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Biomedical subjects

J Sancho

Publications and source records attributed to J Sancho.

At least 163 records · Page 9Linked to original sources

Dopaminergic modulation of aldosterone secretion: effect of sodium balance and postural changes.

The influence of an increased endogenous production of angiotensin II and of sodium homeostasis upon the response of plasma aldosterone to metoclopramide administration has been investigated in 5 normal volunteers. Our results show that the increase of plasma aldosterone after metoclopramide administration is independent of angiotensin II, ACTH and potassium, and that it increases even further due to the endogenous production of angiotensin II induced by postural changes. The state of sodium balance seems to influence the response of plasma aldosterone to metoclopramide administration as it occurs with other stimuli of aldosterone secretion.

Adrenocorticotropic Hormone↗

Binding kinetics of monomeric and aggregated IgG to Kupffer cells and hepatocytes of mice.

The binding kinetics of human monomeric IgG and stable heat-aggregated IgG (A-IgG) to Fc receptors of hepatocytes and Kupffer cells isolated from mice was studied. After injection of radiolabelled proteins the 60-70% of hepatic uptake was recovered in parenchymal cells (hepatocytes). In experiments in vitro the A-IgG bound in larger amounts to hepatocytes and Kupffer cells than monomeric IgG. The association rate constants of aggregates were somewhat higher for Kupffer cells than for hepatocytes whereas the percentage uptake of aggregates by Kupffer cells was only 5-15% of that of hepatocytes. The equilibrium constants of aggregates binding to both cells amounted to 0.4-1 X 10(8) M-1 for A-IgG compared with an equilibrium constant for monomeric IgG of 1-2 X 10(7)M-1. The maximum number of IgG and A-IgG molecules bound per cell was higher on hepatocytes (mean 14 X 10(6)) than on Kupffer cells (mean 2 X 10(5)) which is in agreement with the higher binding capacity of hepatocytes for these proteins observed in vivo and in vitro experiments. The ability to compete for receptor binding seemed to reside exclusively in the Fc portion of IgG since F(ab')2 fragments of IgG failed to inhibit labelled monomeric IgG or A-IgG. The receptor seems to be specific for IgG since unlabelled monomeric IgA demonstrated no binding inhibition of labelled IgG or A-IgG on hepatocytes and Kupffer cells. The overall results further suggest that hepatocytes might through Fc receptors play a collaborative role with the mononuclear phagocytic system in the clearance of circulating immune complexes.

Animals↗

Hepatic and kidney uptake of soluble monomeric and polymeric IgA aggregates.

To investigate the handling of IgA by the mononuclear phagocytic system and by hepatocytes of mice, soluble, similar sized, heat-aggregated monomeric (A-mIgA) and polymeric IgA (ApIgA) were used as akin to IgA immune complexes. The half-life of the clearance from circulation decreased from 2.5 hr to 4.2 min and from 22 min to 1.8 min after aggregation of mIgA and pIgA, respectively. Tissue localization experiments indicated that the liver was the organ predominantly involved in the uptake and catabolism of the proteins injected. The rate of the liver catabolism and/or elimination of aggregated polymeric IgA was the slowest up to 24 hr of injection. Aggregated pIgA was deposited in the kidney in larger amounts than aggregated mIgA. The participation of hepatocytes and nonparenchymal liver cells was determined after isolation and purification of these cells. The four substances injected, pIgA, A-pIgA, mIgA and A-mIgA, were predominantly localized in nonparenchymal cells when the uptake was expressed per volume of cells, due to their lower protein content. However, when the results were expressed cell to cell there was a high ratio of IgA aggregates associated with hepatocytes to nonparenchymal cells. It seems probable, therefore, that hepatocytes are almost exclusively responsible for clearance of IgA aggregates from blood.

Animals↗

Immunological abnormalities in the tonsils of patients with IgA nephropathy: inversion in the ratio of IgA: IgG bearing lymphocytes and increased polymeric IgA synthesis.

In the last few years the mucosal origin of the IgA deposited in the kidneys of patients with IgA nephropathy has been examined by several investigators. We have previously presented evidence that polymeric IgA may have a predominant role in the pathogenesis of IgA nephropathy. Taking into account that these patients often present with macroscopic haematuria following respiratory tract infections we have studied the possible existence of immunological abnormalities in the tonsils of patients with IgA nephropathy. Six patients and 13 controls suffering from chronic tonsillitis were submitted to tonsillectomy. Patients with IgA nephropathy showed a significant increase (P less than 0.00025) in IgA bearing lymphocytes (14.4 +/- 2.3) and a significant decrease (P less than 0.025) in IgG bearing lymphocytes (20.5 +/- 4.6) compared to the control group (2.9 +/- 1.4 and 31.6 +/- 3.6, respectively). After 7 days of culture with pokeweed mitogen the percentage of tonsillar cells producing polymeric IgA was significantly higher in the patients than in the controls (66.5 +/- 12.6 vs 33.4 +/- 10.3; P less than 0.005). These results also suggest a mucosal origin for the IgA deposited in the kidneys of these patients. Our data are consistent with the existence of an immunoregulatory dysfunction in the secretory immune system of patients with IgA nephropathy.

Adolescent↗

A simple method for determining polymeric IgA-containing immune complexes.

A simplified assay to measure polymeric IgA-immune complexes in biological fluids is described. The assay is based upon the specific binding of a secretory component for polymeric IgA. In the first step, multimeric IgA (monomeric and polymeric) immune complexes are determined by the standard Raji cell assay. Secondly, labeled secretory component added to the assay is bound to polymeric IgA-immune complexes previously fixed to Raji cells, but not to monomeric IgA immune complexes. To avoid false positives due to possible complement-fixing IgM immune complexes, prior IgM immunoadsorption is performed. Using anti-IgM antiserum coupled to CNBr-activated Sepharose 4B this step is not time-consuming. Polymeric IgA has a low affinity constant and binds weakly to Raji cells, as Scatchard analysis of the data shows. Thus, polymeric IgA immune complexes do not bind to Raji cells directly through Fc receptors, but through complement breakdown products, as with IgG-immune complexes. Using this method, we have been successful in detecting specific polymeric-IgA immune complexes in patients with IgA nephropathy (Berger's disease) and alcoholic liver disease, as well as in normal subjects after meals of high protein content. This new, simple, rapid and reproducible assay might help to study the physiopathological role of polymeric IgA immune complexes in humans and animals.

Antigen-Antibody Complex↗

T-cell dysfunctions in IgA nephropathy: specific abnormalities in the regulation of IgA synthesis.

This work was undertaken to determine the cellular abnormalities that could explain the high levels of serum IgA frequently found in patients with IgA nephropathy. Seventeen control subjects and twenty-seven patients who had received no therapy were studied. After in vitro pokeweed mitogen (PWM) stimulation, significantly higher amounts of IgA were produced by peripheral blood mononuclear cells (PBM) of patients when compared with those of the control group (560 +/- 97 vs 231 +/- 57 ng/ml, P less than 0.0025). No differences were observed in the synthesis of IgG and IgM. Twenty out of twenty-seven patients presented an increase in the percentages of OKT4+ cells (mean + 2 SD), in relation to the control group, with normal or elevated percentages of OKT8+ cells. The OKT4+/OKT8+ cell ratio was elevated in 12 out of 27 patients. All patients presented some abnormality in the generation of IgA-specific suppressor cells at variable doses of concanavalin A (Con A) on in vitro PWM-stimulated culture of PBM. In both assays low doses of Con A (2.5 micrograms/ml) induced a certain suppression of IgA synthesis in patients that was not observed in the majority of the control group. At these doses some patients also showed an enhancement in the synthesis of IgG and IgM. On the contrary, higher doses of Con A (50 micrograms/ml) produced significantly less IgA suppression than the controls. Normal IgA-suppression values were found at 10 micrograms/ml of Con A. T cells obtained from patients were significantly more efficient than T cells from controls in providing IgA-helper activity for normal allogeneic enriched B cells (P less than 0.025) in PWM-stimulated cocultures. These results show that patients with IgA nephropathy present, after mitogen stimulation in vitro, a specifically increased production of IgA as well as an augmentation in the activity of IgA-helper T cell and a deregulation on IgA-suppressor T-cell function. According to these data, it is suggested that the alteration observed in helper T cells might precede that of suppressor T cells. These immunoregulatory abnormalities might contribute to the pathogenesis of the disease.

Adolescent↗

Abnormalities of immune regulation in patients with IgA mesangial glomerulonephritis (Berger's disease).

Regulation of the immune response was studied in 22 patients with IgA nephropathy. A significant increase in the IgA production by Pokeweed-stimulated peripheral mononuclear cells maintained in culture for seven days was observed. These patients had significantly less IgA suppressor cell activity, as assessed by the Concanavalin A-generated suppressor cell assay, than the normal controls. The fact that most of the patients studied had increased activity of helper T cells on IgA synthesis, together with an augmentation in the percentage of OKT4+ cells, suggest that the abnormalities in helper T cell function might be the primary defect in this nephropathy. The existence of similar alterations in some of the healthy relatives of the patients further supports a genetic basis for susceptibility to this disease.

Concanavalin A↗

Immunological studies in a familial IgA nephropathy.

The hypothesis that abnormalities of immune function might occur in healthy first degree relatives of two patients with a familial IgA nephropathy was tested. After 7 days of culture, pokeweed mitogen stimulated peripheral blood mononuclear cells from the two affected members with IgA nephropathy (father and older son), as well as two other healthy sons, produced significantly more polymeric IgA than the controls. The fact that only the two patients with IgA nephropathy presented high serum levels of polymeric IgA favours the idea that a defect in the clearance of this immunoglobulin might be an important step in the appearance of this nephropathy. All the healthy members of the family had a normal OKT4+/OKT8+ cell ratio and a normal concanavalin A generated IgA suppressor cell function in contrast with the abnormalities observed in the two affected members and the previous results in a large number of patients with IgA nephropathy. These data suggest that the primary cellular abnormality might reside in B cells, being the T cell alterations observed in patients a secondary or subsequent phenomenon. These results further support the existence of genetic bases for the susceptibility to this disease.

Antibodies, Monoclonal↗

Participation of renal prostaglandins in the nephrotic syndrome.

The participation of renal prostaglandins in the nephrotic syndrome has been investigated by the measurement of the urinary excretion of prostaglandin E2 (PGE2), renal function and the renin-angiotensin-aldosterone system before, during and after the administration of indomethacin in a group of patients diagnosed as having chronic idiopathic glomerulonephritis with and without nephrotic syndrome. Our results indicate increased renal production of PGE2 in nephrotic patients. This contributes to the maintenance of renal function, probably by counteracting an activated renin-angiotensin system and could be accompanied by a simultaneous and deleterious enhancement of the degree of proteinuria. Nevertheless, the participation of angiotensin II in this last even cannot be excluded.

Adolescent↗

Immune complexes in IgA nephropathy: presence of antibodies against diet antigens and delayed clearance of specific polymeric IgA immune complexes.

Several features suggest that IgA nephropathy is an immune complex (IC)-mediated disease. The source of antigen(s) is unknown but the predominant involvement of IgA suggest that it is associated in some way with the gut or respiratory tract. Taking into account the specific hepatobiliary transport by polymeric IgA of circulating antigens entering through the mucosal surfaces we examined the possible involvement of antibodies against food antigens in the circulating IC and the existence of a defect in their blood clearance in patients with IgA nephropathy. A rise in multimeric IgA-IC (Raji assay) occurred in three of seven control subjects with a peak at 2-4 h after food ingestion. The amount of multimeric IgA-IC present at fasting in four out of six patients, diminished 2-4 h after food challenge, reaching a new peak around 6 h. At fasting, three out of six patients had IC containing antibodies against diet antigens (e.g. ovalbumin). These IC paralleled, both in patients and controls, the levels of multimeric IgA-IC. In patients small multimeric IgA-IC predominated at fasting and 24 h after food ingestion, while larger IC were detected at 2-4 h of food challenge. The specific polymeric IgA-IC showed in controls a maximal peak with similar distribution to that of multimeric IgA-IC, but with a quicker disappearance from the circulation. By contrast, polymeric IgA-IC remained elevated 24 h after food ingestion in most patients. These results suggest that antibodies against common antigens are within circulating IC and that a defect in the hepatic clearance of circulating polymeric IgA-IC exists in patients with IgA nephropathy.

Antibodies↗

Delayed clearance of specific polymeric IgA immune complexes in patients with IgA nephropathy.

The presence of multimeric (polymeric and monomeric) IgA immune complexes (IC), detected by Raji cell assay and by the inhibition binding assay, as well as the specific polymeric IgA-IC were examined before and after the ingestion of 100 g protein. A rise in multimeric IgA-IC occurred in three out of seven controls with a peak at two to four hours after the meal, being cleared thereafter. The amount of multimeric IC present at fasting in four of six patients diminished at two to four hours after food challenge reaching a new peak around six hours. In both controls and patients, IC containing antibodies against diet antigens (e.g. ovalbumin) paralleled those of multimeric IgA-IC. In controls the specific polymeric IgA-IC presented a maximal peak with distribution similar to multimeric IgA-IC, but with a faster disappearance from the circulation. By contrast, polymeric IgA-IC remained elevated 24 hours after food ingestion in most patients. These results suggest that a defect in the hepatic clearance of circulating polymeric IgA-IC exists in patients with IgA nephropathy.

Adult↗

Role of renal prostaglandin E2 in chronic renal disease hypertension.

The role played by renal prostaglandin E2 in the maintenance of hypertension in chronic renal disease has been investigated through studying the response of body weight, blood pressure, glomerular filtration rate (GFR), 24-hour natriuresis, plasma renin activity (PRA), plasma aldosterone and urinary PGE2 excretion to the administration of indomethacin (2mg/kg daily, during 3 days). A group of 37 patients diagnosed as having chronic renal parenchymatous disease with creatinine clearance above 25 ml/min was included in the study. 21 of them were hypertensive (BP greater than 160/95). 27 normotensive volunteers were also studied and considered as the control group. The initial study disclosed similar levels of PGE2, PRA and plasma aldosterone in volunteers, normotensive patients and hypertensive patients, although the sodium intake was lower in the last two groups. A positive correlation between PRA and urinary PGE2 was found both in normotensive (r = 0.507, p less than 0.01) and in hypertensive patients (r = 0.609, p less than 0.01). The administration of indomethacin induced a diminution of PRA, plasma aldosterone and urinary PGE2 levels together with an increase in diastolic blood pressure (p less than 0.05-0.01) in both volunteers and patients. The remaining parameters measured did not change in volunteers or in normotensive patients. On the contrary, in hypertensive patients, during indomethacin administration, lower values of creatinine clearance (p less than 0.005) and 24-hour natriuresis (p less than 0.05) together with an increase in body weight (p less than 0.01) were observed. These results point to the existence of a protective role of renal prostaglandin E2 upon renal function when hypertension appears in the course of chronic renal parenchymatous disease.

Adolescent↗

The role of urinary PGE2 and renin-angiotensin-aldosterone system in the pathogenesis of essential hypertension.

In a group of 26 patients diagnosed as essential hypertensive (EH) and in a control group (CG) of 27 normotensive volunteers the urinary excretion of PGE2, plasma renin activity (PRA) and plasma aldosterone were measured. EH patients were classified into normoreninemic (NREH) (n = 21) and hyporeninemic (LREH) (n = 5) by the response of PRA to the combined stimuli of ambulation and furosemide. Urinary PGE2 excretion was higher in NREH than in CG (p less than 0.05) while LREH showed values lower than in CG (p less than 0.001). Plasma aldosterone levels were similar in the three groups. In CG and EH patients PRA and urinary PGE2 were closely related (CG r = 0.516, p less than 0.05, EH patients r = 0.674, p less than 0.001). Indomethacin administration induced a decrease of PGE2 in both CG (n = 8) and NREH (n = 8) (p less than 0.01). In contrast, indomethacin induced no changes in PGE2 excretion of LREH (n = 5). Furthermore in the group of patients with NREH indomethacin induced a significant increase in blood pressure (p less than 0.01) and body weight (p less than 0.01) while glomerular filtration rate, 24 hour natriuresis PRA and plasma aldosterone decreased (p less than 0.01). On the contrary, in LREH indomethacin did not alter any of the parameters measured. These results indicate that LREH and NREH may be regarded as two different populations distinguishable not only by different secretion of PRA but also by different excretion of PGE2 in urine and by their characteristic response to indomethacin.

Adult↗

Inhibition of neutrophil migration by serum IgA from patients with IgA nephropathy.

Previously we showed that patients with IgA nephropathy present high serum levels of polymeric IgA and that in vitro polyclonal stimulation of their peripheral blood lymphocytes results in the synthesis of a large amount of true polymeric IgA. The aim of this study was to determine if the serum of patients with IgA nephropathy was capable of suppressing the directional migration of human normal polymorphonuclear cells (PMN), as do the polymeric fractions of IgA myeloma. Incubation of controls' PMN with fresh or heat-inactivated patients' plasma impaired the casein-induced directional migration significantly more than incubation with controls' plasma. This inhibitory effect was closely linked to polymeric IgA fractions and to a lesser extent with monomeric IgA immune complexes. The removal of IgA by immunoadsorption from patients' plasma completely abolished the migration suppression observed on controls' PMN. These results suggest that the high serum levels of polymeric IgA observed in patients with IgA nephropathy, by inhibiting directional migration and phagocytosis of PMN, and probably monocytes, could facilitate the persistent circulation and renal deposition of immune complexes.

Chemotaxis, Leukocyte↗