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Use of monoclonal antibodies against factor H to investigate the role of a membrane-associated protein antigenically related to H in C3b-receptor function.

Three murine monoclonal IgG1 kappa-antibodies, MAH-1, MAH-2, and MAH-3, were raised against factor H purified from human plasma. In cross-inhibition studies MAH-3 did not compete with MAH-1 and MAH-2, and vice versa, for the binding to H, whereas MAH-1 and MAH-2 inhibited each other. MAH-1 and MAH-2 inhibited the binding of H to C3b attached to an ELISA plate as well as to C3b bound to sheep erythrocytes by means of the classical pathway convertase and of C3b to H attached to an ELISA plate. The determinant defined by MAH-1 and MAH-2 was no longer accessible on H bound to C3b. In contrast, MAH-3 interfere with the binding of H to C3b or vice versa only to a smaller extent but recognized a determinant still accessible on H bound to C3b and was able to agglutinate EAC14o23b-H in an indirect Coombs test. All three antibodies were shown to bind to tonsil cells and Raji cells in an indirect cell ELISA. The membrane-associated molecule detected by these antibodies had an apparent m.w. of 140,000 D in SDS-PAGE. All three antibodies partially inhibited the binding of EAC14o23b to tonsil lymphocytes and, in the presence of 0.1 mM DFP, to Raji cells; binding of EAC14o23bi and EAC14o23d to tonsil cells was not affected. We conclude that MAH-3 recognizes a determinant distinct from the ones recognized by MAH-1 and MAH-2, the latter possibly defining identical epitopes that are located close to the binding site for C3b. The fact that these two distinct epitopes could be detected on a 140,000-D membrane-associated protein from lymphoid cells strongly suggests that this molecule is at least antigenically related to serum H and shares with H a region carrying the binding site for C3b. The rosette inhibition studies imply that this structure is important for the binding of C3b-coated particles to lymphoid cells.

Animals↗

[Immunoallergic intravascular hemolysis and tubulointerstitial nephritis due to penicillin G].

A 51-year old woman treated with high doses of penicillin G developed acute intravascular haemolysis and tubulointerstitial nephritis. Immunological investigations showed circulating immune complexes, decreased C3 and C4 components of complement, IgG deposits in the renal interstitium, positive direct Coombs test with anti-IgG sera and complement and circulating anti-penicillin antibodies demonstrated by indirect antiglobulin tests and IgG RAST. Plasma haemoglobin and anti-penicillin antibodies could be removed by an early exsanguino-transfusion. These findings suggest that the nephritis was due to immune complexes and the haemolysis, to a combined hapten-type and immune complex mechanism.

Anemia, Hemolytic, Autoimmune↗

[Immunological aspects of adverse reactions during treatment with rifampicin].

It has already been established that during the treatment with rifampicin severe adverse reactions may occur, especially mediated by immune mechanisms. The most severe are those followed by renal failure. This type of reactions usually occur in patients that have undergone previous long treatments with the drug (RMP), given intermittently, twice a week, who, after an intermission, take up again the treatment with rifampicin. The symptoms occur after the administration of the first dose of the second course. Three cases are presented in the paper, of renal failure that developed after a new course of rifampicin was started. In spite of the treatment applied, which included hemodialysis, two of the patients died. In all three the indirect Coombs test was positive for anti -- RMP antibodies, and the histopathologic investigation revealed extensive lesions, including necrosis, of the renal tubules. Diagnostic, prognostic, pathogenic and therapeutic aspects of the cases are discussed.

Acute Kidney Injury↗

When autoimmune hemolytic anemia complicates chronic lymphocytic leukemia.

Autoimmune hemolytic anemia often develops in patients with chronic lymphocytic leukemia, particularly elderly women. It is heralded by a drop in the hematocrit, elevation of reticulocytes, development of jaundice, or a rise in the indirect fraction of serum bilirubin. Evidence of hemolysis supports the diagnosis, and a positive result of the Coombs test confirms it. Survival time is considerably shorter in patients who have both diseases than in those with chronic lymphocytic leukemia alone. Presenting symptoms in patients with the two diseases may include weakness, dizziness, fever, or hemorrhagic phenomena. If the anemia is severe, palpitations, otic pulsations, and cardiac decompensation are common. Physical examination may show enlargement of reticuloendothelial structures. On the other hand, some patients may be essentially asymptomatic. The hemolytic process must be treated as a separate entity, as even vigorous treatment of the leukemia often does not control it. Corticosteroid therapy is preferred, with splenectomy as a second line of defense. If the patient is not a good surgical risk, chemotherapy should be considered. Transfusions are usually incompatible but should be risked if progressive congestive failure, neurologic disturbance, angina, or signs of an impending infarct are present.

Aged↗

Phototherapy in full-term infants with hemolytic disease secondary to ABO incompatibility.

Current guidelines for treatment of hemolytic disease of the newborn make no differentiation between ABO and Rh incompatibility. A protocol that prolonged the observation period in full-term, ABO-incompatible infants with positive Coombs' tests who were otherwise healthy was tested. Postponement of treatment made it possible to determine more accurately which infants needed phototherapy. This dramatically decreased the number of infants treated without increasing their risk of requiring exchange transfusion.

ABO Blood-Group System↗

[Hemolytic transfusion incident caused by a Kidd-antibody, anti-Jka].

A severe haemolytic transfusion reaction due to anti-Jka, is described. The antibody was not detected in the cross-match test in saline and 22% bovine serum albumin after incubation at 4, 20 and 37 degrees C. This observation shows that the indirect antiglobulin test (= indirect Coombs reaction), which is able to reveal such antibodies, should be routinely performed in all cases with a history of transfusion and/or pregnancy.

Acute Kidney Injury↗

Isoimmunization with anti-U antibody.

Isoimmunization with anti-U antibody is a rare but significant cause of hemolytic disease in black newborns. In this case report, an lgG antibody stimulated by fetomaternal transfusion produced a positive direct Coombs' test on cord blood but not neonatal hyperbilirubinemia. A review of the literature suggests the pathophysiology is similar to Rh isoimmunization. The anti-U antibody may develop as a result of pregnancy or blood transfusion in the 1.2 percent of American blacks who are at risk for developing the antibody. The principles of treatment employed in Rh isoimmunization can be successfully used in isoimmunization due to anti-U.

Adult↗

Increased IgG molecules bound to the surface of red blood cells of patients with sickle cell anemia.

We have used the complement-fixing antibody consumption ( CFAC ) test to detect small concentrations of IgG on red blood cells from patients with hemolytic anemias that are not thought to be caused by an immune mechanism. Although patients with hereditary spherocytosis, pyruvate kinase deficiency, and mechanical hemolytic anemias generally had normal concentrations of IgG bound to their red cells (less than 25 molecules IgG per red cell), we found that 39/62 (63%) patients with sickle cell anemia had elevated values. These 39 patients had a mean of 195 and a maximum of 890 molecules of IgG per red cell. None of the patients had been transfused within the previous 90 days, and some had never been transfused. Direct antiglobulin tests were positive in only two instances and autoantibodies were not found in the serum of any patient. However, eluates from the red cells of 6 of 23 patients demonstrated antibody activity against all of a panel of normal red cells by the indirect antiglobulin test. There was no correlation between the number of IgG molecules on patients' red cells and the severity of their anemia, the incidence of painful sickle cell crises, the reticulocyte count, or with blood transfusion history. We conclude that further study of immunohematologic abnormalities in patients with sickle cell anemia is warranted, especially in view of previous reports in this population of patients with red cell autoantibodies, autoimmune hemolytic anemia, hemolytic transfusion reactions without detectable alloantibodies, and an association of some episodes of pain crises with immunologically mediated red cell destruction.

Adolescent↗

Evaluation of an enzyme-labeled antiglobulin test for anti-Brucella immunoglobulin G among 3 cattle populations.

Antibody to smooth Brucella abortus lipopolysaccharide antigen on the surface of polystyrene tubes was detected with peroxidase-labeled antibody against bovine immunoglobulin G. The enzyme-labeled antiglobulin test (ELAT) activity of samples was expressed in arbitrary units/0.01 ml by reference to a standard curve based on tests of dilutions of a positive serum pool. Reactions greater than 3.0 U/0.01 ml were classified positive because specificity at this level was 99.8% (417/418 samples correctly classified negative) with agglutination test-negative sera from 33 Brucella-free herds. Results of the ELAT were compared with results of agglutination tests and the complement-fixation test (CFT), using 430 sera from cattle in 7 infected herds. Activity of greater than 5.0 ELAT U/0.01 ml was detected in all 54 sera classified as positive (titer greater than 1:10) by the CFT, including 5 sera classified as negative by the tube agglutination test. Sera from 8 nonvaccinated cows in the infected herds reacted only by the ELAT, whereas reactions were obtained with 25 and 5 sera by only agglutination tests and the CFT, respectively. The ELAT and CFT results were in agreement for 25 of 26 sera from agglutination test-reactor cattle in herds of unknown status. Comparisons of milk ring and whey agglutination tests with the whey ELAT on 146 quarter samples from cows in an infected herd revealed no ELAT activity greater than or equal to 1.0 U/0.01 ml in the 73 samples considered negative by the 2 other tests. Samples (n = 47) that contained greater than or equal to 1.0 ELAT U/0.01 ml included all (n = 40) samples with milk ring or whey agglutination titers greater than or equal to 1:16 and greater than or equal to 32, respectively, and 7 samples that gave weaker reactions to the latter tests.

Agglutination Tests↗

Outbreak of brucellosis at a South-Australian abattoir. 1. Clinical and serological findings.

During the period October 1979 to May 1980, 22 cases of acute brucellosis occurred at a South Australian abattoir. We obtained blood samples for serological investigations and culture of Brucella abortus, and tested the sera using the standard agglutination test (SAT), dithiothreitol test (DTT), anti-human globulin test (AHG) and complement fixation test (CFT). Patients showed large variations in antibody levels in each of these tests, both on presentation and after treatment. Blood culture was successful in six of 15 patients in whom it was attempted. Using the experience gained during the outbreak, we defined a set of serological criteria for the diagnosis of acute brucellosis, particularly in those who are occupationally exposed.

Abattoirs↗

Probable graft-vs-graft reaction in an infant after exchange transfusion and marrow transplantation.

A newborn with graft-vs-host (GVH) disease following an exchange transfusion was treated by attempting to eradicate the incompatible graft and to reconstitute the child hematologically and immunologically with a bone marrow transplant. The patient was a female term infant (blood group B, Rh+ Coombs test positive) who received a one-unit group O, Rh- exchange transfusion from an unrelated female donor for hyperbilirubinemia due to ABO incompatibility on day 2. Signs of acute GVH disease began on day 8 and the clinical diagnosis was supported by skin biopsy. With antithymocyte globulin and high dose dexamethasone, the GVH reaction improved somewhat. Cyclophosphamide, 200 mg/kg total dose, was given over four days followed by a marrow graft from a brother who was HLA-A, B identical, and probably also D locus compatible in mixed lymphocyte culture. All signs of GVH resolved with cyclophosphamide treatment and hematologic reconstitution was evident by 14 days after transplant. Two weeks later the GVH reaction and aplastic anemia recurred and Y chromatin was detected in only 6% of marrow cells. The infant died on day 80. Autopsy showed disseminated candidiasis, disseminated cytomegalovirus infection, thymic dysplasia, hypoplastic marrow, and other histopathologic changes consistent with GVH disease. The persistence of female cells in blood and bone marrow and the destruction of the reconstituted marrow suggest that the original incompatible transfusion-derived graft was not eliminated and that it ultimately rejected the histocompatible marrow graft.

ABO Blood-Group System↗

Immunologic abnormalities in myelofibrosis with activation of the complement system.

Eighteen patients with agnogenic myeloid metaplasia with myelofibrosis were studied for clinical and laboratory evidence of immunologic dysfunction. Clinical findings included the presence of arthritis, vasculitis, and erythema nodosum. Laboratory abnormalities included the presence of circulating immune complexes, antinuclear antibodies, positive direct Coombs tests, elevated latex fixations, and a circulating lupus type anticoagulant. Total hemolytic complement was markedly depressed in four patients. Analysis of complement (C) components C1-C9 and factor B demonstrated significant reduction of only C3 and factor B. By crossed-immunoelectrophoresis, both C3 and factor B, but not C4, were cleaved, indicating that C activation was occurring predominantly via the alternative pathway. The control proteins beta 1H and C3b inactivator were decreased in three of four patients with hypocomplementemia. These data suggest that immunologic mechanisms associated with activation of the complement system play an important role in the disease process of some patients with agnogenic myeloid metaplasia with myelofibrosis.

Aged↗

Tumor incidence and development of autoimmune hemolytic anemia in two breeding lines of the NZB mouse strain that differ in chromosome breakage.

Increased chromosome breakage observed in NZB mice was studied. Breeding experiments with mice selected according to breakage frequencies provided evidence that the proportion of mice with high breakage (HB) and low breakage (LB) figures in the progeny depends on the phenotype of the parents. Selective breeding for the "chromosome breakage" characteristic was successful and resulted in the separation of a breeding line with LB incidence. However, the selection could not be continued beyond the fourth generation for the mice with HB incidence because of lethal factors. Comparative studies of HB mice from the HB line and LB mice from the LB line showed significant differences for tumor incidence and positivity of the Coombs' test.

Age Factors↗

The complement fixing properties and class distribution of rheumatoid factors (antiglobulins) in rheumatoid arthritis and other diseases.

The MRSPAH (mixed reverse solid-phase passive antiglobulin haemadherence) test for antiglobulins (Agbs) of IgA, IgG and IgM classes has been quantified and also modified to measure their C3 fixing activity. An alternative ELISA technique is also described. Levels of all Agbs and their C3 fixing activity were significantly raised in established rheumatoid arthritis (RA) patients, early RA patients and established SLE patients. Ankylosing spondylitis (AS) patients had normal levels of Agbs and C3 fixation. Patients with infectious mononucleosis (IM) had high levels of all Agbs, but these did not fix complement. Thus, C3 fixing activity of Agbs is heterogeneous and raised levels are associated with the presence of joint disease. Isolated IgA, IgG and IgM fractions showed examples of Agbs which fixed C3. The proportion of C3 fixed per unit weight of Agbs was no greater in 'hidden' Agbs from serum and synovial fluids (SFs) than in untreated serum, and Agbs in SF do not fix more C3 than in serum. We conclude that the C3 fixing activity of Agbs is not directly related to affinity.

Antibodies, Anti-Idiotypic↗

Platelet-associated complement C3 in immune thrombocytopenic purpura.

Platelet-associated C3 (PA-C3) was measured with a quantitative immunofluorescence assay. With this assay, PA-C3 levels were determined for 78 normal volunteers, 30 patients with immune thrombocytopenic purpura (ITP), and 20 patients with nonimmune thrombocytopenias. Platelet-associated IgG (PA-IgG) levels were also measured with our standard quantitative immunofluorescence assay. All patients with nonimmune thrombocytopenias and ITP in remission had normal PA-C3 levels. Twenty-four patients with active ITP were classified into 3 groups: 9 (38%) with increased PA-IgG and normal PA-C3 levels, 10 (42%) with elevated PA-C3 and PA-IgG levels, and 5 (20%) with increased PA-C3 values only. A direct correlation was found between PA-C3 and PA-IgG levels. PA-IgG levels were higher in the group of patients with elevated PA-C3 levels than in those with normal values. Platelet survival studied showed reduced survival times of 1.5--2.5 days for the 5 patients with elevated PA-C3 levels only. Elevated PA-C3 levels returned to normal in 7 ITP patients whose platelet counts increased in response to corticosteroid therapy or to splenectomy. Therefore, PA-C3 and PA-IgG assays can be used to identify patients with ITP, to follow their response to therapy, and to classify them into immunologic subgroups similar to red cell classification by Coombs' testing in immune hemolytic anemia.

Adolescent↗