Increased airway iron as a potential factor in the persistence of Pseudomonas aeruginosa infection in cystic fibrosis

Iron availability is critical to many bacteria and increased iron has been described in airway secretions in cystic fibrosis (CF). The main aim of the present study was to assess the relationship between iron in CF sputum and the quantitative bacterial burden. Iron, ferritin and total cell counts (TCC) were assessed in sputum samples obtained from 15 clinically stable CF patients chronically infected with Pseudomonas aeruginosa. Sputum samples were also obtained at the commencement of episodes of acute exacerbation in 10 subjects and analyses were repeated in six of these exacerbation cases after i.v. antibiotic treatment. The relationship between iron indices and the presence of P. aeruginosa, as well as total anaerobic bacterial load, was determined. Sputum was also obtained from 10 CF patients with no evidence of infection with P. aeruginosa and 11 normal healthy controls. Sputum iron, ferritin and TCC were significantly elevated in all CF patients, even in those not infected with P. aeruginosa, compared with healthy controls. There was a strong positive relationship between sputum iron and P. aeruginosa in clinically stable patients, but not in samples obtained during an acute exacerbation. There was no relationship between sputum iron and anaerobic bacterial load. Antibiotic treatment significantly reduced sputum TCC and anaerobic bacterial load, but not iron, ferritin or the presence of P. aeruginosa during an exacerbation. In conclusion, the present study suggests that increased airway iron may be important to Pseudomonas aeruginosa persistence in cystic fibrosis.

Rattus norvegicus: not a model for Aeromonas-associated gastroenteritis in man

The lack of a suitable animal model of Aeromonas-associated diarrhoea has hampered investigations into Aeromonas pathogenic mechanisms. Hence, a published report that clindamycin-pretreated rats developed signs and symptoms of enteritis following intragastric inoculation of an Aeromonas strain required further investigation. Although we could demonstrate long-term colonisation (>12 days) and histological damage in this animal model with Pseudomonas aeruginosa isolated from patients with chronic diarrhoea, this was not seen with Aeromonas spp. Six Aeromonas strains, selected for their potential virulence and colonising abilities and including the strain from the original report, were either not recovered from stools or were recovered for no longer than 2 days post inoculation. Intestinal histology remained normal. Destruction of bacteria in vivo appeared to be due to immune mechanisms as inoculum strains were not 'suicidal' or unduly sensitive to low pH or clindamycin. This study was, therefore, unable to validate the clindamycin-treated rat model as a useful one for investigating the enteropathogenicity of Aeromonas species. Possible reasons for the discrepancy between our study and the original report are discussed.

Investigation of the role of type IV Aeromonas pilus (Tap) in the pathogenesis of Aeromonas gastrointestinal infection

Although there is substantial evidence that type IV pili purified from diarrhea-associated Aeromonas species (designated Bfp for bundle-forming pilus) are intestinal colonization factors (S. M. Kirov, L. A. O'Donovan, and K. Sanderson, Infect. Immun. 67:5447-5454, 1999), nothing is known regarding the function of a second family of Aeromonas type IV pili (designated Tap for type IV Aeromonas pilus), identified following the cloning of a pilus biogenesis gene cluster tapABCD. Related pilus gene clusters are widely conserved among gram-negative bacteria, but their significance for virulence has been controversial. To investigate the role of Tap pili in Aeromonas pathogenesis, mutants of Aeromonas strains (a fish isolate of A. hydrophila and a human dysenteric isolate of A. veronii bv. sobria) were prepared by insertional inactivation of the tapA gene which encodes the type IV pilus subunit protein, TapA. Exotoxic activities were unaffected by the mutation in tapA. Inactivation of tapA had no effect on the bacterial adherence of these two isolates to HEp-2 cells. For the A. veronii bv. sobria isolate, adhesion to Henle 407 intestinal cells and to human intestinal tissue was also unaffected. There was no significant effect on the duration of colonization or incidence of diarrhea when the A. veronii bv. sobria strain was tested in the removable intestinal tie adult rabbit diarrhea model or on its ability to colonize infant mice. Evidence was obtained that demonstrated that TapA was expressed by both Aeromonas species and was present on the cell surface, although if assembled into pili this pilus type appears to be an uncommon one under standard bacterial growth conditions. Further studies into factors which may influence Tap expression are required, but the present study suggests that Tap pili may not be as significant as Bfp pili for Aeromonas intestinal colonization.

Functional characterization of type IV pili expressed on diarrhea-associated isolates of Aeromonas species

Our past work has shown that long, flexible type IV pili (single or in bundles) are the predominant pili expressed on fecal isolates of diarrhea-associated species of Aeromonas (Aeromonas veronii biovar sobria and A. caviae). They represent a family of type IV pili which we have designated Bfp (for bundle-forming pili). Reports from Japan suggest that Bfp are intestinal colonization factors. This study presents compelling evidence to support this conclusion. Aeromonas bacteria and/or Bfp purified from a strain of A. veronii biovar sobria were shown to adhere to epithelial and intestinal cell lines, freshly isolated human enterocytes, and fresh and fixed human and rabbit intestinal tissues, as determined by light and electron microscopy and immunohistochemical detection. Removal of Bfp by mechanical means decreased adhesion to cell lines by up to 80%. Purified Bfp blocked adhesion of the test strain to intestinal cells in a dose-dependent manner. Adhesion was also blocked by the Fab fraction of anti-Bfp immunoglobulin G. Moreover, ultrastructural studies (ruthenium red staining and transmission and scanning electron microscopy) demonstrated for the first time that Aeromonas adhesion to human enterocytes is pilus mediated and suggested that Bfp may also promote colonization by forming bacterium-to-bacterium linkages. Bfp-positive isolates examined for type IV pilus-mediated twitching motility in agar and slide culture assays developed for Pseudomonas aeruginosa did not, however, exhibit this function.

The type IV Aeromonas pilus (Tap) gene cluster is widely conserved in Aeromonas species

Nothing is known regarding the expression or function of the type IV Aeromonas pilus (Tap), which was recently identified following the cloning of a pilus biogenesis gene cluster (tapABCD). As a first step to determine the possible significance of Tap for Aeromonas virulence, the distribution of the tapA and tapD genes in hybridization group reference strains and clinical (n=42) and environmental (n=29) isolates was determined. Homologues of tapA and tapD were present in all strains tested. Hybridization with the tapA probe enabled us to differentiate between clinical and environmental isolates of A. veronii biovar sobria.

Pseudomonas aeruginosa as a cause of infectious diarrhoea

Pseudomonas aeruginosa is not generally considered a cause of infectious diarrhoea. However, it was the predominant organism isolated from the faeces of 23 unrelated, hospital outpatients investigated in the course of a year for persistent (> 1 week duration) diarrhoea. To investigate the possible aetiological role of P. aeruginosa, these patient histories were reviewed and a selection of their faecal isolates were investigated in vitro (n > or = 10) and in vivo (n = 2) for virulence. The patients had a mean age of 60 years, were receiving antibiotics and/or had an underlying illness. Extensive microbiological investigations identified no other potential or recognized enteropathogen in the faeces of 20 of these patients. More than 40% of the isolates tested were able to adhere to HEp-2 cells and exhibited twitching motility (type IV pili), properties indicative of their ability to colonize the human intestine. Cytotoxic activity was demonstrated in bacterium-free cell supernatants of over 80% of isolates; supernatants of four isolates tested in infant mice were weakly enterotoxigenic. Two isolates intragastrically inoculated into clindamycin pre-treated rats established persistent infections and induced signs and symptoms of enteritis. Overall these findings suggest that P. aeruginosa can cause diarrhoea particularly in immunodeficient individuals.

Characterisation of a type IV pilus produced by Aeromonas caviae

A pilus produced by a clinical isolate of Aeromonas caviae (strain CA195) was purified and partially characterised. The Mr of the pilin was estimated to be 23 kDa by SDS-PAGE. Its N-terminal amino-acid sequence showed that it was closely related to 'bundle-forming' type IV pili purified from other Aeromonas spp. associated with gastro-enteritis and considered to be important intestinal colonisation factors. Bundle-forming pili, often with a polar location, were seen on the surface of strain CA195 which was highly adherent to HEp-2 cells. Removal of surface structures by mechanical means decreased adhesion (by > or = 50%) suggesting that these pili played some role in HEp-2 cell binding. This pilus type could prove an important marker for enteropathogenic A. caviae which appear to lack other putative virulence factors.

Aeromonas spp. possess at least two distinct type IV pilus families

Type IV pili have been purified from strains of most of the Aeromonas species associated with gastroenteritis (A. veronii biovar sobria, A. hydrophila, A. trota and A. caviae). They appear to be a related family (molecular mass of pilin 19 to 23 kDa) with a tendency to bundle-formation. Hence, we have designated them 'bundle-forming pili' (Bfp). A type IV pilus biogenesis gene cluster (tapABCD) recently cloned from a strain of A. hydrophila, however, encoded a 17 kDa pilin which differed significantly in its N-terminal amino acid sequence from the Bfp pilins. This paper describes the cloning of part (tapA and approximately 20% of tapB) of a homologous pilin gene cluster from a Bfp-positive strain of A. veronii biovar sobria, and presents evidence that the entire pilin gene cluster (tapABCD) is present in this strain. The predicted N-terminal amino acid sequence of the pilin encoded by the A. veronii biovar sobria tapA differed markedly from the corresponding sequence of its Bfp pilin, and those of the Bfp purified from other Aeromonas strains and species. Probing with tapA and tapD genes showed that these Bfp-positive Aeromonas strains also possessed the Tap gene cluster. TapA proteins of A. veronii biovar sobria and A. hydrophila shared 53% identity and 63% homology. We conclude that Aeromonas species are potentially able to express at least two distinct families of type IV pili (Bfp and Tap).

Plasmids and Aeromonas virulence

Most putative virulence determinants of Aeromonas species are chromosomally encoded. However, several recent reports have indicated that some may be carried on or regulated by plasmids. Therefore, we examined the plasmid carriage rate of a total of 140 clinical and environmental Aeromonas isolates. Plasmid carriage was compared with the ability of an isolate to produce toxins and adhere to HEp-2 cells. Overall, plasmid incidence in Aeromonas species was low (23/140, 16%) and independent of the source of the isolate. Plasmids were, however, more common in environmental isolates of A. veronii biovar sobria than in clinical isolates of this species (P < 0.05). We could find no evidence to support the recent literature findings that plasmids may have a role in Aeromonas virulence.

Characterization of a type IV bundle-forming pilus (SFP) from a gastroenteritis-associated strain of Aeromonas veronii biovar sobria

The colonization mechanisms of enteropathogenic Aeromonas strains are poorly characterized, but recent studies indicate that some filamentous structures are intestinal adhesins. This study describes the purification and characterization of a long, flexible pilus from a gastroenteritis-associated strain of Aeromonas veronii biovar sobria. SDS-PAGE analysis (various conditions) of pili preparations yielded a pilin protein band of approximately 21 kDa. Its N-terminal amino acid sequence was unambiguous and homologous with those of type IV pilins. Immunogold electron microscopy with rabbit antisera produced against this pilin protein (SFP) decorated single pili and rope-like bundles of pili on the bacterial surface. These were seen more frequently on strains grown at 22 degrees C compared with 37 degrees C and in liquid rather than on solid medium. SFP was not detected on any of 104 strains of Aeromonas (different species and sources) from our culture collection, although morphologically similar structures were seen on a number of these strains. This finding and differences among other published amino acid sequences show that Aeromonas type IV pili are antigenically diverse. Bundle-forming type IV 'class B' pili are important in the virulence of other enteropathogenic bacteria. The N-terminal amino acid sequence of the Aeromonas SFP, however, showed closer homology to the type IV 'class A' pilins. Studies are in progress to investigate the role of SFP in Aeromonas virulence.

Colonization of streptomycin-treated mice by Aeromonas species

Streptomycin-treated adult mice were investigated as a possible model for studying the enteropathogenicity of Aeromonas species. C57BL mice pre-treated with streptomycin (5.0 g/L drinking water, 48 hours) received a single intragastric dose (10(10) bacteria /10.5 mL) of one of six well-characterized, toxin-producing, human diarrhoeal isolates of A. veronii biovar sobria (n = 3) or A. hydrophila (n = 3). Their faeces were examined for Aeromonas for 10 days post-challenge. All strains colonized the antibiotic-treated mice. Colonization did not occur in mice which did not receive streptomycin. Strains of A. hydrophila were recovered in greater numbers than strains of A. veronii biovar sobria, and colonized ( > or = 10(3) cfu/g of faeces) a greater proportion of mice at day 10. Strains of the latter species, however, were more adherent in cell line assays used as models of intestinal adhesion. A. hydrophila strains localized in the large intestine and appeared not to be cell associated. This study, therefore, points to species-related differences in intestinal colonization mechanisms. The streptomycin-treated adult mouse model may prove useful for further investigation of some of these mechanisms. Diarrhoeal symptoms were, however, not produced in this model.

Adhesion of Aeromonas sp. to cell lines used as models for intestinal adhesion

Adhesion to HEp-2 cells has been shown to correlate with enteropathogenicity for Aeromonas species. Such adhesion is thought to reflect the ability of strains to adhere to human intestinal enterocytes, although HEp-2 cells are not of intestinal origin. In this study strains of Aeromonas veronii biotype sobria isolated from various sources were investigated in parallel assays for their ability to adhere to HEp-2 cells and to an intestinal cell line (Caco-2). Quantitative assays showed identical adhesion values were obtained with both cell lines. Adhesion was best when bacteria were grown at 22 degrees C compared with 37 degrees C and 7 degrees C. Some environmental isolates showed greater adhesion when grown at 7 degrees C than when grown at 37 degrees C. Filamentous structures on these strains are also optimally expressed under the above conditions (reported elsewhere). Mechanical shearing or trypsin treatment to remove surface structures from several adhesive strains grown at 22 degrees C decreased adhesion to cell lines by 50-80% providing further indirect evidence that filamentous adhesins may play a role in cell adhesion for this Aeromonas species.

Electron microscopic examination of factors influencing the expression of filamentous surface structures on clinical and environmental isolates of Aeromonas veronii Biotype sobria

Strains of Aeromonas veronii biotype sobria isolated from clinical and environmental sources were examined for their expression of surface structures under a variety of culture conditions. When grown on solid media at 37 degrees C, more than 95% of bacteria from the majority of strains isolated from human diarrheal feces and chicken carcasses were non-piliated or expressed only a few pili of long, flexible morphology per cell. Strains isolated from water or other foods were much more likely to express pili. Heavily piliated strains (all sources) possessed pili of several morphological types, including long, flexible pili of varying widths and rigid pili of varying lengths. Expression of Pili was favored by growth at temperatures ca. 20 degrees C and below and growth in liquid medium. Most fecal strains expressed some pili under these conditions. In addition, other surface structures (fibrillar aggregates, fibrillar networks bundle-forming pili) were seen on some strains from most sources. These were also seen most frequently when bacteria were grown in liquid media at temperatures ca. 20 degrees C and below. Pili expression was not dramatically influenced by growth under anaerobic conditions, or in iron-depleted media, or by combinations of the above conditions. The role of the above surface structures in Aeromonas pathogenicity remains to be elucidated.

The public health significance of Aeromonas spp. in foods

There is now evidence that some strains of Aeromonas species are enteropathogens. Such strains possess virulence properties, such as the ability to produce enterotoxins, cytotoxins, haemolysins and/or the ability to invade epithelial cells. Strains with these properties are common contaminants of drinking water and a wide range of foods. Contact or consumption of contaminated water, especially in summer, is a major risk factor in Aeromonas-associated gastroenteritis. Aeromonas-contaminated foods may also be vehicles of infection. Given the properties of strains that have been described in foods it has been suggested that food-borne illness could result not only from colonization and in vivo expression of virulence factors, but possibly also by intoxication following ingestion of foods that have been stored for a period of time, even under refrigeration. This paper reviews what is known about Aeromonas spp. in foods, their expression of virulence determinants, particularly at refrigeration temperatures, and the questions remaining to be answered to evaluate the risk they pose, so that an appropriate public health response can be determined.

The growth and expression of virulence factors at refrigeration temperature by Aeromonas strains isolated from foods

A potentially significant subset (10%, 6/61) of Aeromonas strains isolated from food (milk, lamb, chicken, seafood), all A. veronii biotype sobria, were able to produce two or more exotoxins (haemolysin, enterotoxin, and cytotoxin) at 37 degrees C, and grow well at 43 degrees C. Although mesophilic organisms, they grew at 5 degrees C. In addition, they could adhere to HEp-2 cells when grown at 37 degrees C, or at 5 degrees C, and expressed flexible pili (possible colonization factors) in greater numbers at the lower temperature. These strains, as well as other exotoxin-producing strains (A. veronii biotype sobria and A. hydrophila) (33%, 20/61) lacking adhesive ability, were able to produce cytotoxins in broth cultures over a seven to 10-day period at 5 degrees C. One strain in particular, an A. hydrophila isolated from goats' milk, grew rapidly at low temperature. This psychrotrophic strain produced all three exotoxins within 3 days in broth cultures at 5 degrees C. The properties of the above strains suggest they could be of public health significance in food products that have an extended shelf-life at refrigeration temperature.

Pili and the interaction of Aeromonas species with human peripheral blood polymorphonuclear cells

The interaction of differentially piliated Aeromonas strains expressing pili of two broadly different morphologic types (short, rigid (S/R) and/or long, wavy (L/W)) with human peripheral blood mononuclear leukocytes (PMN) was investigated to determine whether host defense cells might exert a selective pressure on pili expression in vivo accounting for the different pili phenotypes of clinical and environmental strains. A majority of Aeromonas veronii biotype sobria strains from water (6/6) and faeces (8/11) readily associated with PMN (> 60% PMN with adherent and/or internalised bacteria), irrespective of their degree, or predominant type, of piliation. Rigid pili of Aeromonas species did not promote interaction with PMN. However, the majority (55%) of strains which interacted well with PMN were adherent to HEp-2 cells. Interaction with PMN is unlikely to be the reason few S/R pili are seen on faecal strains, but it may be a selective pressure on L/W adhesive pili, or other OMP adhesins, resulting in the shedding of strains which have lost critical adhesins.

Adherence to HEp-2 cells and enteropathogenic potential of Aeromonas spp

Aeromonas strains (total = 60) of clinical, water and food origin were tested for adherence to HEp-2 cells. Environmental strains were selected (except for A. caviae) to include primarily those expressing other virulence-associated properties. Adhesion was markedly species-dependent (A. veronii biotype sobria, 15 of 26 [58%]. A caviae, 4 of 12 [33%] and A. hydrophila, 2 of 8 [11%]). A. veronii biotype sobria were adhesive, irrespective of source (62 and 54% for clinical and environmental strains, respectively). Adherent strains of this species were enterotoxin-positive and most (13 of 15) grew at 43 degrees C. A. caviae isolated from clinical specimens contained a higher proportion (75%) of adherent strains than environmental strains (13%). Virulent subsets of A. veronii biotype sobria and A. caviae are adherent to HEp-2 cells. The HEp-2 assay is a useful model for investigating mechanisms of adherence and enteropathogenicity of virulent Aeromonas species.

A note on Aeromonas spp. from chickens as possible food-borne pathogens

The possible role of Aeromonas spp. as potential food-borne psychrotrophic pathogens was investigated by examining organisms isolated from processed raw chicken for their biochemical characteristics, ability to produce exotoxins and to grow at chill temperatures. These strains, in particular A. sobria, with identical characteristics to human diarrhoea-associated aeromonads were readily found. Chicken, and human and environmental (water) strains characterized in a previous study, were investigated for their ability to grow at refrigeration temperatures (5 +/- 2 degrees C) and, for selected strains, the theoretical minimum temperature for growth (Tmin) was determined from the growth pattern in a temperature gradient incubator. All enterotoxigenic chicken strains tested were typical mesophiles, with an optimal growth temperature of approximately 37 degrees C and Tmin values approximately 4.5 degrees C. They were rapidly outgrown by a psychrotrophic Pseudomonas sp. typical of spoilage biota found on food. Enterotoxin was not produced below 15 degrees C by any of the toxigenic food strains tested. The Aeromonas strains isolated from chickens in this study seem unlikely therefore to be a significant health risk, provided the chickens are properly stored and cooked. This would appear to be substantiated by the lack of reports of food-associated outbreaks of illness from these sources.

Seroepidemiological study of infectious mononucleosis in older patients

In southern Tasmania, Australia, primary Epstein-Barr virus infection occurs in adults greater than 30 years of age at a higher frequency (approximately 13% of all cases) than is generally reported for other parts of the world, and approximately 7% of the general population of the region have no antibodies to the virus. Epstein-Barr virus should not be overlooked as a possible cause of disease in older patients in similar populations elsewhere.

Virulence characteristics of Aeromonas spp. in relation to source and biotype

The significance of Aeromonas spp. as potential water-borne enteric pathogens in Tasmania, Australia, an area with a mild climate and comparatively low year-round water temperatures, was investigated in view of the reported marked peak of Aeromonas-associated gastroenteritis in the summer and the apparent influence of temperature on levels of potentially pathogenic species in water supplies. Biochemical characteristics and virulence-associated properties--exotoxin production (hemolysin, enterotoxin), ability to grow at 43 degrees C, and possession of pili--were determined for 105 Tasmanian isolates of Aeromonas spp.; 43 isolates were from clinical specimens (greater than 75% diarrhea associated) and 62 were from water. Current classification schemes were evaluated for these isolates. A. sobria comprised 35% of the clinical isolates and 16% of the water isolates, A. hydrophila comprised 56 and 79%, and A. caviae comprised 9 and 5%. A total of 42% of the clinical isolates and 15% of the environmental isolates were enterotoxigenic (by the suckling mouse assay); these levels were significantly lower than those found in warmer environments. The majority (74%) of enterotoxigenic isolates were A. sobria. Enterotoxin-producing isolates possessed three or more of the following properties. They were Voges-Proskauer positive, did not hydrolyze arabinose, were positive for lysine decarboxylase, were able to grow at 43 degrees C, and produced large amounts of hemolysin (titer, greater than 128). Thus, the biochemical scheme proposed by Burke et al. (V. Burke, J. Robinson, H.M. Atkinson, and M. Gracey, J. Clin. Microbiol. 15:48-52, 1982) for identifying enterotoxigenic isolates appears to have widespread applicability. Environmental enterotoxigenic isolates possessed numerous pili, but these appeared to be lost once infection was established, as a similar isolates from patients with diarrhea were poorly piliated.

Changes in blood lymphocyte populations following surgery

Surgical trauma triggers a significant, but transient, fall in blood lymphocytes in the immediate post-operative period. The relevance of this fall to the controversial issue of post-operative immune suppression is unclear. In order to evaluate whether any long-lasting changes in T-lymphocyte subset distribution occur following trauma, lymphocyte populations and sub-populations were estimated using anti-Ig and monoclonal antibodies in a group of patients undergoing routine elective surgery and in a group of age- and sex-matched normal controls. Surgery triggered an approximately equal percentage fall at 24 hr in both the T-helper and T-suppressor cell populations, so that the Th:Ts ratio remained constant and identical to the control value. Th-cell numbers tended to recover more quickly than Ts cells. The ratio either remained normal or tended to increase by the 7th post-operative day. There was no evidence to suggest that alterations in the distribution of lymphocyte subsets contribute to post-operative immune suppression in the vast majority of surgical patients. Only 2 out of 17 patients developed decreased ratios. The significance of these findings is discussed.

Functional and phenotypic analysis of a T cell prolymphocytic leukemia

Peripheral blood mononuclear cells obtained from a patient with prolymphocytic leukemia expressed the surface membrane markers characteristic of resting mature T helper lymphocytes. These cells responded to the T cell mitogens PHA and Con A in a blast transformation assay but not the anti-T cell monoclonal antibody Leu 4 and the B cell mitogen, PWM. The concentration of PHA or Con A eliciting maximum blast transformation was less than that required by normal mononuclear cells. The leukemic cells recognised and responded to allogeneic pooled mononuclear cells in a mixed lymphocyte culture. In addition, although they did not express Ia antigens, they served as effective stimulators in the mixed lymphocyte reaction. Consistent with the helper phenotype, the leukemic cells did not produce suppressor factors, but provided help for normal B-enriched lymphocytes to respond to PWM as assessed by both blast transformation and IgG production. T lymphocyte colonies developed when the leukemic cells were treated with PHA during a 20 h liquid culture prior to being seeded into semisolid agar medium containing either PHA or an IL2-containing lymphokine. There was no growth when untreated cells were seeded directly into IL2-containing agar. Analysis of colony formation indicated that, as with normal resting T lymphocytes, proliferation occurred in two distinct steps; activation in response to PHA and replication in response to IL2-like growth factors. These findings demonstrate that in this case the helper T prolymphocytes have the functional capabilities of normal mature T lymphocytes as predicted from their helper phenotype.

Immunological types of lymphoproliferative disorders in a cohort: a 4-year study

Immunological testing of malignant cells and serum from most cases of lymphoproliferative disorders (LPD) allows the cell type to be characterised as of B, T or "null" lymphocyte origin. Regional differences in the incidence of neoplasms of these types have been reported. Furthermore, most published series have drawn cases from referral institutions rather than the general population. In order to determine the true incidence of a cohort we surveyed an entire population, that of Tasmania, an island state of Australia with a population of 410,000, during a defined period, the years 1977-1980 inclusive, for the occurrence of LPD. A total of 248 cases was discovered, made up of 133 cases of non-Hodgkin's lymphoma (NHL), 30 of chronic lymphocytic leukaemia (CLL), 18 of acute lymphoblastic leukaemia (ALL), 54 of multiple myeloma (MM), eight of macroglobulinaemia (MGA) and five others. We identified B lymphocytes by the presence of surface membrane immunoglobulin (Smlg) and their ability to rosette with mouse red blood cells, and T lymphocytes by their ability to rosette with sheep red blood cells. Laboratory testing was performed in 201 (81%) of the cases and characterisation of the cell of origin as of B, T or "null" type was successful in 158 (64%). Of these 158, 136 (86%) were B, 4 (3%) T, and 18 (11%) "null". On B cell subtyping by heavy and light chain lg analysis the Tasmanian series, compared with other reports, had an apparent paucity of B-CLL, MM and MGA of lambda subtype (57 k to 12 lambda, k:lambda ratio 4.8:1) and an unusual incidence of B-CLL with the double lg heavy chain combination M+G. Surveys of this type may help to point to environmental or other factors important in the aetiology of LPD.

Characterization of null cells in chronic lymphocytic leukaemia with B-cell allo- and hetero-antisera

Chronic lymphocytic leukaemia peripheral blood mononuclear cells (CLL-PBMN) were separated into B, T and Null-enriched lymphocyte sub-populations using sequential mouse and sheep red blood cell rosetting depletions on Hypaque-Ficoll gradients. The procedure produced viable cell populations with mean percentage purities of 90, 87 and 75 for B, T and non-rosetting (Null-enriched) sub-populations, respectively. More than 80% of PBMN cells were generally accounted for by mouse and sheep rosetting. The purified lymphocyte sub-populations were examined with a panel of B-cell specific alloantisera obtained from kidney transplant recipients and a rabbit antiserum to B cell antigen isolated from a human B-lymphoblastoid line. The results illustrated that the antigens detected by these sera also have potential as a marker for characterizing the CLL population. Where conventional markers were weak or absent, B cell antigens were readily detected in both fluorescent and cytotoxic tests. The majority of the non-rosetting cells (less than 90%) in CLL followed similar patterns of reactivity to the purified B cells, suggesting they are a subset of B cells. A small residual population (0--5% of PBMN) did not react with the antisera, the significance of which is unknown.

Intraoperative and postoperative changes in peripheral white blood cell counts: the contribution of stress

The effect of major surgery, blood loss and psychological stress on the peripheral white blood cell (WBC) populations of human patients and healthy volunteers was examined. During, and in the hours immediately after, major surgery, there was a highly significant fall in the numbers of circulating lymphocytes (mean congruent to 30%-60%) and a highly significant decrease in polymorphs (mean congruent to 160%-350%). Blood loss and psychological stress are not major factors contributing to this fall in peripheral blood lymphocytes in the human, as blood donors and invididuals under temporary stress (anxiety about an imminent dental procedure or an important examination) showed no change in their peripheral blood lymphocyte levels in the hours immediately after these experiences. Significant increases in circulating polymorph numbers, however, accompanied procedures involving even slight tissue trauma, e.g. following blood donation and tooth extraction, but did not occur after psychological stress alone, and were much smaller (congruent to 20%-55%) than those occurring after major surgery. Thus, apart from the complex question of anaesthesia, the nature of the surgical procedure, probably, that is, the degree of tissue trauma involved, is the most important trigger determining changes in the circulating WBC counts after operation.

The effects of major and minor trauma on lymphocyte kinetics in mice

The effects of major and minor trauma on the circulating white blood cell populations of C57BL mice were followed. The results showed that not only major trauma (nephrectomy) but minor injury and stress (e.g. injection, bleeding) triggered a highly significant fall (50-70%) in the number of lymphocytes circulating in the blood. The fall was a gradual one, with the maximal drop 2 h after the operation or handling procedure. Major trauma resulted in a fall in both B and T lymphocytes. Minor trauma produced a fall in B lymphocytes only. A 3-4 fold increase in circulating polymorph numbers also accompanied major trauma, but no increase was observed after minor trauma. The blood picture returned to normal generally within 24 h of both minor and major trauma. Repetition of the trauma stimulus after recovery led to a renewed trauma response. Bilateral adrenalectomy abolished the lymphocyte response to major and minor trauma and decreased the polymorph response to major trauma by more than 50%, indicating that stress hormones played a role in these changes. Studies with 51chromium-labelled lymphocytes, transferred into traumatized and adrenalectomized animals, suggested that decreased entry of lymphocytes into the blood (rather than increased exit from the blood into the tissues, or cell death) was the most likely mechanism of the lymphopenia following trauma.

Evidence that carrier-specific B cells play a role in cellular collaboration

Evidence is presented showing that carrier-specific B cells play a significant role in inducing an anti-hapten antibody response to the thymus-dependent antigen, dinitrophenylated monomeric flagellin (DNP-MON), both in vivo and in vitro. Inactivation of carrier-specific B cells by (125I) polymeric flagellin (POL) suicide decreased the anti-DNP IgM response by 40%-50% and reduced the anti-DNP IgG response by 85%-90%. Several lines of evidence established that the suicide procedure eliminated carrier-specific B cells rather than carrier-specific T (helper) cells.

Involvement of cells with 'B' properties in development of T helpers

Cells bearing Ig on the membrane, fractionated from either 17 day embryonic livers or from normal adult bone marrow, when transferred to splenectomized-irradiated mice, lead to development of helper cells in the thymus of the recipients. The helper function was expressed when the recipients were stimulated with flagellin-MON and the thymus cells were cultured together with anti theta treated spleen cells and stimulated with DNP-MON. The response to DNP was not enhanced when the irradiated mice were inoculated with non Ig bearing cells. Helper activity was related to cells which were eliminated with anti theta antibodies and did not have detectable Ig. Hence, cells with 'B' properties may be involved in development of T helpers.