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Biomedical subjects

L M Lichtenstein

Publications and source records attributed to L M Lichtenstein.

At least 73 records · Page 4Linked to original sources
PubMed1996

Discontinuing venom immunotherapy: outcome after five years.

BACKGROUND: The clinical and immunologic consequences of discontinuing venom immunotherapy are not well-defined. To determine which patients can safely stop treatment, we accepted all volunteers who had completed at least 5 years of maintenance venom immunotherapy regardless of the severity of the historical sting reaction, the persistence of venom skin test sensitivity, or any other variable. METHODS: Sting challenge was performed every 1 to 2 years after therapy was stopped; and venom-specific skin tests were performed, and IgE antibody levels were measured. RESULTS: Systemic symptoms occurred after challenge in eight of 270 stings (3%), in seven of 74 patients (10%); only two reactions were clinically significant. Venom skin test results became negative in 28% after 5 years of venom immunotherapy (at the time of discontinuation) and were negative in 56% to 67% of patients after 2 to 4 years without venom immunotherapy. There was a parallel decrease in the venom-specific IgE antibody levels. Challenge stings did not prevent the progressive decline in sensitivity, nor did they increase the risk of sting reaction even after two sequential stings 1 month apart. CONCLUSIONS: Venom immunotherapy can be safely discontinued after 5 years of maintenance therapy in virtually all patients, with the possible exception of those in whom the level of venom sensitivity has not declined during therapy. Venom sensitivity decreases with time even after venom therapy is stopped. Insect stings do not cause re-sensitization, and there was no increased risk from sequential stings. There appears to be a late-onset, non-IgG-mediated mechanism for long-term suppression of allergic sensitivity by prolonged high-dose venom immunotherapy.

Anaphylaxis↗
PubMed1996

Treatment of cat allergy with T-cell reactive peptides.

We induced in allergic humans the counterpart of murine experimental T-cell tolerance. T-cell lines from cat-allergic humans were used to map T-cell epitopes for the principal allergen of cat dander, Fel d 1. Two peptides of 27 amino acids each were synthesized to contain the dominant epitopes (ALLERVAX CAT). After a safety trial, we carried out a blinded study of the dose required for efficacy. We randomly divided 95 cat-sensitive patients into placebo, 7.5 micrograms, 75 micrograms, and 750 micrograms groups. Patients received a subcutaneous injection weekly for 4 wk. Before and after treatment, patients were exposed in a room inhabited by live cats and scored by nose and lung symptoms. Baseline nasal and lung scores (+/-SEM) were 6.2 +/- 0.56 and 5.4 +/- 0.73 in the 750 micrograms group; 7.8 +/- 0.53 and 4.7 +/- 0.68 in the placebo group. Six weeks after treatment, scores adjusted for baseline differences were reduced in the 750 micrograms group: -2.3 +/- 4.9 and -2.3 +/- 0.59 compared with -0.84 +/- 0.50 and -0.85 +/- 0.62 in the placebo group. The 75 micrograms group showed intermediate effects and the 7.5 micrograms group no effect. Linear trend analysis indicated a significant dose response effect: p = 0.05 for nose and 0.03 for lung symptoms. Allergic side effects occurred an hour or more after the first 750 micrograms dose in 16 of 24 patients but required little or no treatment with one exception. T-cell reactive treatment peptides safely improved allergic responses to cats.

Allergens↗
PubMed1996

Vesicular transport of Charcot-Leyden crystal protein in tumor-promoting phorbol diester-stimulated human basophils.

Secretion from human basophils (HB) that are stimulated with a phorbol ester takes place with slower kinetics than typically regulated secretion, which is stimulated by the IgE-mediated mechanism associated with classical granule exocytosis. Phorbol ester stimulation of HB induces emptying of granule contents (with retention of granule containers) and increases the number of cytoplasmic vesicles, an anatomic process similar to one termed piecemeal degranulation (PMD), which is a secretory process originally described in HB that migrate from the blood in vivo into contact allergy skin lesions. Charcot-Leyden crystal (CLC) protein is a basophil granule-associated protein that is readily imaged by using a postembedding immunogold procedure. This method was used to localize this granule protein in phorbol ester-stimulated, isolated human peripheral blood basophil cytoplasmic vesicles in samples collected within a time frame for which histamine was secreted. The results of this study showed that the proportion of cytoplasmic vesicles that were gold-labeled in stimulated HB, which indicated the presence of CLC protein, increased significantly over unstimulated cells at 2, 5, and 10 minutes after stimulation. Additionally, CLC protein-labeled vesicles in the cells that were stimulated for 10 minutes significantly exceeded the number in stimulated cells at 0, 30, and 45 minutes after exposure to phorbol ester. Thus, transport vesicles carrying a granule-associated protein (CLC protein) were increased in phorbol ester-stimulated HB in the time frame for histamine secretion and the anatomic development of PMD. These findings support vesicular transport as a major mechanism for effecting PMD, which is morphologically the most frequent activation anatomy displayed by HB in human disease in vivo.

Basophils↗
PubMed1996

Recovery of human basophils after FMLP-stimulated secretion.

BACKGROUND: Basophils are circulating, secretory granulocytes that are generally considered to be end-stage cells. In one species of guinea-pigs, basophilic leucocytes have been shown to recover from stimulated secretion in short-term cultures. Similar studies have not been done using human basophils. OBJECTIVE: The purpose of this study was to examine human basophils in short-term recovery intervals following stimulation of secretion to determine whether visual evidence of recovery occurred. METHODS: We examined the ultrastructural morphology of early recovery (10 min-6 h) of human basophils following secretion stimulated by formyl-methionyl-leucyl-phenyl-alanine (FMLP). A combined technique for electron microscopy consisted of post-fixation exposure to cationized ferritin and reduced osmium, providing maximum quality images and allowing identification of intracellular spaces/organelles that opened to the cell surface, often out of the plane of section. RESULTS: The ultrastructural evaluation revealed that control basophils (0 time-6 h) did not undergo regulated secretion or develop the morphologies associated with recovery following secretion. FMLP-stimulated basophils underwent an overlapping continuum of piecemeal degranulation-->anaphylactic degranulation (0 time-1 min), producing vesicle- and granule-free, completely degranulated, viable, mature basophils with polylobed nuclei. The early recovery period (10 min-6 h) following FMLP stimulation was characterized by reconstitution of granules. Morphological mechanisms for granule reconstitution included a mixture of conservation, condensation, and synthetic events. CONCLUSION: Human basophils, like guinea pig basophils, have the potential to recover from regulated secretion.

Basophils↗
PubMed1996

Unilateral nasal allergen challenge leads to bilateral release of prostaglandin D2.

BACKGROUND: Multiple mediators including prostaglandin D2 and leukotriene B4 have been shown to increase in nasal secretions during the early response to nasal challenge with antigen. OBJECTIVE: Our objective was to investigate the time course of prostanoid and leukotriene B4 release into nasal secretions on both the ipsilateral and contralateral side after a unilateral nasal allergen challenge. METHODS: We performed a controlled, randomized trial. Six volunteers were challenged unilaterally with antigen or diluent in a randomized order and discs were used to collect nasal secretions from both nostrils at 2 min intervals for 20 min after the challenge. Prostanoids and leukotriene B4 (LTB4) in recovered nasal secretions were measured by combined capillary gas chromatography-negative ion chemical ionization mass spectrometry (GC/MS). RESULTS: Nasal allergen challenge resulted in a significant and immediate increase in symptoms and sneezing. PGD2 was significantly elevated above diluent values (0.6 +/- 0.6 pg) 30 s after removal of the allergen disc (P < 0.05), reached its peak (423.2 +/- 182.4 pg) at 2 min and then slowly decreased. PGD2 also increased on the contralateral side after unilateral allergen challenge, reaching peak values about six times lower than on the ipsilateral side (70.8 +/- 21.7 pg at 6 min). Levels of 9a, 11b-PGF2 after antigen provocation became significantly higher than after diluent (0 +/- 0 pg) on the ipsilateral side at 2 min (17.2 +/- 5.9 pg), and reached peak levels at 4 min (25.1 +/- 8.0 pg). LTB4 also increased significantly on the side of challenge. For the other prostanoids measured (PGF2, PGF2 alpha, TxB2, 6kPGF1 alpha), no significant changes in either ipsilateral or contralateral secretions were observed after allergen challenge. CONCLUSIONS: Our study described the kinetics of PGD2 and LTB4 release as well as the contralateral release of PGD2.

Adult↗
PubMed1995

Histamine distribution in human basophil secretory granules undergoing FMLP-stimulated secretion and recovery.

We examined subcellular histamine localizations in purified human basophils that were stimulated to degranulate with FMLP using an ultrastructural enzyme-affinity technique. Basophils were collected at early (0, 20 seconds, 1 minute) and late (10 minutes to 6 hours) time points poststimulation and were prepared for routine ultrastructural and diamine oxidase-gold (DAO-gold) cytochemical analysis. Histamine was present in unaltered cytoplasmic secretory granules (30.77 gold particles per square micrometer; P < .001 compared with background); specificity controls (histamine absorption, diamine oxidase digestion) abrogated granule labeling for histamine. Altered granules in stimulated cells were not significantly labeled for histamine, as compared with background (P = not significant); unaltered granules in the same cells contained more histamine than altered granules (P < .05). During recovery times, spanning 10 minutes to 6 hours, granules again appeared to be electron-dense and contained histamine (33.49/microns2; P = not significant as compared with unaltered granules in 1-minute FMLP-stimulated cells, and P < .05 as compared with altered granules in 1-minute FMLP-stimulated samples). Other structures devoid of histamine in actively secreting cells included extruded granules and intragranular and extruded Charcot-Leyden crystals. Recovering basophils displayed morphologic evidence of material and membrane conservation, granule content condensation, and biosynthesis. Subcellular histamine-rich sites in actively recovering basophils included condensing granules and collections of cytoplasmic vesicles in three locations: beneath the plasma membrane, adjacent to granules, and in the Golgi region. These studies show that unaltered granules of actively releasing human basophils, as well as similar granules that are reconstituted after FMLP-stimulated degranulation, contain histamine, but that altered granules in stimulated cells undergoing degranulation are devoid of histamine. Reconstitution of histamine-rich granules is associated with DAO-gold-positive cytoplasmic vesicles, suggesting transport of histamine derived from either new synthesis, re-uptake of released histamine, or both, to reconstituted granules.

Amine Oxidase (Copper-Containing)↗
PubMed1995

IL-13 expression at the sites of allergen challenge in patients with asthma.

Atopic asthma is characterized by inflammatory responses of the airway and is associated with up-regulation of Th2 cytokines, notably IL-4 and IL-5. A recently described human cytokine, IL-13, is a potent in vitro modulator of various cell types, including monocytes, B cells, and endothelial cells. Similar to IL-4, it is also involved in the induction of IgE synthesis. However, the in vivo expression and function of IL-13 and its relation to disease remain to be defined. Using a segmental allergen challenge model, we have examined the in vivo expression of IL-13 in the bronchoalveolar lavage (BAL) cells of atopic patients. We found a significant enhancement of both IL-13 transcripts and secreted proteins in the allergen-challenged BAL compared with the saline-challenged control sites of asthmatic and rhinitic patients. In contrast, the expression of IL-13 transcripts was not detected in the BAL of two normal subjects challenged with the same dose of ragweed allergen. The cellular source of IL-13 mRNA was identified in the mononuclear cell fraction of the allergen-challenged BAL. The allergen-induced quantitative differences in the level of transcripts were confirmed by competitive PCR assays. These results suggest that the significant increase in IL-13 in the allergen-challenged BAL is primarily from the mononuclear cells and is involved in the regulation of allergen-induced late phase inflammatory responses.

Adult↗
PubMed1995

Molecular identification of an IgE-dependent histamine-releasing factor.

An immunoglobulin E (IgE)-dependent histamine-releasing factor (HRF) produced by lymphocytes of atopic children and present in biological fluids of allergic patients has been identified and purified. Amino-terminal sequencing revealed extensive homology to a mouse protein, p21, and its human homolog, p23. Both recombinant proteins caused histamine release from the human basophils of a subpopulation of donors, and this release was dependent on IgE. Polyclonal antibodies recognized and removed the biological activity of recombinant and native HRF. HRF identifies a heterogeneity of IgE and is believed to play a prominent role in chronic allergic disease processes.

Amino Acid Sequence↗
PubMed1995

Expression of the chemokine RANTES by a human bronchial epithelial cell line. Modulation by cytokines and glucocorticoids.

The chemokine RANTES is a potent chemoattractant for eosinophils, lymphocytes, and monocytes, and has been detected recently in the epithelium of human airways mucosa. We have studied, therefore, the expression of RANTES mRNA and protein in the human bronchial epithelial cell line BEAS-2B. Using Northern blot analysis, RANTES mRNA was not detectable in unstimulated BEAS-2B cells. Incubation of cells with TNF-alpha or IFN-gamma induced the expression of RANTES mRNA and protein within 16 h. The combination of TNF-alpha and IFN-gamma displayed a marked synergism in inducing RANTES expression. Pretreatment of cells with the glucocorticoid budesonide (10(-10)-10(-7) M) for 24 h inhibited expression of RANTES mRNA and protein stimulated by either TNF-alpha or TNF-alpha plus IFN-gamma in a concentration- and time-dependent manner. Nonglucocorticoid steroids did not inhibit RANTES mRNA expression. Production of RANTES by epithelium could contribute to the mechanism of selective cellular recruitment occurring in the airways during inflammation, thus playing a relevant role in the pathogenesis of diseases such as asthma, rhinitis, and polyposis. The down-regulation of RANTES production by glucocorticoids in epithelial cells may contribute to the efficacy of these compounds in reducing cellular infiltration and, ultimately, to their anti-inflammatory properties.

Blotting, Northern↗
PubMed1995

Purification of immunoglobulin E (IgE) antibodies from sera with high IgE titers.

A three stage method for the ultrapurification of polyclonal IgE from human serum is reported using anion exchange chromatography followed by monoclonal antibody based positive and negative affinity chromatography. Following dialysis of 25-100 ml of serum (2.3-14 micrograms IgE/ml, n = 4) against 0.05 M Tris pH 8, each specimen was subjected to diethylaminoethyl (DEAE)-cellulose chromatography (serum/matrix = 1/4). IgE was eluted with 0.05 M Tris, 0.05 M NaCl pH 8, yielding an IgE recovery of 61-93%, with removal of approximately 90% of other serum proteins and an IgE purity ([IgE]/[Igs]) of 0.1-1.1%. After adjusting to 0.1 M NaCl and concentrating approximately 30-fold, the eluted IgE was further purified by affinity chromatography using a panel of IUIS/WHO-documented mouse monoclonal anti-human immunoglobulin antibodies (alpha hIg-MAbs). First, the IgE-enriched DEAE-cellulose chromatography fraction was incubated in a batch mode with two alpha hIgE-Fc MAbs (HP6029, HP6061) coupled to CNBr-Sepharose, CL-4B. IgE was eluted with 0.05 M glycine pH 2.8 and immediately neutralized. The IgE recovery was 32-52% and IgE purity was 72-97%. Silver-stained SDS-PAGE and noncompetitive solid-phase two-site immunoenzymetric assays for total human IgA, IgE, IgG and IgM indicated that IgA, IgG and IgM were the only contaminants. Next, the IgE was concentrated 10-30-fold in the presence of 0.1% HSA. One IgE specimen was ultrapurified in a batch mode by negative selection chromatography using three pairs of alpha hIg-MAbs (alpha hIgA: HP6111 + HP6123; alpha hIgG: HP6017 + HP6046; alpha hIgM: HP6081 + HP6083) coupled to CNBr-Sepharose, CL-4B. IgE purity increased from 91% to > 99.9% with approximately 70% recovery of IgE for this step. The ultrapurified IgE antibody was shown to be functionally reactive for allergen and Fc epsilon RI receptors on human basophils. We conclude that alpha hIg-MAbs are powerful tools to facilitate the affinity purification of functionally active human IgE from serum; however, when the analyte is present in low concentration, a carrier protein needs to be added to minimize non-specific loss of the material during this process.

Antibodies, Anti-Idiotypic↗
PubMed1995

IgA, IgG and IgM quantification in bronchoalveolar lavage fluids from allergic rhinitics, allergic asthmatics, and normal subjects by monoclonal antibody-based immunoenzymetric assays.

Recent reports have suggested that human secretory IgA (sIgA) may have a role in the mediation of atopic disease. We have studied the levels of sIgA, IgA, IgG and IgM in bronchoalveolar lavage (BAL) fluids collected from lungs of healthy non-allergic adults (n = 14), allergic subjects with rhinitis (n = 15), and allergic asthmatics (n = 13), using a panel of monoclonal antibody-based immunoenzymetric assays (IEMAs). In contrast to commercially available immunodiffusion and nephelometric assays, these IEMAs employ highly specific monoclonal antibodies and demonstrate required precision (intra-assay CVs < 17%), parallelism (inter-dilutional CVs < 20%) at minimal detectable immunoglobulin levels in the ng/ml range, and excellent specificity with < 0.1% crossreactivity for heterologous immunoglobulin isotypes. Using these assays, we have observed a significant correlation between sIgA levels and total IgA levels in BAL fluids from all the study patients (r = 0.94; p < 0.01). The percentage of sIgA to total IgA was 84.0 +/- 2.2%. sIgA in BAL fluids from allergic rhinitics (18.0 +/- 2.5 micrograms/ml) and allergic asthmatics (15.5 +/- 2.5 micrograms/ml) were higher than those from nonallergic subjects (10.2 +/- 1.9 micrograms/ml). The only statistically significant difference in sIgA levels was observed in BAL fluids from the rhinitics and nonallergic groups (p = 0.03). Similar differences among the groups were found for levels of total IgA in BAL fluid. There were no significant differences in the levels of IgM and IgG in BAL fluids among the three groups of subjects. We conclude from these results that IgA is the predominant immunoglobulin on the airway surface and that it appears to be produced locally.

Adult↗
PubMed1995

Preferential recruitment of activated, memory T lymphocytes into skin chamber fluids during human cutaneous late-phase allergic reactions.

To determine whether activated memory T lymphocytes (CD3+CD4+CD45RO+CD25+HLA-DR+) preferentially accumulate during the cutaneous IgE-dependent late-phase response, we challenged 10 atopic patients with allergen and monitored the cellular influx for 12 hours with a skin blister chamber model. Four patients with allergy were also challenged with irrelevant allergen in control experiments. Histamine release and the size of the cutaneous late-phase response were measured. Light microscopic analysis and phenotyping of recruited and blood lymphocytes were performed with immunofluorescence and flow cytometry. Antigen challenge induced significant histamine release, a macroscopic late-phase response, and significant cellular influx in the appropriately challenged patients with allergy but not in control subjects. In the control group, only limited phenotypic analyses could be performed, which demonstrated an equivalent percentage of CD3+CD4+ cells in the chamber fluids compared with blood. In contrast, a higher proportion of CD4+ T lymphocytes and a lower proportion of CD8+ T lymphocytes accumulated in chamber fluids during the late-phase response compared with that present in blood. The vast majority of the recruited T lymphocytes expressed a memory phenotype (CD45RO+) with enhanced percentages of CD25+ and HLA-DR+ cells. Also, these cells had increased levels of very late antigen-4 (CD49d/CD29) and reduced levels of L-selectin compared with the same cells in blood. These results demonstrate that allergen challenge of the skin in patients with allergy leads to the preferential accumulation of activated, memory T lymphocytes. The mechanism by which these cells are selectively recruited during cutaneous allergic inflammation remains to be determined.

Adult↗
PubMed1995

Histamine release from human basophils induced by platelet activating factor: the role of extracellular calcium, interleukin-3, and granulocyte-macrophage colony-stimulating factor.

Although we have demonstrated that platelet activating factor (PAF) directly induces histamine release from human basophils, other studies have failed to report similar effects. In an attempt to understand the variability of these results, we examined the effect of some factors that could influence the basophils' response to PAF such as, extracellular Ca2+ and cytokines (interleukin-3 and granulocyte-macrophage colony-stimulating factor [GM-CSF]). The secretion of histamine induced by PAF was optimal when the cells were incubated in Ca2+ for 2 to 5 minutes, whereas it declined at longer time intervals up to 15 minutes. If cytochalasin B (5 micrograms/ml) was coincubated with PAF (1 mumol/L) to enhance the secretory response, histamine release was maximal at time 0 and decreased in parallel with the time of the basophils' exposure to Ca2+, like 0.1 microgram/ml anti-IgE-induced histamine secretion but unlike 1 mumol/L formyl-methionyl-leucyl-phenylalanine-induced histamine secretion. We found that there is synergy between interleukin-3 (1 to 3 ng/ml) and PAF (1 mumol/L) for secretion of histamine from human basophils (p < 0.05) and that GM-CSF (10 ng/ml) significantly (p < 0.02) potentiates the secretion of histamine activated by PAF (1 mumol/L). Our results demonstrate that: (1) the kinetics of the interaction between Ca2+ and the activation pathway that leads to histamine secretion are central events in the release reaction elicited by PAF in human basophils, and (2) interleukin-3 and GM-CSF can potentiate the secretory response of human basophils stimulated by PAF.

Antibodies, Anti-Idiotypic↗
PubMed1995

Cold dry air-induced rhinitis: effect of inhalation and exhalation through the nose.

Ten subjects with a history of cold air-induced nasal symptoms participated in a randomized two-period crossover study to evaluate the occurrence and magnitude of the reaction induced by inhalation and exhalation of cold dry air through the nose. The protocol involved breathing of either warm moist or cold dry air for 45 min at resting breathing rates. The nasal response was quantified by determining the amount of produced secretions as well as by measuring histamine and N-alpha-p-tosyl-L-arginine methyl (TAME) esterase activities in recovered nasal lavage fluids. Symptom scores were obtained. Warm moist air did not increase symptoms nor did it result in any significant changes in secretions or mediator levels. Compared with baseline, cold dry air induced significant rhinorrhea and increased both secretion weights (9.6 +/- 1.3 vs. 28.1 +/- 6.5 mg; P = 0.01) and the levels of histamine (3.9 +/- 1.2 vs. 10.6 +/- 2.7 ng/ml; P = 0.02) and TAME esterase activity (3.1 +/- 0.8 vs. 7.0 +/- 2.0 counts.min-1.10(-3); P = 0.01). We conclude that bidirectional nasal breathing of cold dry air results in a reaction that is qualitatively similar to that induced when air is only inhaled through the nose and exhaled through the mouth.

Adult↗
PubMed1995

Effects of nonselective and isozyme selective cyclic nucleotide phosphodiesterase inhibitors on antigen-induced cytokine gene expression in peripheral blood mononuclear cells.

Cyclic nucleotide phosphodiesterase (PDE) enzymes may participate in regulation of the inflammatory response through their effects on second messengers. In the present study, we have investigated the role of nonselective and isozyme selective PDE inhibitors in altering the antigen-driven cytokine gene expression of peripheral blood mononuclear cells (PBMCs) from atopic individuals. Ragweed and tetanus toxoid were used as model antigens. The nonselective PDE inhibitor, 3-isobutyl-1-methylxanthine (IBMX), and the selective PDE4 inhibitor, rolipram, markedly suppressed interleukin-5 (IL-5) and interferon gamma (IFN gamma) gene expression in both antigen-driven systems. Gene expression for IL-4 was unaffected by these agents in the ragweed-driven system. Message for IL-4 could not be detected in the tetanus toxoid-driven system, despite the use of a quantitative, competitive reverse transcription-polymerase chain reaction (RT-PCR) assay sensitive to less than 10 fg of target template. The PDE3 inhibitor, siguazodan, was ineffective in downregulating gene expression for the proinflammatory cytokines assayed; when used in combination with the PDE4 inhibitor, the PDE3 inhibitor provided no increase in efficacy over that seen with the PDE4 inhibitor alone. Gene expression for the A and B isoforms of the PDE4 in PBMCs was unaffected by antigen stimulation or treatment with the PDE4 inhibitor; however, differences in expression of these two isoforms were apparent when a variety of immune cell lines were studied. These data support the hypothesis that the primary anti-inflammatory target for PDE inhibition in PBMCs is the PDE4. Furthermore, the expression of various isoforms of this enzyme may differ between immune cell types. Finally, PDE4 isoform expression in PBMCs is independent of treatment with an isozyme selective inhibitor.

3',5'-Cyclic-AMP Phosphodiesterases↗