Use of the B27 test in the diagnosis of ankylosing spondylitis: a statistical evaluation.
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Biomedical subjects
Publications and source records attributed to B R Hawkins.
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The Se gene is classically considered as a regulatory gene controlling the expression of the structural gene H in external secretions. Under this hypothesis, Bombay (h/h) individuals should not be able to express the Se gene. Statistical analysis of the 44 published Bombay pedigrees suggests on the contrary that there is no suppression of Se in Bombay individuals, and that both Se and H loci can be fully expressed at the phenotypic level. Based on a lod score of 12.9 at 1% recombination units and the existence of two different acceptors for the biosynthesis of the H antigen, a new genetic model is proposed in which H and Se would be two closely linked structural genes coding for two different 2-alpha-L-fucosyltransferases.
A longitudinal study among the population of Busselton, Western Australia, has identified individuals with persistent and transient thyroid microsomal antibodies (TMA). 59 (72%) of 82 subjects with persistent TMA, 18 (72%) of 25 with recently developed TMA, and 12 (23%) of 53 with transient antibody were found to have subclinical hypothyroidism, as indicated by high serum thyroid stimulating hormone concentrations. This study reveals the high specificity, sensitivity, and predictive value of persistent or recently required TMA.
Sera from 2,829 participants in a population health survey were tested for the presence of a heterophilic antibody, detectable by immunofluorescence. The antibody was found in 9.8% of the sera from women and in 12.4% of the sera from men. The age-specific prevalence of the antibody was relatively constant in women but rose steeply in men. The antibody occurred more frequently in individuals with a history of blood transfusion and in multiparous females. It is suggested that the antibody may result from immunization by a ubiquitous agent which can be transmitted by blood transfusion.
A population study on pancreatic islet cell antibodies (pica) among 3766 people from the town of Busselton, Western Australia showed that such antibodies were infrequent, the 'classical' insulin-dependent diabetes associated islet cell antibody being present in less than 0.01%. Pancreatic islet cell antibodies in this population were not associated with insulin-dependent diabetes mellitus, and ten known insulin-dependent diabetics did not have these antibodies. These results for an unselected population are in sharp contrast with those derived from studies on highly selected hospital patients.
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HLA A and B antigens have been determined in 2740 adult responders to a population health survey in Busselton, Western Australia. HLA A, B and C antigens have been determined in 481 schoolchildren. The antigen frequencies are generally close to those obtained elsewhere for subjects of British origin, but there are some differences from the frequencies found in North American Caucasians. The frequencies were not affected by the inclusion of genetically related individuals in the sample. Seventeen HLA A-B haplotypes, six A-C haplotypes and six B-C haplotypes had frequencies above 1%. A total of 1071 distinct phenotypes were identified out of the 5069 which are theoretically possible for the HLA A-B model used in the study. The most frequent phenotype was A2, B12 which occurred in 2.5% of the sample.
So as to distinguish the separate influences of ankylosing spondylitis (AS) and possible HLA B27 associated immune response genes on immune response patterns, a battery of immunological tests were performed on fourteen patients with AS and their first-degree relatives. Previously unrecognized AS was detected by clinical and radiological means. Individuals with ankylosing spondylitis had significantly higher serum IgG and IgA concentrations than both their B27 positive and B27 negative relatives. B27 positive relatives had significantly lower phytohaemagglutinin (PHA) lymphocyte transformations than B27 negative relatives (P less than 0.01), while there was no difference between the ankylosing spondylitic and B27 positive groups. Antibody titres to Streptokinase/Streptodornase were significantly higher in the B27 positive individuals, with or without AS, than their B27 negative relatives (P less than 0.005 and P less than 0.02 respectively). These results show that serum immunoglobulin differences were associated with disease, while differences in PHA stimulation and varidase antibody titres were associated with the B27 antigen. These findings may indicate the presence of HLA associated immune response genes including those involved with reactions to a particular antigenic component of Streptokinase/Streptodornase.
Forty-four patients with systemic lupus erythematosus (SLE) were classified as mild or more severe on the basis of renal biopsy changes and the degree of proteinuria. The HLA phenotype A2 plus B7 was associated with the mild cases, while A1 plus B8 was associated with more severe disease. These findings suggest that immunogenetic factors are important in determining the severity of SLE and that combinations of HLA-A and -B locus antigens may be significant in HLA disease associations.
Human heterophile antibodies reactive with various tissues of different species may be detected by indirect immunofluorescence. Results of screening sera obtained after rhesus immunization and before and after blood transfusion and renal transplantation suggest that such antibodies can appear following alloimmunization of group A and O individuals. Eleven positive sera selected for detailed study were found to have anti-B isohaemagglutinins together with rat erythrocyte agglutinins. Absorption studies suggested that there may be some relationship between the group B antigen and the rat antigen concerned but the precise explanation for alloimmunization remains to be determined.
Approximately 6% of sera submitted for routine immunofluorescent autoantibody screeening produced characteristic reaction patterns against a variety of animal and human tissues. It is suggested that these non-tissue-specific patterns represent a complex family of heterophile antibodies which could be confused with certain autoantibodies. It is further suggested that these heterophile antibodies bear a relationship to IgG isohaemagglutinins.
The distribution of the blood group systems ABO, Rhesus, MNSs and P was studied in all or some of 1,007 Singapore Chinese, ABO gene frequencies were found to be consistent with previous studies and did not vary significantly between dialects. An individual of phenotype A2B was detected although the population showed no other evidence for the A2 gene. The possible significance of this observation in terms of weak H alleles in the population is discussed. The frequencies of the MNSs genes are consistent with previous studies. Two subjects appeared to lack the NA component of the N antigen. The frequency of the R1 gene of the Rhesus system was lower than has been detected previously and may relate to dialect differences. No examples of the CW antigen were detected. The P blood group distribution appears to be subject to regional variation. It is concluded that classification of Chinese into dialect groups is a useful way of assessing genetic heterogeneity.
The distribution of ABO blood groups was studied in 459 Chinese and 65 Malay newborns with deficiency of G6PD, and in 1181 Chinese and 535 Malay newborns with normal levels of the enzyme. Similarly, the distribution of Rhesus blood groups was studied in 248 G6PD deficient Chinese newborns and in 255 normal subjects. No association between the ABO blood groups and G6PD deficiency was observed in either Chinese or Malays. For the Rhesus system there was found to be a statistically significant decrease in the frequency of genotypes containing the complex R1, in G6PD deficient subjects compared with that in normal subjects.
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