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Biomedical subjects

R D Guttmann

Publications and source records attributed to R D Guttmann.

At least 37 records · Page 2Linked to original sources
PubMed1997

Pharmacokinetics, foreign protein immune response, cytokine release, and lymphocyte subsets in patients receiving thymoglobuline and immunosuppression.

The pharmacokinetics and immune response to the rabbit IgG of rabbit antihuman thymocyte globulin, Thymoglobuline has been characterized. A cytokine release pattern of TNF alpha and IL-6 but not IL-1 beta and IFN chi has been demonstrated with the first and not subsequent doses. An effect on lymphocyte depletion of peripheral blood with major subset suppression has been shown to last more than the 3-month observation period in patients on a regimen of quadruple sequential immunosuppression.

Animals↗
PubMed1996

Increased endothelin expression in a rat cardiac allograft model of chronic vascular rejection.

Endothelins (ET) are potent vasoconstrictors that are directly mitogenic for vascular smooth muscle cells and fibroblasts. It is possible that the vasoconstrictor and mitogenic effects of ET could play a significant role in the vascular remodeling process that occurs in chronic vascular rejection (CVR). We have previously shown that cardiac allografts in the indefinitely surviving major histocompatibility complex identical WF.1L (RT1(1)) to Lewis (LEW) (RT1(1)) inbred rat strain combination provide a highly reproducible model of progressive CVR. The objective of this investigation was to measure endothelin-1 ventricular content of WF.1L-LEW cardiac allografts and to determine the immunohistochemical patterns of ET cellular reactivity at well defined posttransplant time periods. Data were compared with those obtained in similar studies of LEW-LEW syngeneic: heart grafts as well as all recipients' own hearts. The ventricular ET-1 content of the WF.1L cardiac allografts was markedly higher (4.3-, 7.0-, and 4.8-fold at 20, 40, and 60 days, respectively) than in corresponding recipients' hearts. Also, the increase in ventricular ET-1 levels as compared with the recipients' hearts rose significantly only in the allograft group. No comparable differences were observed in the syngeneic heart graft controls. Allografts consistently showed ET staining of intimal myocytes at sites of occlusive and subocclusive intimal proliferation associated with CVR. Allografts also showed ET cellular staining in areas of reparative fibrosis associated with indolent interstitial rejection and ischemic myocardial damage. The results of this study strongly suggest that ET may play a significant role in the pathogenesis of CVR.

Animals↗
PubMed1996

Recurrent and de novo glomerulonephritis postrenal transplantation.

Important conceptual advances in recent years have been made in the area of posttransplant GN mainly in the de novo form rather than in recurrent posttransplant glomerulonephritis. Important patient subgroups have been identified for whom a significant risk exists. In particular, those carriers of hepatitis C virus may develop immune-complex renal disease leading to both MGN and MPGN. A de novo form of FSGN may occur in very long-term renal allograft patients. A case cited of an identical twin donor and her recipient developing glomerulosclerosis more than 10 years posttransplant represents an instance where the provocative hyperfiltration hypothesis was not relevant. The possibility that FK 506 may rescue cases of de novo posttransplant HUS11 is exciting and needs further elucidation. Finally, the serious lesions of CyA vasculopathy and those of chronic renal allograft rejection may be ameliorated as experience is gained with newer potent immunosuppressive drugs, such as FK 506 as the UNOS data suggest.

Adolescent↗
PubMed1995

Impact of renal transplantation on uremic cardiomyopathy.

In chronic uremia, cardiomyopathy manifests itself as systolic dysfunction, concentric left ventricular (LV) hypertrophy, or LV dilatation. To determine the impact of renal transplantation on uremic cardiomyopathy, all dialysis patients participating in a long-term cohort study who received a successful renal transplant were followed with echocardiography. The transplanted group comprised 102 of 433 (24%) endstage renal disease (ESRD) patients. They were significantly younger and, on starting ESRD therapy, had significantly less ischemic heart disease and cardiac failure than the overall ESRD cohort. During followup, ischemic heart disease developed in only 1 patient and none experienced cardiac failure. In the 12% (n = 12) of patients with systolic dysfunction before renal transplant, fractional shortening normalized in all patients, increasing from 21.5 +/- 4.6% to 33.5 +/- 5.6% after transplantation. In the 41% (n = 41) with concentric LV hypertrophy before transplantation, the LV mass index improved from 158 +/- 39 g/m2 to 132 +/- 39 g/m2. LV dilatation was present in 32% (n = 32) of patients before transplantation. After transplantation, LV volume fell from 116 +/- 3.1 ml/m2 to 89 +/- 21 ml/m2, and LV mass index in this group fell from 166 +/- 55 g/m2 to 135 +/- 37 g/m2. It was not possible to associate risk factors characteristic of the uremic state with the improvement in cardiac structure and function, although the fall in LV mass was significantly associated with fall in blood pressure. We conclude that correction of the uremic state by renal transplantation leads to normalization of LV contractility in systolic dysfunction, regression of hypertrophy in concentric LV hypertrophy, and improvement of cavity volume in LV dilatation. The degree of improvement suggests that dialysis patients with uremic cardiomyopathy would benefit from renal transplantation.

Adult↗
PubMed1995

Adoptive transfer of allergic airway responses with sensitized lymphocytes in BN rats.

To evaluate the role of lymphocytes in the pathogenesis of allergic bronchoconstriction, we investigated whether allergic airway responses are adoptively transferred by antigen-primed lymphocytes in Brown Norway (BN) rats. Animals were actively sensitized to ovalbumin (OA) or sham sensitized, and 14 d later mononuclear cells (MNCs) were isolated from intrathoracic lymph nodes, passed through a nylon wool column, and transferred to naive syngeneic rats. Recipients were challenged with aerosolized OA or bovine serum albumin (BSA) (5% wt/vol) and analyzed for changes in lung resistance (RL), airway responsiveness to inhaled methacholine (MCh), and bronchoalveolar lavage (BAL) cells. Recipients of MNCs from sensitized rats responded to OA inhalation and exhibited sustained increases in RL throughout the 8-h observation period, but without usual early airway responses. Recipients of sham-sensitized MNCs or BSA-challenged recipients failed to respond to antigen challenge. At 32 h after OA exposure, airway responsiveness to MCh was increased in four of seven rats that had received sensitized MNCs (p = 0.035). BAL eosinophils increased at 32 h in the recipients of both sensitized and sham-sensitized MNCs. However, eosinophil numbers in BAL were inversely correlated with airway responsiveness in the recipients of sensitized MNCs (r = -0.788, p = 0.036). OA-specific immunoglobulin E (IgE) was undetectable by enzyme-linked immunosorbent assay (ELISA) or passive cutaneous anaphylaxis (PCA) in recipient rats following adoptive transfer. In conclusion, allergic late airway responses (LAR) and cholinergic airway hyperresponsiveness, but not antigen-specific IgE and early responses, were adoptively transferred by antigen-primed lymphocytes in BN rats.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1995

Familial cerebral aneurysms: a study of 13 families.

Despite the recent interest in familial cerebral aneurysms, the epidemiology, natural history, pattern of inheritance, screening of asymptomatic relatives, and the search for a biochemical marker remain problematic. To assess these issues, we report the results of our prospective study of 30 patients with 38 aneurysms (27 ruptured) and of the angiographic screening of asymptomatic relatives, all from 13 families seen consecutively since 1986. Women were over-represented (77%), and patients with multiple aneurysms (17%) were under-represented, compared with sporadic cases. Only 16% of the aneurysms were at the anterior communicating artery. Aneurysms occurred at the same or at the mirror site in 10 of 16 siblings (62%) and in 50% of mother-daughter pairs versus 20% for randomly selected, sporadic aneurysm patients. Rupture occurred in the same decade in 10 of 12 siblings (83%) versus the expected 21% for randomly selected, sporadic aneurysms. The average age at rupture was 47.2 years, and 60% of patients with a ruptured aneurysm were 50 years of age or younger. Seventy percent of patients died or were disabled from aneurysmal rupture. Screening of 41 individuals, including 2 dizygous twins, identified 1 aneurysm and 2 infundibula. A specific pattern of inheritance could not be ascertained from the pedigrees. The presence of an aneurysm was not associated with a specific human leukocyte antigen haplotype or antigen, and collagen Type III was qualitatively and quantitatively normal. Until a biological marker is identified, angiographic screening by intra-arterial digital subtraction or magnetic resonance angiography remains the only way to identify patients at risk of harboring a familial cerebral aneurysm.

Adult↗
PubMed1995

Recombinant haplotype bearing the lymphopenia gene of the BB rat.

The development of insulin-dependent diabetes mellitus in the BB rat requires the presence of the class II major histocompatibility complex alleles of the RT1u haplotype and a T cell lymphopenia. The lymphopenia gene (lyp) behaves as an autosomal recessive trait that co-segregates with markers of rat chromosome 4. The current study examines two congenic and four recombinant inbred rat strains derived from BB and Buffalo rat strains using markers for simple-sequence length polymorphisms to confirm the linkage of the lymphopenia gene to chromosome 4. In two of these lines the lymphopenia associates with a recombinant haplotype that is BB-like at the D4Mit6 marker and Buffalo-like at D4Mit7 (neuropeptide Y locus) thus placing the lyp locus between these two closely linked markers.

Animals↗
PubMed1994

Evidence that recipient CD8+ T cell depletion does not alter development of chronic vascular rejection in a rat heart allograft model.

Progressive chronic vascular rejection is a central feature of indefinitely surviving WF.1L LEW/Gut (RT1(1)) heart grafts transplanted to LEW (RT1(1)) recipients in unmodified donor-recipient combinations. At 70 days posttransplantation, large vessels of the grafts are characterized by the presence of vasculitis, vasculitis with associated variable myointimal thickening, and occlusive myointimal thickening with minimal or absent concomitant vasculitis. To assess the potential role of CD8+ T cells as critical effectors of chronic vascular rejection in this model, LEW recipients of WF.1L heart grafts were effectively depleted of CD8+ T cells as a result of prior thymectomy and anti-CD8 (MRC OX8) monoclonal antibody administration prior to transplantation. WF.1L heart grafts transplanted to LEW recipients that had undergone prior sham thymectomy and MRC OX8 administration, or thymectomy and administration of antibody-free culture supernatant, provided appropriate controls. At 70 days posttransplantation, large vessels of WF.1L heart grafts in all 3 transplantation groups showed similar morphologic features, which were comparable to those observed in heart grafts of long-surviving unmodified donor-recipient pairs. This study has shown that profound selective depression of recipient CD8+ T cells does not alter the characteristic features of chronic vascular rejection in this rat cardiac model, and provides evidence that CD8+ T cells play no critical role in the initiation or development of progressive vascular damage in this setting.

Animals↗
PubMed1994

New medical technologies and clinical practice: a survey of lymphocyte subset monitoring.

BACKGROUND: Since its inception in the early 1980s, lymphocyte subset (LS) monitoring of transplant patients has been a controversial technique. The clinical literature is replete with contradictory claims concerning its usefulness. No systematic information is however available on clinicians' attitudes towards the new technology. METHOD: We carried out a mail survey of the members of The Transplantation Society concerning the availability, use, value, and critical assessment of LS monitoring. RESULTS: Results show that LS monitoring technology is available in most clinical settings surveyed and is regularly used by about half of the respondents associated with a clinical transplant program. About half of the users obtain diagnostically relevant measurements (T4/T8 ratios), as opposed to measurements related to OKT3 anti-rejection therapy. While claiming that LS measurement is a useful tool, respondents attribute a low average score to the diagnostic value of the technique; about 2/3 believe that its absence would not affect their clinical judgment. Finally, 25% of the respondents send blood for LS measurements although they do not believe the technique is useful. CONCLUSIONS: The results suggest that research instruments which generate clinical interest may develop clinical-diagnostic routines despite a lack of consensus concerning their usefulness. More importantly, these routines avoid a critical assessment of key notions such as "immune monitoring" which tend to blur the distinction between research and therapy.

Attitude of Health Personnel↗
PubMed1994

Cyclosporine and the reversibility of chronic vascular rejection.

A model of chronic vascular rejection of cardiac allografts has been developed in inbred rats using the WF.1L/Gut congenic strain as donor into LEW recipients. The hearts beat for more than 200 days without the need for exogenous immunosuppression. The histopathology is characterized by cellular rejection, vasculitis, and myointimal arterial wall thickening, and by day 60 posttransplant, there are widespread occlusive vascular changes similar to those seen in human cardiac allografts. CsA, at a dose of 15 mg/kg/d, is effective in preventing as well as reversing the vasculopathy. These data (1) confirm other studies of ours on the reliability of the experimental model using this strain combination, (2) establish the time window of days 40 to 60 whereby mechanisms of lesion regression can be studied, (3) prove the MHC class I and class II antigen incompatibility are not a necessary condition for the generation of the vascular lesions, (4) show that CsA is a useful probe for study of the vasculopathy, and (5) suggest that the model is a useful probe of the mechanism of action of CsA.

Animals↗
PubMed1993

Live and learn: patient education delays the need to initiate renal replacement therapy in end-stage renal disease.

During a longitudinal study of the quality of life of end-stage renal disease, 204 patients with deteriorating renal function were identified before dialysis or transplantation was required to preserve their lives. These patients were randomly assigned to either an enhanced or a standard education condition. The enhanced education condition consisted of a specially prepared slide-lecture show concerning kidney diseases and their treatment that was delivered by a trained research assistant. The standard education condition consisted of whatever educational procedures were routinely available at the participating hospital. All but six patients have now started treatment by maintenance dialysis. Individuals in the enhanced education condition survived an average of 4.6 months longer than did those in the standard education group without requiring the initiation of renal replacement therapy. This effect could not be attributed to physical differences between the groups, to cohort effects, to delays in contacting the patients, or to when or where they were identified. Possible mechanisms for this effect are discussed.

Attitude to Health↗