[Myospherulosis: an iatrogenic disease. Apropos of 2 cases with immunomorphologic and experimental study].
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Biomedical subjects
Publications and source records attributed to R Oriol.
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In baboons ABH antigens are found on vascular endothelium but not on red blood cells. This newly observed pattern of distribution is intermediate between that of lower mammals (in which ABH antigens are not found on endothelia or on red cells) and that of humans (in whom ABH antigens are present on both). In both types of cells the expression of these ABH antigens was expected to be under the same H-h genetic control, but the dissociation between the expression of ABH on red cells and on vascular endothelium shows that some other factor must by involved. The ABH antigens of exocrine secretions were expected to be under control of the Se-se system. However, some epithelial structures express ABH antigens in nonsecretor baboons (e.g., striated ducts), some cells express only H without A or B (e.g. biliary ducts and acinar cells of salivary glands), and some cells express only the H antigen at early stages of differentiation and the A or B antigens at later stages of differentiation (e.g. epidermis). ABH antigens were also found in the nervous system, a previously unreported site. All of these observations necessitate a reappraisal of current theory of the genetic control of tissue expression of ABH antigens.
At least six hydrolases of the human intestinal brush-border membrane bear ABH blood group antigenic determinants related to the erythrocyte phenotype: the intestinal glycoproteins of blood group A and B subjects express A or B determinants, respectively, while blood group O subjects express the H determinant identified with Ulex europaeus lectin I. These expressions are under the control of the secretor gene: ABH antigens were not detected in the hydrolases of non-secretor subjects.
Mounting immunofluorescent slides in an oxidized solution of p-phenylenediamine in 90% glycerol, resulted in brown fluorescent staining of nuclei. This contrasts well with the fluorescence of fluorescein and rhodamine conjugates and facilitates excellent morphological localization of antigens. The antifading effect of p-phenylenediamine is maintained in this oxidized solution. In addition, amyloid substance gives a bright yellow-orange fluorescence with this medium. This method of staining is more sensitive and less time consuming than the usual methods for amyloid. Alternative techniques to keep the antifading effect without either nuclear or amyloid counterstain (for identification of nuclear antigens), or to show up amyloid deposits without nuclear counterstain (for small amyloid deposits) are described.
alpha-2-L-fucosyltransferase activity was found in the sera of 4 H-deficient secretor individuals (Hz). This activity represented about 5-10% of the activity present in the serum of normal H phenotypes.
Radioimmunoassays were prepared using two anti-A and one anti-B reagents. The specificity of the procedures was assessed with 13 artificial antigens. The amounts of A and B natural antigens in saliva of ABH secretors of known Lewis phenotype were measured with these assays. The results confirmed that the average amount of A antigen is lower in Lewis-positive (Leb) than in Lewis-negative (Led) donors and in A2 than in A1 donors. However, the differences among the four combined A and Lewis phenotypes were only supported by significantly lower amounts of A antigenic determinants in A2Leb as compared to the other three phenotypes (A1Leb, A1Led and A2Led) that had similar amounts of A antigenic determinants. No Lewis-related difference could be detected in the amounts of B antigens between BLeb and BLed donors. The results are discussed in terms of competition between A, B and Lewis-gene-specified enzymes for their common acceptors. The difference in the efficiency of the A2 enzyme as compared to that of the A1 enzyme is proposed as a possible explanation for the A1-A2 phenotypic difference.
One B- and two A-specific radioimmunoassays detected A and B antigenic determinants in saliva of ABH nonsecretors. The A or B antigens found in saliva of nonsecretors had lower efficiency and higher heterogeneity, in the inhibition of the A or B assays, as compared to A or B antigens in saliva of ABH secretors. In the 3 assays, samples of nonsecretor Lewis positive donors (Lea) had less A or B antigens than samples of nonsecretor Lewis negative donors (Lec), suggesting that there is a competition between A or B and Le gene-specified products.
Two variants of recessive, H-deficient nonsecretor individuals (h/h, se/se) were identified on Reunion Island: (1) H-negative individuals corresponding to the classical Bombay phenotypes (OhO, OhA, OhB, OhAB) who lack completely the H antigen on their red cells; all of them were Indian and had strong anti-H antibodies reacting with normal O and Oh red cells from whites; and (2) H-weak individuals (Oh, Ah, Bh, ABh). This phenotype represented the majority (85%) of the H-deficient phenotypes on Reunion Island, and all of them were white. They had only a weak expression of the H antigen and showed small but detectable amounts of ABH antigens on their red cells. Their anti-H antibodies reacted with normal O erythrocytes, but failed to react with Oh red cells, regardless of the ethnic origin of the donor. They were all from the same geographical area on the Island (Cilaos) and showed homogeneous titers of anti-H antibodies in sera. We propose to call this particular variant of weak H phenotype, belonging to the so-called para-Bombay series, Reunion.
Small amounts of H-enzyme activity (from 500 to 1,280 counts per minute [cpm]) were detected in sera of white H-deficient individuals (h/h; Reunion phenotype), while no significant H activity (less than 500 cpm) could be detected in sera of Indian H-deficient individuals (h/h; Bombay phenotype). The H-enzyme levels of the unaffected members of H-deficient pedigrees showed an H-related dosage effect. Heterozygous H/h individuals had only half as much H activity in sera (17,000 +/- 3,400 cpm) compared with homozygous H/H individuals (31,600 +/- 3,700 cpm). Data suggesting interactions between the H enzyme and the other gene specified glycosyltransferases working on the same oligosaccharide chains carrying combined ABH and Lewis antigens are analyzed in terms of their possible genetic or biochemical origin.
The low graft survival rate in black recipients (36 +/- 2% at 1 year) as compared with the graft survival rate in white recipients (48 +/- 1%) might be secondary to a higher incidence of vascular lesions, inducing hypertensive disease, in blacks than in whites. The relative frequency of malignant hypertension in black recipients was six times that of white recipients, and recipients with malignant hypertension had a significant lower graft survival rate (43 +/- 2%) than recipients with glomerulonephritis (54 +/- 1%). In addition, patients with vascular lesions (diabetes, malignant hypertension, and glomerulonephritis) showed significantly lower graft survival rates in black than in white recipients, in contrast to patients with primary tubular or interstitial lesions (polycystic kidneys and pyelonephritis), who showed similar graft survival rates in blacks and whites. Only a small fraction of this racial effect could be traced back to the higher incidence of Lewis-negative phenotypes in black recipients and a similar beneficial effect of transfusions, on graft survival, was observed in both black and white recipients. The effects of graft survival of age (6%), race (9%), and transfusions (18%) were significant in good (A) and poor (B) centers. No overlap between A and B centers was observed for any of these three parameters when analyzed separately. However, when the cumulative effects of these three risk parameters were analyzed together a partial overlap appeared, i.e., higher graft survival rates were observed in low-risk recipients that received transplants in B centers than in high-risk recipients that received transplants in A centers. Consequently, the selection of the recipient may play a role in the overall results of different transplantation units, leading to their classification into A or B centers, but cannot explain all of the differences between A and B centers.
Artificial antigens: Antibodies were raised in rabbits with beta DGal(1 linked to 3)beta DGlcNAc-BSA and purified by absorption elution on a column of the synthetic oligosaccharide covalently bound to a silicate instead of BSA. The purified antibodies agglutinated specifically erythrocytes from Le (a-b-) nonsecretor donors (Lec). Natural antigens: Antibodies were raised in goats using boiled saliva from O/O, le/le, se/se donors. The population of antibodies which was absorbed on a column consisting of beta DGal(1 linked to 3)etaDGlcNAc-O-R (type 1 chain precursor disaccharide) groupings attached to a silicate was collected and then refined by passage through a column which consisted of similarly immobilized alpha LFuc(1 linked to 2)beta DGal(1 linked to 3)betaGDlcNAc-(H type 1), beta(DGal(1 linked to 3)-[alpha LFuc(1 linked to 4)]beta DGlcNAc-(Lea), and beta DGal(1 replaced by 4)beta DGlcNAc-(type 2 core chain precursor) groupings. The refined antibodies proved to have a reaction pattern with salivas that is the same as that previously reported for anti-Lec sera. The data obtained with natural and artificial antigens are thus compatible with the biosynthetic pathway for the formation of the Lewis antigenic determinants proposed by Graham and suggest that the Lec antigen may simply be the type 1 precursor chain which is required for the formation of the Lea, Led and Leb antigenic determinants.
A radioimmunoassay specific for the H type 1 antigenic determinant demonstrated that the H type 1 antigen is under the strict control of the Se gene in both serum and saliva. Similar amounts of H type 1 antigenic determinants were found in saliva from Se/-, le/le donors and in saliva from Se/-, Le/- donors. However, sera from Se/-, le/le donors were about 100 times more efficient in inhibiting the H type 1 assay than were sera from Se/-, Le/- donors. A radioimmunoassay, based on the binding of Ulex europaeus with the H type 2 antigenic determinant, showed that all the H type 2 antigen in saliva is under the control of the Se gene, while only one-third of the H type 2 antigen present in serum is under the control of this gene. The remaining two-thirds of H type 2 antigen in sera is independent of the ABH secretor status of the donor. The amount of H type 2 antigen in both serum and saliva is independent of the Le gene. These results are compatible with the existence of two alpha (1 leads to 2) fucosyl-transferases but suggest that the enzyme of epithelial origin, coded by the Se gene, should be able to transform both type 1 and type 2 natural substrates, while the enzyme of mesodermic origin, coded by the H gene, would work preferentially on the natural type 2 substrates.
Forty-two H-deficient individuals (lacking H antigen on erythrocytes) with anti-H in their sera were found on Reunion Island. A, B, and AB Bombay subjects had small but detectable amounts of A and/or B antigens on erythrocytes. All the H-deficient phenotypes tested were nonsecretors of ABH in their saliva, and one-third were Lewis negative. Fifty-three of the 108 (49%) unaffected members in the 14 Bombay pedigrees analyzed were se/se, showing that the families were selected for the nonsecretor trait, and suggesting that the Bombay probands used to select the families have se/se genotype. In accordance with this concept, all the children from Bombay nonsecretor x unaffected nonsecretor matings were se/se. Segregation of H and Se is compatible with the genetic model proposing that Se and H are closely linked structural genes, and the analysis of the present and previously published Bombay pedigrees strongly supports this model.
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Twelve information bone marrow transplants, with at least one difference in ABO and/or Lewis types between donor and recipient, were retrospectively studied. ABH and Lewis antigens were determined in plasma, erythrocytes, and lymphocytes. Donor lymphocytes acquired the ABH and Lewis antigens from the recipient's plasma in the same way that donor erythrocytes acquired the Lewis antigens from it. Lymphocytotoxicity detected type 1 ABH and Lewis antigens only, providing evidence for the existence of combined ABH and Lewis antigens on lymphocytes. This was in contrast with the ABH antigens on type 2 chains of red cells, which are devoid of Lewis specificities. The differences in genetic control, probable chemical structure, and cellular origin of these two types of ABH antigens are presented in a theoretical model that accounts for most of the known data.
The Se gene is classically considered as a regulatory gene controlling the expression of the structural gene H in external secretions. Under this hypothesis, Bombay (h/h) individuals should not be able to express the Se gene. Statistical analysis of the 44 published Bombay pedigrees suggests on the contrary that there is no suppression of Se in Bombay individuals, and that both Se and H loci can be fully expressed at the phenotypic level. Based on a lod score of 12.9 at 1% recombination units and the existence of two different acceptors for the biosynthesis of the H antigen, a new genetic model is proposed in which H and Se would be two closely linked structural genes coding for two different 2-alpha-L-fucosyltransferases.
Analysis of lymphocytotoxic reactions with peripheral blood lymphocytes from 74 donors, typed for ABO, secretor, and Lewis phenotypes, identified clusters of reactions distinguishing six antigens resulting from the interactions of Lewis, secretor, and ABO systems: Lea, Leb, ALed, BLed, ALeb, and BLeb. In these experiments, Led on O lymphocytes and Lec were not detected as expected from the experience of other authors with A antigen, B and Leb were detected only on the lymphocytes of ABH secretors, demonstrating that all the ABH antigens of lymphocytes are controlled by the secretor system as are the ABH antigens in external secretions. The ABH and Lewis antigens identified on lymphocytes could be transferred in vitro to lymphocytes, cultured for 2 to 7 days at 37 degrees C in the serum of donors of selected ABO, Lewis, and secretor phenotypes, confirming that ABH and Lewis antigens are not synthesized by lymphocytes but are acquired from circulation as are the Lewis antigens on erythrocytes. As expected, the HLA antigens of lymphocytes were not modified after culture.
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