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Biomedical subjects

G Holm

Publications and source records attributed to G Holm.

At least 55 records · Page 3Linked to original sources

Generation of dendritic cells from peripheral blood adherent cells in medium with human serum.

Dendritic cells (DC) provide an effective pathway for presenting antigens to T cells, both self-antigens during T-cell development and foreign antigens during immunity. As such, these cells may be promising adjuvants for immunotherapy. Thus, it is important to establish simple and fast method(s) to generate sufficient numbers of human DC in medium free of calf serum so that the cells can be used for both experimental and clinical purposes. In this report, we used peripheral blood adherent cells, without laborious cell purification or depletion, as the starting population and cultured them in medium supplemented with granulocyte/macrophage colony-stimulating factor and interleukin-4. Substantial numbers of cells with the phenotypical and functional characteristics of immature DC were obtained in a 7-day culture. We then compared DC cultured in medium supplemented with either fetal calf serum or pooled human ABRh+ serum and found no difference in cell yields and in their ability to stimulate alloreactive T cells or to present soluble antigens to T cells. Irradiated cells were less efficient than non-irradiated cells in antigen presentation and stimulation of T cells. Finally, we have examined DC with or without additional tumour necrosis factor-alpha treatment and found that antigen-pulsed mature cells could as efficiently present antigen to T cells as did immature cells. This method is suitable for the generation of DC in studies of large clinical materials.

Adult↗

Risk indicators for recurrence among patients with coronary artery disease. Problems associated with their modification.

Various risk indicators associated with recurrence of a new ischemic event among patients with coronary artery disease are described and the impact of the implementation of a secondary preventive program on such risk indicators is evaluated. At Sahlgrenska Hospital in Göteborg 293 consecutive patients under the age of 70 years were followed for one to two years after an acute myocardial infarction (AMI), coronary artery bypass grafting (CABG), or percutaneous transluminal coronary angioplasty (PTCA). Enrollment and follow-up began after institution of a secondary preventive program among physicians and nurses at the hospital. A secondary preventive nurse was appointed and guidelines for risk factor modification were provided. The lipid guidelines were rather modest, with hyperlipidemia defined as cholesterol > 6.5 mmol/l or triglycerides > 3.0 mmol/l. The mean value for low density lipoprotein (LDL) cholesterol was 3.96 mmol/l at first screening and 3.94 mmol/l at second screening. Smoking was modestly reduced, from 36% at first screening to 26% at second screening (p < 0.01) It was found that 70% of all the patients had one or more of the following risk indicators at the first screening: s-cholesterol > 6.5 mmol/l (30%), s-triglycerides > 3.0 mmol/l (19%), fasting blood glucose > 6.7 mmol/l (29%), systolic blood pressure > 160 mmHg (9%), diastolic blood pressure > 90 mmHg (8%) or smoking, compared with 67% one to two years later (p > 0.2). This is a clear demonstration of the difficulty in modifying risk indicators in patients, even with the aid of health-care professionals, in order to achieve risk-factor reduction in coronary artery disease.

Adult↗

Effects of two antiandrogen treatments on hirsutism and insulin sensitivity in women with polycystic ovary syndrome.

Thirty-two women with polycystic ovary syndrome (PCOS) were allocated to two antiandrogen treatment regimens; 28 women completed the trial. Twenty women were treated with ethinyloestradiol and cyproterone acetate (EO-CA) cyclically for 6 months and eight women were treated with the gonadotrophin releasing hormone (GnRH) analogue, goserelin for 6 months. Effects on hirsutism, insulin sensitivity (estimated by glucose clamp technique), blood lipids and hormones were measured. Women treated with EO-CA showed a reduction in hirsutism (P <0.05), and decreased serum androgen concentrations (P <0.001) as well as reduced insulin sensitivity (P <0.05). In women treated with goserelin, serum androgen concentrations also decreased (P <0.001), but there was no significant reduction of hirsutism. This group, however, showed an improved insulin sensitivity (P <0.05) despite an unchanged body mass index. Bone mineral density was unaltered in both treatment groups. The reduction in androgen concentrations caused by EO-CA was not paralleled by increased insulin sensitivity, most probably due to the effect of ethinyloestradiol per se. In contrast, the reduction in androgen concentrations by goserelin was accompanied by an improved insulin sensitivity.

Adult↗

The Swedish National Dental Insurance's periodontal diagnosis. Used on an individual level.

The Swedish National Dental Insurance Board requires a periodontal diagnosis (FKF 2030 86.12GR) from general practitioners before treating patients, a process which is expensive. The Swedish National Dental Insurance-index (SNDI-index) is based on clinical data and radiographs and every tooth is assigned a rating between 0 and 4. From the time of introduction of the Swedish National Dental Insurance plan in 1974, data can have been collected for 1.7 million patients if the regulations were followed according to the Swedish National Dental Insurance Board in Stockholm, Sweden. It is of interest to examine whether all of these collected periodontal data reflect periodontal status. In this study includings 56 individuals, the Swedish National Dental Insurance-index, used on an individual level, correlated significantly with the individual changes in bone support (as percent of toothlength) of the tooth in 1979 (rs = -0.80, t = -9.7, p < 0.001, ci 95% = -0.88(-)-0.68) as well as in 1989 (rs = -0.79, t = -9.5, p < 0.001, ci 95% = -0.87(-)-0.67).

Alveolar Bone Loss↗

Myeloma bone marrow plasma cells: evidence for their capacity as antigen-presenting cells.

Myeloma plasma cells constitute 10% to 90% of the total bone marrow cell count in patients with multiple myeloma (MM). These cells express a variety of cell surface markers, such as HLA-ABC and HLA-DR, and surface antigens that are necessary for professional antigen-presenting cells, including adhesion and costimulatory molecules. In this study, we examined the expression of major histocompatability complex (MHC) and costimulatory molecules on CD38(bright,++) plasma cells in bone marrow aspirates from eight MM patients. Small percentages of plasma cells expressed weak but detectable levels of HLA-DR, HLA-DQ, CD40, CD80, and CD86, which could be upregulated by interferon-gamma (IFN-gamma) and tumor necrosis factor-alpha. CD38++ plasma cell and CD38(dim,+) cells were sorted from freshly isolated bone marrow mononuclear cells and tested for their capacity to act as antigen-presenting cells. Indeed, both CD38++ plasma cells and CD38+ cells were able to stimulate allogeneic T cells and present the soluble antigens purified protein derivative and tetanus toxoid to autologous T cells. Recognition of the antigens led to T-cell proliferation and secretion of IFN-gamma and was MHC class-I and -II restricted. Antigen processing and presentation by CD38++ and CD38+ cells were abolished by treatment of the cells with chloroquine. Hence, our study provides for the first time evidence that myeloma plasma cells may act as antigen-presenting cells. Further studies are warranted to examine in detail the molecules required for inducing T-cell stimulation.

ADP-ribosyl Cyclase↗

Comparison of antioxidant activity in lipoprotein fractions from insulin-dependent diabetics and healthy controls.

The insulin-dependent diabetic patient is at greatly increased risk of premature atherosclerosis. Oxidative damage to lipoproteins has been implicated as an important factor in the atherogenic process. Diabetic patients are exposed to excessive oxidative stress because of non-enzymatic glycation of proteins and a variety of defects in antioxidant systems. We have previously described an enhanced chemiluminescent method for measuring protective 'chain-breaking' antioxidant activity in plasma lipoprotein fractions. In this study we compare the lipid content and antioxidant activity of plasma lipoproteins in 22 young insulin-dependent diabetics without vascular complications and 20 age- and sex-matched controls. Mean levels of haemoglobin A 1c in the diabetic group were 8.8 +/- 0.2%. There were no significant differences in serum total cholesterol, apolipoprotein A, apolipoprotein B or lipoprotein(a) levels between the study groups. Serum total triglyceride levels (1.32 +/- 0.11 versus 1.01 +/- 0.08 mmol/l; P < 0.05) and LDL-associated triglyceride (0.28 +/- 0.04 versus 0.15 +/- 0.02 mmol/l; P < 0.05) were significantly elevated in the diabetic group. Total plasma antioxidant activity was significantly reduced in the diabetic group (272.0 +/- 15.4 versus 338.3 +/- 20.7 micromol/l; P < 0.05). Antioxidant activity measured in five lipoprotein fractions isolated by density gradient ultracentrifugation (VLDL1. VLDL2, LDL1, LDL2 and HDL) showed no significant differences between groups when corrected for protein, total lipid or cholesterol content. When corrected for triglyceride content significantly lower antioxidant values were found in the diabetic HDL fraction only. The results of this study imply that the susceptibility of the insulin-dependent diabetic to the development of premature atherosclerosis cannot be attributed to reduced antioxidant activity in circulating plasma lipoproteins.

Adult↗

Immune complex mediated vasculitis in hepatitis B and C infections and the effect of antiviral therapy.

Case reports of seven patients with vasculitis and past or present viral hepatitis infection are presented, including studies on circulating immune complexes (CICs) and cryoglobulins by sucrose density gradient centrifugation or gel filtration, before and after antiviral therapy. Three patients had unusual vasculitic manifestations: coronary, large vessel, and muscle vasculitis, respectively. All the patients had high levels of CICs by the above methods, but only two had CICs by the C1q binding and conglutinin methods. The CICs/ cryoglobulins contained HBV and/or HCV antibodies, antigens, and genome. The concentration of hepatitis antibodies in immune complex form was severalfold higher than in the free form in serum. In one patient, the HBs antigen was present only in the CICs and in another, only hepatitis antibodies (no antigen/genome) were present in the serum or the cryoglobulins. With antiviral therapy, six patients went into long-lasting remissions. There was a temporal relationship between the regression of the vasculitic lesions and the decline in the levels of CICs/cryoglobulins.

Adult↗

Small doses of triiodothyronine can change some risk factors associated with abdominal obesity.

OBJECTIVE: To elucidate whether the administration of small doses of triidothyronine (T3) can increase concentrations of sex hormone binding globulin (SHBG) in obese women with different types of obesity and to evaluate the potential metabolic benefits of such treatment. DESIGN: Daily administration of 20 micrograms of T3 during six weeks while maintaining habitual food intake and physical activity. SUBJECTS: Seventy premenopausal obese women (age: 41.2 +/- 1.5 y mean +/- s.e.m., body mass index (BMI): 34.4 +/- 0.7). MEASUREMENTS: Plasma concentrations of SHBG, lipids, insulin, thyroid hormones, sex hormones, blood glucose and insulin sensitivity (by euglycemic insulin clamp in 12 patients) at base line after six weeks of treatment. RESULTS: Six weeks treatment with small doses of T3 resulted in a significant increase in plasma SHBG. The increase of SHBG was higher in abdominal obesity and not associated with a significant change in body weight, plasma insulin concentration, insulin/glucose ratio of plasma insulin sensitivity (glucose disposal during insulin clamp). In patients with initially high SHBG the significant increase of insulin removal (as judged from the increase of c-peptide/insulin ratio) was observed. Treatment resulted in a reciprocal increase of T3, decrease of thyroxine (T4), and a more than double increase of T3/T4 ratio. CONCLUSIONS: Administration of small doses of T3 can increase the concentration of SHBG without changing insulin concentrations or sensitivity. As there was a significant decrease (by 36%) of T4 and parallel increase of T3 with a clear increase of T3/T4 ratio it seems possible that rather than lack of thyroid hormones a lower peripheral deiodination of T4 might be a factor contributing to the low SHBG concentration in abdominal obesity. Treatment with small doses of T3 may be considered to ameliorate some of the risk factors associated with abdominal obesity, particularly in some subgroups of obese women with a relative resistance to thyroid hormones possibly dependent on decreased peripheral deiodination of thyroxine.

Abdomen↗

Idiotype-specific T lymphocytes in monoclonal gammopathies: evidence for the presence of CD4+ and CD8+ subsets.

Tumour-specific CD4+ T helper (Th) and CD8+ T cytotoxic (Tc) cells may participate in the control and eradication of tumour cells. In the present study, idiotype-specific stimulation of CD4+ and CD8+ blood T cells from patients with monoclonal gammopathy of undetermined significance and patients with untreated multiple myeloma stage I was examined. Activation was measured in the CD4+ and CD8+ subsets enriched by magnetic microbeads as the incorporation of 3H-thymidine and the secretion of interferon (IFN)-gamma, interleukin (IL)-2 and IL-4 by single cells using the enzyme-linked immunospot assay. Idiotype-specific T cells were found in four of seven patients. Stimulation was mainly confined to the CD4+ subset in three of the four responding patients. This type of response was major histocompatibility complex (MHC) class II restricted as it could be inhibited by monoclonal antibodies against MHC class II (HLA-DR), but not against class I (HLA-ABC) molecules. Idiotype-specific CD8+ T cells were also demonstrated in these patients although at a lower frequency. One patient showed a strong and dominating activation of CD8+ T cells which could be blocked by antibodies against HLA-ABC but not against HLA-DR. Idiotype-specific CD4+ or CD8+ T cells were mainly of the type-1 subsets as judged by their secretion of IFN-gamma and IL-2. Thus, this study provides evidence for the presence of idiotype-specific and MHC-restricted CD4+ and CD8+ T cells of the type-1 subsets in patients with monoclonal gammopathies. Such T cells with the potential to control the growth of tumour B cells may be a suitable target for immunotherapeutic interventions in patients.

CD4-CD8 Ratio↗

Antibodies against cardiolipin and oxidatively modified LDL in 50-year-old men predict myocardial infarction.

Autoantibodies against oxidatively modified low-density lipoproteins (oxLDL) and cardiolipin occur in patients with vascular diseases, including atherosclerosis. The ability of such antibodies to predict myocardial infarction (MI) was investigated in a prospective nested case-control study in which healthy 50-year-old men were followed up for 20 years. Raised levels of antibodies against oxLDL and cardiolipin at 50 years of age correlated positively with the incidence of MI and mortality related to MI 10 to 20 years later. IgG and IgA antibodies against cardiolipin were associated with MI between 50 to 60 years of age and IgG and IgA antibodies against oxLDL with MI at 60 to 70 years of age. Moreover, higher antibody levels were noted in those who died from acute MI in comparison to those who survived. The predictive power of IgA and IgG antibodies was strong and largely independent of that of other strong risk factors. In conclusion, raised levels of antibodies against oxLDL and cardiolipin may predict MI and MI-related death.

Aged↗

Estrogen replacement therapy decreases hyperandrogenicity and improves glucose homeostasis and plasma lipids in postmenopausal women with noninsulin-dependent diabetes mellitus.

Hyperandrogenicity in women is closely associated with insulin resistance and a risk factor for cardiovascular disease and noninsulin-dependent diabetes mellitus (NIDDM). Therefore, 25 postmenopausal women with NIDDM and sex hormone-binding globulin values less than 60 nmol/L, as an indicator of a moderate hyperandrogenicity, were treated with 2 mg 17-beta-estradiol orally for 3 months in a double-blind, cross-over, placebo-controlled trial. During the last 16 days of active treatment, 1 mg norethisterone acetate was added for 10 days for endometrial protection. Blood glucose, glycosylated hemoglobin, insulin, c-peptide, lipoprotein profile, sex steroid hormones, GH, and insulin-like growth factor I (IGF-I) were measured, and insulin sensitivity was determined by the euglycemic hyperinsulinemic clamp method. All metabolic measurements were taken at baseline and after 68 days of active or placebo treatment. Estradiol treatment, compared with the placebo period, was followed by a marked increase of sex hormone-binding globulin and a decrease of free testosterone. Blood glucose, glycosylated hemoglobin, c-peptide, total cholesterol, low-density lipoprotein cholesterol, and IGF-I decreased significantly (P < 0.01-P < 0.001), whereas high-density lipoprotein cholesterol rose (P < 0.001). In conclusion, estrogen replacement therapy in postmenopausal women with NIDDM ameliorated hyperandrogenicity, and this was accompanied by marked improvements in glucose homeostasis and lipoprotein profile.

Androgens↗

Bone support as per cent of tooth length. A methodological study.

A technique is presented for calculating the amount of bone support as a percentage of the total tooth length measured on intra oral x-ray pictures. An evaluation was made of differences in total tooth length of 1128 teeth recorded in 1979 and in 1989. The differences found in the ten year period were minimal (0.3%). Between 1979 and 1989 0.7% or 2 mm of the bone support was lost. The accuracy obtainable by the use of measurements from x-ray pictures taken by trained personnel was found to be satisfactory. This indicate that the method could be of value for comparison of changes in mesial and distal bone support over a period of time. The advantages of using bone support measurements instead of attachment level measurements are several: ease of reevaluation of initial values, the patient does not have to be present the whole time, and properly trained dental assistants can make the measurements.

Adult↗

Blood clonal B-cell excess in patients with monoclonal gammopathy of undetermined significance (MGUS): association with malignant transformation.

Fifty-seven patients with monoclonal gammopathy of undetermined significance (MGUS) were analysed for the presence of blood clonal B-cell excess (CBE), defined as a lymphocyte surface membrane kappa/lambda light chain ratio outside the normal range (> 3.5 in kappa-type MGUS and < 0.9 in lambda-type MGUS). 15 patients (26%) had a CBE. The patients were followed for a median time of 8.4 years (range 0.5-20.2). Eight of the 15 CBE+ MGUS patients (53%) developed a B-cell malignancy as compared to 7/42 patients (17%) in the CBE group and the difference in event-free (malignancy-free) observation time was statistically significant (P = 0.01). Cox's regression analysis showed that the presence of CBE was the most powerful predictor of progression to a malignant disease. Two patients with a normal kappa/lambda ratio at first test were analysed repeatedly during follow-up. Subsequently, a CBE appeared which gradually increased in size preceding the clinical diagnosis of a malignant disease.

Adult↗

Modulation of anti-idiotypic immune response by immunization with the autologous M-component protein in multiple myeloma patients.

Multiple myeloma is characterized by a proliferation of clonal B lymphocytes and plasma cells. The idiotypic structure of clonal immunoglobulin (Ig) expressed on the tumour B-cell surface can be regarded as a tumour-specific antigen and, as such, a potential target for anti-idiotypic T and B-cells in an immune regulation of the tumour-cell clone. Active immunization using the autologous mono-clonal Ig as a 'vaccine' was shown to induce tumour-specific immunity in murine B-cell tumours and in human B-cell lymphoma. With the aim to induce or amplify an anti-idiotypic response in multiple myeloma, five stage I-III patients were repeatedly immunized with the autologous monoclonal IgG. Induction of idiotype-specific cellular immunity was analysed in vitro by an enzyme-linked immunospot assay (interferon-gamma and interleukin-4 secreting cells). B cells secreting anti-idiotypic IgM antibodies were also analysed. An anti-idiotypic T-cell response was amplified 1.9-5-fold in three of the five patients during immunization. The number of B cells secreting anti-idiotypic antibodies also increased in these three patients. In two of the patients induction of idiotype-specific immunity was associated with a gradual decrease of blood CD19+ B cells. The induced T-cell response was eliminated during repeated immunization. Further studies are warranted to optimize the immunization schedule in order to achieve a long-lasting T-cell immunity against idiotypic determinants on the tumour clone. A role for immunity in controlling the tumour clone remains to be established.

Adult↗

Idiotype-induced T cell stimulation requires antigen presentation in association with HLA-DR molecules.

An important and yet unresolved question concerns the mode of T cell recognition of idiotypic epitopes on immunoglobulin molecules in humans. Results from murine and human studies show that some idiotype-specific T cells recognize conformational epitopes on immunoglobulin, and such T cells are not MHC-restricted. In the present study T cell stimulation induced by idiotypic determinants on the autologous monoclonal IgG (M-components) from patients with monoclonal gammopathies was studied. In parallel, T cell stimulation in response to a conventional antigen, purified protein derivative, was also examined. It is shown that, as with conventional antigen, idiotype-induced T cell stimulation requires the presence of antigen-presenting cells (APC; monocytes and/or B cells), and is MHC class II (DR)-restricted. B cells, but not monocytes, can present idiotypic determinants to T cells at very low antigen concentrations, while monocytes do so only when antigen is present at high concentrations. Antigen processing and presentation is abrogated by treatment of APC with chloroquine. In conclusion, our study demonstrates that human idiotype-specific T cells recognize processed idiotypic determinants presented by MHC class II (HLA-DR) molecules on APC, and that B cells require about 1000-fold less antigen that monocytes.

Antigen Presentation↗

Induction of human cytotoxic T lymphocytes by oxidized low density lipoproteins.

Oxidized low density lipoproteins (oxLDL) stimulated human blood T cells to a specific cytotoxic response with autologous PHA activated blood mononuclear cells which had been pre-incubated with oxLDL. The cytotoxic reaction was exerted by CD8+ enriched cells but not by CD4+ enriched cells. Allogeneic target cells from HLA mismatched donors were not damaged and the reaction was consistently inhibited by monoclonal antibody against HLA class I. Antigen-specific cytotoxic T cells might contribute to lysis of cells in the atherosclerotic plaque that have taken up oxLDL and thus participate in the inflammatory process associated with atherosclerosis.

Cytotoxicity Tests, Immunologic↗

Idiotype-reactive T-cell subsets and tumor load in monoclonal gammopathies.

The presence of idiotype-reactive T-cell subsets and their relation to the tumor load were analyzed in 9 patients with monoclonal gammopathy of undetermined significance (MGUS), in 12 patients with multiple myeloma (MM) clinical stage I, and in 9 patients with MM stage II/III. An enzyme-linked immunospot assay was used to identify interferon-gamma (IFN-gamma)-, interleukin-2 (IL-2)-, or IL-4-secreting T cells after stimulation by F(ab')2 fragments of monoclonal IgG. The response to autologous IgG was significantly higher than that induced by isotypic monoclonal IgG. Comparable results were obtained in a proliferation assay (3H-thymidine incorporation). A total of 8 of 9 patients with MGUS, 7 of 12 patients with MM stage I, and 3 of 9 with MM stage II/III had T cells secreting IFN-gamma and/or IL-2 (T helper [Th1] type-1 cells), whereas cells secreting both Th1 and Th2 or Th0 types of cytokines were more frequent in patients with MM, particularly in those with MM stage II/III. The number and frequency of Th1-type cells were significantly higher in MGUS patients as compared with those of MM stage II/III. The results indicate that idiotype-reactive T cells of the Th1 and Th2 or Th0 subsets were present in MGs and might provide indirect evidence that idiotype-reactive Th1-type cells may have a regulatory impact on the human tumor B cells.

Adult↗