Acrodermatitis enteropathica: zinc levels and cell-mediated immunity.
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Biomedical subjects
Publications and source records attributed to R K Chandra.
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1. The proportions of both saturated and polyunsaturated fatty acids were measured in the erythrocytes in Cystic Fibrosis (CF) patients along with two membrane bound enzymes ATPase and acetylcholinesterase. Linoleic acid was found to be significantly decreased and arachidonic acid increased in CF patients. The proportion of saturated fatty acids were not significantly different from the controls. Only adenosinetriphosphatase activity was found to be reduced and not acetylcholinesterase in CF patients.
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Clinical and epidemiologic data point to a causal interrelationship between nutritional deficiency and infectious illness. Both are major contributors to childhood morbidity and mortality, particularly in underprivileged population groups. Energy-protein undernutrition and deficiencies of iron, folates and pyridoxine, depress a variety of immunity functions. Delayed hypersensitivity and number of T lymphocytes are consistently reduced. In small-for-gestation low birth weight infants, cell-mediated immunity may remain depressed for several years. B lymphocytes, immunoglobulin levels and antibody responses are generally normal, but secretory IgA-antibody is reduced. Serum complement components are low and there is evidence of in vivo consumption of complement C 3. Neutrophil phagocytosis of bacteria and fungi is intact but the next step of intracellular killing is impaired. There are changes also in the production of lysozyme and interferon. Infection per se results in nutrient losses, either actual or by sequestration, and produces immunosuppression. The correction of postnatal nutritional deficits and/or infection is associated with reversal of immunological functions to normal. The interplay of nutrition, immunity and infection, and its biological implications are described.
Children with energy-protein undernutrition showed a reduction in the number of circulating T lymphocytes identified on the basis of their ability to form rosettes with sheep red blood cells. T cells with a receptor for IgM (Tmu) were decreased whereas T cells with a receptor for IgG (T gamma) were increased. Surface immunoglobulin bearing B cells were comparable in well nourished and malnourished subjects but the proportion of B alpha was increased in the latter. "Null" cells without the conventional markers of T or B cells were proportionately increased. Leukocyte terminal deoxynucleotidyl-transferase activity was elevated in the majority of undernourished children and correlated with the proportion of "null" cells. The significance of these observations is discussed and it is suggested that "null" cells represent immature undifferentiated T lymphocytes.
The effect of exclusive breast feeding in the first few weeks after birth on infant morbidity due to infectious and allergic disorders was investigated in three separate prospective studies. In a rural community in India, breast-fed infants had a significantly lower incidence of respiratory infection, otitis, diarrhoea, dehydration and pneumonia. In an urban population in Canada, breast feeding was associated with a marked decrease in the occurrence of otitis and respiratory disease and to a lesser extent of diarrhoea and dehydration. In newborn siblings of children with atopic disease exclusively breast-fed for a minimum of six weeks, the incidence of eczema, recurrent wheezing, elevated serum IgE-antibodies to cow's milk, complement activation in vivo after milk challenge and hemagglutinating antibodies to beta-lactoglobulin was significantly lower compared with formula-fed matched group. These observations provide clinical data attesting the immunologic advantages of human milk.
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To characterize the underlying mechanisms of impaired cell-mediated immunity in protein-energy malnutrition, thymic hormone activity was measured in the serum samples of undernourished children and was found to be reduced in the majority. This indicates that the cellular immunological deficit in nutritional deficiency may be due to reduced thymic inductive activity.
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In a case of laevocardia, bronchiectasis, and paranasal sinus abnormalities, assessment on 2 occasions showed the presence of moderate immunodeficiency. Serum concentrations of IgG and IgM were low, and serum and salivary IgA was not detected. T-lymphocytes were reduced in number and cell-mediated immunity in vivo and in vitro was impaired. Opsonisation, complement system, and neutrophil functions were normal.
Tonsil size and serum immunoglobulin (G, A, M and D) measurements were studied in 1049 individuals during a health survey on the West Coast of Newfoundland. The data were subjected to multifactorial analysis of variance. People with vestigial tonsils had the lowest mean IgG-levels, whereas those with naturally absent tonsils had the highest mean IgG-levels. There were also statistical differences in the mean IgA levels in relation to tonsil size. Individuals with vestigial tonsil sizes had the highest mean IgA levels whereas those who had had a tonsillectomy had the lowest. There are no tonsil size-related differences for IgM or IgD concentrations.
The incorporation of fucose to glycoprotein acceptors prepared from the saliva of Cystic Fibrosis (CF) patients was compared with the incorporation into acceptors from controls. The CF acceptor glycoprotein incorporated significantly more fucose in the presence of either patients' or control plasma. The fucosyl transferase activity in the patients' plasma was not significantly different from controls. Fucosidase activity was similar also for both groups. The protein bands of the acceptor glycoproteins from the patients' saliva differed from those of the control in number and electrophoretic mobility. On the basis of these studies of fucose incorporation we propose that glycoprotein in the salivary secretion of CF patients are qualitatively different from normal.
Serum alpha-fetoprotein (AFP) estimated in 33 malnourished children, was found to be elevated in 11 of 17 fetally growth-retarded infants and in 5 to 16 with postnatal nutritional deficiency. The majority of those with increased serum AFP concentration had associated liver dysfunction. Nutritional deprivation of growing rats resulted in an increase in AFP levels, especially in the offspring of starved female animals. The administration of purified AFP was associated with reduced antibody formation to sheep red blood cells. It is suggested that AFP exerts a modulating influence on immune response.