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Effects of selenium supplementation on immune parameters in gut failure patients on home parenteral nutrition.

The relationships between some parameters of the immune response and selenium were investigated in five patients receiving home parenteral nutrition for short-bowel syndrome. They were first submitted to a relative depletion by providing 20 micrograms selenium/day as L-selenomethionine for 1 mo. Then, daily selenium intake was raised to 200 micrograms for 2-4 mo. On entering the study, the patients presented a relatively good health status, and immunological parameters were at the lowest limit of the normal range. Four patients rapidly responded to the 200-micrograms supplementation by a continuous increase in their plasma selenium levels, whereas the fifth patient showed a moderate and late increase. At the end of the trial, there was an improvement in the lymphocyte response to pokeweed and phytohemagglutinin mitogens in four patients and to CD3 in three patients. The response to two of three antigens (Candidin, Varidase) tested was also enhanced in the same patients, but the response to the third antigen (tetanus toxoid) was uniformly low in all patients. The only patient showing essentially no immune improvement after selenium supplementation was the one with a low and delayed increase in plasma selenium. This study supports a role for selenium in the maintenance of an optimal immune response in humans.

Aged↗

[Hodgkin's disease: study of delayed hypersensitivity of 64 non treated patients. Value of epicutaneous test using croton oil].

Cellular immunity in 64 patients with Hodgkin's disease was studied during diagnosis before any treatment. The functional deficiency of the thymodependent lymphocyte was demonstrated in vivo by skin tests and, in vitro, by the test of inhibition of leucocyte migration to phytohemagglutininin and spontaneous rosette formation, to sheep red cells. This deficiency correlates with the clinical spread and the histological severity. The relationship between skin anergy and biological tests was found. The epicutaneous test using croton oil possesses non-specific inflammatory activity. It is negative this test is negative, skin reactivity to specific antigens is reduced. The croton tests help interpretation of skin responses to specific antigens and thus assessment of the immune state.

Adolescent↗

[Special aspects of abdominal adhesions in gynecology].

Even minor adhesions in the oviduct or in the ovarial region may lead to infertility. In a controlled trial the adhesion status was documented in 103 patients who underwent microsurgical operations for infertility. Solutions of (a) streptokinase/streptodornase, (b) hydrocortisone acetate or (c) Ringer's solution only were administered intraperitoneally as adhesion prophylaxis. During a control laparoscopy 1 week after the primary operation, newly formed adhesions of mainly intermediate extent were observed in about 10% of the patients. There was no significant difference in efficacy between the prophylactic treatment.

Combined Modality Therapy↗

[Prevention of adhesions in abdominal surgery. A dose finding study with streptokinase/streptodornase].

UNLABELLED: Measurement of intraperitoneal fibrinolytic activity on 50 patients having undergone abdominal surgery (four of them controls). Instillation of streptokinase/streptodornase (Varidase) into the abdominal cavity. Determination of total protein, plasminogen, antiplasmin, alpha 2 Mx-plasmin-complex, spontaneous fibrinolysis and fibrinolysis + activator at different points in time p.op. RESULTS: Intraperitoneal fibrinolysis may be stimulated by local substitution of a plasminogen activator (Varidase). Systemic effects are confined to a high dose. No impaired wound healing nor increased propensity to hemorrhaging occurred.

Abdomen↗

[Side effects of adhesion prevention by fibrinolytic drugs--in vitro studies of resorbable suture material and fibrin glue].

Surgical threads of a variety of resorbable suture materials (Cat plain and Chrom Cat, Serag Wiessner, Polyglactin 910 and Polydioxanon, Ethicon and polyglycolic acid, Dexon) were incubated up to 7 days at 37 degrees C in Varidase-containing media (Lederle Cyanamid, 1000 IU/ml in 0.9% NaCl or citrated human plasma). Thereafter the knot-breaking strength remained within 90.0 and 108.2% of the respective control threads (incubation in Varidase-free media, n = 7, n.s.). The dose-dependent lysis of fibrin glue by Varidase is effectively inhibited by small amounts of aprotinin (15 KIU/ml as compared with 1000-3000 KIU/ml in routine application). The inhibitor is bound to the matrix and not readily eluted.

Abdomen↗

Immunodeficiency in the Wiskott-Aldrich syndrome.

The immune system in the Wiskott-Aldrich syndrome is characterized by a host of paradoxes. Elements of the effector limbs of both humoral and cellular immunity such as immunoglobulin synthesis and in vitro lymphocyte proliferative, secretory and killer responses to nonspecific mitogens are intact. Yet, these patients fail to produce specific antibody normally following immunization and they are anergic. This combination of findings is consistent with a defect in the appropriate initiation of specific immune responses, ie a defect in the afferent limb of immunity.

Agglutinins↗

[Correlation of growth-phase and streptodornase-production of beta-hemolytic streptococci group A (author's transl)].

77 M- and 48 T-typed strains of A-streptococci were compared with respect to their extinction, acidification and nuclease-production as a function of the growth-time. Strains of the same serotype (M 12) showed a change in the distribution of the isoenzymes of nucleases with respect to the growth-time. Half of the strains produced nuclease activity after 4 h. Streptodornase B was produced by all strains. With the growth the number of the nucleases found at the same time diminished, after 96 h in 70% of the strains the nuclease activity was represented by streptodornase B only.

Hydrogen-Ion Concentration↗

Histamine releasing lymphokines: a new approach to some old problems.

Studies carried out in recent years reveal that some endogenous substances can degranulate mast cells and basophils. Lymphokines produced in vitro by T lymphocytes in presence of an antigen or a mitogen, which are capable of provoking histamine liberation in basophils and mast cells have been described. Lastly the mechanisms for histamine release not mediated by IgE in bronchial asthma and which can be mediated by these factors, is discussed.

Animals↗

The selective suppression of immunogenicity by hyaluronic acid.

A hyaluronidase-sensitive component of human peritoneal fluid from a patient with Wilms' tumor when injected into rabbits has been shown to suppress the formation of humoral precipitating antibodies to certain major classes of proteins present in the fluid. Furthermore, it has been found that hyaluronic acid, when included with certain test antigens (serum albumin, fetuin) or antigen mixtures (tumor isolates or mixtures of albumin, immunoglobulin G and immunoglobulin M), produces a marked distortion or complete blockage of immunoelectrophoresis precipitin arcs, as well as altered gel chromatography elution profiles. These findings that hyaluronic acid can interfere profoundly with both the elicitation of a complete antibody response and the formation of "normal" patterns of antigen-antibody precipitates in laboratory tests supports the possibility that this polysaccharide may play an immuno-regulatory role by masking potential immunogens. Consideration of the mechanisms for these in vivo and in vitro effects suggests that there may be some common basis in an "excluded volume" property of the hyaluronate, but this does not appear sufficient to explain the complexity and selectivity of the observed phenomena.

Animals↗

A comparative study of ciprofloxacin and conventional therapy in the treatment of patients with chronic lower leg ulcers infected with Pseudomonas aeruginosa or other gram-negative rods.

Twenty-six elderly patients with chronic leg ulcers infected by Pseudomonas aeruginosa or other aerobic Gram-negative rods were randomised to two treatment groups. The control group (eight patients) received conventional local therapy and the other group (18 patients) was treated with oral ciprofloxacin for three months in addition to conventional local therapy. In the beginning of the study both groups were comparable with the age of the patients and the associated diseases including impairment of arterial and venous circulation in the lower legs. Also the size, duration and the severity of the inflammation reaction in the leg ulcers were comparable before the start of the therapy. Ciprofloxacin was clinically more effective than the standard therapy in reducing the size of the ulcer (p less than 0.05). Also the need of extra systemic antibiotics decreased significantly in the ciprofloxacin group compared with the controls. In three out of eighteen ciprofloxacin treated patients the leg ulcers disappeared completely during the three months' study period compared with none in the control group. However, ciprofloxacin resistant strains, mainly staphylococci, appeared in the leg ulcers in 67% of the ciprofloxacin treated patients compared with 0% in the control group (p less than 0.01). No significant side-effects due to ciprofloxacin except the resistant strains were noticed. We conclude that oral long-term ciprofloxacin therapy is effective in the treatment of chronic leg ulcer infections due to Gram-negative rods but selection of ciprofloxacin resistant strains is a problem in this patient group.

Administration, Oral↗

Defective production of and response to IL-2 in acute human falciparum malaria.

Patients with acute Plasmodium falciparum malaria have defective cell-mediated immune responses to malaria-specific Ag (MA). This immunologic defect may partially explain the difficulty with which natural immunity to falciparum malaria develops and may have important implications for the efficacy of potential malaria vaccines in endemic areas. To investigate the basis of this immune defect, we have examined the capacity of PBMC from patients with acute falciparum malaria to produce IL-2 and to express I1-2R in response to Ag stimulation. The effect of exogenous IL-1 and IL-2 on lymphocyte proliferation was studied. Soluble IL-2R levels were measured in acute and convalescent sera. Our results showed that no detectable IL-2 was produced and no IL-2R were expressed by PBMC in response to MA during the acute infection. IL-2 production and IL-2R expression were also depressed when PBMC were exposed to streptococcal Ag. The specific immune defect was not reconstituted by the addition of graded doses of purified human IL-1 or IL-2 and could not be attributed to suppressor adherent cells. In contrast to the absence of IL-2 and cell-bound IL-2R, circulating soluble IL-2R was elevated in acute sera. These findings suggest that the lack of IL-2, through either a defect in its production or inhibition of its activity, may be the basis of the Ag-specific immune unresponsiveness in acute P. falciparum malaria.

Acute Disease↗

Parameters of T cell mediated immunity to commensal micro-organisms in patients with chronic purulent rhinosinusitis: a comparison between delayed type hypersensitivity skin test, lymphocyte transformation test and macrophage migration inhibition factor assay.

In 75 patients with unexplained chronic purulent rhinosinusitis T cell mediated immunity to three micro-organisms frequently colonizing the human upper respiratory tract, viz. Haemophilus influenzae, streptococci and Candida albicans, was assessed. Delayed type hypersensitivity (DTH) skin test reactivity was measured in vivo, whereas the blastogenic responsiveness (lymphocyte transformation test; LTT) and lymphokine production (e.g. migration inhibition factor; MIF) of the lymphocytes upon antigen stimulation were measured in vitro. MIF was assayed with a recently developed test system using the human monocytoid cell-line U937 as indicator cells in agarose microdroplets. Two-thirds of the 75 patients tested showed a defective DTH response to one or more of the microbial antigens; this contrasted to the findings in 25 healthy subjects, of whom over 90% showed a positive DTH reaction to any of the three antigens. PHA skin tests were entirely normal in both patients and healthy controls. Microbial antigen-specific LTT responses fluctuated considerably in time from strongly positive to negative and vice versa in healthy individuals as well as in patients. In general however, blastogenic responses in patients were comparable to or even higher than those of healthy persons. In the MIF assay, lymphocytes of all healthy individuals tested showed production of MIF upon stimulation with all three antigens; this again contrasted to two-thirds of the patients, whose lymphocytes showed a defective MIF production. Fluctuations of MIF-production in time could not be established and a very good correlation existed between the data obtained in the MIF assay and those of the DTH skin tests. These results indicate that apart from skin testing, the MIF assay seems to be the most suitable parameter to assess defects in T cell reactivity towards microbial antigens. These defects exist in two-thirds of our patients suffering from chronic purulent rhinosinusitis.

Adolescent↗

In vitro suppression of lymphocyte blastogenic response to mitogen and antigen by Leishmania tropica.

Cell-mediated immune (CMI) responses are important in the immunity against Leishmania spp. infection in man. However, an infection continues to persist for a limited or indefinite period of time in spite of demonstrable CMI. The factors which allow the infection to persist in the presence of the CMI are hitherto unknown. Evidence is presented here that Leishmania tropica or their products suppress the in vitro proliferative response of normal human lymphocytes to mitogen and specific antigens. The suppressive effect of L. tropica is neither due to a direct toxic action on lymphocytes nor to competition for nutrients or antigens. In vivo such an immunosuppressive effect could both facilitate macrophage parasitization and the intracellular survival of L. tropica, even after the CMI develops to processed L. tropica antigen. Persistence of infection is seen in many other bacterial, viral and fungal infections. The in vitro suppressive effect of L. tropica on the immune response observed in our study therefore becomes relevant to the understanding of the host-parasite interaction, which may determine the eventual outcome of infection in many other intracellular infections.

Animals↗

Delayed skin hypersensitivity reaction in normal children.

The delayed skin hypersensitivity reaction was assessed in normal children using candida, PPD and sterptokinase/streptodornase antigens. There was an increase in reactivity from 20 percent in children under three years to 90 percent in the 12--16 age group which approximates adult levels. The conclusion is that this test of cell-mediated immunity is unsatisfactory in young children.

Adolescent↗