Biomedical subjects
Publications and source records attributed to D C Kilpatrick.
A 45-yr-old man developed severe non-cardiogenic pulmonary oedema after a blood transfusion reaction which was resistant to standard therapy. We describe its successful treatment with extracorporeal membrane oxygenation.
OBJECTIVE: To determine whether any simple, purely genetic mechanism can account for susceptibility to pre-eclampsia. DESIGN: Six simple Mendelian models of inheritance were considered, and predictions concerning the incidence of pre-eclampsia in various family members of index cases were calculated for each genetic model. Data were then extracted from published family studies in which a suitable disease definition had been used, and compared to our theoretical expectations. RESULTS: Only one of the genetic models considered, in which both mother and fetus must express the same recessive gene to confer susceptibility, was consistent with the observed incidence values for relatives of index cases. This model was also consistent with the putative association with HLA-DR4, but could not account for the comparative rarity of pre-eclampsia in parous women. CONCLUSION: Homozygosity for a single recessive gene shared by mother and fetus, unlike five other genetic mechanisms tested, is consistent with published family studies in pre-eclampsia, and should be considered the best working hypothesis at present.
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Anti-cardiolipin antibodies of IgG class were found in 48% of intravenous drug users, 38% of homosexuals and 14% of heterosexuals (with no other risk factor) infected with HIV. Anti-cardiolipin antibodies were not increased in HIV-negative heterosexual partners of HIV-infected patients, but mildly elevated levels were detected in HIV-negative drug users, relative to healthy controls unselected for HIV status. Among HIV infected drug users, anti-cardiolipin antibodies were not associated with thrombocytopenia, Pneumocystis carinii pneumonia, disease progression or clinical stage. Anti-cardiolipin antibodies appear to be another non-specific marker of HIV infection which may be particularly common in male intravenous drug users infected with the virus.
Full HLA-A,B and DR typing was carried out on 92 women with proteinuric pre-eclampsia, 80 of their husbands and 46 of their babies. The results were compared with corresponding data from 65 normotensive pregnancies involving primiparous women. The frequency of HLA-DR4 was increased in the pre-eclamptic women (RR 3.1; p less than 0.005) and in the babies of pre-eclamptic pregnancies (RR 2.6; p less than 0.03). The strongest association, however, was with sharing of HLA-DR4 between mother and fetus (RR 4.2; p = 0.01). There was no increase in HLA antigen sharing in general between spouses or maternal-fetal pairs in pre-eclampsia. Nor did pre-eclamptic women exhibit increased homozygosity in general at any HLA locus. We conclude that genetic susceptibility to pre-eclampsia depends at least partly on fetomaternal compatibility for a gene or genes associated with HLA-DR4.
56 women who had had proteinuric pre-eclampsia and who had parous sisters were studied. In first pregnancy, proteinuric pre-eclampsia was more common in the sisters than in the maternity hospital population (8/71 [11%] vs 41/1978 [2%]); the relative risk was 6.0. The frequency of HLA DR4 was higher in sisters with pregnancy-induced hypertension than in sisters with normotensive pregnancies (8/18 [44%] vs 10/54 [19%]) and more of them shared HLA DR4 with their spouses (4/14 [29%] vs 0/29). Genetic susceptibility to pre-eclampsia is associated with HLA DR4; it may be conferred by fetomaternal sharing of a single recessive HLA-linked gene.
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Thirty-one patients with endometriosis were typed for HLA-A, B and DR antigens. No association was found between the disease and any DR specificity, which may be taken as evidence against an autoimmune aetiology.
We present three cases of post-transfusion purpura (PTP) developing in the immediate post operative period after open heart surgery. All had developed platelet specific antibodies and severe anaphylactoid reactions occurred to platelet transfusion in two cases. Treatment with high dose intravenous immunoglobulin (IV IgG) led to complete recovery in two patients one of whom demonstrated a marked biphasic response pattern to therapy. The other died from congestive cardiac failure. PTP is a potentially fatal complication which may well become more frequent with increasing blood product usage.
The lectins from Datura stramonium, Lycopersicon esculentum, and Solanum tuberosum are structurally related and possess a similar carbohydrate specificity, yet the Datura lectin is mitogenic for human lymphocytes while the other two are not. However, the Datura lectin was found to antagonize blast transformation induced by purified protein derivative (PPD), even within the concentration range at which it was optimally mitogenic on its own. The presence of a submitogenic concentration of the phorbol ester 12-O-tetradecanoyl-phorbol-13-acetate (TPA) enormously enhanced the mitogenic activity of Datura lectin. No such synergy was observed, however, between tomato lectin or S. tuberosum agglutinin (STA) and TPA, nor between Datura lectin and the calcium ionophore A 23187.
Monocytes suppressed the mitogenic response of human T lymphocytes to the lectin from Datura stramonium but enhanced the mitogenic response of the same lymphocytes to wheat germ agglutinin under identical culture conditions. The inhibitory action was probably cell-mediated, but was not the result of cytotoxicity. The stimulative activity could be replaced by cell-free conditioned medium.
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Wheat germ agglutinin (WGA) was found to stimulate DNA synthesis in human peripheral blood mononuclear cells at relatively low concentrations and to inhibit DNA synthesis at higher concentrations. Both actions were inhibited by oligomers of N-acetyl-D-glucosamine. Significant mitogenic activity was dependent on the use of human (as opposed to fetal calf) serum to supplement the culture medium. Purified T cells responded to WGA very weakly and the incorporation of thymidine into non-T cells in response to WGA was less than the lectin-free control. The full ability of T cells to respond to WGA was restored by the addition of monocytes, but not by any other blood cells. Interleukin 2 partially restored the ability of T cells to respond to WGA; interleukin 1 was less effective. WGA displayed a strong synergistic action with the tumour promoter, 12-O-tetradecanoyl-13-acetate (TPA), in stimulating DNA synthesis in separated T (but not non-T) cell fractions, and in unfractioned mononuclear cells. These results reconcile most of the conflicting reports in the literature concerning the interaction of WGA with human lymphocytes.
One hundred and thirty-two families consisting of healthy babies born after normal pregnancies at an Edinburgh maternity unit and their parents were tissue-typed for HLA-A, B and DR antigens. The antigen frequencies and the commonest haplotype frequencies are reported.
Full HLA-A, B and DR types were obtained for 22 families (mothers, fathers and neonates) associated with severe (proteinuric) pre-eclampsia, 21 families associated with mild pre-eclampsia, and 132 families associated with normal pregnancies. There was an increased frequency of DR4 (relative risk 3.6: p less than 0.003, uncorrected) in both neonates and mothers of the severe pre-eclampsia families when compared to the normotensive controls. There were no significant differences between either pre-eclampsia group and controls in HLA antigen homozygosity, HLA antigen sharing or in lymphocytotoxin production.
Sex ratio was investigated in relation to feto-maternal HLA-DR compatibility in 49 families having their first child and 37 families having their second child. No bias was found.