Immunity to Aspergillus in patients with chronic granulomatous disease.
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Biomedical subjects
Publications and source records attributed to A J Ammann.
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Removal of, or irradiation to, the thymus during the neonatal period in man has resulted in no reported adverse effects on cellular immunity, although thymectomy in neonatal experimental animals is known to produce profound immunological disturbances. Adverse effects in humans may not be recognized until several decades have passed. The immunological capabilities of 7 adults with histories of thymic irradiation as infants were evaluated; normal tests results indicated intact immune systems in all cases. The 3 women tested, however, had abnormal clinical histories, including 2 with multiple tumors and 1 with chronic mucocutaneous candidiasis.
The urines of two unrelated children with inherited deficiencies of purine nucleoside phosphorylase have been found to contain significant quantities of orotic acid in addition to the previously reported purine nucleosides. The data are consistent with some cell types of these immunodeficient patients being deplete of pyrophosphoribosylphosphate, a precursor of both purine, and pyrimidine nucleosides. It is suggested that the pyrophosphoribosyl-phosphate-depleted cells may be some component of the thymus-dependent immune system.
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To delineate the normal function of purine nucleoside phosphorylase and to understand the pathogenesis of the immune dysfunction associated with deficiency of this enzyme, we studied purine metabolism in a patient deficient in purine nucleoside phosphorylase, her erythrocytes and cultured fibroblasts. She exhibited severe hypouricemia and hypouricosuria but excreted excessive amounts of purines in her urine, the major components of which were inosine and guanosine. Her urine also contained deoxyinosine, deoxyguanosine and uric acid 9-N riboside. The patient's erythrocytes but not her cultured fibroblasts contained increased concentrations of phosphoribosylpyrophosphate and inosine. The metabolic abnormalities resembled those in the erythrocytes of patients with the Lesch-Nyhan syndrome. Purine nucleoside phosphorylase is a necessary component of the major, if not the sole, pathway for the conversion of purine nucleosides and nucleotides to uric acid. The increased intracellular concentrations of inosine may, by inhibiting adenosine deaminase, be related to the immunologic dysfunction.
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A 5-year-old girl with a history of recurrent infection and anaemia has no measurable purine nucleoside phosphorylase (N.P.) activity in her red blood-cells. Her serum-immunoglobulin levels are normal, as are her antibody responses to thymus dependent and independent antigens. However, she has severe lymphopenia, pronounced depression of lymphocyte response to mitogenic and allogeneic cell stimuli, and greatly decreased T-cell rosette formation. Her parents are second cousins; their red cells contain less than half the normal level of N.P. activity. They also share an unusual N.P. isozyme pattern indicative of molecular hybridisation between catalytically active and inactive subunits, which strongly supports the assumption that they are heterozygous and their daughter is homozygous for a "silent" allele at the N.P. gene locus. Inherited deficiency of adenosine deaminase, an enzyme catalysing a reaction only one metabolic step away from that of N.P., is known to cause immunodeficiency. It is therefore very likely that this patient's lack of demonstrable N.P. activity is responsible for her syndrome.
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An extract of calf thymus, thymosin, induces an increase in percentage of T-cell rosettes when incubated in vitro with sheep erythrocytes and lymphocytes from patients with primary immunodeficiency diseases or viral illness. Precursor lymphocytes are required for this increase to occur. The percentage of T-cell rosettes, when they are normal, is not increased further upon incubation with thymosin. A patient with thymic hypoplasia and immunoglobulin synthesis was selected to receive thymosin in vivo when her T-cell rosettes had increased from 15 to 48 per cent after in vitro incubation with thymosin. During therapy, she clinically improved, the percentage of T-cell rosettes gradually increased to normal, and positive delayed hypersensitivity skin tests developed. Thymosin may be useful clinically for partial reconstitution of cellular immunity. An increased percentage of T-cell rosettes after incubation with thymosin in vitro may predict which patients will respond to thymosin therapy in vivo.
Fourteen patients with nasopharyngeal carcinoma were evaluated immunologically prior to standard radiotion therapy. All had elevations of serum IgA, ranging from 300 mg/100 ml to 1000 mg/100 ml, with a mean value of 549 mg/100 ml. Seven patients demonstrated depression of cell-mediated immunity as measured by delayed hypersensitivity skin tests, total lymphocyte count, in vitro stimulation with PHA, and T-cell rosette formation. Elevation of serum IgA associated with depression of cell mediated immunity may be characteristic of patients with nasopharyngeal carcinoma.
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