alpha 1-Acid glycoprotein, alpha 1-antitrypsin, and ceruloplasmin in human intestinal helminthiases

Types of acute phase reactants and their importance in vaccination

Vaccines are considered to be one of the most cost-effective life-saving interventions in human history. The body's inflammatory response to vaccines has both desired effects (immune response), undesired effects [(acute phase reactions (APRs)] and trade-offs. Trade-offs are more potent immune responses which may be potentially difficult to separate from potent acute phase reactions. Thus, studying acute phase proteins (APPs) during vaccination may aid our understanding of APRs and homeostatic changes which can result from inflammatory responses. Depending on the severity of the response in humans, these reactions can be classified as major, moderate or minor. In this review, types of APPs and their importance in vaccination will be discussed.

Plasma proteins in children with trichuris dysentery syndrome

AIMS

To determine whether in Trichuris trichiura dysentery there is (1) evidence of a systemic inflammatory response, (2) evidence that the plasma protein disturbance has special characteristics compared with uninfected children in the endemic environment.

METHODS

Three groups of children (age 1.6 to 11.4 years) were studied: 53 cases of trichuris dysentery syndrome (TDS), 16 cases of chronic non-secretory diarrhoea not infected with the parasite ("disease controls", DC), and 20 asymptomatic, parasite-free primary schoolchildren (normal controls, NC). C reactive protein, alpha 1 antitrypsin, caeruloplasmin, albumin, total globulin, fibrinogen, fibronectin, ferritin, and transferrin were measured on a single occasion for each. The study was thus a cross sectional descriptive survey for group comparison. Plasma viscosity was measured on admission for TDS and DC and repeated after six weeks and six months for TDS.

RESULTS

Plasma C reactive protein, alpha 1 antitrypsin, total globulin, fibronectin, and viscosity were significantly higher in TDS than in NC. DC children also had acute phase protein elevations (C reactive protein, caeruloplasmin, viscosity). However, the increase in caeruloplasmin was specific to the DC group while an increase in fibronectin was specific to the TDS group. Serial measurement of viscosity in TDS showed a modest but significant fall during the six months following treatment.

CONCLUSIONS

There is an acute phase response in intense trichuriasis and a specific elevation of plasma fibronectin. Plasma viscosity remains abnormally high six months after treatment, although lower than at diagnosis.

Intestinal nematode infections in children: the pathophysiological price paid

The mechanism by which small animals such as rodents resist or eliminate nematode parasites requires mucosal inflammation as the final effector of the immune response. The resulting freedom from chronic infection may be worth the price of short-term illness. Putative vaccines which attempt to enhance the natural effect will have to take into account the inflammatory cost to the host. Human helminthiases involve a more stable equilibrium between host and parasite. The medical literature on hookworm disease and clinical ascariasis describes, for the former, some chronic inflammatory effects correlated with worm burden, but for the latter a less quantified or predictable set of detrimental effects. We describe a current, systematic study of the inflammatory response to whipworm infection, in which anaemia, growth retardation and intestinal leakiness are viewed as predictable consequences related to infection intensity. There is evidence for the absence of cell-mediated immunopathology. However, a specific, IgE-mediated local anaphylaxis may, at least partly, mediate the deleterious effects. Increased numbers of mucosal macrophages may also contribute to the chronic, systemic effects through their output of cytokines. Similar attempts to show the mechanisms of pathogenesis and quantify the effects of hookworm disease should be undertaken.

The acute phase protein response during parasitic infection

There is a paucity of comprehensive studies of the APP response in parasitic infection. This should be remedied for two reasons. First, as there is a limited number of cytokines with hepatocyte-stimulating activities, and as each one elicits a unique spectrum of protein changes, examination of the APP response during infection could provide insight into the cytokines involved. Second, the presence of IL-1, IL-6 and TNF, the mediators of the APR, in tissues and circulation have important implications for subsequent immune responses.

A study of acute-phase reactant proteins in Indonesian patients with pulmonary tuberculosis

The levels of 8 acute phase reactants (alpha 1-antitrypsin, alpha 2-macroglobulin, transferrin, alpha 1-acid glycoprotein, C-reactive protein, ceruloplasmin, haptoglobin and the third component of complement) and immunoglobulin in the IgG, IgM and IgA classes were assayed, by laser nephelometry, in sera from 107 East Japanese patients with smear-positive pulmonary tuberculosis and 144 healthy subjects. These levels were correlated with clinical, haematological and radiological features, the levels of antibody to Mycobacterium tuberculosis, and the diameters of the tuberculin skin test read at various times. Levels of all acute phase reactants increased significantly in tuberculosis except for that of transferrin which was lowered. The correlations between the various acute phase reactants in health and disease were calculated. In general, the correlations were lower in disease than in health, except for the third component of complement and a greatly increased correlation between the levels of alpha 1-antitrypsin and ceruloplasmin. There was a significant correlation between levels of some of the acute phase reactants and those of antibodies to M. tuberculosis, mainly with IgG, less with IgA and least with IgM antibodies. By contrast correlations between acute phase protein and total immunoglobulin levels were most evident in the IgM class, less with IgA and not at all with IgG. Although there were some associations between protein levels and age, sex and weight of controls and patients, these were not great enough to account for the differences between the two groups. There was a tendency for patients, but not controls, with intestinal helminthiasis to have higher levels of total IgM than those without evidence of parasites. In general, the levels of proteins bore very little relation to the clinical and radiological features of disease and were, with the exception of the antimycobacterial antibodies, of no diagnostic value. Likewise, protein levels were not associated with the extent of disease; better correlations were found with the ESR and leucocyte count. Transferrin levels tended to be higher in those with chronic disease and showed a correlation with the diameters of the dermal reactions to tuberculin at 24 hours, which were also significantly larger in chronic disease. Among the haematological findings, the most significant was a negative correlation between the lymphocyte count and haptoglobin levels in disease, suggesting a possible regulatory role for this protein.