and other autoantibody-like serum factors. Lymphoblastic transformation revealed a similar diminution in response to phytohaemagglutinin stimulation in both groups of patients compared to the normal controls. An increase of the 3H-thymidine incorporation was seen after stimulation with human liver mitochondrial antigen, and leukocyte migration inhibition could be observed with this antigen in both forms of chronic active hepatitis.

Genetic toxicology of lysergic acid diethylamide (LSD-25)

The acute and the chronic psychotomimetic potentials of the hallucinogen lysergic acid diethylamide (LSD-25) have been recognized for almost 40 years. That additional types of the biological effects should have come under scrutiny was directly attributable to widespread use and abuse of this drug on a world-wide basis. Although "genetic toxicology" encompasses a broad spectrum of disciplines, including many areas of highly specialized research, perhaps the most germane, and those on which this review has concentrated, are Clastogenicity, Mutagenicity, Teratogenicity and Oncogenicity. Based on our current understanding and interpretation of the available data, the genetic toxicology of LSD provides an excellent example of Newton's "third law of motion", e.g., to every force there is an equal and opposite reaction force. From the published material it is impossible to draw clear cut conclusions regarding any of the above "problem areas" in spite of the considerable scientific effort invested. Most of the in vitro studies performed on the clastogenicity of LSD indicate either suppression of mitosis or enhanced chromosome damage. However, extrapolation of such results to the in vivo situation is very difficult. With regard to in vivo human use of the drug, no concensus is attainable as to chromosome breakage and the inconsistencies within and between studies remain inexplicable. However, several of the "controlled" investigations assessing the in vivo effect of chemically pure LSD suggest a transient increase in lymphocyte chromosome breakage. On the other hand, the results of cytogenetic studies on experimental animals are contradictory. Although human studies are nonexistent, in those experimental organisms tested, using accepted techniques, LSD proved to be, at best, a weak mutagen, if mutagenic at all. Teratogenicity studies in animals are confusing due to the multitude of organisms and plethora of discriminant parameters studied. However, with regard to man there has been ample opportunity and one can conclude that LSD is not teratogenic. As to the drug's oncogenic potential, the 3 reported cases of leukemia in LSD users are most likely the result of coincidence.

Lymphocyte populations in acute viral gastroenteritis

Viral gastroenteritis was induced in 16 of 24 normal volunteers after oral administration of either the Norwalk or Hawaii agents. Clinical illness lasted for 24 to 48 h and resolved spontaneously. During acute illness, a transient lymphopenia was noted which involved all lymphocyte subpopulations (thymus-and bone marrow-derived, and null cells). No circulating lymphocytotoxins were detected, and the lymphocytes remaining in the circulation responded normally to mitogenic stimuli. The acute lymphopenia occurred at the time that mononuclear cell infiltration of the jejunal mucosa has been noted. These findings are consistent with the occurrence of a redistribution of circulating lymphocytes during acute illness, with accumulation of lymphocytes at the site of infection in the gut.

Investigation of the nature of Australia antigen. I: The absence of biological activity of Australia antigen in human blood leukocyte culture

Purified and concentrated preparations of Australia antigen had no stimulating effect on leukocytes of human subjects under study when tested either on DNA-polymerase activity, 3H-thymidine uptake or chromosomal alterations. Moreover, in patients with chronic hepatitis and cirrhosis of the liver no correlation between antigenemia and chromosome aberrations in blood leukocyte cultures could be detected. On the other hand, a serum obtained from a virus hepatitis patient with Australia antigen in the blood was found to stimulate leukocyte cultures from one patient with Down's syndrome and antigenemia, one mentally retarded patient and three normal donors. This stimulating agent is obviously not associated with Australia antigen.

Cell-mediated immunity in acute and chronic hepatitis

Peripheral lymphocytes from patients with hepatitis-B surface antigen (HBsAg)-positive and -negative acute hepatitis (AH), chronic active hepatitis (CAH), chronic persistent hepatitis (CPH), and normal controls were tested for in vitro cytotoxicity and blast transformation. Cytotoxicity was measured by chrominum (21Cr) release into the medium from 51Cr-labeled Chang liver cells after incubation for 6 h with peripheral lymphocytes at a lymphocyte target cell ratio of 200:1. Concomitant 72-h incubation studies were performed to assess thymus cell-dependent (T) lymphocyte function as measured by conccanavalin A (Con A)- stimulated incorporation of tritiated thymidine (blast transformation) and by cytotoxicity. It was found that (a) lymphocytes from patients with AH are cytotoxic to Chang liver cells compared to controls (P less than 0.001); (b) lymphocytes from patients with acute and chronic hepatitis are less cytotoxic when incubated with autologous and homologous HB2Ag-positive and -negative AH, CAH, and CPH are as cytotoxic as normal controls when stimulated with a nonspecific mitogen such as Con A; and (d) lymphocytes from patients with CAH while on prednisone therapy showed marked depression of cytotoxicity when stimulated with Con A. Thus these studies show that patients with AH have circulating T lymphocytes which are capable of causing the destruction of Chang liver cells. There is no defect in T-cell function as measured by Con A-stimulated cytotoxicity. There is a serum factor (s) in patients with acute and chronic hepatitis which inhibits spontaneous and induced lymphocyte cytotoxicity and blast transformation. Finally, prednisone treatment appears to inhibit lymphocyte cytotoxicity in patients with CAH.

Antibody titre changes and skin reactivity in patients with liver cirrhosis undergoing portocaval shunt operation

Ten patients with liver cirrhosis undergoing portocaval shunt operation have been followed immunologically during their postoperative course regarding antibody titres to various antigens, viral as well as bacterial. The antibody determinations included rubella, vaccinia and cytomagalo viruses, diptheria toxoid, Candida albicans, streptolysin O, typhoid and paratyphoid O and H and the syphilis reactions: Kahn, Wassermann and Meinicke. Twenty-one blood donors served as controls. Skin test reactions to diptheria, Candida albicans, streptokinase and tuberculin were performed on the same patients. Eight patients submitted to cholecystectomy served as controls for pre-and postoperative skin tests and antibody titres. The liver cirrhosis group before operation had a significantly higher number of elevated antibody titres concomitant with a significantly reduced skin test reactivity to diphtheria toxoid and streptokinase. An increase in the number of elevated antibody titres was seen after portocaval shunt operation. In no case was a higher antibody titre associated with an increase in skin reactivity to the corresponding antigen. A number of significant titre changes to viral antigens were seen in the postoperative course without clinical evidence of the corresponding viral disease. Thes findings indicate that under certain circumstances antibody titre changes should be interpreted with caution.

Chromosome abnormalities in chronic active hepatitis

An investigation on human peripheral blood lymphocyte chromosomes in chronic active hepatitis was carried out. A higher percentage of chromatid and chromosome lesions was recorded in all patients studied as compared with control groups-normal individuals, healthy subjects who had suffered from acute viral hepatitis, patients with alcoholic liver disease, and patients with mechanical jaundice due to cancer. The possible origin of these abnormalities is discussed.

Chromosomal aberrations in infective hepatitis

Structural chromosomal aberrations, in the form of breaks, were found in a significantly higher proportion of bone marrow cells in patients with infective hepatitis than in controls. These anomalies were observed during the first and third weeks after the onset of jaundice but had subsided by the sixth week. Chromosomal aberrations did not appear to be related to the severity of infective hepatitis or to the sex or age of the patients.The distribution of chromosomal abnormalities did not appear to be random; they were observed predominantly in the A(2) and B(4-5) series. Since no abnormalities were detected in the G-group chromosomes, no evidence in support of a relationship between infective hepatitis and Down's syndrome was obtained. Numerical chromosomal aberrations were not observed, nor was any evidence obtained that mitotic activity of bone marrow cells is suppressed in patients with infective hepatitis.

Australia (hepatitis-associated) antigen: physicochemical and immunological characteristics

This chapter discusses the discovery, characterization, immunology, and etiological significance of “Australia antigen (Au),” a new antigenic specificity appearing in the serum of patients with serum hepatitis, and carried on characteristic lipoprotein particles. In addition to its original name, given before its relationship to viral hepatitis became known, the antigen has also been given the designations, including Au(1) , SH antigen, Au/SH antigen, hepatitis antigen, and hepatitis-associated antigen (HAA). The synthesis of Au antigen, and its appearance in the serum, is specifically associated with infection by the causal agent of the SH type of viral hepatitis. The chapter discusses properties of the antigen, and of the particles which carry the Au specificity. It also discusses various serological techniques for Au antigen, such as two-dimensional double immunodiffusion (ID), complement fixation (CF), immunofluorescence (IF), reversed passive hemagglutination (RPHA) of antibody-coated red cells, immune electron microscopy (IEM), immunoelectroosmophoresis (IEOP), and radioimmunoassay (RIA).

Abnormalities of in vitro lymphocyte responses during rubella virus infections

In vitro rubella virus infections of lymphocytes from normal adult humans impaired their responsiveness to phytohemagglutinin (PHA) stimulations; a situation which seemed analogous to the PHA unresponsiveness of peripheral lymphocytes from babies with the congenital rubella syndrome. Such in vitro viral infection of normal cells also decreased the synthesis of normal nucleic acids and structural proteins, and abrogated the enhanced DNA synthesis induced by pokeweed and specific antigen stimulations. Furthermore, it was shown that live rubella virus, but not ultraviolet-irradiated virus, was necessary for the impaired mitogenic responses of normal leukocytes. These observations are interpreted to favor the view that the virus achieves its inhibitory effect on the action of mitogens by interference either directly or indirectly at an intracellular site. Such an action could reduce the functional potential of lymphocytes and impair their effectiveness as immunologically competent cells or as effectors in immunologic reactions.