Biomedical subjects
Publications and source records attributed to S Bonini.
The sensitivity and specificity of the Pharmacia CAP System, a new in vitro assay for measuring IgE antibodies, were evaluated in a multicentric study on 286 allergic patients and 243 normal subjects. Sensitivity was 95.5%, with results significantly better than RAST for some allergens, and specificity was excellent, 98.1%.
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Eleven ryegrass-sensitive patients were challenged weekly for 4 weeks with incremental doses of ryegrass allergen applied topically to one eye; a buffer was applied to the other eye. A clinical examination and tear-fluid cytology were performed before challenge and at 20 minutes, 1 hour, and 6 hours after challenge. A significant clinical reaction and neutrophil accumulation in the tear film occurred at 20 minutes. At 1 hour, a clinical response and tear cytologic reaction were present only at higher antigen concentrations. Six hours after antigen challenge, only the highest allergen concentration (320,000 BU/ml) produced a clinical late-phase reaction (LPR) (p less than 0.01) and tear cytologic change (presence of eosinophils and lymphocytes). Five nonryegrass-sensitive control subjects were unresponsive to a similar challenge. These results indicate that a conjunctival response to allergen challenge is dose dependent, that is, the higher the dose, the more likely an LPR will occur and that an LPR correlates with significant numbers of inflammatory cells in the tear film.
Histamine release and leukotrienes (LTB4 and LTC4) production from circulating basophil have been studied in 13 patients with episodic cluster headache (CH) during the remission phase of symptoms, and in 9 normal subjects. Cell suspensions of basophils were stimulated with scalar dilutions of anti-IgE, f-met-peptide and Ca2+ ionophore A23187. Histamine was measured by an automated fluorimetric method; LTB4 and LTC4 with RIA in individual cases, and with Reverse-Phase HPLC in the two pools obtained from the supernatants of CH patients and controls. Mean values of histamine release in patients with CH were significantly lower when compared to those obtained in control subjects after stimulation with anti-IgE at the three dilutions used. LTC4 mean levels measured in CH patients were significantly lower than those of supernatants from controls after stimulation with 0.05 gamma/ml of A23187. A reduction of LTC4 and LTB4 levels in CH patients was also observed in R-P HPLC, which showed different elution patterns in the two groups. The histamine release in individual cases was related to leukotriene production: LTC4 levels were significantly (p less than .05) higher in "high histamine releasers" than in "low histamine releasers". Our results indicate that CH patients have complex abnormalities of histamine release and of leukotriene production during the painless phase of the disease.
The clinical response after allergen challenge and immunologic mechanisms leading to tissue inflammation have been extensively studied in the skin, nose and lung of allergic subjects. The present paper reviews personal studies aimed at evaluating clinical, cellular and humoral events after administration of specific allergen to the eye. Specific conjunctival provocation tests performed in grass-sensitive patients caused persisting inflammatory changes in conjunctival scrapings and tear fluid with a significant accumulation of different inflammatory cells depending on the time of observation (neutrophils, 20 min; eosinophils, 6 h; neutrophils, eosinophils and lymphocytes, 12-24 h after provocation). Increasing the dose of allergen resulted in a dose-dependent increase in the number of inflammatory cells recruited. When high doses of allergen were used, the challenge not only induced late-phase histological changes, but also clinical symptoms 6-10 h after provocation. Several mediators of allergic inflammation, such as histamine, C3a des-Arg, leukotrienes B4 and C4, were also present and could be measured in tears after allergen challenge. Our studies represent the first evidence in humans that a late phase of allergic reaction occurs in the eye. They also suggest that the conjunctival provocation test may represent a model for the study of cells and mediators involved in the pathophysiology of allergic inflammation as well as of its pharmacologic modulation.
The study of the late-phase reaction to allergen challenge has greatly contributed to increasing understanding of the relationship existing between immunoglobulin E (IgE) triggering, allergic inflammation and bronchial hyperreactivity, as well as to changing our concept from "causes" to "triggers" of asthma. This paper reviews personal studies on a model of conjunctival provocation in allergic subjects. These studies represent the first evidence of a late-phase reaction in the human eye and contribute to a better knowledge of the network of cells and mediators involved in allergic inflammation which are responsible for heightened bronchial reactivity in allergic asthma.
This study was performed to investigate the inflammatory changes occurring in the human conjunctiva at different time periods after allergen provocation. Twenty-three ryegrass-sensitive patients with allergic conjunctivitis (19 with hayfever and four with vernal conjunctivitis) were challenged by topical administration of ryegrass antigen to the eye. Allergen concentrations were increased in increments until an immediate ocular allergic reaction was elicited. Numbers of various inflammatory cells (neutrophils, eosinophils, lymphocytes, and monocytes) found in conjunctival scrapings were quantified and correlated with the clinical profile, total serum IgE, and serum IgE to Rye I antigen. Twenty minutes after some level of antigen topical challenge to the eye, all patients had ocular redness, tearing, and itching. Compared with findings in seven control subjects, significant inflammatory cells were found in the conjunctival scrapings of patients before challenge (p less than 0.05) and 20 minutes (p less than 0.001) and 6 hours (p less than 0.002) after effective challenge. Significant increases in neutrophils of patients occurred after 20 minutes (p less than 0.001), and in eosinophils at 6 hours (p less than 0.005), compared with values of control subjects. When each case was evaluated individually, nine of the 23 patients had highly evident inflammatory changes 6 hours after allergen provocation. The levels of total serum IgE and serum IgE to Rye I antigen of these nine patients did not differ significantly from the other patients in the study. Our data provide the first evidence in humans that significant inflammatory changes in conjunctival scrapings are present long after allergen exposure has ended.
We tested the effects of pre-treatment with dexamethasone on topically induced ocular anaphylaxis in the rat. Rats were immunized with dinitrophenylated Ascaris suum extract and challenged with di-DNP-lysine. Dexamethasone was administered topically once (24, 6, or 1 h before challenge) or three times (6, 4, and 2 h before challenge). A single pre-treatment given at 24 or 6 h had no significant effect. A single pre-treatment 1 h before challenge reduced the extent of edema assessed histologically but not clinically, and had no significant effect on the eosinophil count in conjunctival tissue examined 6 h after challenge. Eyes pre-treated with dexamethasone 6, 4, and 2 h before challenge showed a significant reduction in conjunctival edema assessed histologically and clinically 1 h after challenge. In addition, 6 h after challenge the number of eosinophils was significantly reduced. We conclude that repeated pre-treatment with dexamethasone can suppress both the immediate phase and the cellular late phase of topically induced ocular anaphylaxis.
A cellular late-phase reaction is described in a rat model of topically induced ocular anaphylaxis. Rats were immunized with dinitrophenylated Ascaris suum extract and alum and were tested for active cutaneous anaphylaxis on day 13. Rats with a strong skin test response were selected for ocular challenge with di-DNP-lysine. Macroscopic observation and histologic evaluation were performed at 1, 6, and 24 h. In rats showing a moderate macroscopic ocular response at 1 h, mast cell degranulation was significantly increased at 1 h; no significant increase in eosinophils, neutrophils or lymphocytes was found in the conjunctive of these animals. In rats showing a marked macroscopic ocular response at 1 h, mast cell degranulation was significantly increased at 1 and 6 h; the number of eosinophils was significantly increased at 1 and 6 h, and of neutrophils at 6 h only. At 24 h, neutrophil and eosinophil numbers returned to baseline levels. There was no macroscopic evidence of a late-phase response in either group of animals. Our results suggest that, in keeping with earlier observations in human skin, a strong early response to antigen is required for the development of a late-phase ocular response in the rat.
A major allergen of Parietaria officinalis, a species responsible for a large number of respiratory allergies in Mediterranean areas, has been identified and characterized. This allergen (Pol) was found in the fraction which precipitates between 70 and 100% ammonium sulphate saturation. Pol showed a molecular weight of 15,000 daltons as determined by SDS-PAGE and HPLC. The pI of Pol was in the pH region 4-6, IEF showing four major bands. Two major bands were shown by CIE, CRIE and immunoblotting; major contaminants or aggregates were also revealed by the latter technique and by HPLC. Pol showed an allergic specific activity 2 times higher than the crude extract; moreover it was shown to be a major allergen since it inhibited 29 out of 30 sera from allergic patients sensitive to P. officinalis.
Tear fluid cytology is described for the early and late phases of ocular anaphylaxis in actively immunized Sprague-Dawley rats. Tears were collected from both eyes of the rats before challenge and at 1, 2, 4, 6, 8, 10, 12, 24, and 48 h after topical challenge with di-DNP-lysine in one eye and PBS in the fellow eye. Results showed a statistically significant increase in the Aggregate Cell Rating, which represents the aggregate scores in neutrophil, eosinophil, lymphocyte, and atypical epithelial cell levels, in antigen-treated vs control eyes. This report is the first to use a cytologic study of tear film to detect the late phase of ocular anaphylaxis in the rat. Cytology of the tear film could be applied to the study of allergic conjunctivitis in both animals and humans.
A hapten (DNP) model of topically induced ocular anaphylaxis has been developed. Rats immunized with DNP-Ascaris were skin-tested with DNP-bovine serum albumin (DNP-BSA) and Evans blue and challenged topically with varying amounts of di-DNP-lysine. The degree of clinical conjunctival edema was assessed, and eye tissues were evaluated histologically. Clinical conjunctival edema and histologic mast cell degranulation increased with higher concentration of di-DNP-lysine. In general, rats with positive skin tests showed more clinical conjunctival edema and more mast cell degranulation than those with negative skin tests. Three other groups of rats with positive skin tests to the DNP-BSA were injected intravenously with 125I-BSA and challenged topically with di-DNP-lysine. Retention of 125I-BSA in ocular adnexa and in globes was higher in di-DNP-lysine- than in PBS-challenged eyes. The hapten model simulates the ocular component of human hay fever in that ocular anaphylaxis is induced in immunized rats by topical challenge with antigen alone.
Basophil releasability implies that, in addition to the surface density of IgE molecules, biochemical events determine the capacity to release chemical mediators in response to activating stimuli. We studied the IgE (anti-IgE)-mediated and non-IgE-mediated (f-met peptide and the Ca2+ ionophore A23187) releasability of human basophils obtained from 14 monozygotic (MZ) (ages 25.7 +/- 13.3 yr; mean +/- SDM) and 13 dizygotic (DZ) twin pairs (ages 20.4 +/- 9.9 yr). A significant intrapair correlation coefficient of the maximal percent of anti-IgE-induced histamine release was found in the MZ, whereas no significant correlation was found in the DZ. The mean intrapair variance of anti-IgE-induced histamine release in MZ (VMZ) and in DZ (VDZ) gave an F value equal to 3.84 (p less than 0.01) and a heritability (H) index of 0.74. Similar findings were obtained with respect to the sensitivity to a standard concentration (10(-1) micrograms/ml) of anti-IgE. No correlation between serum IgE level and anti-IgE-induced histamine release was found in either MZ or DZ. A significant intrapair correlation coefficient of f-met peptide-induced histamine release was found in both the MZ and the DZ. The difference between MZ and DZ was not significant. The VMZ and the VDZ of the f-met peptide-induced histamine release gave an F value of 1.52 (NS) and an H value of 0.34. The intrapair correlation coefficient of A23187-induced release was significant in MZ and not significant in DZ. The mean intrapair variance of A23187-induced histamine release gave an F value of 2.33 (NS) and an H index of 0.57. Similar findings were obtained by using suboptimal (3 X 10(-1) micrograms/ml) concentrations of A23187. There was no correlation between the sensitivity of basophils to release in response to anti-IgE and their response to f-met peptide or A23187, in either the MZ or the DZ. We conclude that the ability of basophils to respond to anti-IgE and A23187 is influenced by genetic factors.
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Basophil releasability is an important parameter in several pathophysiological conditions. In normal donors, the maximum percent histamine release and cell sensitivity to rabbit anti-Fc epsilon (anti-IgE) is correlated with the age of cell donors. A positive correlation between serum IgE level and anti-IgE-induced histamine release was found in subjects below 20 years old. The response to formyl-Met-Leu-Phe (f-met peptide) was significantly reduced in subjects above 60 years old. In twins, IgE-mediated releasability and serum IgE levels appear to be controlled by two different genetic mechanisms. Basophils of patients with atopic dermatitis were more responsive than those of control subjects of matched ages to anti-IgE.
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