An association of HL-A3 and HL-A7 with paralytic poliomyelitis

Life-long morbidity among Danes with poliomyelitis

OBJECTIVE

To estimate long-term morbidity in a cohort of Danish poliomyelitis patients.

DESIGN

A historical prospective cohort study of 27,047 persons.

SETTING

Denmark.

PARTICIPANTS

A total of 5421 persons hospitalized for poliomyelitis between 1919 to 1954 in Copenhagen, Denmark, and 21,626 age- and gender-matched Danes. Participants were followed up on average for 20.6 years, yielding a total of 555,884 person-years of follow-up.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

The exposed (poliomyelitis) cohort and the unexposed (control) cohort were followed up for somatic hospitalization from 1977 to 1999 in the Danish Hospital Discharge Register. The incidence rate ratio (IRR) was calculated as the ratio between the incidence rate of disease in the exposed and unexposed cohorts.

RESULTS

Overall, polio patients had a 1.2- to 1.3-fold increased risk of being hospitalized with pulmonary diseases, heart diseases, gastrointestinal disorders, or diseases of the locomotive apparatus. Among paralytic polio patients, long-term morbidity seems to be associated with the acute severity of poliomyelitis, as well as young age at infection. Paralytic patients, who contracted respiratory polio under the age of 5, had the highest risk of being hospitalized with lung diseases (IRR=7.26; 95% confidence interval [CI], 3.06-18.33), diseases of the locomotive apparatus (IRR=4.05; 95% CI, 1.66-9.86), heart diseases (IRR=1.70; 95% CI, 0.65-3.98), and diseases of the digestive system (IRR= 2.23; 95% CI, 1.03-4.62). Surprisingly, patients without paralyses, especially women, also had an increased morbidity.

CONCLUSIONS

Overall, a history of poliomyelitis was associated with a slightly increased morbidity measured by hospitalizations. Long-term morbidity was highest among respiratory polio patients; however, patients presumably left without any residual symptoms also had an increased morbidity.

Comparative study of spinal cord ubiquitin expression in post-poliomyelitis and sporadic amyotrophic lateral sclerosis

This study addresses the suggested possible pathogenetic relationship between the late-onset muscular atrophy in patients with the prior diagnosis of poliomyelitis and amyotrophic lateral sclerosis (ALS). For this purpose we applied immunohistochemical techniques to determine the presence of pathological structures that were stained for ubiquitin (a protein involved in degenerative processes) in the spinal cords of patients with a history of poliomyelitis and compared the results with those of ALS, a condition in which cytoplasmic ubiquitin-positive inclusions are invariably found in the anterior horn cells. Our results indicate that post-poliomyelitis patients have no ubiquitin-reactive inclusion bodies in these cells; however, some immunopositive globular and cord-shaped structures are seen in less-affected areas. Similar structures were also found in the spinal cords from patients with ALS and from normal individuals. Our findings would suggest that the pathogenesis of late muscular atrophy in post-poliomyelitis patients is dissimilar to that of ALS.

Susceptibility and resistance to poliovirus-induced paralysis of inbred mouse strains

Susceptibility to human poliovirus-induced disease in different inbred mouse strains was analyzed after intracerebral inoculation of two mouse-adapted type 2 polioviruses, the attenuated W-2 strain and the virulent Lansing strain. In contrast to inoculation with the Lansing strain, which was invariably lethal, inoculation with the W-2 strain defined three groups of mice with high, intermediate, or low disease incidence. Those in the high-disease-incidence group, the DBA/1J and DBA/2J mice, exhibited a high level of virus replication in the spinal cord by day 2 postinfection, with no detectable neutralizing-antibody response. Mice in the intermediate- and low-incidence groups had lower levels of virus replication in the spinal cord and/or produced neutralizing antibodies. No correlation was observed between H-2 haplotype and the extent of virus replication, production of neutralizing or enzyme-linked immunosorbent assay-detectable antibodies, or T-cell-proliferative response. However, mice of the H-2k haplotype manifested a low incidence of disease.

Cell-mediated immune responses to poliovirus II. Survey of delayed hypersensitivity and T-cell proliferative responses in inbred mouse strains

Some epidemiological reports suggest a human genetic predisposition for susceptibility to the development of paralytic poliomyelitis. In a previous study of cell-mediated immune responses by mice to poliovirus (PV), we showed differences in the responses by BALB/c and C57BL/6 (B6) mice. The present study is a further analysis of the delayed hypersensitivity (DTH) and T cell proliferative (Tprlf) responses to PV in 17 different inbred strains of mice, to determine if these responses were under major histocompatibility complex (MHC) or other genetic control. Both DTH and Tprlf to PV did not correlate with MHC for responses to any of the three PV serotypes. Further, we found a lack of concordance of DTH and Tprlf responses to a given PV serotype. The cell-mediated immune responses by any one mouse strain to one PV serotype is not predictive of that mouse strain's response to another PV serotype.

Amyotrophic lateral sclerosis: Part 2. Etiopathogenesis

The pathogenesis of the motor neuronal degeneration in amyotrophic lateral sclerosis (ALS) is unclear, though several possible etiological factors are currently being investigated. A unifying hypothesis will have to explain the diverse geographical occurrence, clinical features, and selective vulnerability and relative resistance of different neuronal populations in the disease. It is possible that different biochemical defects underlie this diversity, or alternatively that the many factors incriminated in the etiology may act upon an underlying genetic-biochemical abnormality to trigger premature neuronal death. Viruses, metals, endogenous toxins, immune dysfunction, endocrine abnormalities, impaired DNA repair, altered axonal transport, and trauma have all been etiologically linked with ALS, but convincing research evidence of a causative role for any of these factors is yet to be demonstrated.

HLA-A, -B, and -D antigens in paralytic poliomyelitis

Sixty-two unrelated Caucasian patients from the Munich area who had had paralytic poliomyelitis in the 1950s and the early 1960s were analyzed. HLA-A and -B typing was performed for 26 antigens. HLA-D tying was done using six different established homozygous typing cells defining the specificities Dw1-Dw5 and Dw11, plus one locally defined typing cell. None of the HLA-A, -B or -D determinants showed a significant deviation in frequency from control populations. Of interest may be a decrease of B8 and an increase of Bw16 (Bw38/39) and B27, but these deviations are not significant in their P values are corrected for the number of comparisons made.

Is the polio virus responsible for late central nervous system tumors?

A hypothesis is advanced concerning the relationship of poliomyelitis viruses and late developing neoplasia in the central nervous system. The literature is surveyed, and several experimental approaches based upon known evidence of viral and neoplastic behaviour are advanced. The present status of world polio incidence is discussed as it applies to this possible relationship.

Jejunal immunopathology in amyotrophic lateral sclerosis and multiple sclerosis. Identification of viral antigens by immunofluorescence

Jejunal mucosa from 7 patients with amyotrophic lateral sclerosis (A.L.S.), 20 newly reported patients with multiple sclerosis (M.S.), and 35 control patients without either disease was studied by immunofluorescence. An immune reaction was present in all A.L.S. specimens and consisted of altered ratios of immunoglobulin-labelled cells in the lamina propria, complement-labelled cells in the same location, and, in some, immunoglobulin and complement deposits in the epithelial basement membrane. Poliovirus antigen was detected in 4 cases, and in 1 of the these cases measles antigen was also present. A fifth specimen showed large amounts of herpesvirus antigen. In 2 cases studied at necropsy, both viral infection and immunological change was confined to the proximal jejunum. Measles antigen was identified in every case of M.S., and in biopsy specimens from 16 of the 20 M.S. patients immunological reactions similar to those seen in A.L.S. were present. With 2 exceptions, the controls did not show these changes in the jejunal mucosa. The exceptions were a patient with Friedreich's ataxia, who had an increase of IgG-labelled cells and some complement-bearing cells in the lamina propria, and a patient diagnosed as having non-tropical sprue, in whom large quantities of herpes antigen were seen.

Demyelinative myelopathy in mice induced by the DA virus

An attenuated tissue culture adapted strain of DA virus, an agent related to the Theiler murine encephalomyelitis viruses (TMEV), was used to induce a chronic myelopathy in mice. Spastic paraparesis first appeared 5 months after weanings were inoculated intracerebrally with the virus. None died as a direct result of the infection, and none improved once paretic. The major pathological change in these mice was demyelination of thoracic segments of spinal cord. No clinical illness or demyelinative pathology were detected during the first 4 months after inoculation. Encephalitic virus was present in brain and spinal cord as late as 10 months after inoculation. No neutralization antibody activity to DA virus was present in sera from 10 patients with amyotrophic lateral sclerosis, 10 with multiple sclerosis, or in 10 controls.

[Histocompatibility-(HLA) antigens in patients with HBsAg positive and negative hepatitis and healthy carriers of HBsAg and anti-HBs. (author's transl)]

New own data and a survey of published data concerning the frequencies of 23 HLA antigens in patients with HBsAg positive and negative chronic active hepatitis (CAH) and healthy carriers of Hepatitis-surface antigen (HBsAg) and high titers of antibodies to HBaAg (Anti-HBs) allow to conclude as follows: 1. Patients with CAH and persistence of HBsAg show a normal frequency of HLA-B8. 2. There is no increased frequency of HLA-B8 in HBsAg negative CAH without autoimmune antibodies. 3. Only in patients with HBsAg negative CAH with autoimmune antibodies is the frequency of HLA-B8 is statistically significantly increased (p less than 0.01 after correction for the number of antigens and different groups of patients compared). These are patients with the autoimmune form of CAH. 4. There exist no significant differences in the frequencies of the HLA antigens tested in patients with HBsAg positive CAH and healthy carriers of HBsAg and Anti-HBs. Thus no indications could be found for HLA-associated factors in the different behaviour to the hepatitis-B virus.

A study of HL-A types in Rh haemolytic disease of the newborn

The HL-A types of 288 women, immunised to the Rh(D) antigen as a result of pregnancy, have been compared to the HL-A types of 139 women who although they have had Rh(D)-positive children have not produced anti-Rh(D). There is an indication that an increased incidence of the HL-A3 antigen is associated with the immunised mothers. A study of the HL-A types of husbands and children of both immunised and non-immunised women did not suggest that their HL-A types played a significant role in anti-Rh(D) production. The frequencies of the HL-A antigens in each category studied have been tabulated for record purposes, as well as the frequencies in a random panel of persons living in the Newcastle environs. Full ABO, Rh and HL-A details of 50 immunised mothers and their families and of 58 non-immunised mothers and their families are available.