Intravascular coagulation (IVC) in human renal allograft rejection.
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Biomedical subjects
Publications and source records attributed to C B Carpenter.
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Heterologous rabbit anti-rat thymocyte sera, its immunoglobulin G fraction, and the bivalent and univalent antibody fragments obtained by pepsin digestion are potent immunosuppressive reagents when tested in a system of renal allotransplantation between the LBN F(1) hybrid and Lewis rat strains. The AT F(ab')(2) is not lymphocytotoxic in vitro but has agglutinating ability, while the AT Fab' neither agglutinates nor is cytotoxic to rat lymphocytes, but will inhibit the in vitro reaction. The AT IgG and the F(ab')(2) are more immunogenic in their host than normal rabbit IgG and F(ab')(2), probably due to increased delivery of the antibody to the immune system. Donor pretreatment studies demonstrate that a cross-reacting, highly immunogenic antibody with anti-lymphocyte specificity may bind to renal sites and be transferred to the new host after transplantation. In addition, the crude unabsorbed anti-thymocyte antisera may induce a nephritis characteristic of immune complex disease which can be eliminated by complete absorption with serum proteins. Further in vivo and in vitro evidence is presented that the AT IgG contains small amounts of antibody to glomerular basement membrane antigens and may induce an autologous phase-nephrotoxic nephritis. The amount of in vivo binding by AT IgG to GBM was reduced by subcutaneous rather than intravenous administration. Most of the rabbit antisera tested contain antibody in low titer to sheep erythrocytes and in vivo experiments indicate that the nature of the immunodepressive effect of AT globulin to sheep erythrocytes is due in part to the passive transfer of antibody and is not necessarily due to a specific anti-lymphocyte effect.
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A group of patients has been identified with cutaneous necrotizing venulitis (vasculitis). These patients, some with concomitant connective tissue disorders, have skin lesions that separate them from the arteritis commonly described as rheumatoid vasculitis. HLA typing has been performed on 31 of these unrelated patients with cutaneous necrotizing venulitis, including 19 with associated chronic disorders. The antigen pair A11, BW35 was found in 5 of these 19 patients and in 11 of 346 controls. This difference in frequency is statistically significant. Because HLA genes appear to be linked to immune response genes, these data suggest that such genes may exist in patients with this form of cutaneous necrotizing venulitis with associated connective tissue disease.
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One of the puzzles in clinical and experimental organ and tissue transplantation has been why it is that, with the exception of transplantation between genetically identical twin pairs, transplantation results in a rapidly progressing immune response to the point of tissue necrosis in a matter of a few days, even though the recipient has not been immunized to the donor. Indeed, the numbers of T lymphocytes predetermined to react against grafts are relatively abundant compared to those that recognize microbial antigens. Cellular, molecular, and genetic studies are now revealing the nature of T-cell recognition, and why it is that we cannot freely exchange tissue grafts.
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