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Biomedical subjects

P Kern

Publications and source records attributed to P Kern.

At least 163 records · Page 9Linked to original sources

Synthesis, inactivation, and localization of extracellular and intracellular Escherichia coli hemolysins.

Extra- and intracellular Escherichia coli hemolysin expressed by two cloned hly determinants, both under the control of the activator element hlyR, were analyzed. One determinant carried all four hly genes (hlyC, hlyA, hlyB, and hlyD), whereas the other carried only the two genes (hlyC and hlyA) required for synthesis of active hemolysin but not those essential for its secretion. It was shown that the total amounts of HlyA protein and of hemolytic activity are similar in both cases in logarithmically growing cultures. The E. coli strain carrying the complete hly determinant released most hemolysin into the media and accumulated very little HlyA intracellularly. The active extracellular hemolysin (HlyA*) was inactivated in the stationary phase without degradation of the HlyA protein. In contrast, the hemolysin which accumulated intracellularly in the E. coli strain carrying hlyA and hlyC only was proteolytically degraded at the end of the logarithmic growth phase. Immunogold labeling indicates that active intracellular HlyA bound preferentially to the inner membrane, whereas that part of the extracellular HlyA which remained cell-bound was located exclusively at the cell surface. It was shown by fluorescence-activated cell sorter analysis that active extra- and intracellular HlyA* bound with similar efficiency to erythrocytes, whereas hemolytically inactive HlyA protein did not bind to these target cells.

Biological Transport↗

CEA-containing immune complexes in sera of patients with colorectal and breast cancer--analysis of complexed immunoglobulin classes.

A sandwich enzyme immunoassay was developed to detect circulating immune complexes containing carcinoembryonic antigen (CEA) and immunoglobulin (Ig) G, IgA, or IgM using a nitrocellulose-bound anti-CEA antibody as the solid phase reagent. Elevated levels of CEA-containing circulating immune complexes (CEA-IC) were found in 15.4% of 117 sera from patients with colorectal cancer in a postsurgery follow-up study. Also in 24.5% of 102 sera from patients with breast cancer in different states of disease CEA-IC were found. The predominant Ig determined in CEA-IC of colorectal cancer patients was IgA, followed by IgG and IgM, whereas IgG and IgM were the most frequent Igs in CEA-IC of breast cancer patients. Elevated CEA levels were found in 12.0% of the colorectal cancer patients and in 25.4% of sera from breast cancer patients. No significance for the coincidence of elevated CEA levels and CEA-IC was recorded in all patients sera tested. In sera of patients with disease recurrence, however, both parameters were shown to be elevated (CEA 80.7% and CEA-IC 42.3%). The data presented indicate the detection of CEA-IC as an additional parameter for the identification of patients at increased risk for disease recurrence.

Antigen-Antibody Complex↗

Immunohistochemical, electron microscopic and in situ hybridization evidence for the involvement of lymphatics in the spread of HIV-1.

To investigate the role of the lymphatic vessels and the sinus systems of the lymph node in the spread of HIV-1, we evaluated 15 lymph nodes from patients with persistent generalized lymphadenopathy (PGL). Fifteen lymph nodes taken from patients with follicular hyperplasia not related to HIV-1 infection served as controls. Immunohistochemical and in situ hybridization techniques revealed infected cells within the sinuses and the efferent lymphatics of the PGL lymph nodes. In contrast, infected cells could not be detected within the walls of the high endothelial venules nor in the areas immediately adjacent. The parenchymal side of the marginal sinus was lined by a discontinuous endothelium. Macrophages and lymphocytes were located within the gaps of this endothelium. More importantly, when the enlarged follicle extended as far as the wall of the marginal sinus, the processes of follicular dendritic cells could be seen extending through the gaps into the lumen of the sinus. This suggests that these cells could transport antigens (including HIV-1) from the sinuses directly to the germinal centers. In addition, HIV-1 particles within cytoplasmic vacuoles were seen in infected macrophages located in the submarginal zone. Positive cells were also found in the extrafollicular lymphoid parenchyma, especially in the area between the marginal sinus and the follicles. The observed distribution of the virus-positive cells within the PGL lymph nodes strongly implicates the lymphatic vessels in the spread of HIV-1 infection.

Acquired Immunodeficiency Syndrome↗

The in vitro influence of rIL2 on the B-cell dysfunction in patients with persistent generalized lymph node enlargement (PGL) or AIDS.

In AIDS elevated serum Ig levels and autoimmune phenomena indicate that B cells are also involved. The human immunodeficiency virus (HIV) can be cultivated in B cells, and HIV can stimulate B cells. In order to characterize the B-cell dysfunction and conditions for modulating it, functional studies with highly purified B cells were done in four patients with PGL and HIV-positive sera. Data were compared with those from patients with AIDS and normal controls. The experiments consisted of an in vitro study of the differentiation response (IgM/G secretion into culture supernatants) to a T cell-independent polyclonal B-cell activator (PBA) [Klebsiella pneumoniae, KlebsM]. A weak increase in IgM/G levels under stimulatory conditions was characteristic. Addition of recombinant interleukin 2 (rIL2) failed to increase the spontaneous Ig levels. However, coculture experiments using KlebsM and rIL2 resulted in Ig levels like those known from healthy individuals. Patients with frank AIDS did not respond with increased IgG secretion. This indicates that the abnormal B-cell differentiation response to PBAs can be modulated by rIL2 in patients with PGL and partly in AIDS (only IgM).

Acquired Immunodeficiency Syndrome↗

Failure of high dose mebendazole as a microfilaricide in patients with loiasis.

The effectiveness of mebendazole as a microfilaricide in patients with loiasis was studied. The drug regimen was 1 g twice daily for 21 days in adults. During and after treatment, the microfilarial density was unchanged. Therefore, mebendazole has no direct effect on the microfilarial density of Loa loa.

Clinical Trials as Topic↗

Eosinophil production in human bone-marrow cultures induced by 80-85 kDa serum component(s) of patients with eosinophilia.

Eosinophil production from normal human bone-marrow cells was induced by plasma or serum of patients with eosinophilia. After 10-12 d of liquid suspension culture, 14-42% of bone-marrow cells were identified as maturing eosinophil granulocytes. Upon molecular sieve chromatography, the activity eluted in a single peak corresponding to a substance of 80-85 kDa molecular weight. The activity did not stimulate colony formation in semi-solid agar media, but was detected in liquid suspension cultures only. Furthermore, addition of exogenous colony-stimulating factor (CSF) had a differential effect depending on the culture system used. In semi-solid media, predominance of eosinophil colonies was only observed when CSF was added at a low concentration. In liquid suspension cultures, however, 30-40% of cultured cells were eosinophils independent of the CSF concentration used. These findings extend recent studies in an animal model and support the hypothesis that a differentiation factor is involved in the regulation of eosinophil production in man.

Bone Marrow↗

Interferon alpha in the treatment of AIDS-associated Kaposi's sarcoma.

Twenty-three patients with biopsy-proven Kaposi's sarcoma and HIV infection were treated with recombinant interferon-alpha-2a (Roferon-A). Two dosage regimens were used: 21 patients received 18 X 10(6) units intramuscularly per day for 3 months, followed by injections of 18 X 10(6) units three times a week. The remaining 2 patients were treated with 2 X 18 X 10(6) units i.m. per day for 3 months. Three patients either refused further treatment or were lost to follow-up within the first few weeks. Thus, a median observation period of 7.5 months (range 1.5-17) was available for 20 patients. Within the first 3 months, 6 patients (30%) responded to treatment, 6 patients (30%) showed no progression, whereas in 8 cases (40%) progressive disease was noted. A similar rate of responders versus nonresponders was found after 6 months of observation. In progressive disease, interferon could be effectively combined with cytostatic drugs. Dose-dependent neurological and hematological side effects were observed in a few patients only. Opportunistic infections were diagnosed in 12 patients with a median onset of 6 months (range 1-10) after start of interferon treatment. The total number of lymphocytes expressing the CD4 antigen or the ratio of CD4 to CD8 positive cells were of prognostic value. These data suggest that interferon alpha is an active agent in the treatment of Kaposi's sarcoma, that it shows tolerable side effects and can be combined effectively with cytostatic drugs in case of progression.

Acquired Immunodeficiency Syndrome↗

Monoclonal antibodies to human immunodeficiency virus: their relation to the patterns of lymph node changes in persistent generalized lymphadenopathy and AIDS.

Recently there has been much interest in using immunohistology with monoclonal antibodies (MABs) against different cells of the immune system in lymph nodes (LNs) of patients with HIV infection. The panel of these MABs is becoming increasingly extensive. In this study we report on our finding that by using a limited number of properly chosen MABs, diagnostically and prognostically relevant parameters can be acquired. One hundred and twenty-one LN biopsy specimens from patients with HIV infection were reviewed and classified according to our expanded working classification and a fifth main type of LN lesion, the small lymphocyte follicular type, was added to our earlier classification. We propose that this new type represents a transitional form between the mixed follicular type and the follicular depleted type. In the follicular type of LN lesion there is no marked change in the number of CD4 cells within the follicles and in the extrafollicular parenchyma. The reaction against the major core proteins of HIV is always positive and the number of proliferating cells is very high. The positivity is weaker in the earlier cases and stronger in the older ones. The follicular dendritic cell (FDC) network shows degenerative changes. In the hypervascular follicular type the reaction pattern with these selected MABs is very similar to the one in the follicular type. In the mixed type there are hyperplastic follicles and regressively transformed follicles in the same node. The hyperplastic follicles show a pattern similar to those in the follicular type. However, the reaction with MABs against core proteins of HIV is often markedly stronger. The number of proliferating cells is decreased markedly. Some follicles show extensive FDC network destruction. CD4 cells within the follicles and in the extrafollicular parenchyma are decreased. The regressively transformed follicles contain very few proliferating cells and the reaction with MABs against core proteins is variable, being strong in some follicles and weak in others. The small lymphocyte type contains follicles consisting mainly of small lymphocytes. These lymphocytes are of the same phenotype as those in the primary follicles. In contrast to these, however, the numbers of CD4 and Leu 7+ cells are much decreased. The reaction with MABs to core proteins is weak and limited to the germinal centres (GCs). The number of proliferating cells is strongly diminished. The FDC network, however, is well developed in most follicles. In the follicular depleted LNs there are no follicles; however, in some LNs remnants of FDC can be seen.

AIDS-Related Complex↗

B-cell reactivity in homosexuals with persistent generalized lymphadenopathy (PGL).

In addition to the well known T-cell dysfunctions in AIDS, hypergammaglobulinaemia and autoimmune phenomena indicate an involvement of the B cell as well. Reports of HTLV-III/LAV-infected B cells suggest T-cell-independent B-cell abnormalities. To look for early B-cell dysfunctions, we examined a high-risk group of AIDS consisting of six homosexuals with PGL and HTLV-III/LAV antibodies, comparing these data to those of patients with AIDS/ARC and a normal control. In vitro studies included the B-cell proliferation response (3H-thymidine uptake) to Staphylococcus aureus Cowan I and the differentiation response (Ig secretion into culture supernatants) to T-cell-dependent/-independent polyclonal B-cell activators (PBAs). Profound alterations were found in both the proliferation and the differentiation responses. The weak response even to T-cell-independent PBAs indicates a B-cell dysfunction that is not due only to a T-cell defect in patients with PGL, similar to that observed in AIDS.

AIDS-Related Complex↗

Rehabilitation in dual disability of hemiplegia and upper extremity amputation: two case reports.

Dual disability involving amputation and hemiplegia is relatively rare. The vast majority of these cases involve lower extremity amputations. In this report two patients sustained a right-sided hemiplegia complicating an old left upper extremity amputation. Through the comprehensive rehabilitation program these two patients were able to make gains, especially in some activities of daily living and in lower extremity functions. Since some of the upper extremity activities, such as dressing or bathing, could not be accomplished, it appears that patients with upper extremity amputation who have a contralateral hemiplegia have a poorer prognosis for achieving functional independence than patients with lower extremity amputation and similar neurologic loss.

Amputation, Surgical↗

[Kaposi sarcoma within the scope of AIDS].

The disseminated form of Kaposi's sarcoma (KS) is an important cutaneous manifestation of acquired immune deficiency syndrome (AIDS). Since 1983, we observed 5 patients suffering from this rare multifocal cancer associated with AIDS. We report on clinical picture, histopathologic changes, and immunologic parameters.

Acquired Immunodeficiency Syndrome↗

Eosinophil differentiating activity in sera of patients with AIDS under recombinant IL-2 substitution.

An increase in circulating eosinophils was observed in patients with AIDS or ARC who were substituted for a period of 14 days with exogenous recombinant IL-2 in the context of a Phase I/II study. IL-2 exerts a broad range of biological properties and enhances the production of a variety of other cytokines, i.e., factors for haemopoietic cell growth and differentiation. After having excluded a direct effect of r IL-2 on haemopoietic precursor cells in semi-solid agar cultures, we developed a liquid culture system and studied the effect of patients' sera collected at different time intervals before, during and after r IL-2 substitution on cell differentiation of normal human bone-marrow cells in vitro. Patients' eosinophilia was preceded by a detectable activity in the sera which induced light-density, non-adherent bone-marrow cells to differentiate into the eosinophil lineage and was assessed by the presence of eosinophil primary granules or Luxol-fast blue positive granules. Thus, these in vitro data suggest the presence of circulating mediator(s) enhancing eosinophil production and differentiation in response to in vivo substitution of r IL-2.

Acquired Immunodeficiency Syndrome↗

Effects of systemic in vivo interleukin-2 (IL-2) reconstitution in patients with acquired immune deficiency syndrome (AIDS) and AIDS-related complex (ARC) on phenotypes and functions of peripheral blood mononuclear cells (PBMC).

In the context of a clinical phase I/II therapy study with recombinant interleukin-2 (rIL-2), we monitored immunological alterations in four patients with acquired immune deficiency syndrome (AIDS) and three patients with AIDS-related complex (ARC). By determining the surface phenotypes and in vitro functions of peripheral blood mononuclear cells (PBMC) before, during, and after treatment with rIL-2, we observed transient changes in all important leukocyte subpopulations, a minor restoration of immune reactivity in vitro, and an improvement in skin reactivity in vivo. In particular, we found a transient increase in C3b receptor-mediated monocyte activation in ARC patients; no influence of therapy on the otherwise intact LPS-induced interleukin-1 production in vitro; in some patients a transient corrective influence on the high pretherapeutic immunoglobulin secretion of B cells and their nonresponsiveness to pokeweed mitogen; low T-cell responses to soluble antigens and alloantigens, which were partially restored during rIL-2 treatment in ARC patients and in one AIDS patient; defective NK activity in PBMC of two AIDS patients, which was found to be restored when measured at the end of rIL-2 therapy; and a rather constant phenotypic pattern of PBMC in each patient during therapy except for the decreasing proportion of OKT9-positive lymphocytes in AIDS patients, the increasing proportion of Leu8-Leu3a+ lymphocytes in all patients, and in particular, the transient significant decrease in the Leu7+/OKT3+ ratio, which pretherapeutically was very high in AIDS patients (0.78 +/- 0.21) and high in ARC patients (0.48 +/- 0.06) as compared to healthy controls (0.18 +/- 0.08).

Acquired Immunodeficiency Syndrome↗

HTLV-III/LAV viral antigens in lymph nodes of homosexual men with persistent generalized lymphadenopathy and AIDS.

The presence of core antigens of retrovirus HTLV-III/LAV, referred to as "AIDS-related virus" (AV), has been sought in lymph node samples of patients with persistent generalized lymphadenopathy (PGL, 28 patients), prodromal AIDS (1 patient) and AIDS with Kaposi sarcoma (3 patients). In 30 patients the deposition of viral antigens, detected by monoclonal antibodies to HTLV-III and LAV, could be observed within the germinal centers (GCs) primarily within the extracellular network of immune complexes, and the two patients who were negative were atypical. No AV could be found in normal tonsil or in samples with follicular hyperplasia of unknown etiology (20 cases). These findings, taken together with the ultrastructural identification of typical retrovirus particles in all 9 PGL and 2 AIDS cases studied, indicates that the network of follicular dendritic (FD) cells is an important reservoir of AV virus antigen at this site. The persistence of this retrovirus inside the GCs helps explain how the follicular hyperplasia affecting FD cells and B blasts in PGL may in progressive cases be accompanied by destruction of FD cells and gradual development of T4+ lymphopenia. T4+ T cells may circulate through the GCs and become infected with AV there. In addition, the identification of retrovirus antigen in situ may be of diagnostic value.

Acquired Immunodeficiency Syndrome↗