[Nonresponse to hepatits B vaccine in health care workers]

The authors report the results of an investigation of witness cases realised in collaboration between Occupational Medecine Service and Immunology Laboratory of Hedi CHAKER University Hospital SFAX during the year 2000. The purpose was to search the genetic control of the HLA class I system for the non-response to hepatitis B vaccine and to evaluate the contribution of other favorite factors as tabac, sex, age. Thus, in a population of 32 healthy agents found nonresponders to hepatitis B vaccine by the titers of anti HBs antibody, we have performed the HLA-A, -B phenotypes by the technique of complement dependent microcytotoxicity. The frequency of studied HLA class I antigens, was compared for the non-responders group, to the frequency observed in witnesses group, done with 52 responders healthy agents. The rate of nonresponsiveness hepatitis B vaccine was evaluated up to 5 %. Statistically significant difference was observed for HLA A1 and-B44 markers showing fraquencies which were considerably higher in the non-responders than in witnesses.

[Hydatid pulmonary embolism]

Hydatid pulmonary embolism is an uncommon condition resulting from the rupture of hydatid heart cyst or the opening of a visceral hydatid cyst often in the liver into the venous circulation. We report a case of 60 years old woman, admitted to hospital for acute heart pulmonale due to fistulization of an hepatic hydatid cyst into the inferior vena cava.

[Pregnancy in patients with prosthetic heart valves]

In women with prosthetic heart valves, pregnancy carry a risk for both mother and fetus, requiring an obstetrical and cardiological management at an optimal level. We performed a systematic review of the literature to estimate the maternal and fetal complications and in order to offer pregnant women carrying a prosthetic heart valve the most practical approach enabling reduction of these risks. As there are no available controlled clinical trials, larger prospective studies are needed to provide guidelines for effective antithrombotic therapy.

[Mitral valve prolapse and sudden death: a case report]

Mitral valve prolapse (MVP) is a common disorder that, in general, has a good prognosis. Rare occasions of sudden death have been reported in patients with MVP and it is presumed that the basis of sudden death is arrhythmias. We report a case of a 47 years old men affected by MVP complicated by ventricular arrhythmias and sinoatrial block; who died suddenly from ventricular tachycardia. The pathophysiology and risk factors of sudden cardiac death in MVP are discussed.

Smoking cessation counseling practices of general practitioners in Montreal

BACKGROUND

Despite the cost-effectiveness of physician smoking cessation counseling, many physicians do not adhere to current clinical practice guidelines.

METHODS

A cross-sectional mail survey was conducted in a random sample of general practitioners in Montreal to document cessation-counseling practices and identify correlates of these activities.

RESULTS

Of 440 eligible general practitioners, 337 (77%) completed the questionnaire. Despite favorable beliefs/attitudes about cessation counseling, only 10.5% of general practitioners provided "thorough" counseling. While high proportions of general practitioners ascertained smoking status and encouraged patients to quit, relatively few offered adjunct support (i.e., for patients preparing to quit, 49.8% offered follow-up visits; 42.5% offered educational material; 20% referred patients to community resources). Correlates of counseling completeness included high self-efficacy to provide counseling (odds ratio (OR) = 2.0, 95% confidence interval (1.1-3.6)) and favorable beliefs/attitudes about counseling (OR = 3.6 (2.0-6.4)). Correlates of ascertaining smoking status included female gender (OR = 2.3 (1.5-3.5)), high self-efficacy (OR = 3.5 (2.0-5.9)), and favorable beliefs/attitudes (OR = 2.7 (1.6-4.5)). Correlates of offering adjunct support included female gender (OR = 1.9 (1.1-3.2)), awareness of stages of change (OR = 2.4 (1.3-4.4)), and knowledge of community resources to help patients quit (OR = 2.3 (1.3-3.9)).

CONCLUSION

Support, training, and intervention programs to overcome lack of awareness and knowledge, unfavorable beliefs/attitudes, and low self-efficacy could increase and enhance cessation counseling practices among general practitioners.

Lack of linkage and association between autoimmune thyroid diseases and the CTLA-4 gene in a large Tunisian family

The autoimmune thyroid diseases (AITDs) including Graves' disease and Hashimoto's thyroiditis are inherited as complex traits. We have performed linkage and association studies to investigate the role of CTLA-4 gene in the AITDs development using the D2S311, D2S143, the intragenic CTLA-4 (AT)(n) microsatellite markers and the CTLA-4 (A/G) dimorphism in exon 1. Four extended pedigrees belonging to a large Tunisian family named Akr and including 154 individuals from which 20 were affected with Hashimoto's thyroiditis and 26 with Graves' disease, were used in this investigation. No evidence for linkage with none of the markers was found under neither dominant nor recessive models [Z=-7.14 and Z=-14.32 at theta=0.0, respectively for the CTLA-4 (AT)(n) marker]. A family-based association study on 51 nuclear families derived from the Akr pedigree was performed by the FBAT approach applied to the CTLA-4 (AT)(n) marker and the CTLA-4 (A/G) dimorphism. We found no association of individual alleles to disease for both markers. These results showed no evidence for the involvement of the CTLA-4 locus in the AITDs pathogenesis.

Physicians Taking Action Against Smoking: an intervention program to optimize smoking cessation counselling by Montreal general practitioners

In 1997 the Direction de la santé publique de Montréal-Centre initiated "Physicians Taking Action Against Smoking," a 5-year intervention program to improve the smoking cessation counselling practices of general practitioners (GPs) in Montreal. Program development was guided by the precede-proceed model. This model advocates identifying factors influencing the outcome, in this case counselling practices. These factors are then used to determine the program objectives, to develop and tailor program activities and to design the evaluation. Program activities during the first 3 years included cessation counselling workshops and conferences for GPs, publication of articles in professional interest journals, publication of clinical guidelines for smoking cessation counselling and dissemination of educational material for both GPs and smokers. The program also supported activities encouraging smokers to ask their GPs to help them stop smoking. Results from 2 cross-sectional surveys, conducted in 1998 and 2000, of random samples of approximately 300 GPs suggest some improvements over time in several counselling practices, including offering counselling to more patients and discussing setting a quit date. More improvements were observed among female than male GPs in both psychosocial factors related to counselling and specific counselling practices. For example, improvements were noted among female GPs in self-perceived ability to provide effective counselling and in the belief that it is important to schedule specific appointments to help patients quit; in addition, the perceived importance of several barriers to counselling decreased among female GPs. A greater proportion of the female respondents to the 2000 survey offered written educational material than was the case in 1998, and a greater proportion of the male GPs devoted more time to counselling in 2000 than in 1998; however, among male GPs the proportion who discussed the pros and cons of smoking with patients in the pre-contemplation stage declined between 1998 and 2000, as did the proportion who referred patients in the preparation stage to community resources. Our experience suggests that an integrated, theory-based program to improve physicians' counselling practices could be a key component of a comprehensive strategy to reduce tobacco use.

A full genome screening in a large Tunisian family affected with thyroid autoimmune disorders

The autoimmune thyroid diseases (AITDs) including Graves' disease (GD) and Hashimoto's thyroiditis (HT) are inherited as complex traits. We initiated a whole genome linkage study of patients with AITD, in order to identify the susceptibility genes involved in their pathogenesis. We studied 39 patients affected with GD or HT and 68 related controls, who belonged to a large consanguinous family composed of more than 200 members. Linkage analysis was performed using the lod score method under two arbitrary models, one dominant and one recessive. A positive lod score was found for D2S171, assuming a recessive mode of inheritance and 50% penetrance, which suggests the presence of a major AITD susceptibility gene on chromosome 2p21. However, no linkage was found with microsatellite markers spanning the HLA system. This locus localised outside MHC will be of interest for investigation of other autoimmune disorders.

Disinfection of secondary effluents by infiltration percolation

Among the most attractive applications of reclaimed wastewater are: irrigation of public parks, sports fields, golf courses and market gardening. These uses require advanced wastewater treatment including disinfection. According to WHO guidelines (1989) and current rules and regulations in Tunisia, faecal coliform levels have to be reduced to < 10(3) or 10(2) CFU/100 mL. In Tunisia, most wastewater plants are only secondary treatment and, in order to meet health related regulations, the effluents need to be disinfected. However, it is usual for secondary effluents to need filtration prior to disinfection. Effectiveness of conventional disinfection processes, such as chlorination and UV radiation, are dependent upon the oxidation level and the levels of suspended solids of the treated water. Ozonation is relatively expensive and energy consuming. The consideration of the advantages and disadvantages of conventional techniques, their reliability, investment needs and operational costs will lead to the use of less sophisticated alternative techniques for certain facilities. Among alternative techniques, soil aquifer treatment and infiltration percolation through sand beds have been studied in Arizona, Israel, France, Spain and Morocco. Infiltration percolation plants have been intermittently fed with secondary or high quality primary effluents which percolated through 1.5-2 m unsaturated coarse sand and were recovered by under-drains. In such infiltration percolation facilities, microorganisms were eliminated through numerous physical, physicochemical and biological inter-related processes (mechanical filtration, adsorption and microbial degradation respectively). Efficiency of faecal coliform removal was dependent upon the water detention times in the filtering medium and on the oxidation of the filtered water. Effluents of Sfax town aerated ponds were infiltrated through 1.5 m deep sand columns in order to determine the performance of infiltration percolation in the polishing of secondary effluents. Elimination of bacteria (total and coliforms, faecal streptococci) and their relationship with the hydraulic load and the temperature were investigated.

[Hypertrophic cardiomyopathy and pregnancy]

We report the case of a 32 years old patient, with a known diagnostic of hypertrophic cardiomyopathy; who has presented at the first trimester of pregnancy a ventricular fibrillation treated by electric shock with a favorable outcome. The risks for the mother and the foetus are discussed; The recommendations for the conduct of the delivery are reviewed.

Deposition of IgG anti-actin antibodies on kidneys of glomerular nephropathy patients with an enhanced glomerular alpha smooth muscle actin expression

In this study, we have attempted to evaluate by immunohistochemistry assay the glomerular alpha smooth muscle actin (ASMA) expression in 53 kidney biopsy specimens obtained from patients with glomerular nephropathy as compared with 16 histologically normal human kidneys. An enhanced mesangial ASMA expression was observed in 26 of 53 specimens of patients with glomerulonephritis. In contrast, normal glomeruli showed no ASMA-positive mesangial cells. Furthermore, we have analyzed the specificities of antibodies eluted from kidney biopsy specimens from patients and controls using an enzyme immunoassay against a panel of self antigens composed of actin, myosin, tubulin and DNA. The antibodies eluted from exclusively renal biopsy specimens of patients with an enhanced glomerular ASMA expression showed high IgG activity restricted to actin. Our results demonstrated the presence of IgG anti-actin activity in glomerular nephropathy patients with an enhanced mesangial ASMA expression.

Functional outcome and satisfaction after photorefractive keratectomy. Part 2: survey of 690 patients

PURPOSE

To document patient satisfaction and self-perceived quality of vision after bilateral photorefractive keratectomy (PRK).

DESIGN

Noncomparative, interventional case series.

PARTICIPANTS

Consecutive patients who underwent bilateral PRK from May 1994 through May 1997 by the 12 surgeons of four collaborating centers with a minimum of 4 months since the last surgery and up to 30 months since the first surgery.

METHODS

A questionnaire with known psychometric properties was self-administered by the patients.

MAIN OUTCOME MEASURES

Responses to individual questions and scale scores.

RESULTS

A total of 929 questionnaires were sent, of which 690 were answered and returned (74.3% response rate). The preoperative spherical equivalent ranged from -0.38 diopters [D] to -27.75 D (mean, -5.32 D; standard deviation, 2.85 D). Although 91.8% of the patients were satisfied or very satisfied with their surgery, 96.3% considered that their main goal had been reached, and 95.7% would still choose to have surgery if they had it to do over. The degree of satisfaction was proportional to the postoperative uncorrected visual acuity in the best eye expressed in LogMAR (r = -0.18, P: = 0. 0001) and was negatively correlated with the importance of the corneal haze (r = -0.23, P = 0.0001). Daytime glare was reported to be greater than before surgery by 55.1% of patients. A decrease in night vision was reported by 31.7% of patients, and 31.1% of patients reported increased difficulty driving at night because of their vision.

CONCLUSIONS

Overall satisfaction after PRK for low to severe myopia appears to be very good. Glare and night vision disturbance, particularly bothersome for night driving, seem to constitute significant secondary effects that deserve further investigation and should be kept in mind for future improvements in the technique.

Functional outcome and satisfaction after photorefractive keratectomy. Part 1: development and validation of a survey questionnaire

OBJECTIVE

The aim of this study was to develop a valid, reliable, and easy-to-administer instrument to assess patient satisfaction and perceived outcome after bilateral excimer laser photorefractive keratectomy.

DESIGN

Development and validation of a psychometric questionnaire.

PARTICIPANTS

Consecutive patients who underwent bilateral excimer laser photorefractive keratectomy from May 1994 through May 1997 by 12 surgeons from four collaborating centers. To be eligible, a minimum of 4 months since the last surgery and a maximum of 30 months since the first surgery was required.

METHODS

The new instrument was derived in part from the Prospective Evaluation of Radial Keratotomy (PERK) study 10-year psychometric questionnaire and the Visual Functional Index (VF-14), an index of functional impairment in patients with cataract. Questions were grouped in seven scales, each covering a specific aspect of quality of vision. These included global satisfaction, quality of uncorrected vision, quality of corrected vision, quality of night vision, glare, daytime driving, and night driving.

MAIN OUTCOME MEASURES

Acceptability, reliability, validity, and interpretability of the instrument, as well as its ease of administration.

RESULTS

The instrument scale structure was examined and scale scores were created. Item-discriminant validity ensured that questions belonged to their hypothesized scale, based on multitrait correlation analysis. The instrument was shown to be reliable by a high level of internal consistency, and all Cronbach's alpha coefficients were superior or equal to 0.83. Construct-related validity and interpretability were assessed based on correlations between scale scores and clinically recognized success criteria such as visual acuity and refraction. Respondent burden was shown to be minimal. Acceptability of the instrument was shown to be very good, with a participation rate of 74.3% (690 of 929 patients). The instrument is available in English and in French and the translation was shown to be reliable.

CONCLUSIONS

The acceptability, reliability, and interpretability of the instrument, as well as its ease of administration, were shown to be adequate. This questionnaire appears clinically useful to document patient satisfaction after excimer laser photorefractive keratectomy.

P53 polymorphism in codon 72 and risk of human papillomavirus-induced cervical cancer: effect of inter-laboratory variation

An association between codon-72 p53 polymorphism and risk of human papillomavirus (HPV)-induced cervical cancer has been found recently, but it has been difficult to replicate. In this study, we assess the impact of inter-laboratory variation in p53 genotyping on the validity of the proposed association. DNA specimens were randomly selected from 54 invasive, squamous cell carcinoma cases, 52 HPV-negative, and 39 HPV-positive controls from a previous case-control study in Brazil. Codon-72 polymorphism was blindly analyzed in three different laboratories. We calculated age- and race-adjusted odds ratios (OR) and 95% confidence intervals (CI) using logistic regression for gauging the association between p53 polymorphism and cervical cancer risk. The proportions of the Arg/Arg, Arg/Pro, and Pro/Pro genotypes varied substantially among laboratories with Kappa coefficients in the 0.49-0.63 range. When disagreement between labs was allowed, the OR for the Arg/Arg genotype, compared to other forms, was as low as 1.5 (95% CI: 0.5-3. 9). In contrast, the OR increased to 8.0 (95% CI: 2.3-28.5) after exclusion of discordant genotypes. Restricting the comparison to HPV-positive controls increased the magnitude of the relation appreciably. After exclusion of all discordant diagnoses, the OR was 21.5 (95% CI: 3.4-137.8), whereas with disagreed genotypes the association was not significant (OR = 2.9, 95% CI: 0.7-11.9). Homozygous codon-72 p53-Arg apparently confers a higher susceptibility to HPV-associated cervical tumorigenesis. However, exposure misclassification consequent to inter-laboratory variation in protocols may affect the ability to detect the association.

Polymorphisms of HLA DQB1 CAR1/CAR2 and TNFalpha IR2/IR4 microsatellite markers in patients affected with Graves disease

Graves disease is an autoimmune thyroid disorder in which HLA class I and II confer susceptibility in different ethnic groups. An allele-specific polymerase chain reaction was used to characterize the variation of the HLA-DQB1 CAR1/CAR2 and TNFalpha markers located on chromosome 6 in 85 unrelated Tunisian patients affected with Graves disease and 148 healthy control subjects. In contrast to the results regarding TNFalpha alleles showing no difference between patients and controls (P = 0.904), the analysis of the HLA-DQB1 CAR1/CAR2 polymorphism showed a significant difference in its alleles (P < 0.0001). Nevertheless, no allele exhibited a predispositional effect on GD pathogenesis.

Structure génétique des cécidomyies des céréales en Tunisie

Genetic structure of Hessian flies in Tunisia. The genetic structure of M. destructor and M. hordei was investigated by sampling 21 fields of cereals in 14 localities of central and southern Tunisia. As previously shown, there was no strict association between the cereal species (wheat, barley and oat) and the Mayetiola species. M. destructor males displayed no heterozygosity at the Pgm3 locus, indicating that they were hemizygous as is the PGM locus in North America. In M. hordei, heterozygous males were observed at all loci, but strong heterozygote deficits were found at two loci (Mdh2 et Hk). Since no such deficit was observed in females, the population structure of M. hordei was studied only in females. Although heterozygosity was two fold higher in M. hordei than in M. destructor, the two species were similar for other genetic characteristics, including a low (Fst < 0.05) but significant (P < 0.05) genetic differentiation, no isolation by distance, and similar rates of gene flow (5.7 ≤ Nm ≤ 9.6). These results are discussed in relation to their consequences in the event of controlling Tunisian Hessian flies using wheat cultivars that are resistant to a M. destructor biotype.

Analysis of heat shock protein polymorphisms in a large family with autoimmune thyroid diseases

Graves disease and Hashimoto's thyroiditis are autoimmune thyroid diseases (AITD) in which the genetic contribution is complex. The purpose of this work was to analyze the influence of hsp70 gene polymorphisms on the susceptibility to AITD. The hsp 70-2 and hsp 70-hom polymorphism was analyzed, by PCR-RFLP using PstI and NcoI enzymes, respectively, in 40 patients affected with AITD and 38 related healthy individuals belonging to a large consanguineous family named Akr. The transmission disequilibrium test (TDT) was applied on nuclear families, deduced from the Akr pedigree, with at least one heterozygous parent for each studied polymorphism. The corresponding x2 values for hsp 70-2 and hsp 70-hom were, respectively, of 0.52, p > 0.05 and 2.77, p > 0.05. Our data indicated lack of association between these hsp polymorphisms and AITD in this large family.

Analysis of immunoglobulin VH and TCR cbeta polymorphisms in a large family with thyroid autoimmune disorder

In order to investigate the association of TCR Cbeta and immunoglobulin (Ig) VH polymorphisms with thyroid autoimmune diseases (TAD), we analyzed restriction-endonuclease-generated polymorphisms using T-cell receptor (TCR) Cbeta and VH gene-family-specific probes. We tested genomic DNAs of patients isolated from a large family affected with Graves' disease and Hashimoto's thyroiditis as well as the genomic DNA of unrelated Tunisian controls. Hybridization of BglII-digested DNA with a TCR Cbeta probe revealed two alleles of 9.2 and 10 kb. These Cbeta polymorphisms have already been found in the Caucasian population. However, there was no abnormal distribution of this polymorphism in patients with TAD, compared to related healthy individuals and to unrelated Tunisian controls. Besides, there was a low VH polymorphism in members of the family affected with TAD. Analysis of the Ig gene families revealed no restriction site polymorphism pattern specific for TAD.

[Predisposition to thyroid autoimmune diseases]

OBJECTIVES

Genetic predisposition is required for the expression of thyroid autoimmune disorder addition to the immune dysfunction and the environmental factors.

METHODS

In order to evaluate the role of this genetic factor, we reported the results of immunological and hormonal investigations of 62 members (TD), belonging to a large Akr family, who are related to 40 patients with Graves' disease or Hashimoto's thyroiditis.

RESULTS

The hormonal analyses showed that 19 subjects exhibited an infraclinical hypothyroidism, subdivided into 7 members with pathological rates of TSH evocative of thyroid insufficiency and 12 others with compensative thyroid insufficiency. Seventeen subjects of the Akr family who had solely antithyroid autoantibodies were considered as potential candidates to develop thyroid autoimmune diseases. The clinical follow-up, during two years, confirmed the diagnosis of Hashimoto's thyroiditis in 3 members among 19 subjects with infraclinical hypothyroidism (TD05, TD28 and TD54) and in only 1 member out of the 17 potential candidates (TD03).

CONCLUSION

Our results showed that a serological study of hormones and/or autoantibodies directed against thyroid antigens, could allow the detection of predisposed subjects to develop a thyroid autoimmune pathology. The Akr family seems to be suitable for the study of the localization of susceptibility genes to TAID.

HLA-B27 polymorphism and worldwide susceptibility to ankylosing spondylitis

HLA-B27 is strongly associated to ankylosing spondylitis (AS) and represents a family of eleven B27 alleles (B*2701-11). Our aim was to analyze the distribution of B27 subtypes by PCR/SSOP and genomic sequencing in a large group of populations (n = 17). 711 B27-positive samples from Caucasoid, Asian, African, Amerindian and Polynesian populations were selected to ascertain transracial gene mapping of the B27 subtypes. 476 of these were AS patients, chosen to investigate the contribution of B27 alleles to AS susceptibility. Some significant new findings have arisen from this study: 1) B*2705 was the predominant subtype in circumpolar and subarctic areas. B*2702 was found to be practically restricted to Caucasian populations, showing a higher frequency in Middle-East (Jews) and North Africa (Arabs/Berbers) groups. 2) B*2703 appears associated with AS in Western Africans. This is of remarkable interest since it was suggested that B*2703 would be negatively disease-associated. 3) Although B*2706 appears negatively associated with AS in Thais, we identified two patients from northern China carrying it. This may be a reflection of a disease heterogeneity and could indicate that more than one pathogenic agent can be involved in AS. B*2709 has been recently described as negatively associated with AS in Sardinians. The molecular changes His114Asp (B*2706) and Asp116His (B*2709) could modify the genetic susceptibility to AS.

Expression of the autoreactive Ig repertoire in a large family, with high prevalence of thyroid autoimmune diseases

We have investigated the autoreactive Ig repertoire expressed by sera Ig of patients and healthy relatives individuals, who belong to a large family with high prevalence of autoimmune thyroid diseases (AITD). We have used a panel of thyroid, muscular and nuclear self antigens. IgG autoantibodies directed against thyroid antigens were found in 17 out of 29 patients (58.62%) and in 10 out of 46 (21.7%) of relatives sera which suggested that some relatives were either predisposed to develop the AITD or already affected with AITD. IgM natural autoantibodies (NAAb) directed against muscular and nuclear antigens were found in 27 out of 46 (58.69%) of healthy individuals but not exhibited in all of the patients. In relative's sera, the presence of anti-Tg and anti-TPO seems to be associated with the increase of the NAAb activity. Our Data suggested that The emergence of anti-Tg and anti-TPO auto-antibodies is secondary to a polyclonal activation.

Analysis of CD2 and TCR-beta gene expression in Jurkat cell mutants suggests a cis regulation of gene transcription

Thirty CD2- J32 stable clones, derived by mutagenesis and subsequent immunoselection with anti-CD2 Ab, were used to study the regulation of CD2 and TCR gene expression. Analysis of RNA expression revealed that the loss of surface expression of CD2 was due to a lack of expression of CD2 mRNA and was associated with a lack of expression of VDJ TCR-beta transcripts in 12 of these mutants, sparing the expression of DJ TCR-beta, TCR-alpha, CD3 gamma, delta, epsilon, and zeta RNA. The expression of other differentiation molecules was unaffected, except for CD1, CD4, and CD5, which were either decreased or absent in most of these mutants. A gain in the expression of TCR-gamma transcripts was observed in each of these mutants, while, as expected, no TCR-gamma transcripts were detected in wild-type J32 cells. Several mutants were able to use the human CD2 enhancer and the murine TCR-beta enhancer and promoter to activate transcription from reporter genes in the context of heterologous promoters, indicating that the mutation(s) does not affect transcription pathways. Consistent with this finding is the adequate expression in these mutants of several lineage-specific transcription factors. The expression of CD2 in several of these mutants was rescued by gene transfer using a genomic 28.5-kb CD2 fragment, suggesting that the enhancer function of this gene may be dependent on the enhancer site. These observations suggest that the coordinate expressions of CD2 and TCR-beta genes share common regulatory mechanisms involving factors regulating chromatin structure and accessibility.

Analysis of CD2 and TCR-beta gene expression in Jurkat cell mutants suggests a cis regulation of gene transcription

Thirty CD2- J32 stable clones, derived by mutagenesis and subsequent immunoselection with anti-CD2 Ab, were used to study the regulation of CD2 and TCR gene expression. Analysis of RNA expression revealed that the loss of surface expression of CD2 was due to a lack of expression of CD2 mRNA and was associated with a lack of expression of VDJ TCR-beta transcripts in 12 of these mutants, sparing the expression of DJ TCR-beta, TCR-alpha, CD3 gamma, delta, epsilon, and zeta RNA. The expression of other differentiation molecules was unaffected, except for CD1, CD4, and CD5, which were either decreased or absent in most of these mutants. A gain in the expression of TCR-gamma transcripts was observed in each of these mutants, while, as expected, no TCR-gamma transcripts were detected in wild-type J32 cells. Several mutants were able to use the human CD2 enhancer and the murine TCR-beta enhancer and promoter to activate transcription from reporter genes in the context of heterologous promoters, indicating that the mutation(s) does not affect transcription pathways. Consistent with this finding is the adequate expression in these mutants of several lineage-specific transcription factors. The expression of CD2 in several of these mutants was rescued by gene transfer using a genomic 28.5-kb CD2 fragment, suggesting that the enhancer function of this gene may be dependent on the enhancer site. These observations suggest that the coordinate expressions of CD2 and TCR-beta genes share common regulatory mechanisms involving factors regulating chromatin structure and accessibility.

CD28-stimulated IL-2 gene expression in Jurkat T cells occurs in part transcriptionally and is cyclosporine-A sensitive

CD28 is a glycoprotein expressed as a homodimer on the surface of a major subset of human T cells. Previous studies have shown that proliferation of peripheral blood T cells involving the CD28 pathway is associated with cyclosporine A (CsA) resistant IL-2 gene expression. This pathway was shown to specifically regulate the stability of mRNA for several lymphokines including IL-2. We have investigated the expression of the IL-2 gene in the Jurkat cell line, J32 clone, induced by CD28 stimulation. Cross-linked anti-CD28 mAb alone was sufficient to induce the release of small amounts of IL-2 (256 U/ml). The CD28-mediated IL-2 release was enhanced with simultaneous engagement of CD28 and CD2 or CD28 and CD3 molecules. Hybrid constructs in which the human IL-2 gene 5' flanking region drives luciferase expression (pIL-2-Luc) were used to help delineate whether the CD28 pathway activates the IL-2 gene transcriptionally. Costimulation of cells with CD28 mAb and either PHA or CD2 mAb induced a 20- to 90-fold increase in the expression of pIL-2-Luc as well as IL-2 release. Costimulation with CD28 mAb plus PMA gave only five- to sevenfold increase in enhancer activity. In contrast, no enhancer activity was detected after stimulation with CD28 or CD2 mAb alone. Both IL-2 release and pIL-2-Luc activity were inhibited by CsA in J32 cells. The degree of CsA inhibition was concentration dependent and was similar in cells stimulated with either CD28 mAb or CD3 mAb. Maximum inhibition was achieved with 1 microgram/ml of CsA. Studies with internal deletion mutations of the IL-2 gene 5' flanking sequence revealed that as with stimulation through the TCR pathway, the CD28 pathway requires 5' flanking sequences located within 500 bp of the transcription start site. These results are the first direct evidence that the triggering of CD28 molecule is sufficient to induce IL-2 release in J32 cells. Furthermore these studies strongly indicate that IL-2 gene expression induced by CD28 stimulation occurs, in part, transcriptionally and is CsA sensitive in these cells.

CD28-stimulated IL-2 gene expression in Jurkat T cells occurs in part transcriptionally and is cyclosporine-A sensitive

CD28 is a glycoprotein expressed as a homodimer on the surface of a major subset of human T cells. Previous studies have shown that proliferation of peripheral blood T cells involving the CD28 pathway is associated with cyclosporine A (CsA) resistant IL-2 gene expression. This pathway was shown to specifically regulate the stability of mRNA for several lymphokines including IL-2. We have investigated the expression of the IL-2 gene in the Jurkat cell line, J32 clone, induced by CD28 stimulation. Cross-linked anti-CD28 mAb alone was sufficient to induce the release of small amounts of IL-2 (256 U/ml). The CD28-mediated IL-2 release was enhanced with simultaneous engagement of CD28 and CD2 or CD28 and CD3 molecules. Hybrid constructs in which the human IL-2 gene 5' flanking region drives luciferase expression (pIL-2-Luc) were used to help delineate whether the CD28 pathway activates the IL-2 gene transcriptionally. Costimulation of cells with CD28 mAb and either PHA or CD2 mAb induced a 20- to 90-fold increase in the expression of pIL-2-Luc as well as IL-2 release. Costimulation with CD28 mAb plus PMA gave only five- to sevenfold increase in enhancer activity. In contrast, no enhancer activity was detected after stimulation with CD28 or CD2 mAb alone. Both IL-2 release and pIL-2-Luc activity were inhibited by CsA in J32 cells. The degree of CsA inhibition was concentration dependent and was similar in cells stimulated with either CD28 mAb or CD3 mAb. Maximum inhibition was achieved with 1 microgram/ml of CsA. Studies with internal deletion mutations of the IL-2 gene 5' flanking sequence revealed that as with stimulation through the TCR pathway, the CD28 pathway requires 5' flanking sequences located within 500 bp of the transcription start site. These results are the first direct evidence that the triggering of CD28 molecule is sufficient to induce IL-2 release in J32 cells. Furthermore these studies strongly indicate that IL-2 gene expression induced by CD28 stimulation occurs, in part, transcriptionally and is CsA sensitive in these cells.

[Determination of the frequency of the A2m (2) allele of immunoglobin A in the Tunisian population by RFLP analysis]

The human IgA2 subclass has two allotypes A2m(1) and A2m (2). Using the RFLP technique, we determined the A2m(2) frequency in a sample of 29 tunisian individuals. In accordance with Lefranc and all. [6], the presence of a polymorphic EcoRI site of the A2m(2) allele was confirmed in our RFLP study whereas no BamHI nor HindIII polymorphisms were shown. Among the 29 cases studies, 11 were heterozygous A2m2-1, 17 homozygous A2m1-1 and 1 homozygous A2m2-2. The A2m2 allele frequency in the Tunisian population (0,22) is intermediate between the European frequency and the African one.

Reconstitution of an active surface CD2 by DNA transfer in CD2-CD3+ Jurkat cells facilitates CD3-T cell receptor-mediated IL-2 production

To investigate the requirements for CD2 expression in the activation of T lymphocytes via the CD3-TCR complex, we produced and characterized a series of CD2-variants of the IL-2 producing Jurkat leukemia cell line, J32 (surface phenotype, CD2+, CD3+, CD28+). These mutants were derived by radiation and immunoselection, and were cloned under limiting dilution conditions. A total of 3 out of 30 of these mutants selectively lost the expression of both CD2 surface molecules and CD2 mRNA, and retained the expression of the CD3-TCR complex and the CD28 molecule. A mitogenic combination of anti-CD2 antibodies (9.6 + 9-1) failed to stimulate activation of these variants as measured by mobilization of intracellular Ca2+ and by IL-2 production. The CD2- mutants stimulated with anti-CD3 or anti-TCR mAb revealed an 8- to 32-fold decrease in IL-2 production and IL-2 mRNA accumulation as compared with the parental cells. No alteration of CD3-TCR-induced mobilization of intracellular Ca2+ was observed in the CD2- mutants. Reconstitution of CD2 expression by gene transfer in two J32 CD2- mutants restored IL-2 production and IL-2 mRNA accumulation in responses to both anti-CD2 and anti-CD3-TCR mAb. These results are the first direct demonstration of the requirement for CD2 molecules in optimizing IL-2 response in human T cells stimulated via CD3-TCR complex.

Reconstitution of an active surface CD2 by DNA transfer in CD2-CD3+ Jurkat cells facilitates CD3-T cell receptor-mediated IL-2 production

To investigate the requirements for CD2 expression in the activation of T lymphocytes via the CD3-TCR complex, we produced and characterized a series of CD2-variants of the IL-2 producing Jurkat leukemia cell line, J32 (surface phenotype, CD2+, CD3+, CD28+). These mutants were derived by radiation and immunoselection, and were cloned under limiting dilution conditions. A total of 3 out of 30 of these mutants selectively lost the expression of both CD2 surface molecules and CD2 mRNA, and retained the expression of the CD3-TCR complex and the CD28 molecule. A mitogenic combination of anti-CD2 antibodies (9.6 + 9-1) failed to stimulate activation of these variants as measured by mobilization of intracellular Ca2+ and by IL-2 production. The CD2- mutants stimulated with anti-CD3 or anti-TCR mAb revealed an 8- to 32-fold decrease in IL-2 production and IL-2 mRNA accumulation as compared with the parental cells. No alteration of CD3-TCR-induced mobilization of intracellular Ca2+ was observed in the CD2- mutants. Reconstitution of CD2 expression by gene transfer in two J32 CD2- mutants restored IL-2 production and IL-2 mRNA accumulation in responses to both anti-CD2 and anti-CD3-TCR mAb. These results are the first direct demonstration of the requirement for CD2 molecules in optimizing IL-2 response in human T cells stimulated via CD3-TCR complex.

Detection of CD2 polymorphism on chromosome 1 with EcoRI

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