Reply to the letter entitled 'Immunoglobulins containing circulating immune complexes in hypercholesterolaemic patients'.
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Biomedical subjects
Publications and source records attributed to S Gerö.
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The incidence of circulating immune complexes, anti-low density lipoprotein (LDL) autoantibodies and the anti-LDL activity of immune complexes was studied in healthy young and aged controls and in patients with vascular diseases. Circulating immune complexes (CIC) frequently occurred both in the young or old patient groups and in the aged healthy control groups, whereas they could not be found in the young controls. Marked differences were found in the incidence of anti-LDL antibodies between the groups tested. In both young and aged control groups such antibodies were very rarely observed (4-5%). In contrast anti-LDL antibodies were present in 35-45% in the aged, or young patients. Similarly, no anti-LDL activity was found in CIC of the controls, whereas in the patients with vascular diseases a significant CIC-associated anti-LDL activity was detected. These results suggest that the presence of anti-LDL antibodies are associated with the arteriosclerotic manifestations, while that of circulating immune complexes is connected by the ageing process itself.
The antiatherosclerotic profile of nicotinic acid and of its new water-insoluble derivative was studied in an 8-day experiment in rats. Both drugs lowered plasma triglyceride levels significantly, while other lipoprotein parameters were unaffected. Circulating immune complex levels were decreased with lysosomal membrane permeability by both drugs. Glunicate proved to be a powerful antioxidant with regard to enzymatic lipid peroxidation when studied in the liver microsomal system. The relevance of these findings to the antiatherosclerotic effect of the drugs and the biological significance of antioxidant treatment is discussed. On the basis of these data glunicate seems to be a promising new therapeutic tool against atherosclerosis and merits further study.
The cell-mediated immune response against low density lipoproteins (LDL) was demonstrated by the migration inhibition test in patients with various vascular diseases. Anti-high density lipoprotein2 (HDL2) cellular immune response was found only in a few patients. LDL and HDL2 binding factors were detected in about 50% of coronary patients. No significant difference in their occurrence was found between the normolipidemic and hyperlipidemic patients nor between patients with hyperlipidemia type II/b and type IV. On the assumption that lipoproteins may act as auto-antigens by forming immune complexes, the presence of anti-LDL and anti-HDL2 activity was investigated in circulating immune complexes obtained by polyethylene glycol (PEG) precipitation from the sera of coronary patients and controls. Using an ELISA technique, PEG-precipitable anti-LDL activity was detected in 23, 11 and 18% of cases with myocardial infarction, angina pectoris and healthy old subjects, respectively. In the immune complexes obtained from the sera of the healthy young donors no anti-LDL activity was found. Anti-HDL2 activity in the immune complexes was demonstrated only in a few cases from among the patients and elderly persons we investigated.
To study the changes in the quantity of circulating immune complexes in myocardial infarction two serial investigations were performed in 45 and 63 patients, respectively. For the detection of circulating immune complexes in the first series, two methods, a complement consumption test and a Clq-solubility test were used. In the second series, a polyethylene glycol (PEG)-precipitation assay was added to these methods. The incidence of circulating immune complexes was studied on the first, third, seventh, 14th, and 21st day. On the first day the complexes were detected in 59% of the patients. Their occurrence increased in the further samplings to 77%, but from the seventh day their concentration decreased and on the 21st day they were detected in 63%. Three types of changes in the level of circulating immune complexes could be shown. In type I immune complexes were detected in the first days after the onset of the infarction, then, after a gradual decrease, the results became negative. In type II immune complexes appeared in the second to third week and their quantity did not alter during the entire observation period. In type III the circulating immune complexes could be detected throughout the whole period of the study. These changes in their concentration were frequently associated with the clinical course of the disease.
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The presence of circulating immune complexes was studied in 347 samples of serum from 212 patients with various vascular diseases. Two quantitative methods (complement-consumption assay and C1q-solubility test) were used for the measurement of the concentration of the complexes. Immune complexes were detected in each group of patients tested (coronary arteriosclerosis, myocardial infarction, cerebral artery sclerosis, arteriosclerosis obliterans, phlebothrombosis, pulmonary infarction). A high proportion of positivity was recorded in myocardial infarction (in 43 patients out of the 94 tested) and in arteriosclerosis obliterans (7 out of 11 cases). The possible pathogenic role of the circulating immune complexes is discussed.
Cholesterol-fed rabbits were treated with clofibrate, pyridinol carbamate and with both drugs simultaneously. The quantity of circulating immune complexes in the sera of the animals was measured weekly and the migration inhibition test was carried out in the 12th week of the experiment. The trend of the changes in the concentration of the immune complexes was rather similar to that of the cellular immune response. Compared with the values obtained in the control animals, in the cholesterol-fed group a markedly higher level of immune complexes and a significant migration inhibition could be detected. The administration of clofibrate or pyridinol carbamate alone had no effect on the concentration of immune complexes. Pyridinol carbamate did not influence the migration inhibition; however, it became similar to the healthy controls in the clofibrate-treated group. Simultaneous treatment with both drugs resulted in a decrease in the quantity of immune complexes and a diminution of the migration inhibition.
The effects have been studied of human vessel wall on the cell-mediated and humoral immune response, as well as the morphological changes produced in the aorta in guinea-pigs. In animals immunized with calcium chloride-tris-citrate extracts of the aortic and vessel wall a definite cell-mediated and humoral immune response was observed. A cross-reaction was found between the 2 vessel wall extracts in the skin test and in the migration inhibition test. The induction of desoxyribonucleic acid synthesis was found to be specific. Antibody production as well as the concentration of IgG in the serum was increased. Simultaneously with increased production of the antibodies the cellular immune response did not diminish util the 9th week. A definite alteration was found in the aortic intima by histological, histochemical, immunofluorescence and electron microscopic methods. In addition some slight changes could be observed in the media and in the aventitia of the aorta.
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The results of our preliminary investigations support the opinion that a modification of the macromolecular components of the arterial or venous tissue conditioned by a certain aggression may stimulate the formation of auto-antigens and lead to a humoral as well as cellular immune reaction.
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