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Taylor JA, Burnell M, Ryana A, Karpinskyj C, Kalsi JK, Taylor H, Apostolidou S, Sharma A, Manchanda R, Woolas R, Campbell S, Parmar M, Singh N, Jacobs IJ, Menon U, Gentry-Maharaj A. Association of hysterectomy and invasive epithelial ovarian and tubal cancer: a cohort study within UKCTOCS. BJOG 2022; 129:110-118. [PMID: 34555263 PMCID: PMC7615389 DOI: 10.1111/1471-0528.16943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate the association between hysterectomy with conservation of one or both adnexa and ovarian and tubal cancer. DESIGN Prospective cohort study. SETTING Thirteen NHS Trusts in England, Wales and Northern Ireland. POPULATION A total of 202 506 postmenopausal women recruited between 2001 and 2005 to the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS) and followed up until 31 December 2014. METHODS Multiple sources (questionnaires, hospital notes, Hospital Episodes Statistics, national cancer/death registries, ultrasound reports) were used to obtain accurate data on hysterectomy (with conservation of one or both adnexa) and outcomes censored at bilateral oophorectomy, death, ovarian/tubal cancer diagnosis, loss to follow up or 31 December 2014. Cox proportional hazards regression models were used to assess the association. MAIN OUTCOME MEASURES Invasive epithelial ovarian and tubal cancer (WHO 2014) on independent outcome review. RESULTS Hysterectomy with conservation of one or both adnexa was reported in 41 912 (20.7%; 41 912/202 506) women. Median follow up was 11.1 years (interquartile range 9.96-12.04), totalling >2.17 million woman-years. Among women who had undergone hysterectomy, 0.55% (231/41 912) were diagnosed with ovarian/tubal cancer, compared with 0.59% (945/160 594) of those with intact uterus. Multivariable analysis showed no evidence of an association between hysterectomy and invasive epithelial ovarian/tubal cancer (hazard ratio 0.98, 95% CI 0.85-1.13, P = 0.765). CONCLUSIONS This large cohort study provides further independent validation that hysterectomy is not associated with alteration of invasive epithelial ovarian and tubal cancer risk. These data are important both for clinical counselling and for refining risk prediction models. TWEETABLE ABSTRACT Hysterectomy does not alter risk of invasive epithelial ovarian and tubal cancer.
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Affiliation(s)
- JA Taylor
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - M Burnell
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - A Ryana
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - C Karpinskyj
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - JK Kalsi
- Department of Women’s Cancer, Institute for Women’s Health, University College London, London, UK
- Department Epidemiology and Public Health, Institute of Epidemiology and Health Care, UCL, London, UK
| | - H Taylor
- Department of Surgery and Cancer, Imperial College Healthcare NHS Trust, London, UK
| | - S Apostolidou
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - A Sharma
- Department of Obstetrics and Gynaecology, University Hospital of Wales, Cardiff, UK
| | - R Manchanda
- Barts Health NHS Trust and Wolfson Institute of Preventive Medicine, CRUK Barts Cancer Centre, Queen Mary University of London, London, UK
| | - R Woolas
- Department of Gynaecological Oncology, Queen Alexandra Hospital, Portsmouth, UK
| | | | - M Parmar
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - N Singh
- Department of Cellular Pathology, Barts Health NHS Trust, London, UK
| | - IJ Jacobs
- Department of Women’s Cancer, Institute for Women’s Health, University College London, London, UK
- University of New South Wales, Sydney, NSW, Australia
| | - U Menon
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - A Gentry-Maharaj
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK
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Burnell M, Gentry‐Maharaj A, Glazer C, Karpinskyj C, Ryan A, Apostolidou S, Kalsi J, Parmar M, Campbell S, Jacobs I, Menon U. Serial endometrial thickness and risk of non-endometrial hormone-dependent cancers in postmenopausal women in UK Collaborative Trial of Ovarian Cancer Screening. Ultrasound Obstet Gynecol 2020; 56:267-275. [PMID: 31614036 PMCID: PMC7496247 DOI: 10.1002/uog.21894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 09/27/2019] [Accepted: 10/02/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Estrogen is a well-established risk factor for various cancers. It causes endometrial proliferation, which is assessed routinely as endometrial thickness (ET) using transvaginal ultrasound (TVS). Only one previous study, restricted to endometrial and breast cancer, has considered ET and the risk of non-endometrial cancer. The aim of this study was to explore the association between baseline and serial ET measurements and nine non-endometrial hormone-sensitive cancers, in postmenopausal women, using contemporary statistical methodology that attempts to minimize the biases typical of endogenous serial data. METHODS This was a cohort study nested within the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS). In the ultrasound arm of UKCTOCS, 50639 postmenopausal women, aged 50-74, underwent annual TVS examination, of whom 38 105 had a valid ET measurement, no prior hysterectomy and complete covariate data, and were included in this study. All women were followed up through linkage to national cancer registries. The effect of ET on the risk of six estrogen-dependent cancers (breast, ovarian, colorectal, bladder, lung and pancreatic) was assessed using joint models for longitudinal biomarker and time-to-event data, and Cox models were used to assess the association between baseline ET measurement and these six cancers in addition to liver cancer, gastric cancer and non-Hodgkin's lymphoma (NHL). All models were adjusted for current hormone-replacement therapy (HRT) use, body mass index, age at last menstrual period, parity and oral contraceptive pill use. RESULTS The 38 105 included women had a combined total of 267 567 (median, 8; interquartile range, 5-9) valid ET measurements. During a combined total of 407 838 (median, 10.9) years of follow-up, 1398 breast, 351 endometrial, 381 lung, 495 colorectal, 222 ovarian, 94 pancreatic, 79 bladder, 62 gastric, 38 liver cancers and 52 NHLs were registered. Using joint models, a doubling of ET increased significantly the risk of breast (hazard ratio (HR), 1.21; 95% CI, 1.09-1.36; P = 0.001), ovarian (HR, 1.39; 95% CI, 1.06-1.82; P = 0.018) and lung (HR, 1.25; 95% CI, 1.02-1.54; P = 0.036) cancers. There were no statistically significant associations between ET and the remaining six cancers. CONCLUSION Postmenopausal women with high/increasing ET on TVS are at increased risk of breast, ovarian and lung cancer. It is important that clinicians are aware of these risks, as TVS is a common investigation. © 2019 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- M. Burnell
- MRC CTU, Institute of Clinical Trials and MethodologyUniversity College LondonLondonUK
| | - A. Gentry‐Maharaj
- MRC CTU, Institute of Clinical Trials and MethodologyUniversity College LondonLondonUK
| | - C. Glazer
- Department of Occupational and Environmental MedicineFrederiksberg‐Bispebjerg University HospitalCopenhagenNVDenmark
| | - C. Karpinskyj
- MRC CTU, Institute of Clinical Trials and MethodologyUniversity College LondonLondonUK
| | - A. Ryan
- MRC CTU, Institute of Clinical Trials and MethodologyUniversity College LondonLondonUK
- Department of Women's Cancer, Institute for Women's HealthUniversity College LondonLondonUK
| | - S. Apostolidou
- MRC CTU, Institute of Clinical Trials and MethodologyUniversity College LondonLondonUK
| | - J. Kalsi
- Department of Women's Cancer, Institute for Women's HealthUniversity College LondonLondonUK
| | - M. Parmar
- MRC CTU, Institute of Clinical Trials and MethodologyUniversity College LondonLondonUK
| | | | - I. Jacobs
- Department of Women's Cancer, Institute for Women's HealthUniversity College LondonLondonUK
- University of New South WalesSydneyAustralia
| | - U. Menon
- MRC CTU, Institute of Clinical Trials and MethodologyUniversity College LondonLondonUK
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Stott W, Campbell S, Franchini A, Blyuss O, Zaikin A, Ryan A, Jones C, Gentry‐Maharaj A, Fletcher G, Kalsi J, Skates S, Parmar M, Amso N, Jacobs I, Menon U. Sonographers' self-reported visualization of normal postmenopausal ovaries on transvaginal ultrasound is not reliable: results of expert review of archived images from UKCTOCS. Ultrasound Obstet Gynecol 2018; 51:401-408. [PMID: 28796383 PMCID: PMC5888153 DOI: 10.1002/uog.18836] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 07/28/2017] [Accepted: 08/01/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE In the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS), self-reported visualization rate (VR) of the ovaries by the sonographer on annual transvaginal sonographic (TVS) examinations was a key quality control (QC) metric. The objective of this study was to assess self-reported VR using expert review of a random sample of archived images of TVS examinations from UKCTOCS, and then to develop software for measuring VR automatically. METHODS A single expert reviewed images archived from 1000 TVS examinations selected randomly from 68 931 TVS scans performed in UKCTOCS between 2008 and 2011 with ovaries reported as 'seen and normal'. Software was developed to identify the exact images used by the sonographer to measure the ovaries. This was achieved by measuring caliper dimensions in the image and matching them to those recorded by the sonographer. A logistic regression classifier to determine visualization was trained and validated using ovarian dimensions and visualization data reported by the expert. RESULTS The expert reviewer confirmed visualization of both ovaries (VR-Both) in 50.2% (502/1000) of the examinations. The software identified the measurement image in 534 exams, which were split 2:1:1 providing training, validation and test data. Classifier mean accuracy on validation data was 70.9% (95% CI, 70.0-71.8%). Analysis of test data (133 exams) provided a sensitivity of 90.5% (95% CI, 80.9-95.8%) and specificity of 47.5% (95% CI, 34.5-60.8%) in detecting expert confirmed visualization of both ovaries. CONCLUSIONS Our results suggest that, in a significant proportion of TVS annual screens, the sonographers may have mistaken other structures for normal ovaries. It is uncertain whether or not this affected the sensitivity and stage at detection of ovarian cancer in the ultrasound arm of UKCTOCS, but we conclude that QC metrics based on self-reported visualization of normal ovaries are unreliable. The classifier shows some potential for addressing this problem, though further research is needed. © 2017 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- W. Stott
- Women's CancerUCL EGA Institute for Women's HealthLondonUK
| | | | - A. Franchini
- London School of Hygiene and Tropical MedicineLondonUK
| | - O. Blyuss
- Women's CancerUCL EGA Institute for Women's HealthLondonUK
| | - A. Zaikin
- Women's CancerUCL EGA Institute for Women's HealthLondonUK
| | - A. Ryan
- Women's CancerUCL EGA Institute for Women's HealthLondonUK
| | - C. Jones
- Women's CancerUCL EGA Institute for Women's HealthLondonUK
| | | | - G. Fletcher
- Women's CancerUCL EGA Institute for Women's HealthLondonUK
| | - J. Kalsi
- Women's CancerUCL EGA Institute for Women's HealthLondonUK
| | - S. Skates
- Biostatistics CenterMassachusetts General HospitalBostonMAUSA
| | - M. Parmar
- Medical Research Council Clinical Trials Unit at UCLLondonUK
| | - N. Amso
- School of Medicine, College of Biomedical and Life SciencesCardiff UniversityCardiffUK
| | - I. Jacobs
- Women's CancerUCL EGA Institute for Women's HealthLondonUK
- University of New South Wales, SydneyAustralia
| | - U. Menon
- Women's CancerUCL EGA Institute for Women's HealthLondonUK
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Kalsi JK, Grossman J, Kim J, Sieling P, Gjertson DW, Reed EF, Ebling FM, Linker-Israeli M, Hahn BH. Peptides from antibodies to DNA elicit cytokine release from peripheral blood mononuclear cells of patients with systemic lupus erythematosus: relation of cytokine pattern to disease duration. Lupus 2016; 13:490-500. [PMID: 15352419 DOI: 10.1191/0961203303lu1060oa] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Peptides from VH regions of antibodies to DNA drive immune responses in systemic lupus erythematosus (SLE). We studied peptide-induced cytokine release by peripheral blood mononuclear cells (PBMC) of patients, the influence of peptide concentration, disease characteristics and HLA-D haplotypes. Cells secreting cytokines (IFNg, IL-2, IL-4 and IL-10) were measured by ELISPOT in PBMC from 31 patients with SLE and 20 matched healthy controls in response to seven peptides (A-G) from the CDR1/FR2 to CDR2/FR3 VH regions of human anti-DNA MAbs. Disease activity was assessed by SELENA-SLEDAI. HLA-DR and -DQ alleles were determined by molecular typing techniques. PBMC from significantly higher proportions of SLE patients than controls responded to VH peptides by generating IFNg and IL-10. Type of cytokines released in response to at least one peptide (D) depended on antigen concentration. Cytokine release was not associated with clinical features of SLE except for disease duration. A shift occurred from IFNg, IL-4 and IL-10 production in early disease to IL-4 and IL-10 in late disease (suggesting increasing TH2-like responses over time). Three peptides (B, D, G) were more stimulatory in the SLE patients than controls. Although none of the peptides was restricted by any particular MHC class II allele, among responders there was increased prevalence of HLA-DQB1 0201 and/or DRB1 0301, alleles known to predispose to SLE. Thus, responses to some VH peptides are more frequent in SLE and vary with disease duration. Increased responses in individuals with HLA class II genotypes that predispose to SLE suggest that peptide presentation by those molecules permits brisker peripheral blood cell responses to autoantibody peptides, thus increasing risk for disease.
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Affiliation(s)
- J K Kalsi
- Division of Rheumatology, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA 90095, USA
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Bailey K, Pikhart H, Ryan A, Apostolidou S, Fourkala E, Burnell M, Gentry-Maharaj A, Kalsi J, Parmar M, Jacobs I, Menon U. Socioeconomic inequalities in mortality in national sample of English women: the UKCTOCS Study. Eur J Public Health 2014. [DOI: 10.1093/eurpub/cku151.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Kalsi J. Bone reformation: contemporary bone augmentation procedures in oral and maxillofacial implant surgery. Br Dent J 2009. [DOI: 10.1038/sj.bdj.2009.508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Kalsi J, Minhas S, Christopher N, Ralph D. The Results of Plaque Incision and Venous Grafting (Lue Procedure) to Correct the Penile Deformity of Peyronie’s Disease. J Urol 2006. [DOI: 10.1016/s0022-5347(05)00286-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- J. Kalsi
- St. Peter’s Andrology Centre and Institute of Urology, London, United Kingdom
| | - S. Minhas
- St. Peter’s Andrology Centre and Institute of Urology, London, United Kingdom
| | - N. Christopher
- St. Peter’s Andrology Centre and Institute of Urology, London, United Kingdom
| | - D. Ralph
- St. Peter’s Andrology Centre and Institute of Urology, London, United Kingdom
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Kalsi J, Ravirajan CT, Rahman A, Isenberg DA. Structure–function
analysis and the molecular origins of anti-DNA antibodies in systemic lupus erythematosus. Expert Rev Mol Med 2004; 1999:1-28. [PMID: 14585125 DOI: 10.1017/s1462399499000423] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Patients with the autoimmune rheumatic disease systemic lupus erythematosus
(SLE or ‘lupus’) develop a wide variety of clinical and serological manifestations
including the presence of antibodies to double-stranded DNA (dsDNA), which are
often diagnostic and potentially pathogenic. In this review, we have examined
the links between the structure and function of anti-dsDNA antibodies, emphasising
their clinical associations. We have also reviewed studies involving animal
models, the analysis of human antibody sequences and studies of, and using,
computer modelling and crystal structure.
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Affiliation(s)
- J Kalsi
- Centre for Rheumatology/Bloomsbury Rheumatology Unit, Department of Medicine, University College London, Arthur Stanley House, 50 Tottenham Street, London W1P 9PG, UK
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Kumar S, Nagl S, Kalsi JK, Ravirajan CT, Athwal D, Latchman DS, Pearl LH, Isenberg DA. Anti-cardiolipin/beta-2 glycoprotein activities co-exist on human anti-DNA antibody light chains. Mol Immunol 2003; 40:517-30. [PMID: 14563371 DOI: 10.1016/s0161-5890(03)00225-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
We have recently shown that the human anti-DNA antibodies B3 and 33H11 also bind cardiolipin and that the anti-autoantigen activity resides predominantly on their lambda light chains. We now show that the two auto-antibodies possess strong reactivity to the plasma-protein 2-Glycoprotein I (beta2-GPI) also. Utilizing chain shuffling experiments involving an unrelated anti-p185 antibody 4D5 with insignificant reactivity to cardiolipin or to beta2-GPI, we now demonstrate that hybrid Fabs with constituent light chain, but not the heavy chain, of B3 or 33H11, exhibit anti-cardiolipin activity. Furthermore, the constructs possessing the auto-antibody-derived light chain also exhibited significant reactivity to beta2-GPI. The results suggest that anti-DNA, anti-cardiolipin and anti-beta2-GPI activities co-exist on the light chains of the antibodies studied and, importantly, these activities could be transferred to antibody constructs by their light chains alone. Computer-generated models of the three-dimensional structures of the auto-antibodies and their hybrids, suggest predominant interaction of their light chains with domain IV of beta2-GPI.
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Affiliation(s)
- Sanjeev Kumar
- Bloomsbury Rheumatology Unit, Department of Medicine, Centre for Rheumatology, University College London Hospital, Arthur Stanley House, 40-50 Tottenham Street, London W1P 9PG, UK.
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Kumar S, Kalsi JK, Ravirajan CT, Latchman DS, Pearl LH, Isenberg DA. Molecular expression systems for anti-DNA antibodies--2. Lupus 2003; 11:833-42. [PMID: 12529048 DOI: 10.1191/0961203302lu304rr] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Antibodies to double-stranded DNA are the best-known serological markers of systemic lupus erythematosus, and are closely associated with its renal pathogenesis. How these antibodies recognize DNA is not fully understood. An understanding of the relationship between the functional attributes of an antibody with the three-dimensional structure of its antigen-combining site would allow an insight into the rules that dictate auto-antibody-nucleic acid interaction and consequent pathogenicity of the autoantibody. Data from such studies could assist the development of novel drugs as an approach to specific therapies that can inhibit or disrupt protein-nucleic acid interactions. A full understanding of the binding specificities can be achieved only by experimental determination of detailed three-dimensional structure of these antibodies alone, and of their complexes with specific DNA antigens. A prerequisite of such a study is the ability to produce multimilligram quantities of the antibody protein. However, these antibodies are particularly difficult to express, probably due to their DNA-binding activity. This review attempts to focus on the recent developments on the over-expression of anti-DNA antibody fragments in heterologous cell expression systems and their purification to homogeneity that would in turn allow their structural studies via crystallization.
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Affiliation(s)
- S Kumar
- Centre for Rheumatology, Bloomsbury Rheumatology Unit, Department of Medicine, University College London Hospital, London, UK.
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Abstract
The V-regions of anti-DNA antibodies contain determinants which can drive the autoimmune in SLE. Most of the evidence comes from murine studies where VH-derived epitopes accelerate the disease process in lupus prone-mice and can elicit mild inflammatory changes reminiscent of lupus in healthy animals. T helper cells reactive with VH peptides arise spontaneously during the disease and are thought to assist production of both anti-peptide antibodies and the generation of autoantibodies that deposit in the glomeruli. In mice stimulatory epitopes may be unique to autoantibodies. As tolerogens VH peptides may delay or diminish the autoimmune response by altering the production of cytokines. An artificial VH peptide, (pCONCENSUS) has been derived and this inhibits responses to VH and other autoantigens but leaves the murine immune system intact and able to generate reponses to external antigens. Limited number of studies of V-region determinants of human anti-DNA MAbs indicate prior sensitization of lupus T cells to VH determinants and that V-region reactive T cells are not deleted in periphery of healthy individuals.
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Affiliation(s)
- J K Kalsi
- Centre for Rheumatology Research, Windeyer Institute for Medical Sciences, University College London, London, UK.
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Kalsi J, Arya M, Wilson P, Mundy A. Hospital-acquired urinary tract infection. Int J Clin Pract 2003; 57:388-91. [PMID: 12846343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/03/2023] Open
Abstract
Nosocomial urinary tract infections (UTIs) account for up to 40% of all hospital-acquired infections. The associated morbidity and mortality are a major drain on hospital resources. Patients with indwelling urinary catheters, patients undergoing urological manipulations, long-stay elderly male patients and patients with debilitating diseases are at high risk of developing nosocomial UTIs. The organisms responsible usually originate from patients' endogenous intestinal flora, but occasionally from a moist site in the hospital environment. Nosocomial pathogens causing UTIs tend to have a higher antibiotic resistance than simple UTIs. Infection control policies are important in limiting the number of hospital-acquired UTIs. Other important points include catheterisation using an aseptic technique and sterile equipment and the use of closed drainage systems. UTIs should be treated only after a urine sample has been sent and the advice of a microbiologist sought. In the future catheters impregnated with antibiotics, and the use of newer materials, may lead to further reductions in the incidence of nosocomial UTIs.
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Affiliation(s)
- J Kalsi
- Institute of Urology and Nephrology, University College London, UK
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Abstract
OBJECTIVE To evaluate the outcome of patients undergoing the immediate insertion of a penile prosthesis as a treatment for acute low-flow priapism. PATIENTS AND METHODS Eight patients presenting with low-flow priapism with a mean duration of 91 h (range 32-192) were prospectively evaluated. All had failed conservative management with the instillation of alpha-adrenergic agents, and four had already undergone shunt procedures elsewhere. Immediate management consisted of the insertion of a malleable prosthesis in six patients and an inflatable prosthesis in two. One of the malleable prostheses was subsequently changed to an inflatable device. RESULTS There were no early complications, with all patients being satisfied with the end result, and seven having sexual intercourse. One patient developed a penile deformity after surgery, cause by fibrosis around one inflatable cylinder. All patients have maintained their penile length. CONCLUSIONS Prolonged low-flow priapism results in a variable degree of cavernosal fibrosis and a subsequent loss of penile length. The delayed insertion of a penile prosthesis can be difficult, with high complication rates. The immediate insertion of a penile prosthesis in patients with prolonged low-flow priapism is simple and maintains penile length. This should always be offered to the patient at initial presentation, as the complication rate is low and the subsequent outcome excellent.
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Affiliation(s)
- R W Rees
- Institute of Urology, London, UK
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Gu J, Märker-Hermann E, Baeten D, Tsai WC, Gladman D, Xiong M, Deister H, Kuipers JG, Huang F, Song YW, Maksymowych W, Kalsi J, Bannai M, Seta N, Rihl M, Crofford LJ, Veys E, De Keyser F, Yu DTY. A 588-gene microarray analysis of the peripheral blood mononuclear cells of spondyloarthropathy patients. Rheumatology (Oxford) 2002; 41:759-66. [PMID: 12096225 DOI: 10.1093/rheumatology/41.7.759] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To identify genes which are more highly expressed in the peripheral blood mononuclear cells (PBMC) of patients with spondyloarthropathy (SpA), rheumatoid arthritis (RA) and psoriatic arthritis (PsA), in comparison to normal subjects. METHODS A 588-gene microarray was used as a screening tool to select a panel of such genes from PBMC of these subjects and of normal subjects. Results were then validated by reverse transcription-polymerase chain reaction (RT-PCR). RESULTS The following genes were more highly expressed in arthritis patients than in normal subjects: macrophage differentiation marker MNDA (myeloid nuclear differentiation antigen), MRP8 and MRP14 (migratory inhibitory factor-related proteins); signalling molecules JAK3 (janus kinase 3) and MAP kinase p38 (mitogen-activated protein kinase); receptors TNFR2/p75, C-C-chemokine receptor type 1 (CCR1), C-X-C-chemokine receptor type 4 (CXCR4) and integrin beta1; and the cytokines/chemokines interleukin (IL) 1beta and IL-8. Expression of CXCR4 was unexpectedly high among all arthritis subjects. Using RT-PCR, ELISA and immunohistology, expression of stromal cell-derived factor 1 (SDF-1) was demonstrated in arthritis joints. CONCLUSIONS The CXCR4/SDF-1 is a potential pro-inflammatory axis for RA, PsA and SpA.
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MESH Headings
- Adolescent
- Adult
- Aged
- Antigens, Differentiation/blood
- Antigens, Differentiation/genetics
- Arthritis, Psoriatic/blood
- Arthritis, Psoriatic/genetics
- Arthritis, Rheumatoid/blood
- Arthritis, Rheumatoid/genetics
- Chemokine CXCL12
- Chemokines, CXC/blood
- Chemokines, CXC/genetics
- DNA/analysis
- Female
- Genetic Markers
- Humans
- Leukocytes, Mononuclear/metabolism
- Male
- Middle Aged
- Oligonucleotide Array Sequence Analysis
- Receptors, CXCR4/blood
- Receptors, CXCR4/genetics
- Reverse Transcriptase Polymerase Chain Reaction
- Spondylitis, Ankylosing/blood
- Spondylitis, Ankylosing/genetics
- Spondylitis, Ankylosing/pathology
- Synovial Membrane/metabolism
- Synovial Membrane/pathology
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Affiliation(s)
- J Gu
- University of California at Los Angeles, CA 90095, USA
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Kumar S, Kalsi J, Latchman DS, Pearl LH, Isenberg DA. Expression of the Fabs of human auto-antibodies in Escherichia coli: optimization and determination of their fine binding characteristics and cross-reactivity. J Mol Biol 2001; 308:527-39. [PMID: 11327785 DOI: 10.1006/jmbi.2001.4534] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The Fabs of three human auto-antibodies (B3/33H11, anti-DNA; UK4, anti-phospholipid) and six related hybrids have been cloned and expressed in Escherichia coli, and their relative binding to single-stranded or double-stranded DNA or to cardiolipin has been assessed in the presence of modulators (salts and serum). We describe optimized conditions that have led to significant improvement in the quality and quantity of the purified auto-antibodies. Protein expression of the assembled and functionally active Fabs was achievable with a yield of up to 5 to 9 mg/l of culture. The comparative DNA/cardiolipin-binding analyses of the nine Fabs in the presence of modulators demonstrated that B3 and 33H11 L chains possess both anti-DNA and anti-cardiolipin activities. This is the first report of the demonstration that both anti-DNA and anti-cardiolipin activities may lie on the same light chain of a human auto-antibody. We provide evidence that the auto-antibodies that appeared to be similar, in that they bound DNA or cardiolipin in conventional ELISA immunoassays, exhibited significant difference in their cross-reactivity and binding to the antigen in the presence of modulators. Such auto- antigen specificity and/or cross-reactivity may dictate the potential of an auto-antibody to cause pathogenicity and may provide an explanation as to why apparently similar auto-antibodies behave differently in vivo.
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Affiliation(s)
- S Kumar
- Centre for Rheumatology, and Department of Biochemistry and Molecular Biology, University College London, UK.
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16
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Kumar S, Kalsi J, Ravirajan CT, Rahman A, Athwal D, Latchman DS, Isenberg DA, Pearl LH. Molecular cloning and expression of the Fabs of human autoantibodies in Escherichia coli. Determination of the heavy or light chain contribution to the anti-DNA/-cardiolipin activity of the Fab. J Biol Chem 2000; 275:35129-36. [PMID: 10893224 DOI: 10.1074/jbc.m001976200] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The Fabs of three human autoantibodies (B3/33H11, anti-DNA; UK4, anti-phospholipid) and six related hybrids have been cloned, expressed in Escherichia coli, and purified to homogeneity. SDS-polyacrylamide gel electrophoresis and Western blot analysis of the recombinant Fab demonstrated the purified Fab to be of correct size and in assembled form. Protein expression levels of up to 5-9 mg per liter of culture were achievable. A sensitive and reliable comparative anti-DNA enzyme-linked immunosorbent assay, involving a defined biotinylated 35-mer oligonucleotide in its single- or double-stranded form, is also described. Crithidia assay and anti-DNA or anti-cardiolipin antibody enzyme-linked immunosorbent assay analyses demonstrated convincing binding of the recombinant Fab proteins to DNA/cardiolipin, confirming the expression of functional molecule. The comparative DNA/cardiolipin binding analyses of the nine Fabs revealed that the anti-DNA (light, B3/33H11) or anti-cardiolipin (heavy, UK4) activity lies predominantly on one of the two chains. However, a compatible partner chain is necessary for optimum antigen binding activity of the antibody.
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Affiliation(s)
- S Kumar
- Centre for Rheumatology, Bloomsbury Rheumatology Unit, the Department of Medicine and the Department of Biochemistry and Molecular Biology, University College London, London W1P 9PG, UK.
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17
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Mason LJ, Timothy LM, Isenberg DA, Kalsi JK. Immunization with a peptide of Sm B/B' results in limited epitope spreading but not autoimmune disease. J Immunol 1999; 162:5099-105. [PMID: 10227979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
An experimental model of systemic lupus erythematosus has recently been described in normal animals. We sought to confirm and extend this model, which involved immunization of normal rabbits and mice with a peptide of Sm B/B', PPPGMRPP. This peptide is an early target of the immune response in anti-Sm-positive patients with lupus. The peptide was used in a multiple Ag peptide format, with multiple copies of PPPGMRPP bound to an inert lysine backbone. New Zealand White rabbits and A/J and C57BL/10ScSn mouse strains were immunized with PPPGMRPP-MAP. Pepscan assays were used to determine the epitope spreading of the anti-PPPGMRPP-MAP response to other octamers of SmB/B' following immunization. We obtained high titer anti-PPPGMRPP-MAP IgG responses in the New Zealand White rabbits and A/J mice. The rabbits immunized with PPPGMRPP-MAP showed varying degrees of epitope spreading, while the A/J mice showed no spreading. We observed no autoantibodies to dsDNA or other anti-nuclear autoantibodies in our animals by ELISA or immunofluorescence, although anti-nuclear autoantibodies were found by Western blotting in some of the rabbits. No evidence of clinical disease was seen in our normal animals. These data underline the difficulties often associated with the reproduction of animal models in different laboratories.
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MESH Headings
- Animals
- Autoantibodies/biosynthesis
- Autoantigens/administration & dosage
- Autoantigens/immunology
- Autoantigens/metabolism
- Disease Models, Animal
- Epitopes, B-Lymphocyte/administration & dosage
- Epitopes, B-Lymphocyte/metabolism
- Female
- Immunization, Secondary
- Immunoglobulin G/biosynthesis
- Injections, Intraperitoneal
- Injections, Intravenous
- Injections, Subcutaneous
- Lupus Erythematosus, Systemic/etiology
- Lupus Erythematosus, Systemic/immunology
- Lupus Erythematosus, Systemic/pathology
- Mice
- Mice, Inbred A
- Mice, Inbred C57BL
- Mice, Inbred MRL lpr
- Oligopeptides/administration & dosage
- Oligopeptides/immunology
- Oligopeptides/metabolism
- Rabbits
- Ribonucleoproteins, Small Nuclear
- snRNP Core Proteins
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Affiliation(s)
- L J Mason
- Center for Rheumatology/Bloomsbury Rheumatology Unit, Department of Medicine, University College London, United Kingdom
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18
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Ravirajan CT, Rahman MA, Papadaki L, Griffiths MH, Kalsi J, Martin AC, Ehrenstein MR, Latchman DS, Isenberg DA. Genetic, structural and functional properties of an IgG DNA-binding monoclonal antibody from a lupus patient with nephritis. Eur J Immunol 1998; 28:339-50. [PMID: 9485213 DOI: 10.1002/(sici)1521-4141(199801)28:01<339::aid-immu339>3.0.co;2-c] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Antibodies binding to double-stranded (ds) DNA are strongly associated with renal involvement in patients with systemic lupus erythematosus (SLE). We have generated two new IgG DNA-binding monoclonal antibodies (mAb), RH-14 and DIL-6, from the peripheral blood lymphocytes of two SLE patients with glomerulonephritis using the heteromyeloma cell line CB-F7. RH-14 is an IgG1 lambda antibody which also bound to single-stranded DNA, histones and nucleosomes. DIL-6 is an IgG3 lambda antibody with restricted antigen binding specificity. cDNA encoding the variable regions of the heavy (V(H)) and light (V(L)) chains of RH-14 was sequenced and the antigen binding site of this mAb was computer modelled. Sequence analysis of V(H) and V(L) regions of RH-14 showed that V(H) is derived from germ-line gene V3-7, a member of the V(H)3 family, and V(L) is derived from DPL 11, a member of the V(lambda)2 family. Somatic mutations and basic amino acid residues are identified in the complementarity-determining regions of both V(H) and V(L) regions. The nephritogenic properties of these mAb were analyzed by implanting and growing the hybridoma cells secreting the mAb in the peritoneum of SCID mice. The animals that received the RH-14 hybridoma produced higher levels of proteinuria (3 to > or = 4) (p < 0.001) compared to the groups that received DIL-6 (trace to > or = 1) or CB-F7 (trace). Electron microscopy of kidney sections from all the RH-14-implanted animals showed granular immunoglobulin deposition in the renal glomerular capillaries and mesangium. In this study we have shown for the first time using electron microscopy that a human IgG anti-dsDNA mAb, RH-14, is nephritogenic and that deposition of such an antibody alone is sufficient to induce renal damage.
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MESH Headings
- Amino Acid Sequence
- Animals
- Antibodies, Antinuclear/chemistry
- Antibodies, Antinuclear/genetics
- Antibodies, Antinuclear/immunology
- Antibodies, Antinuclear/isolation & purification
- Antibodies, Monoclonal/chemistry
- Antibodies, Monoclonal/genetics
- Antibodies, Monoclonal/immunology
- Antibodies, Monoclonal/isolation & purification
- Antibody Affinity
- Antibody Specificity
- Antigen-Antibody Reactions
- Autoimmune Diseases/immunology
- Base Sequence
- Binding, Competitive
- DNA/immunology
- DNA, Complementary/genetics
- DNA, Single-Stranded/immunology
- Female
- Genes, Immunoglobulin
- Humans
- Hybridomas/transplantation
- Immunoglobulin G/chemistry
- Immunoglobulin G/genetics
- Immunoglobulin G/immunology
- Immunoglobulin G/isolation & purification
- Immunoglobulin Heavy Chains/genetics
- Kidney/immunology
- Kidney/ultrastructure
- Lupus Nephritis/immunology
- Lupus Nephritis/pathology
- Mice
- Mice, SCID
- Microscopy, Electron
- Models, Molecular
- Molecular Sequence Data
- Protein Conformation
- Proteinuria/etiology
- Sequence Alignment
- Sequence Homology, Nucleic Acid
- Structure-Activity Relationship
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Affiliation(s)
- C T Ravirajan
- Department of Medicine, University College London, GB.
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Affiliation(s)
- J K Kalsi
- Bloomsbury Rheumatology Unit, University College London
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20
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Isenberg DA, Ravirajan CT, Rahman A, Kalsi J. The role of antibodies to DNA in systemic lupus erythematosus--a review and introduction to an international workshop on DNA antibodies held in London, May 1996. Lupus 1997; 6:290-304. [PMID: 9296771 DOI: 10.1177/096120339700600316] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
MESH Headings
- Animals
- Antibodies, Antinuclear/chemistry
- Antibodies, Antinuclear/classification
- Antibodies, Antinuclear/genetics
- Antibodies, Antinuclear/immunology
- Antibody Affinity
- Antibody Diversity
- Antibody Specificity
- Autoimmune Diseases/genetics
- Autoimmune Diseases/immunology
- Clone Cells/immunology
- Cloning, Molecular
- Crystallography, X-Ray
- DNA/immunology
- Disease Models, Animal
- Gene Expression Regulation
- Genes, Immunoglobulin
- Humans
- Immunoglobulin Variable Region/genetics
- Lupus Erythematosus, Systemic/genetics
- Lupus Erythematosus, Systemic/immunology
- Lupus Nephritis/immunology
- Magnetic Resonance Spectroscopy
- Mice
- Mice, Inbred MRL lpr
- Mice, Inbred NZB
- Mutagenesis, Site-Directed
- Mutation
- Transfection
- fas Receptor/physiology
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Affiliation(s)
- D A Isenberg
- Department of Medicine, University College, London, UK
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21
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Affiliation(s)
- D Isenberg
- Dept of Medicine, University College London, UK.
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22
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Affiliation(s)
- D.A. Isenberg
- Centre for Rheumatology/ Bloomsbury Rheumatology Unit, Dept of Medicine University College London
| | - J. Kalsi
- Centre for Rheumatology/ Bloomsbury Rheumatology Unit, Dept of Medicine University College London
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23
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Youinou P, Isenberg DA, Kalsi JK, Dugoujon JM, Ravirajan CT, Muller S, Blanco F, Piette JC, Guillevin L, Jouquan J, Semana G, Salmon D, Shoenfeld Y, Bach JF. Interplay of four idiotypes and interaction with autoantibodies in lupus patients, their relatives and their spouses. J Autoimmun 1996; 9:767-75. [PMID: 9115579 DOI: 10.1006/jaut.1996.0099] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Our aim was to investigate links between systemic lupus erythematosus (SLE)-associated autoantibodies, idiotypes (Id) and genetic predisposition to their development. We studied four public Ids (16/6, WRI 176 beta, RT72 and RT84), identified the Km and Gm phenotypes and sought six selected autoantibodies in 32 SLE patients, 174 of their relatives and 15 spouses. Though anti-double-stranded DNA antibody was uncommon in the relatives (9%), the range of antinuclear reactivities was as broad in the relatives as in the probands. Antibodies to the synthetic peptide U1-RNP-A 35-38 were found in 56% of the patients, 28% of their relatives and 20% of the spouses, whereas antibodies to the Golgi apparatus was present in 7% of the patients, 26% of their relatives and 33% of the spouses. However, most of these family members were unaffected. RT84 Id was positively associated with antibodies to Sm-D peptide 1-20 and to Ro/SSA 60 kD peptide 304-324, but negatively associated with anti-dsDNA activity. The median of age was significantly lower in the RT84 Id-positive than in the RT84 Id-negative individuals. These data suggest that genetic as well as environmental factors are involved in the aetiology of SLE. In addition, RT84-carrying immunoglobulins (Ab2) might be directed to one of many cross-reactive Ids of dsDNA-binding antibodies (Ab1), perhaps down-regulating their production.
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Affiliation(s)
- P Youinou
- Brest University Medical School, France
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24
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Kalsi JK, Martin AC, Hirabayashi Y, Ehrenstein M, Longhurst CM, Ravirajan C, Zvelebil M, Stollar BD, Thornton JM, Isenberg DA. Functional and modelling studies of the binding of human monoclonal anti-DNA antibodies to DNA. Mol Immunol 1996; 33:471-83. [PMID: 8676898 DOI: 10.1016/0161-5890(95)00138-7] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The relationships between the antigen-binding specificities of four human monoclonal anti-DNA antibodies and the structural aspects of the combining sites of two of these were examined. Competition ELISAs were used to examine the reactivities of two IgM MAbs (WRI-176 and RT-79) and two IgG mAbs (D5 and B3) to a wide range of polynucleotides. The mAbs WRI-176 and RT-79 were found to bind predominantly ssDNA, with a preference for poly (dT), whilst D5 and B3 bound components of both ss- and dsDNA, and Z-DNA. The mAb B3 also exhibited a preference for A(T) rich nucleotides. Computer models were generated for the Fv regions of WRI-176 and B3. Models for RT-79 and D5 were not generated as the structure of the long CDR-H3 loops in these mAbs could not be predicted. The B3 combining site contains a groove flanked by three arginines at positions CDR-L1-27A, CDR-L2-54 and CDR-H2-53. Using interactive molecular graphics, B-DNA was docked into the B3 antigen combining site along the plane of the VH/VL interface, whilst Z-DNA was best-fitted at approximately 90 degrees to this direction. The models provide a hypothesis to explain the ability of a single autoantibody to bind two different antigens. In addition, aspects of the base specificity of B3 may be explained. The model of the WRI-176 Fv region revealed a relatively flat surface, on which a large number of hydrophobic and aromatic residues were present. Trp-H52, in particular, is prominent on the surface. This may participate in ssDNA binding through base stacking interactions. The models allow identification of potential targets for site-directed mutagenesis.
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Affiliation(s)
- J K Kalsi
- Bloomsbury Rheumatology Unit, Department of Medicine, University College London, U.K
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25
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Kalsi JK, Ravirajan CT, Wiloch-Winska H, Blanco F, Longhurst CM, Williams W, Chapman C, Hillson J, Youniou P, Latchman D. Analysis of three new idiotypes on human monoclonal autoantibodies. Lupus 1995; 4:375-89. [PMID: 8563732 DOI: 10.1177/096120339500400508] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
We have identified and characterised three new idiotypes on human IgM McAbs generated from the splenocytes of a SLE patient with active disease. RT-6, which binds H1 and Sm/RNP, expresses essentially a private Id. Its expression is limited to a small number of human McAbs and the sera from patients with infectious diseases. In contrast RT-72Id and RT-84Id, expressed on McAbs which are polyreactive for two or more antigens, have a public distribution. RT-72Id and RT-84Id are found on McAbs from murine and human adult, and foetal tissues. In sera, significant numbers of SLE, RA and patients with other autoimmune diseases are positive for both Ids. RT-84Id is also elevated in SLE relatives and spouses, and in patients with Klebsiella infection. No correlation with disease activity, IgM or IgG levels was observed with either Id. However, RT-72Id was significantly associated with anti-ssDNA antibodies and RhF. RT-6Id and RT-72Id are located on the framework regions of the mu heavy chain, whereas RT-84Id is present on the kappa light chain, within the binding site. The McAbs are encoded by mainly germline genes: heavy chains of RT-6, RT-72 and RT-84 are encoded by the genes VH26, VH4.22 and VH4.21, respectively, and the light chain sequences of RT-6 and RT-72 are derived from DPL11 and HK102. Immunofluorescent staining revealed the presence of RT-72Id and RT-84Id positive immunoglobulin deposits in 18% and 45%, respectively, of the lupus renal sections compared with none in the disease control group, suggesting that these Ids may contribute to the pathology of the disease.
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Affiliation(s)
- J K Kalsi
- Department of Rheumatology Research, Bloomsbury Rheumatology Unit, London, UK
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26
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Blanco F, Longhurst C, Watts R, Kalsi J, Wiloch HW, Youinou P, Latchman DS, Isenberg DA. Identification and characterization of a new human DNA reactive monoclonal antibody and a common idiotype, WRI 176 Id beta. Lupus 1994; 3:15-24. [PMID: 8025580 DOI: 10.1177/096120339400300105] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
We describe a human monoclonal antibody designated WRI 176 beta and a common idiotype that it carries. This antibody was derived from the spleen of a patient with SLE. WRI 176 is an IgM kappa monoclonal reacting with ssDNA, dsDNA, poly(dT) and it is likely that mAb WRI 176 beta is a representative of the so-called natural autoantibodies. The common Id designated WRI 176 Id beta is located on the heavy chain of the mAb WRI 176 beta molecule and appears to be located outside the binding site. Sequence analysis of the WRI 176 beta heavy chain showed it to be highly homologous (97.3%) with a germline gene 56PI derived from a human fetus. In a retrospective analysis, although 44% of SLE patients had raised levels of the WRI 176 beta no correlation was found with the activity of the disease. The idiotype was also expressed frequently in a range of autoimmune rheumatic and infectious diseases and in some healthy first-degree relatives of SLE patients.
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Affiliation(s)
- F Blanco
- Bloomsbury Rheumatology Unit, Department of Medicine, University College London Medical School, UK
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28
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Isenberg DA, Ehrenstein MR, Longhurst C, Kalsi JK. The origin, sequence, structure, and consequences of developing anti-DNA antibodies. A human perspective. Arthritis Rheum 1994; 37:169-80. [PMID: 7510484 DOI: 10.1002/art.1780370204] [Citation(s) in RCA: 79] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- D A Isenberg
- Department of Medicine, University College London, England
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29
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Abstract
Autoimmunity and autoimmune diseases are the focus of intensive research using the concepts and tools of immunology, molecular genetics and cell biology. A group of scientists recently gathered to discuss recent developments in organ-specific and systemic autoimmune diseases in both human and animal models. In this article, we hope to convey some of the excitement and enthusiasm evident at the meeting which placed emphasis on work at the molecular level.
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Affiliation(s)
- M Zouali
- Institut Pasteur, Immunogenetique Cellulaire, Paris, France
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30
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Kalsi JK, Clay K, Rickard D, Hall ND. Suppressive effects of a novel antioxidant compound on human T cell functions in vitro. Agents Actions 1993; 39 Spec No:C110-2. [PMID: 8273546 DOI: 10.1007/bf01972738] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The use of antioxidant compounds with differing modes of action has clearly demonstrated involvement of oxidative processes in the activation of T lymphocytes. In this paper, we show that a novel antioxidant (lazaroid U75412E, a free radical scavenger) suppressed mitogen-induced T cell proliferation in vitro. Similar results were obtained with diphenylene iodonium (DPI), a known inhibitor of NADPH oxidase. The lazaroid was further shown to inhibit IL 2 production but to be less potent in suppressing IL 2 receptor expression. Thus, scavenger-type antioxidants act on T cells primarily by blocking a signal necessary for the induction of IL 2 synthesis such as the activation of NF kappa B. Furthermore, the potent inhibition of lymphocyte responses caused by the specific enzyme inhibitor DPI provides direct proof of the source of the oxidants involved in these processes.
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Affiliation(s)
- J K Kalsi
- Bath Institute for Rheumatic Diseases, University of Bath, UK
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31
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Abstract
Rheumatoid factors have been recognised and studied for over fifty years. They are anti-IgG immunoglobulins which occur in most patients with rheumatoid arthritis. Their precise contribution to the pathology of this disease however remains an enigma, since they are also demonstrable in other autoimmune and infectious diseases, as well as in normal healthy controls. Thus the importance of RF in RA may not pertain merely to their presence, but to the nature of the autoantibodies themselves. RF in RA are found to differ from those in control subjects and in other diseases such Waldenstrom's macroglobulinaemia in terms of their binding affinities for IgG, subclass specificity and V gene usage. The role of RF as either the initiating factor or its occurrence as a secondary event in RA is discussed.
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Affiliation(s)
- J Kalsi
- Bloomsbury Rheumatology Unit, University College, University of London, UK
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32
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Abstract
In this study the concentration of the different subclasses of IgG in sera from patients with a range of autoimmune rheumatic diseases (ARD) was detected by radial immunodiffusion. In the second part the IgG subclasses of autoantibodies that recognize single-stranded DNA (ssDNA), double-stranded DNA (dsDNA), Ro, La, Sm and RNP in patients with ARD were measured by enzyme-linked immunosorbent assay. We studied 15 patients with lupus, 20 patients each with primary and secondary Sjögren's syndrome (SS) and 10 each with rheumatoid arthritis (RA), scleroderma and myositis. Twenty healthy controls were also measured. The serum concentration of IgG2 in ARD patients was generally reduced. In contrast, the concentrations of IgG1, IgG3 and IgG4 subclasses were normal or raised. A high degree of correspondence in the IgG1, IgG2 and IgG3 responses to dsDNA and ssDNA in SLE was found. Notable differences in the IgG1 anti-Ro and ssDNA responses compared to the other subclasses were seen in 1 degree and 2 degrees SS. In addition, an unexpected high level of IgG4 antibodies to ssDNA in 1 degree SS (65%) and IgG4 antibodies to Sm/RNP in RA was observed.
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Affiliation(s)
- F Blanco
- Department of Rheumatology Research, University College and Middlesex School of Medicine, London, UK
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33
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Ravirajan CT, Kalsi J, Wiloch HW, Barakat S, Tuaillon N, Irvine W, Cockayne A, Harris A, Williams DG, Williams W. Antigen-binding diversity of human hybridoma autoantibodies derived from splenocytes of patients with SLE. Lupus 1992; 1:157-65. [PMID: 1301976 DOI: 10.1177/096120339200100307] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The antigen-binding specificity of human hybridoma-derived monoclonal autoantibodies (mAb) was analysed with mAbs derived from the spleens of two patients with active systemic lupus erythematosus (SLE). From one patient 72 mAbs (RSP clones) and from the other 173 mAbs (RT clones) were obtained. The binding specificity of these mAbs was analysed by solid- and fluid-phase ELISA against the autoantigens ssDNA, dsDNA, cardiolipin, SmRNP, histones, Sm-D and SS-B (La) synthetic peptides, and foreign antigens including bacterial polysaccharides. In addition, antinuclear antibody activity and anti-dsDNA binding were confirmed by fluorescence staining methods. Reflecting the patient's serological profile, none of the antibodies from the RSP clones reacted with ssDNA or dsDNA but 12 reacted with cardiolipin. In addition, three mAbs reacted with H4, five with U1 RNP, two with Sm-D peptides and 12 with SS-B peptides. In contrast, from the RT fusion, nine mAbs reacted with ssDNA, HI and SS-B peptides, seven with cardiolipin, four with dsDNA, two with Sm-D peptides and one each with H2A, H3 and H4. In many cases one mAb showed reactivity with more than one antigen: for example, mAb RT 72 binds to ssDNA, dsDNA, cardiolipin, H1, H4 and an Sm-D peptide; RT 6 binds to H1, SmRNP and ubiquitinated histone H2A. However, none of the antibodies showed 'across the board' polyreactivity; indeed, the selectivity of the reactions was notable and marked variation in antibody affinity was recorded. Eight of the mAbs bound to Salmonella typhimurium and two to the Klebsiella polysaccharide K-30.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- C T Ravirajan
- Department of Rheumatology Research, University College and Middlesex School of Medicine, London, UK
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34
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MacGregor AJ, Kalsi J, Ravirajan CT, Leaker B, Watts R, Winska-Wiloch H, Knight B, Norden A, Isenberg DA, Cambridge G. Analysis of antibody reactivity in the sera of 42 patients with paraproteinaemia. Autoimmunity 1992; 13:101-5. [PMID: 1467431 DOI: 10.3109/08916939209001910] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The clinical expression of disease in patients with conditions in which autoimmunity is thought to contribute to the pathogenesis of disease is the result of an unfortunate combination of predisposing and environmental factors. The presence of autoantibodies showing a variety of antigen specificities in sera from many of these patients has been closely correlated with particular spectra of organ involvement or tissue destruction. Their precise role in the disease process is as yet unclear. Sera from patients with paraproteinaemia also often contain autoantibodies to a variety of cell components, although symptoms of autoimmune disease are rarely found in this group of individuals. In this study of 42 sera from patients with paraproteinaemia we have confirmed the presence of autoantibodies in 33% (13/42) of samples. Amongst the autoantibodies detected were those to human neutrophils (3), U1RNP (8) and cardiolipin (4). In five sera, the immunoglobulin class of autoantibody did not correlate with that of the monoclonal band. This study extends previous reports of the repertoire of autoantibodies present in sera from patients with paraproteinaemia.
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Affiliation(s)
- A J MacGregor
- Department of Rheumatology Research, University College and Middlesex Hospital, School of Medicine, London
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Affiliation(s)
- J K Kalsi
- Department of Rheumatology Research, University College, London
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Kalsi JK, Hall ND. Feedback regulation of antibody production: a role in rheumatoid arthritis? Ann Rheum Dis 1991; 50:833-5. [PMID: 1772303 PMCID: PMC1004571 DOI: 10.1136/ard.50.11.833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- J K Kalsi
- Bath Institute for Rheumatic Diseases
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Abstract
The frequency and clinical associations of anti-RNA antibodies measured by ELISA were assessed in 138 patients with systemic lupus erythematosus (SLE). Of the sera from these patients 9.4% had anti-RNA antibodies but no distinguishing features, clinical, serological or immunogenetic, between those with or without these antibodies could be identified. However, investigations of patients with other autoimmune rheumatic diseases did not reveal any anti-RNA positivity, which indicates a marked disease specificity for anti-RNA antibodies in SLE. The initial anti-RNA antibody screen used a soluble yeast extract as test antigen. The positive sera were further tested against a range of RNAs from 10 different types of rat tissue. In essence few differences were observed, suggesting that the anti-RNA response is directed against common, highly conserved epitopes.
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Affiliation(s)
- F Blanco
- Bloomsbury Rheumatology Unit, University College and Middlesex School of Medicine, London, UK
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Affiliation(s)
- J K Kalsi
- Bath Institute For Rheumatic Disease, University of Bath, U.K
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Pan BR, Kalsi J, Hodgson HJ. Immunoglobulin abnormalities in chronic liver disease. Chin Med J (Engl) 1986; 99:688-90. [PMID: 2948783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
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Rong PB, Kalsi J, Hodgson HJ. Hyperglobulinaemia in chronic liver disease: relationships between in vitro immunoglobulin synthesis, short lived suppressor cell activity and serum immunoglobulin levels. Clin Exp Immunol 1984; 55:546-52. [PMID: 6231144 PMCID: PMC1535931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
In a group of patients with chronic liver diseases (CLD), including both chronic active hepatitis of 'immunological' type and alcoholic cirrhosis, simultaneous measurements were made of serum immunoglobulin levels, in vitro synthesis of immunoglobulin by peripheral blood mononuclear cells, and in vitro short lived suppressor cell activity. In both forms of CLD, decreased short lived suppressor cell activity was found. There was a strong linear correlation between the amount of IgG released into supernatant of 7 day in vitro cultures and the serum IgG levels amongst patients with CLD. There was also a strong inverse correlation in the patient group between in vitro synthesis of IgG and IgA and the suppressor cell activity measured in the same cell population, suggesting that the short lived suppressor cell test may reflect activity of cells modulating immunoglobulin both in vitro and in vivo.
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Kalsi J, Delacroix DL, Hodgson HJ. IgA in alcoholic cirrhosis. Clin Exp Immunol 1983; 52:499-504. [PMID: 6872315 PMCID: PMC1536036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Circulating IgA in patients with alcoholic cirrhosis was quantitated and characterized to determine the proportion of monomer and dimer present. Polymeric (p) IgA formed a significantly greater proportion of the total serum IgA in cirrhosis, but these individuals showed significant elevations of serum levels of monomeric (m) as well as pIgA. Thus a selective disturbance of pIgA metabolism could not entirely account for the abnormal serum IgA levels. Studies on spontaneous IgA synthesis in vitro by peripheral blood lymphocytes showed that greater amounts of both mIgA and pIgA were formed by cells from patients with cirrhosis compared with control individuals.
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