Longitudinal assessment of sweat-based TNF-alpha in inflammatory bowel disease using a wearable device

Wearable devices can non-invasively monitor patients with chronic diseases. Sweat is an easily accessible biofluid for continuous sampling of analytes, including inflammatory markers and cytokines. We evaluated a sweat sensing wearable device in subjects with and without inflammatory bowel disease (IBD), a chronic inflammatory condition of the gastrointestinal tract. Participants with an IBD related hospital admission and a C-reactive protein level above 5 mg/L wore a sweat sensing wearable device for up to 5 days. Tumor necrosis factor-alpha (TNF-α) levels were continually assessed in the sweat via the sensor, and daily in the blood. A second cohort of healthy subjects without chronic diseases wore the device for up to 48 h. Twenty-eight subjects were enrolled. In the 16 subjects with IBD, a moderate linear relationship between serum and sweat TNF-α levels was observed (R2 = 0.72). Subjects with IBD were found to have a mean sweat TNF-α level of 2.11 pg/mL, compared to a mean value of 0.19 pg/mL in 12 healthy controls (p < 0.0001). Sweat TNF-α measurements differentiated subjects with active IBD from healthy subjects with an AUC of 0.962 (95% CI 0.894-1.000). A sweat sensing wearable device can longitudinally measure key sweat-based markers of IBD. TNF-α levels in the sweat of subjects with IBD correlate with serum values, suggesting feasibility in non-invasive disease monitoring.

Longitudinal monitoring of IL-6 and CRP in inflammatory bowel disease using IBD-AWARE

There are limitations to monitoring modalities for chronic inflammatory conditions, including inflammatory bowel disease (IBD). Wearable devices are scalable mobile health technology that present an opportunity to monitor markers that have been linked to worsening, chronic inflammatory conditions and enable remote monitoring. In this research article, we evaluate and demonstrate a proof-of-concept wearable device to longitudinally monitor inflammatory and immune markers linked to IBD disease activity in sweat compared to expression in serum. Sixteen participants with an IBD-related hospital admission and a C-reactive protein (CRP) > 5 μg/mL were followed for up to 5 days. The sweat sensing device also known as IBD AWARE was worn to continuously measure CRP and interleukin-6 (IL-6) in the sweat of participants via electrochemical impedance spectroscopy. Serum samples were collected daily. A linear relationship between serum and sweat readings for CRP and IL-6 was demonstrated based on individual linear correlation coefficients. Pooled CRP and IL-6 serum-to-sweat ratios demonstrated improving correlation coefficients as serum cutoffs decreased. Between the first and last day of observation, significant and non-significant trends in serum CRP and IL-6 were observed in the sweat. Comparison of sweat measurements between the subjects with active IBD and 10 healthy subjects distinguished an inflamed and uninflamed state with an AUC of 0.85 (95% CI: 0.68-1.00) and a sensitivity and specificity of 82% and 70% at a CRP cutoff of 938.9 pg/mL. IBD AWARE wearable device holds promise in longitudinally monitoring individuals with IBD and other inflammatory diseases.

Enalaprilat attenuates ischemic rises in intracellular sodium in the isolated rat heart via the bradykinin receptor

PURPOSE

Angiotensin-converting enzyme (ACE) inhibitors have been shown to have beneficial effects on ischemic myocardium. We examined whether the ACE inhibitor, enalaprilat (EN), improves intracellular sodium homeostasis during myocardial ischemia and the relationship of this effect to bradykinin.

METHODS

EN (3.2 nM) was administered to isolated rat hearts that were subjected to ischemia and reperfusion. Intracellular sodium and pH were monitored using magnetic resonance spectroscopy (MRS). The specific bradykinin B2 receptor antagonist, HOE 140 (10 nM), was administered with EN in some hearts to determine the effect of bradykinin blockade on EN-mediated effects.

RESULTS

EN blunted the rise in ischemic intracellular sodium, measured using MRS. With reperfusion, EN-treated hearts recovered 80% of their preischemic ventricular function, compared with negligible recover, in controls. These beneficial effects of EN were blocked when the bradykinin receptor antagonist, HOE 140, was coadministered with EN. HOE 140 also blocked EN-mediated attenuation of ischemic intracellular acidosis.

CONCLUSIONS

These results suggest that EN exerts beneficial effects on ischemic intracellular sodium and pH homeostasis via the bradykinin receptor. These effects of EN may provide a mechanism for the beneficial actions of this agent during ischemia.

Protection of ischemic myocardium in diabetics by inhibition of electroneutral Na+-K+-2Cl- cotransporter

Diabetes increases both the incidence of cardiovascular disease and complications of myocardial infarction and heart failure. Studies using diabetic animals have shown that changes in myocardial sodium transporters result in alterations in intracellular sodium (Na(i)) homeostasis. Because the changes in sodium homeostasis can be due to increased entry of Na+ via the electroneutral Na+-K+-2Cl- cotransporter (NKCC), we conducted experiments in acute diabetic hearts to determine if 1) net inward cation flux via NKCC is increased, 2) this cotransporter contributes to a greater increase in Na(i) during ischemia, and 3) inhibition of NKCC limits injury and improves function after ischemia-reperfusion. These issues were investigated in perfused type I diabetic and nondiabetic rat hearts subjected to ischemia and 60 min of reperfusion. A group of diabetic and nondiabetic hearts was perfused with 5 microM of bumetanide, an inhibitor of NKCC. Flux via NKCC, Na(i), and ATP was measured in each group with the use of radiotracer 86Rb, 23Na, and 31P nuclear magnetic resonance spectroscopy, respectively, whereas ischemic injury was assessed by measuring creatine kinase release on reperfusion. Cation flux via NKCC, as measured by 86Rb uptake, was significantly increased in diabetic hearts. Inhibition of NKCC significantly reduced ischemic injury in diabetic hearts, improved functional recovery on reperfusion, attenuated the ischemic rise in Na(i), and conserved ATP during ischemia-reperfusion. Parallel studies in nondiabetic hearts showed that NKCC inhibition was not cardioprotective. These findings demonstrate that flux via NKCC is increased in type I diabetic hearts and that inhibition with bumetanide attenuates changes in Na(i) and ATP during ischemia and protects against ischemic injury. The data suggest a therapeutic role for pharmacological agents that inhibit flux via NKCC in diabetic patients with myocardial ischemia.

Protection of ischemic hearts by high glucose is mediated, in part, by GLUT-4

Metabolic interventions that promote glucose use during ischemia have been shown to protect ischemic myocardium and improve functional recovery on reperfusion. We evaluated whether the cardioprotection afforded by high glucose during low-flow ischemia is associated with changes in the sarcolemmal content of glucose transporters, specifically GLUT-4. Isolated rat hearts were paced at 300 beats/min and perfused under normal glucose (5 mM) or high glucose (10 mM) conditions in buffer containing 0.4 mM albumin, 0.4 mM palmitate, and 70 mU/l insulin and subjected to 50 min of low-flow ischemia and 60 min of reperfusion. To determine the importance of insulin-sensitive glucose transporters in mediating cardioprotection, a separate group of hearts were perfused in the presence of cytochalasin B (10 microM), a preferential inhibitor of insulin-sensitive glucose transporters. Ischemic contracture during low-flow ischemia and creatine kinase release on reperfusion was decreased, and the percent recovery of left ventricular function with reperfusion was enhanced in hearts perfused with high glucose (P < 0.03). Hearts perfused with high glucose exhibited increased GLUT-4 protein expression in the sarcolemmal membrane compared with control hearts under baseline conditions, and these changes were additive with low-flow ischemia. In addition, high glucose did not affect the baseline distribution of sarcolemmal GLUT-1 and blunted any changes with low-flow ischemia. These salutary effects were abolished when glucose transporters are blocked with cytochalasin B. These data demonstrate that protection of ischemic myocardium by high glucose is associated with increased sarcolemmal content of the insulin-sensitive GLUT-4 and suggest a target for the protection of jeopardized myocardium.

Experimental assessment of non-treated bentonite as the buffer material of a radioactive waste repository

The bentonite-based material being evaluated in several countries as potential barriers and seals for a nuclear waste disposal system is of mostly sodium type, whereas most bentonite available in Korea is known to be of calcium type. In order to investigate whether local Korean bentonite could be useful as a buffer or sealing material in an HLW repository system, raw bentonites sampled from the south-east area of Korea were examined in terms of their physicochemical properties such as surface area, CEC, swelling rate, and distribution coefficient. The diffusion behavior of some radionuclides of interest in compacted bentonite was also investigated. Considering that HLW generates decay heat over a long time, the thermal effect on the physicochemical properties of bentonite was also included. Four local samples were identified as Ca-bentonite through XRD and chemical analysis. Of the measured values of surface area, CEC and swelling rate of the local samples, Sample-A was found to have the greatest properties as the most likely candidate barrier material. The distribution coefficients of Cs-137, Sr-85, Co-60 and Am-241 for Sample-A sample were measured by the batch method. Sorption equilibrium was reached in around 8 to 10 days, but that of Sr was found to be reached earlier. Comparing the results of this study with the reference data, domestic bentonite was found to have a relatively high sorption ability. For the effect of varying concentration on sorption, the values of Kd peaked at 10(-9)-10(-7) mol/l of radionuclide concentration. In XRD analysis, the (001) peak of Sample-A was fully collapsed above 200 degrees C. The shoulder appearing at about 150 degrees C in the DSC curve was found to be evidence that Sample-A is predominated by Ca-montmorillonite. The loss of swelling capacity and CEC of Sample-A started at about 100 degrees C. The swelling data and the (001) peak intensity of the heat-treated sample showed that they were linearly interrelated. The measured Kd values of Co-60, Cs-137 and Am-241 for the samples heat-treated at various temperature showed that the domestic bentonite still retained sorption capacity below 100 degrees C. In addition to such findings of thermal effects, it was found that the presence of calcium in bentonite may help to assure long-term stability under the expected thermo-hydro conditions. The Da values of Sr-85, Cs-137, Co-60, Am-241 and Cl-36 were measured to be 1.073 x 10(1), 6.705 x 10(-1), 1.226 x 10(-1), 1.310 x 10(-2) and 9.490 x 10(1) microns 2/sec, respectively, which could be arranged with the magnitude of their distribution coefficients, i.e. Cl > Sr > Cs > Co > Am. As the as-pressed density of bentonite increasing from 1.8 to 2.0 g/cm3, the Da-value of Cs-137 decreased by 25%. From the analyses of the diffusion mechanism of radionuclides in compacted bentonite, the surface diffusion due to the concentration gradients of radionuclide sorbed on the bentonite particles was found to be a dominating transport process of radionuclides in compacted bentonite with 1.8 g/cm3. Bases on these results, it was identified that domestic bentonite has potential as a chemical barrier material in a repository system. Some data obtained in the results could contribute to the engineering parameters to design a waste package and engineered barrier or to develop an appropriate disposal concept satisfying the safety requirements.

Lack of utility in clinical practice of cytologic examination of nonbloody cyst fluid from palpable breast cysts

OBJECTIVE

This study was undertaken to answer the following question: Does cytologic evaluation of nonbloody fluid aspirated from breast cysts contribute to appropriate clinical management?

STUDY DESIGN

A retrospective review of palpable breast cyst fluid cytologic reports and associated medical records was undertaken to determine whether the cytologic findings affected patient management. Breast cyst size, fluid volume, fluid color, and patient age were abstracted from 689 medical records (1988-1999) of women whose palpable cysts had been aspirated at the Breast Diagnostic Center, Women's and Children's Hospital, Los Angeles. These observations were correlated with the fluid cytologic reports.

RESULTS

Except for frankly bloody fluid, all breast fluid cytologic reports listed the results as acellular, inadequate for cytologic diagnosis, or no malignant cells identified.

CONCLUSION

In clinical practice only frankly bloody fluid should be submitted for cytologic analysis. All other cyst fluid should be discarded.

Human biodistribution and dosimetry of the PET perfusion agent copper-62-PTSM

Copper-62-pyruvaldehyde bis(N4-methyl)thiosemicarbazone (PTSM) has been proposed as a generator-produced radiopharmaceutical for perfusion imaging using PET. Several clinical studies have demonstrated the ability of 62Cu-PTSM to quantitate myocardial and cerebral perfusion in humans. Because 62Cu-PTSM is generator-produced, it can be provided to clinical centers without cyclotron availability and, therefore, represents a cost-effective, practical PET perfusion tracer for clinical applications. To assess the safety, time-dependent biodistribution, and whole-body and organ-specific absorbed radiation dose estimates of this tracer, a Phase I study of 62Cu-PTSM was performed using whole-body imaging with PET in 10 healthy volunteers and with the radiopharmaceutical delivered by a compact modular generator unit.

METHODS

Five male and five female subjects underwent a series of clinical tests and head-to-midthigh, whole-body PET scans at three time points over 1 hr after intravenous injection of 62Cu-PTSM. Before injection of the tracer, PET transmission scans were performed and used to correct the emission data for attenuation. Final image data were expressed in units of mCi/cc. Using standard organ weights, the percent injected dose per organ was calculated. Biodistribution data were obtained at three different time points and from these data biological half-lives in different organs were determined for calculation of radiation absorbed dose estimates.

RESULTS

The liver was seen as the critical organ receiving a dose of 0.0886 rad/mCi. This organ defined the maximum single injected dose at 56 mCi using the limit of 5 rads to a critical organ per study per year. The whole-body dose is 0.0111 rad/mCi, resulting in a 0.622 rad exposure with a maximum single injection dose. Only trace levels of activity were found in the urine, which suggests low levels of urinary excretion and bladder exposure. No significant clinical, electrocardiographic or laboratory abnormalities were seen after the injection of 62Cu-PTSM.

CONCLUSION

Copper-62-PTSM is a clinically safe radiopharmaceutical with favorable dosimetry for human studies at injected doses significantly above those projected for use in clinical studies.

Metabolic inhibition in the perfused rat heart: evidence for glycolytic requirement for normal sodium homeostasis

Subcellular compartmentalization of energy stores to support different myocardial processes has been exemplified by the glycolytic control of the ATP-sensitive K+ channel. Recent data suggest that the control of intracellular sodium (Nai) may also rely on glycolytically derived ATP; however, the degree of this dependence is unclear. To examine this question, isolated, perfused rat hearts were exposed to hypoxia, to selectively inhibit oxidative metabolism, or iodoacetate (IAA, 100 mumol/l), to selectively inhibit glycolysis. Nai and myocardial high-energy phosphate levels were monitored using triple-quantum-filtered (TQF) 23Na and 31P magnetic resonance spectroscopy, respectively. The effects of ion exchange mechanisms (Na+/Ca2+, Na+/H+) on Nai were examined by pharmacological manipulation of these channels. Nai, as monitored by shift reagent-aided TQF 23Na spectral amplitudes, increased by approximately 220% relative to baseline after 45 min of perfusion with IAA, with or without rapid pacing. During hypoxia, Nai increased by approximately 200% during rapid pacing but did not increase in unpaced hearts or when the Na+/H+ exchange blocker ethylisopropylamiloride (EIPA, 10 mumol/l) was used. Neither EIPA nor a low-Ca2+ perfusate (50 mumol/l) could prevent the rise in Nai during perfusion with IAA. Myocardial function and high-energy phosphate stores were preserved during inhibition of glycolysis with IAA and continued oxidative metabolism. These results suggest that glycolysis is required for normal Na+ homeostasis in the perfused rat heart, possibly because of preferential fueling of Na-K-adenosinetriphosphatase by glycolytically derived ATP.

Evaluation of multiple-quantum-filtered 23Na NMR in monitoring intracellular Na content in the isolated perfused rat heart in the absence of a chemical-shift reagent

The feasibility of employing triple-quantum-filtered (TQF) or double-quantum-filtered (DQF) 23Na NMR spectra to monitor intracellular Na (Nain) content in isolated rat hearts perfused in the absence of a chemical-shift reagent (SR) was investigated. This necessitated characterization of the following: first, the pool of Nain represented by the intracellular TQF (TQFin) spectrum; second, the maximum extent to which altered transverse relaxation times affect TQFin spectral amplitudes; and finally, the situations for which the SR-free method can reliably be applied. The rates of increase in peak amplitudes of both intracellular TQF spectra, adjusted for changes in both fast (T2f) and slow (T2s) transverse relaxation times, and intracellular single-quantum (SQin) spectra were identical during no-flow ischemia, indicating that TQFin and SQin spectra represent the same Nain population. Addition of an Na/K ATPase inhibitor, ouabain (>/=500 microM), and no-flow ischemia induced similar rates of increase of Nain content. However, the Nain level for which the T2 values started to increase was lower for ischemic (<140% of preischemic values) than for ouabain-exposed (>165%) hearts, which is consistent with the known earlier onset of intracellular swelling in ischemic hearts. Exposure of hearts to hyperosmotic perfusate (200 mM sucrose) increased [Nain], due to a decreased cell volume and an unchanged Nain content, but caused a decrease in T2 values, a trend opposite to that observed with exposure of hearts to ouabain or ischemia. T2 values therefore consistently correlated only with cell volume, not with Nain content or concentration, indicating an important role for intracellular macromolecule concentration in modulating transverse relaxation behavior. The combined effect of ischemia-induced increases in T2 values and their inhomogeneous broadened forms was an approximately 6% overestimation of Nain content from amplitudes of SR-aided TQFin spectra, indicating negligible effect of transverse relaxation-dependent alterations on TQFin spectral amplitudes. Thus, Nain content may be reliably determined from SR-free TQF spectra when the contribution from extracellular Na does not appreciably vary, such as during constant pressure perfusion. Following complete reduction in perfusion pressure, both SR-free TQF and DQF spectra respond to increases in Nain content. However, SR-free DQF NMR provides an estimate of Nain content much closer to that provided by the SR-aided method, due to the appreciable decrease of the extracellular DQF signal resulting from destructive interference between second- and third-rank tensors.

Mutant and wild-type androgen receptors exhibit cross-talk on androgen-, glucocorticoid-, and progesterone-mediated transcription

Androgen, glucocorticoid, and progesterone receptors (ARs, GRs, and PRs) often can regulate transcription via composite hormone response elements in target genes. We have used artificial and natural mutant ARs from patients with androgen resistance to study their effects on dominant negative activity on wild type AR, GR, and PR function on mouse mammary tumor virus (MMTV) and tyrosine aminotransferase (TAT) promoters. Artificial ARs that contained internal deletions within the amino-terminal region had minimal transcriptional activity but blocked ligand-mediated transcription by wild type AR. Mutants containing deletions of the DNA-binding and ligand-binding domains had minimal or weak dominant negative activity. We then tested the ability of wild type and mutant ARs to modulate GR- and PR-mediated transcriptional activity. The amino-terminal deletion mutants exerted dominant negative effects on GR- and PR-mediated activity, both in the absence and presence of testosterone. Surprisingly, wild type AR, which had approximately 20% of the maximal transcriptional activity of GR on the MMTV promoter, also had dominant negative activity on dexamethasone-regulated transcription mediated by GR. This dominant negative activity likely involves DNA binding because a point mutation in the DNA-binding domain abrogated such activity of an amino-terminal deletion mutant. Additionally, natural human AR mutants from patients with androgen resistance, which do not bind either DNA or ligand, did not block dexamethasone-mediated transcription. In summary, these studies suggest that mutant and wild type ARs can display dominant negative activity on other steroid hormone receptors that bind to a composite hormone response element This cross-regulation may be important in regulating maximal transcriptional activity in tissues where these receptors are coexpressed and may contribute to the phenotype of patients with steroid hormone resistance.

Factors that enhance Escherichia coli-expressed TR beta binding to T3 and DNA

Thyroid hormone receptors (TRs) recently have been produced in E. coli by several laboratories. We produced E. coli-expressed human TR beta using the histidine/fusion protein system. Surprisingly, we observed that reticulocyte lysate, nonspecific proteins, and 1% Triton X dramatically increased both the T3- and DNA-binding activities of human TR beta. These studies demonstrate that there are a number of factors that will enhance ligand and DNA binding of E. coli-expressed TR beta. Addition of these factors to reaction samples containing E. coli-expressed TRs will help to optimize measurement conditions. These findings also suggest that experiments in which cellular proteins are added to highly purified TR preparations may require controls to eliminate contributions by nonspecific proteins.

Estimation of right ventricular mass in normal subjects and in patients with primary pulmonary hypertension by nuclear magnetic resonance imaging

OBJECTIVES

This study was designed to test the accuracy of nuclear magnetic resonance (NMR) imaging as a noninvasive technique for estimating right ventricular mass in normal subjects and in patients with primary pulmonary hypertension.

BACKGROUND

An accurate means of noninvasively estimating right ventricular mass may allow better characterization of the degree of right-sided pressure or volume overload caused by underlying cardiac or pulmonary diseases.

METHODS

End-diastolic short-axis electrocardiogram (ECG)-gated spin echo NMR images of the heart were obtained in vivo in 13 patients with primary pulmonary hypertension and 10 normal adult volunteers. Both right and left ventricular mass were computed by summing the myocardial slice volumes over all slices spanning the myocardium and multiplying by myocardial density. This technique of myocardial mass determination was verified by imaging 10 calf hearts and comparing the NMR-determined right and left myocardial mass with the actual mass determined by weighing the right and left ventricles.

RESULTS

In the calf heart study, an excellent correlation was obtained between the directly measured ventricular mass and the NMR-calculated mass, for both the right and the left ventricle. Patients with primary pulmonary hypertension had an elevated right ventricular mass index compared with that of normal subjects (62.69 +/- 8.72 g/m2 vs. 23.32 +/- 1.36 g/m2, p < 0.0005). There was no significant difference in left ventricular mass index between the two groups. Both mean intraobserver and inter-observer variability in myocardial mass determination were low. Linear regression analysis between right ventricular mass index and mean pulmonary artery pressure was significant (r = 0.75, p < 0.003).

CONCLUSIONS

Electrocardiogram-gated spin echo NMR imaging of the heart may be used for quantitating right ventricular mass in normal subjects and in patients with primary pulmonary hypertension, in whom it may also provide an alternative noninvasive technique for estimating mean pulmonary artery pressure.

Effects of portacaval shunt and hepatic artery ligation on liver surface oxygen tension and effective hepatic blood flow

Liver surface oxygen tension (LSOT) and nutrient hepatic blood flow (NHBF) were measured in rats 1 hr and 1 week after sham operation, portacaval shunt (PCS), and hepatic artery ligation (HAL). LSOT was measured using a heated Clark electrode (37 deg) and was expressed as percentage of rectus muscle O2 tension to correct for changes in systemic oxygenation. Nutrient hepatic blood flow (NHBF) was measured using steady-state, low-dose galactose clearance pharmacokinetics. Acutely, we found a close correlation between LSOT and nutrient hepatic blood flow after both hepatic artery ligation and portacaval shunt. At one week after hepatic artery ligation, LSOT and nutrient hepatic blood flow made parallel increases. However, 1 week after portacaval shunt, LSOT increased while nutrient hepatic blood flow remained reduced. The divergence in these results between the two methods of producing hepatic hypoperfusion, implies that LSOT recovers via a different mechanism after portacaval shunt. Recovery of LSOT at one week probably reflects normalization of hepatic O2 delivery after hepatic artery ligation and impaired oxygen utilization after portacaval shunt.

Gas transport during oscillatory flow in a network of branching tubes

A transport coefficient was measured for a range of oscillatory flow conditions in a branching network of tubes. Measurements were made both across the first generation of a three-generation network and the second generation of a four-generation network. The results for these two series of tests were similar, indicating that there was no significant effect due to the system boundaries. The results are cast in terms of an effective axial diffusion coefficient of the form (Formula: see text) where kappa is the molecular diffusivity, Vt is the local stroke volume (cc); and f is the oscillation frequency (Hz). These results are compared to those obtained by other investigators in branching systems of similar geometry. At low frequency, this result is found to be in approximate agreement with the steady flow result of Scherer, et al. [15]. This expression differs from the oscillatory flow results of Tarbell, et al. [19] for liquids, primarily in terms of the effects of oscillation frequency.

Chinese traditional food therapy

Chinese food therapy has endured and evolved from the beginning of Chinese civilization to the present day. Basic tenets central to food therapy such as "curing and nourishing come from the same source" and "when you eat, satisfy only seven-tenths of your hunger" have been passed down from generation to generation. Dietetic practice today must take into consideration and respect many of the ancient beliefs for maximum effectiveness with many of today's Chinese.

The effect of skin homograft rejection on recipient and donor mixed leukocyte cultures

The lymphocyte proliferation in repeatedly studied mixed leukocyte cultures of peripheral white blood cells from a skin graft donor and 2 recipients was significantly increased at the time of graft rejection. This was determined from the increased proportions of mononuclear cells labeling with tritiated thymidine, increased mitotic indices, and the appearance of increased numbers of transformed lymphocytes after rejection of 1st and 2nd skin grafts. The temporarily enhanced response occurred sooner and was of shorter duration after the second than after the first graft, but was quantitatively similar each time. The cell proliferation in the mixed leukocyte cultures of the two recipients was similarly affected by the homograft rejections. The cultures containing three cell populations usually manifested a greater lymphocyte response than corresponding cultures of leukocytes from only two unrelated subjects. An increase in the ratio of female recipient to male graft donor metaphases in the cultures at the time of enhanced lymphocyte transformation indicated that proliferation of the graft recipient lymphocytes was responsible for the above findings. Unmixed, unstimulated control cultures grown in autologous, the other subjects plasma, or heterologous calf serum failed to support significant lymphocyte transformation. The role of humoral factors and relationship of the in vitro cellular responses to the in vivo homograft reaction are discussed.