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Biomedical subjects

R J Levinsky

Publications and source records attributed to R J Levinsky.

At least 73 records · Page 4Linked to original sources
PubMed1990

Preparative procedures of cooling and re-warming increase leukocyte integrin expression and function on neutrophils.

The majority of studies involving neutrophil integrin expression and function are performed at physiological temperatures subsequent to routine preparative procedures at 4 degrees C. We have shown that surface expression of the leukocyte integrin molecules on neutrophils is increased by cooling and subsequently re-warming of neutrophils to 37 degrees C when compared with cells held at room temperature or 37 degrees C. This increase in expression is secondary to prior cooling of the neutrophils. There is an associated increase in function of these newly expressed adhesion molecules, making the neutrophils more adherent to endothelium. Preparation of cells at 4 degrees C and subsequently warmed to 37 degrees C is stimulatory for neutrophils, probably causing translocation of intracellular stores of the leukocyte integrins to the cell surface in a manner analogous to the stimulant FMLP. Our results indicate that the cooling of neutrophils during isolation is an inappropriate method of neutrophil preparation.

Adult↗
PubMed1990

An enzyme-linked immunosorbent assay for the determination of human IgG subclass antibodies directed against Branhamella catarrhalis.

An ELISA procedure to determine the distribution of human IgG subclass antibodies directed against the gram-negative bacterium Branhamella catarrhalis has been developed using commercially available monoclonal anti-IgG subclass antibodies. Using whole bacteria as coating antigen the specificity of the assay was determined and showed minimal cross-reactivity with a range of other bacteria. Estimations of IgG1, IgG2, IgG3, IgG4 and total IgG antibodies directed against this antigen were performed. All normal adult sera tested had measurable antibody levels of specific IgG1, IgG2, IgG3 and total IgG. Specific IgG4 was undetectable in the majority of adult sera. These assays will be of value for investigation of both children and adults with suspected immunodeficiency and recurrent upper respiratory tract infection.

Adult↗
PubMed1990

Fibronectin degradation; an in-vitro model of neutrophil mediated endothelial cell damage.

We have observed that fibronectin has a characteristic fibrillar morphology within the extracellular matrix surrounding endothelial cells. This morphology, which is easily recognizable by conventional immunoperoxidase techniques, is disrupted if neutrophils are induced to degranulate on endothelial monolayers. Loss of the fibrillar morphology (degraded fibronectin) is characterized by fragmentation and diffuse spreading of fibronectin over the surface of the endothelial cells. Loss of the normal fibronectin architecture following neutrophil degranulation is more rapid and extensive in endothelium pretreated with Interleukin-1 (IL-1). In addition, there is loss from the fibronectin molecule of a chymotryptic protease-sensitive epitope recognized by a cellular fibronectin specific antibody. Degraded fibronectin is stimulatory for neutrophils, and is likely to induce further fibronectin breakdown. This sequence has the potential to set up an amplification inflammatory loop with neutrophil mediated loss of vascular homeostasis. Alteration of fibronectin architecture is a useful marker of endothelial injury, and has important pathophysiological consequences.

Cell Degranulation↗
PubMed1990

Inosine triphosphate pyrophosphohydrolase deficiency in a kindred with adenosine deaminase deficiency.

A complete deficiency of inosine triphosphate pyrophosphohydrolase (ITPase) has been identified, together with high concentrations (mean 157 mumol/l) of the unusual nucleotide ITP, in the erythrocytes of 3 members of a consanguineous United Kingdom kindred. The defect has been noted previously in North America and Sweden, but even in presumed homozygotes some residual ITPase activity was reported. Homozygosity for the defect has not been associated previously with any clinical abnormality. In this kindred it was co-existent with adenosine deaminase (ADA) deficient severe combined immunodeficiency. Since the genes for both ITPase and ADA are localised on the same chromosome, segregation analysis of ITPase and ADA activity was undertaken in available kindred members. The results confirmed an autosomal recessive mode of inheritance for ITPase deficiency, but suggested that the co-existence with ADA deficiency was coincidental.

Adenosine Deaminase↗
PubMed1990

Branhamella catarrhalis: antigenic determinants and the development of the IgG subclass response in childhood.

A recently developed whole cell ELISA was used to investigate the development of IgG subclass antibodies to Branhamella catarrhalis in childhood. In addition, SDS-PAGE and immunoblotting were used to study the interaction between the outer membrane proteins (OMPs) of B. catarrhalis and IgG subclass antibodies. Specific IgG3 antibodies were undetectable or present only in low amounts in children less than 4 years old but were an important constituent of the response of older children. OMPs prepared from different isolates had similar molecular masses and bound IgG with identical immunoblotting patterns. Binding appeared subclass-specific, with IgG3 binding to the broadest range of OMPs. These findings should provide a better understanding of the pathogenic role of this organism and suggest possible strategies for the development of a vaccine.

Agammaglobulinemia↗
PubMed1990

The level of mannan-binding protein regulates the binding of complement-derived opsonins to mannan and zymosan at low serum concentrations.

When sera diluted to 5% in a buffer containing calcium and magnesium were incubated with mannan-coated ELISA plates, C4 fragments, properdin and factor B were bound to the plates as well as the expected opsonic C3 fragments, C3b and C3bi. The calcium-dependent lectin mannan-binding protein, which is structurally similar to C1q, was also shown to bind in this assay and analysis of sera from 179 healthy blood donors revealed that the binding levels of all these proteins were highly significantly correlated. Results obtained with a previously described C3b opsonic assay using zymosan also correlated with the mannan-binding levels. When the sera were diluted to 5% in the presence of Mg-EGTA there was no detectable binding of complement proteins to the mannan surface, confirming that no alternative pathway activation occurred at this serum concentration. When sera were diluted to 5% in a buffer containing EDTA in order to study immunoglobulin binding in the absence of complement activation, the levels of bound IgG1, IgG2, IgG3, IgA and IgM antibodies were found to be completely unrelated to the C3bi binding levels previously observed. The results suggest that in this experimental system using low concentrations of serum, mannan-binding protein initiates an antibody-independent mechanism of cleavage of the classical pathway component C4, which subsequently regulates the degree of cleavage of C3 and recruitment of alternative pathway proteins.

Carrier Proteins↗
PubMed1990

Prognosis of chronic granulomatous disease.

The records of 28 patients with chronic granulomatous disease born over a 32 year period were reviewed. The characteristics of the group, and the frequency with which various clinical and laboratory features had been recorded, was assessed. Nine patients were known to have died, in most cases of progressive suppurative infection. Actuarial analysis showed 50% survival through the third decade of life. The long term survival of patients developing symptoms after the end of the first year of life was significantly better than that of patients whose illness started in infancy. Our data confirm that the severity of chronic granulomatous disease is not uniform, and that the prognosis for long term survival is better than that suggested in earlier reports. Early onset may be a poor prognostic sign and invasive aspergillosis is a life threatening complication. In the absence of curative treatment, trials to assess the effectiveness of interferon gamma are necessary and early antenatal diagnosis should be offered to as many affected families as possible.

Actuarial Analysis↗
PubMed1990

Central nervous system involvement in the erythrophagocytic disorders of infancy: the role of cerebrospinal fluid neopterins in their differential diagnosis and clinical management.

In two children with familial erythrophagocytic lymphohistiocytosis accompanied by neurologic symptoms, total neopterin concentrations in cerebrospinal fluid were 200 times higher than in controls and 10 to 20 times higher than in five children with presumed neurologic disease due to primary viral infections (human immunodeficiency virus, herpes simplex, measles) of the CNS. In one child with familial erythrophagocytic lymphohistiocytosis, clinical remission was accompanied by a fall in neopterin concentrations to normal; in a second child, who died, total neopterin concentrations remained high. In two other children with a diagnosis of infection-associated hemophagocytic syndrome without any neurologic disturbance, neopterin concentrations were also elevated but only to 10 times the concentrations in controls. Total neopterin concentrations in cerebrospinal fluid provide a measure of the severity of macrophage infiltration and activation within the CNS, and are useful in assessing the need for intensive chemotherapy and monitoring the response to treatment.

Biopterins↗
PubMed1989

Association of low levels of mannan-binding protein with a common defect of opsonisation.

Failure to opsonise bakers' yeast (Saccharomyces cerevisiae) is a defect found in 5-7% of the general population. In this study, the presence of the defect was linked with low levels of mannan-binding protein (MBP), a calcium-dependent serum lectin. Purified MBP corrected the defect in a dose-dependent way in an in-vitro assay measuring the deposition of complement moieties on a mannan-coated surface. There was a highly significant correlation between the serum MBP level and the generation of C3b opsonins in a population of healthy blood donors. The median MBP level of ten children previously shown to have the functional opsonic defect was 4.9 micrograms/l (range 2.5-35.0 micrograms/l) compared with 143 micrograms/l (range 2.5-880 micrograms/l) for a paediatric control group.

Adolescent↗
PubMed1989

Neutrophil-mediated endothelial injury in haemolytic uraemic syndrome.

Neutrophil leucocytosis is associated with a poor outcome in the haemolytic uraemic syndrome (HUS). This study tested the hypothesis that neutrophils from HUS patients are activated and through release of their intracellular contents damage endothelium. The proportion of neutrophils adhering to endothelium in culture was twice as high for HUS patients' neutrophils as for control neutrophils (n = 12). In addition, these neutrophils induced endothelial injury, assessed morphologically by degradation of endothelial cell fibronectin. In an attempt to inhibit neutrophil adhesion and subsequent endothelial damage the hyperadhesive neutrophils from HUS patients were incubated with a CD18 antibody directed against the common beta chain of the leucocyte integrin molecules. The CD18 antibody was able to abrogate endothelial damage in four of the ten subjects studied. These observations suggest that the neutrophil is of prime pathophysiological importance in HUS, and that methods aimed at reducing neutrophil adhesion and neutrophil-mediated endothelial damage are likely to be beneficial.

Acute Disease↗
PubMed1989

CD15 antibodies increase neutrophil adhesion to endothelium by an LFA-1-dependent mechanism.

Anti-neutrophil antibodies (CD15) bind to a simple sugar (lactose-N-fucopentaose III, LNF III) known to be present on the chains of the adhesion molecules on neutrophils. We have demonstrated that pre-incubation of neutrophils with a CD15 antibody increases neutrophil adherence to endothelium by a neutrophil-dependent mechanism. This augmented adhesion can be inhibited by antibodies directed against the alpha and beta chain of the leukocyte function-associated antigen 1 (LFA-1) molecule. There is also some increase in surface LFA-1 expression on neutrophils after CD15 incubation, suggesting that CD15 antibodies increase neutrophil adhesion by an LFA-1-dependent mechanism. The increase in LFA-1 expression after CD15 incubation occurs in the presence of a protein synthesis inhibitor. As LFA-1 is not stored intracellularly, the increased adherence of the neutrophils, and increased LFA-1 expression on their surface, suggests the possibility that the CD15 antibodies are binding to the LNF III antigen present on the alpha and beta chains of LFA-1, producing their effect by activating the molecule, perhaps by exposing new antigen sites by a stearic effect.

Antigen-Antibody Reactions↗
PubMed1989

Fatal graft versus host disease after platelet transfusions in a child with purine nucleoside phosphorylase deficiency.

Fatal graft versus host disease (GVHD) developed in a child with purine nucleoside phosphorylase (PNP) deficiency following an unirradiated platelet transfusion. IV treatment with an anti-T-cell monoclonal antibody (CD7) led to a transient improvement of his GVHD (Grade IV) but did not prevent the fatal outcome. This report emphasizes the need for blood products to be irradiated when cell mediated immunodeficiency is suspected, even in patients with residual immunocompetence.

Blood Transfusion↗
PubMed1989

Neurodevelopmental delay and focal seizures as presenting symptoms of human immunodeficiency virus I infection.

Three children presenting with neurological symptoms were subsequently diagnosed as being infected with the human immunodeficiency virus I (HIV). All children showed normal development for about 12-18 months of age but later developed psychomotor and developmental regression. One child presented with generalised hypotonia, another with focal seizures, and the third with spastic quadriplegia. Two of the children showed areas of abnormal brain density on computed tomography and in one case there was calcification of the basal ganglia. In two of the children cerebrospinal fluid contained reduced amounts of total folate and elevated concentrations of neopterin. The possibility of a link between the deranged folate metabolism and the neurological symptoms in HIV infection is discussed.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Recent advances in bone marrow transplantation.

An increasing number of diseases may be treated successfully by allogeneic bone marrow transplantation (BMT). Initially used for the treatment of immunodeficiency where a cell series or product is replaced, it has now become routine treatment for many forms of leukemia where the transplant provides the rescue after lethal marrow ablation. Recently, diseases such as thalassemia and other inherited metabolic diseases have also been treated by BMT. Formerly the problems of BMT were mainly concerned with graft versus host disease (GVHD) in HLA-matched transplants with HLA-mismatched ones not being possible as GVHD was usually fatal. Since the development of techniques for T cell removal the incidence of GVHD has greatly diminished. T cell removal has also allowed HLA haploidentical mismatched grafts to be performed successfully for immunodeficiency, but there is still a high graft rejection rate in leukemia. This also occurs to a lesser extent with HLA-matched grafts in leukemia. Furthermore, in certain forms of leukemia, particularly chronic granulocytic leukemia, the relapse rate after T cell-depleted BMT is much higher. Trials of better forms of bone marrow conditioning of the recipient are being attempted in order to prevent graft rejection and leukemia relapse. These include total lymphoid irradiation, heavier irradiation and chemotherapeutic regimens, or the use of in vivo monoclonal antibodies such as CAMPATH 1G or anti-LFA-1 (CD11a). In the future, positive selection of stem cells combined with hemopoietic growth factors may allow engraftment without graft versus host disease. This should become the method of choice for autologous transplantation for malignancy. Two monoclonal antibodies directed against the human progenitor cell antigen 1 (HPCA-1) (CD34) have been used for autologous positive stem cell selection in primates and these cells gave full hemopoietic reconstitution in the animals following lethal total body irradiation.

Bone Marrow Transplantation↗
PubMed1989

Surgery, sepsis, and nonspecific immune function in neonates.

An audit of 143 neonatal surgical operations identified low birth weight infants as being at particular risk of developing post-operative sepsis following major surgical trauma. Activity of the nonspecific immune system was examined pre- and post-operatively in order to elucidate the susceptibility to post-operative sepsis of these infants. A chemiluminescence micro-method was developed specifically for this purpose. Neonatal plasma was shown to have significantly impaired opsonising activity, and activity was further reduced in low birth weight infants. Levels of immunoglobulin and complement factors were also reduced, particularly in the low birth weight infant. Following major surgical trauma polymorph activity was significantly lower in low birth weight infants than in mature neonates.

Anti-Bacterial Agents↗