[Studies on immunoglobulin hereditary traits (Gm-and InV groups) in subhuman primates].
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Biomedical subjects
Publications and source records attributed to H Deicher.
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40 adults with symptomatic HIV-1 infection (AIDS related complex [ARC] WR 2B-4B or AIDS WR 5-6) were randomized into two groups, receiving either 200 mg of an i.v. immunoglobulin preparation (ivIg)/kg body weight every other week or no such treatment. Medical care and antibiotic therapy were comparable in the two groups. Frequency of opportunistic infections, "B"-symptoms, number of T-helper cells, change of disease stage (Walter Reed Classification, WR), delayed cutaneous hypersensitivity, onset and clinical course of Kaposi's sarcoma, neurological manifestations and proportion of patients alive at the end of the observation period were evaluated. After an average observation period of 13.8 months, decreased mortality was observed in ivIg treated patients of WR 5-6 (p less than 0.004). Frequency and microbial spectrum of opportunistic infections, the most frequent cause of death, were not influenced significantly by ivIg treatment. No statistically relevant differences concerning the other parameters were observed. A similar beneficial effect of ivIg in WR 2B-4 patients has not become apparent so far.
A computer simulation of the morbidity and mortality rates of the "Acquired Immunodeficiency Syndrome" in the Federal Republic of Germany was performed. Since sexual intercourse is the main mode of transmission, the population was divided into six groups with different sexual behaviour. In several variations of the program it is demonstrated that during the next 15 years up to 41,000 AIDS patients can be expected. The importance of female prostitutes and male bisexuals as "vectors" who may transmit the infection into exclusively heterosexual groups is shown. Using this program, the effect of prophylaxis against infection as well as of changes of sexual behaviour within the population at large can also be examined.
Urinary excretion of Cytomegalovirus and the presence of serum antibodies against CMV were examined in 79 HIV-1-infected patients at different stages of the disease, as well as in 27 heterosexual and 52 male homosexual controls and correlated to clinical and laboratory results. HIV-1-infected and healthy individuals differed significantly with regard to cutaneous delayed type reactions, absolute numbers of CD4+ cells and CD4+/CD8+ ratios. IgG antibodies against CMV were found in 87% of homosexual and in 52% of heterosexual controls, and in all HIV-1-infected homosexuals. CMV excretion in the urine was exclusively found in HIV-1-infected individuals where the incidence correlated with the CDC-defined disease stage (stage II: 6%, stage III/IV A: 22%, stage IV B/C: 55%). HIV-1-infected patients excreting CMV in the urine also exhibited distinctly decreased numbers of CD4+ cells and significantly decreased CD4+/CD8+ ratios compared to those without CMV viruria.
Three years experience with post operative BCG adjuvant immunotherapy in stage II malignant melanoma is reported. Compared to a historical control group (35 cases), 23 melanoma patients showed a significantly improved remission duration and survival rate. It appears that patients with weak initial BCG reactions, which become gradually positive after several immunizations, get more benefit from the adjuvant immunotherapy than do patients with strongly positive initial BCG reactions.
A set of early diagnostic (ED) criteria comprising clinical data, ESR, radiological spinal signs, and the risk factor HLA B27 was evaluated after 5 and 10 years in a follow-up of 54 patients with an initial diagnosis of possible ankylosing spondylitis (AS). After 10 years 32 patients (59%) had developed definite AS according to the New York criteria, 10 individuals (19%) had possible or undifferentiated spondylarthropathy (SA), whereas in 12 patients (22%) other diagnoses were stated. ED criteria had a high discriminatory significance for the development of AS after 5 and 10 years (P less than 0.005, P less than 0.001 respectively). In this respect they were more valuable than B27 determination alone (P less than 0.01) or the ED criteria without HLA B27 (P less than 0.05). Furthermore, patients with still possible or undifferentiated SA had a higher mean score at the first examination than individuals with other final diagnosis (P less than 0.05). Thus, the ED criteria were useful for the identification of patients developing definite AS and of individuals in the AS related group of possible or undifferentiated SA.
Sera of patients with RA and SLE contain platelet-reactive IgG antibodies, which bring about the release of serotonin from platelets. They can also induce the aggregation of normal human platelets. In addition, such antibodies cause a decreased in vitro disaggregation of platelets after ADP exposure, as well as a significantly reduced collagen-induced aggregation. Thus, IgG platelet antibodies in RA and SLE can cause a functional impairment of patients' platelets, and may also be instrumental in systemic inflammatory rheumatoid disease by releasing proinflammatory mediators.
Central nervous system involvement of periarteritis nodosa is a rare complication of this disease. The diagnosis of CNS manifestation in vasculitis has been improved by using imaging techniques (i.e., magnetic resonance tomography, computed tomography, positron emission tomography). A case of polyarteritis nodosa with CNS involvement is presented; the diagnostic value of magnetic resonance imaging and positron emission tomography is discussed.
In vitro transofrmation of peripheral blood lymphocytes (PBL) by phytohaemagglutinin (PHA) and concanavalin A (Con A) was found to be decreased in 17 RA patients. The addition of 50 microliter RA serum or serum from normal controls exhibited an inhibitory effect on the mitogenic reactivity to Con A but not to PHA of both normal and RA patient's PBL. Allogeneic antiglobulin preparations (a-Ig) stimulated the spontaneous in vitro DNA synthesis of PBL from normal control and, to a smaller degree, also from RA patients. The simultaneous addition of a-Ig's and mitogens to PBL of normal controls and RA patients did not exhibit a significant effect on the mitogenic reactivity.
23 "high risk" melanoma patients treated with BCG-AIT are compared with a non-randomized control group of 35 Stage II melanoma patients receiving other treatment. The results are discussed. It has been noted that patients with weak initial BCG reactions survived longer than patients with strongly positive first BCG reactions. This observation could be interesting for the choice of immunotherapy.
Activation of the complement system via immune complex formation plays an important role in the perpetuation of chronic inflammatory disorders. The serum levels of C3 or C4 do not necessarily reflect the actual complement catabolism. By measurement of the long-lived C3 split product "C3d" direct information about complement activation can be obtained. C3d was measured with a modified immunoelectrophoresis technique in EDTA-plasma of 106 patients with rheumatoid arthritis. 36% of them showed significantly elevated C3d levels (mean: 8.93 micrograms/ml). Significant linear correlations were found for C3d with ESR, Lansbury-Index and plasma viscosity.
Platelets show a supportive effect on human endothelial cells in culture. Platelets of patients with systemic lupus erythematosus showed a significantly reduced growth stimulation as demonstrated by reduced DNA synthesis of the endothelial cells.
Early diagnostic criteria, a combination of the HLA-B27 test with clinical data, ESR and radiological signs, were evaluated in a 5-6 year follow-up study of 77 patients with possible ankylosing spondylitis (AS) and 45 with other rheumatic diseases. 34 (44%) with possible AS at first examination developed definite AS according to the New York criteria and 29 (38%) were classified as still possible AS. From these data a sensitivity of 82%, a specificity of 68%, a positive predictive value of 50% and a negative predictive value of 91% were calculated. Therefore the early diagnostic criteria, although of limited value for the diagnosis of definite AS, may clearly define patients at risk of AS or unclassified seronegative spondylarthropathies.
Circulating immune complexes were determined in rheumatoid arthritis and systemic lupus erythematosus using a semiautomated PEG-precipitation laser-nephelometer technique. Immunoglobulins IgA, IgG and IgM as well as complement proteins C3c and C4 were quantitatively determined in 2.75% PEG-precipitates. The PEG-precipitates obtained from the sera of healthy controls, SLE patients, and RA subjects displayed different protein patterns. In RA sera a significant elevation of all investigated proteins was found. In SLE sera, a significant increase of IgG, IgA, IgM, and C3 was found, whereas C4 was significantly reduced as compared to the controls. Typical values for a calculated IgG/C4 ratio in circulating immune complexes were obtained for RA and SLE. In RA this ratio remained unchanged in different activity stages and was found in seropositive as well as in seronegative sera. Thus circulating immune complexes from SLE and RA sera differ with respect to the degree of complement-dependent solubilization.
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