High incidence of autoantibodies in Taiwanese patients with oral submucous fibrosis

BACKGROUND

Previous study has shown a high incidence of autoantibodies including antinuclear (ANA), antismooth muscle (SMA), antigastric parietal cell (GPCA), antithyroid microsomal (TMA), and antireticulin antibodies in a small group of 26 patients with oral submucous fibrosis (OSF). The reasons why some of the OSF patients have high titers of autoantibodies in serum have not been completely explained and no further study on autoantibodies in OSF patients has been done in a large group of patients.

METHODS

In this study, we determined the serum levels of ANA, SMA, GPCA, and TMA in a large group of 109 male Taiwanese patients with OSF by an indirect immunofluorescence technique (for ANA, SMA, and GPCA), and by a semiquantitative microtiter particle agglutination test (for TMA). The presence of serum autoantibodies in OSF patients was further correlated with patients' oral habits and the severity of OSF measured by maximum mouth opening (MMO) and sites of involvement.

RESULTS

We found that the frequencies of presence of serum ANA (23.9%), SMA (23.9%), and GPCA (14.7%) in OSF patients were significantly higher than those (9.2, 7.3, and 5.5%, respectively) in healthy control subjects (P < 0.01, P < 0.005, and P < 0.05, respectively). Although the frequency of presence of TMA (5.5%) in OSF patients was also greater than that (2.8%) in healthy control subjects, the difference was not significant (P > 0.05). The presence of serum GPCA in OSF patients was significantly associated with daily areca quid (AQ) consumption (P < 0.05). The presence of serum ANA in OSF patients associated with daily AQ consumption was of borderline statistical significance (P = 0.066). However, no significant correlations were demonstrated between the presence of serum autoantibodies in OSF patients and other variables of oral habits, MMO, and sites of involvement.

CONCLUSION

In this study, all the 109 OSF patients had AQ chewing habit and 73.4% of the OSF patients swallowed the 'juice' of AQ during the chewing process. The presence of serum GPCA and ANA in OSF patients was associated with daily consumption of AQs. AQ chewing caused mucosal microtrauma, and ulcerations facilitated the diffusion of genotoxic and cytotoxic AQ ingredients into the oral and gastric tissues. Altered autoantigens released from AQ ingredients-damaged cells may induce autoantibody production. Higher frequencies of specific HLA-DR antigens in OSF patients may also help autoantibody production. Therefore, we conclude that the high incidence of autoantibodies in OSF patients may be due to AQ chewing habit, toxic AQ ingredients, and genetic susceptibility of the OSF patients.

Some specific human leukocyte antigen (HLA)-DR/DQ haplotypes are more important than individual HLA-DR and -DQ phenotypes for the development of mucocutaneous type of Behçet's disease and for disease shift from recurrent aphthous stomatitis to mucocutaneous type of Behçet's disease

The phenotype and haplotype frequencies of human leukocyte antigens (HLA)-DR and -DQ in 32 Chinese patients with the mucocutaneous (MC) type of Behçet's disease (BD) were calculated and compared with those in 310 healthy control Chinese and with those in 80 Chinese patients with recurrent aphthous stomatitis (RAS). We found that the phenotype frequency of HLA-DRw8 [corrected P (Pc)<0.005] and the haplotype frequencies of HLA-DRw8/DQw1 (Pc<0.005), -DRw8/DQw5(w1) (Pc<0.0005), -DRw12(5)/DQw1 (Pc<0.005), -DRw12(5)/DQw6(w1) (Pc< 0.0005), and -DRw52/DQw1 (Pc<0.005) in patients with the MC type of BD were significantly greater than those in healthy control subjects. This finding suggests that individual Chinese with HLA-DRw8 antigen and HLA-DRw8/DQw1, -DRw8/DQw5(w1), -DRw12(5)/DQw1, -DRw12(5)/DQw6(w1) and -DRw52/DQw1 haplotypes are more likely to have the MC type of BD. Furthermore, the relative risks (RRs) of HLA-DRw8/DQw1 (5.6), -DRw8/ DQw5 (w1) (10.0), and -DRw12(5)/DQw6(w1) (14.4) haplotypes in patients with the MC type of BD were equal to or higher than the RR of HLA-DRw8 phenotype (5.6), suggesting that some of the HLA-DR/DQ haplotypes may play more important roles than the individual HLA-DR and -DQ phenotypes for the development of the MC type of BD. The phenotype frequencies of HLA-DR5 (Pc<0.01), -DRw8 (Pc<0.005) and -DQw1 (Pc<0.05) as well as the haplotype frequencies of HLA-DR5/DQw1 (P<0.005) and -DRw8/DQw1 (Pc<0.00005) in patients with the MC type of BD were significantly higher than those in patients with RAS. Moreover, the RRs of HLA-DR5/DQw1 (29.1) and -DRw8/DQw1 (47.4) haplotypes were greater than the RRs of HLA-DR5 (10.4), -DRw8 (23.4) and -DQw1 (4.0) antigens. These results suggest that some specific HLA-DR/DQ haplotypes may be more important than the individual HLA-DR and -DQ phenotypes in the disease shift from RAS to the MC type of BD.

Strong association of antiepithelial cell antibodies with HLA-DR3 or DR7 phenotype in patients with recurrent oral ulcers

BACKGROUND

Previous studies showed that antiepithelial cell antibodies (anti-ECA) were present in 71% (15/21) of patients with recurrent oral ulcers (ROU) and that there was a strong association of human leukocyte antigen (HLA)-DRw9 with ROU in Chinese patients. In this study, we assessed anti-ECA in a larger group of Chinese patients with ROU (n = 88) in order to further investigate the association of anti-ECA with HLA-DR and -DQ antigens.

METHODS

The anti-ECA in the sera of ROU patients were detected by an indirect immunofluorescence technique with rat esophagus as the substrate, and the HLA-DR and -DQ antigens in ROU patients were typed by a standard microcytotoxicity assay using Terasaki's oriental tray.

RESULTS

The rate of anti-ECA positivity was significantly higher (p < 0.0001) in ROU patients (68%) than in healthy control subjects (0%). Furthermore, the rate of anti-ECA positivity in patients with major or minor oral ulcers (72%) was significantly higher (29%) than that in patients with herpetiform ulcers (p < 0.05). There was a significant increase in the frequency of DR3 or DR7 antigen expression (p < 0.0001, pc [p corrected] < 0.001, relative risk [RR] = 4.3, etiologic fraction = 0.41) in anti-ECA-positive ROU patients compared with the corresponding frequencies in healthy control subjects. There was also a significant increase in the frequency of DR7 or DRw9 antigen expression (p < 0.005, pc < 0.05, RR = 4.7, etiologic fraction = 0.45) compared to healthy controls.

CONCLUSIONS

Because only DR3 or DR7 antigen occurred more frequently in anti-ECA-positive than in anti-ECA-negative ROU patients (p < 0.0007, pc < 0.05, RR = 19.6, etiologic fraction = 0.51), we concluded that the gene coding for DR3 or DR7 antigen may contribute to the presence of anti-ECA in Chinese patients with ROU.

Human leukocyte antigen polymorphisms in the Taiwanese population

Polymorphisms of human leukocyte antigens (HLA) are important in transplantation medicine, anthropologic studies, and paternity testing. We investigated the polymorphisms of HLA classes I and II in the Taiwanese population by means of serologic typing and polymerase chain reaction (PCR) analysis with sequence-specific primers. We calculated the HLA-A, -B, and -C gene frequencies in 673 Taiwanese subjects and the HLA-DRB1, and HLA-DQB1 gene frequencies in 204 subjects with available DNA samples. Haplotype frequencies and linkage-disequilibrium were analyzed on the basis of these data. The common HLA class I antigens were A11 (gene frequency, 34.9%), A2 (29.3%), A24 (15.8%), and A33 (9.8%); B60 (21.9%), B46 (13.1%), B58 (9.7%), and B13 (8.5%); and Cw1 (18.8%), Cw7 (15.3%), and Cw10 (10.7%). The common HLA-DRB1 and HLA-DQB1 alleles were DRB1*12 (15.2%), DRB1*09 (15.2%), DRB1*08 (12.0%), and DRB1*04 (12.0%); and DQB1*0301 (23.5%), DQB1*0303 (15.2%), DQB1*0601 (14.5%), and DQB1*02 (10.8%). The common two-locus haplotypes were A2-B46 (frequency, 9. 7%), A11-B60 (9.6%), and A33-B58 (6.8%); DRB1*09-DQB1*0303 (14.9%), DRB1*12-DQB1*0301 (14.2%), and DRB1*08-DQB1*0601 (10.7%). This study is the first to report the gene frequencies of HLA-DQB1 alleles and the common HLA-DR-DQ haplotypes among Taiwanese. Comparison of our results with those from two other Chinese populations in mainland China reveals that Taiwanese are more closely related to southern Han than to northern Han Chinese.

Humoral and cellular immune responses to hepatitis B vaccination in hepatitis B surface antigen-carrier children who cleared serum-hepatitis B surface antigen

The immune responses to hepatitis B vaccine were studied in 11 hepatitis B surface antigen (HBsAg) carrier children who had cleared HBsAg but failed to develop hepatitis B surface antigen antibodies (anti-HBs) in sera (group 1), 5 HBsAg carrier children who had cleared HBsAg and developed detectable anti-HBs in sera (group 2), and 5 healthy subjects seronegative for all hepatitis B virus (HBV) markers (group 3). After receiving three doses of HB vaccine, group 1 subjects failed to develop detectable anti-HBs. Subsequently, each subject of the three groups was given one dose of the same vaccine for a cellular immunity study, and a measurable proliferation of peripheral blood mononuclear cells (PBMC) to HBsAg was detected in 1 of 8 (12.5%), 0 of 5, and 4 of 5 (80%) of the cases in each group, respectively, after vaccination. The removal of CD8+ cells enhanced the HBsAg blastogenic response in group 3 but did not reverse the unresponsiveness in group 1 and group 2 subjects. The addition of interleukin (IL)-2 in culture reversed unresponsiveness in all cases except one case in group 1. Compared with before vaccination, PBMC from group 2 subjects produced significantly less interferon gamma (IFN-gamma) and more IL-4 in response to HBsAg after vaccination, a cytokine response not observed in group 1 subjects. HLA typing indicated that 3 of 10 patients in group 1 (30%) and 1 of 5 patients in group 2 (20%) had HLA-DRw14-DRw52, a marker previously linked to low anti-HBs response to hepatitis B vaccine in Taiwan. We conclude that the underlying causes of poor anti-HBs response in group 1 subjects are multifactorial, including specific failure of antigen presentation or T-cell activation, or the lack of T helper (Th)2 cell-like response to HBsAg. HLA-DRw14-DRw52 does not confer absolute nonresponsiveness to HBsAg. These patients are not benefited by hepatitis B immunization.

HLA DQA1 genotypes and its interaction with HLA DQB1 in Chinese IDDM living in Taiwan

To study the role of the HLA DQA1 gene and its interaction with DQB1 in the susceptibility of IDDM, subjects with insulin-dependent (type 1) diabetes mellitus and non-diabetic unrelated controls were recruited from a Chinese population living in northern Taiwan. HLA DQA1 exon 2 was enzymatically amplified by polymerase chain reaction. HLA DQA1 alleles were diagnosed by dot blotting and hybridization with 11 sequence-specific oligonucleotide probes. Among all the DQA1 alleles, DQA1*0301 and DQA1*0501 were more frequent while DQA1*0102, DQA1*0103 and DQA1*0601 were less frequent in Chinese with IDDM than in controls. Among the DQA1 genotypes, only DQA1*0301/0301 and DQA1*0301/0501 were associated with increased risk to IDDM while DQA1*0301/0601 and DQA1*0102/0103 were protective against IDDM in our population. As the cell surface HLA DQ molecules were formed from each DQA1 and DQB1 alleles either in cis- or trans-position, the numbers of susceptible HLA DQ alpha beta heterodimers were then derived from the genotypes of HLA DQA1/DQB1 in each person. The numbers of the possible diabetogenic DQ alpha beta dimers correlated with the degree of risk to IDDM (r = 0.92) but were not statistically significant (p > 0.05). Subjects with absence of diabetogenic HLA DQ molecules were resistant to developing IDDM while subjects with two or more forms of diabetogenic DQ molecules were associated with increased risk to IDDM. In conclusion, both DQA1 and DQB1 genes, which determine the formation of susceptible DQ alpha beta heterodimers, were significantly associated with IDDM in Chinese subjects living in Taiwan.

Genotype of classic congenital adrenal hyperplasia and the 60-minute adrenocorticotropic hormone stimulation test

Twelve Taiwanese patients with classic congenital adrenal hyperplasia and 86 family members underwent human leukocyte antigen (HLA) genotyping and the 60-minute adrenocorticotropic hormone (ACTH) stimulation test. The baseline serum 17-hydroxyprogesterone level (mean +/- SEM) before ACTH testing was 1.595 +/- 792 nmol/L in homozygotes, 4.6 +/- 0.5 nmol/L in heterozygotes, and 2.1 +/- 0.8 nmol/L in the unaffected group. The stimulated serum 17-hydroxyprogesterone level (mean +/- SEM) was 1.926 +/- 778 nmol/L in homozygotes, 20.6 +/- 0.9 nmol/L in heterozygotes, and 6.8 +/- 0.6 nmol/L in the unaffected group. There was minimal overlap among the heterozygote and unaffected groups. The 60-minute ACTH stimulation test can provide clinicians with hormonal criteria for the assessment of the genotype of classic 21-hydroxylase deficiency in the Chinese population.

HLA-DQB1 codon 57 and IDDM in Chinese living in Taiwan

OBJECTIVE

To study the human leukocyte antigen (HLA)-DQB1 genetic background in the Chinese population in Taiwan and its association with the low incidence of insulin-dependent diabetes mellitus (IDDM) in this population.

RESEARCH DESIGN AND METHODS

Forty-eight IDDM patients and 59 nondiabetic unrelated control subjects were recruited from the population in Taiwan. HLA-DQB1 exon 2 was enzymatically amplified by polymerase chain reaction. HLA-DQB1 alleles were diagnosed by dot blotting and hybridization with 16 sequence-specific oligonucleotide probes.

RESULTS

DQB1*0201 and DQB1*0302 alleles were more frequent and DQB1*0301 and DQB1*0601 were less frequent in Chinese with IDDM than in control subjects. Genotypes for homozygous non-aspartic acid residue (NA/NA) at position 57 were positively associated with IDDM at a relative risk of 4.34 (P < 0.001), and those for homozygous aspartic acid (A/A) were negatively associated with IDDM at a relative risk of 0.14 (P < 0.001). Among the NA/A heterozygotes, only DQB1*0201/DQB1*0303 was significantly increased in IDDM subjects.

CONCLUSIONS

The amino acid residue at position 57 of HLA-DQ beta-chain is significantly associated with the development or prevention of IDDM in Chinese subjects living in Taiwan. Other genetic and environmental factors may also play important roles in pathogenesis of IDDM.

Age-specific prevalence of hepatitis B surface and e antigenemia in pregnant women in Taiwan

To investigate the age-specific prevalence of hepatitis B surface and e antigens (HBsAg and HBeAg) in pregnant women, we studied all the parturients encountered in National Taiwan University Hospital between 1985 and 1990. Serum HBsAg and HBeAg were checked by radioimmunoassay. The prevalence rate of HBsAg in pregnant women was 13.2%, 12.7%, 11.4%, 11.7%, 12.9% and 14.2%, respectively for each year. The figures seemed stable. The positive rate of HBeAg in HBsAg-positive pregnant women was 32.8%, 39.9%, 42.6%, 30.8%, 32.0% and 31.7%, respectively during the past 6 years. We also analyzed the results in different age-grouped pregnant women. The positive rate of HBsAg was 12.8%, 13.1%, 11.6% and 11.5% respectively in 21-25 year-old, 26-30 year-old, 31-35 year-old and 36-40 year-old groups. The positive rate of HBeAg in HBsAg-positive pregnant women was 49.4%, 36.5%, 31.5% and 20.0% respectively in these 4 age groups, with a prevalence declining with the advanced age. We conclude that HBsAg-positive rate was 11-14% in the pregnant women who visited our hospital, and their HBeAg-positive rate was 31-43%. No decrease of HBsAg carriage or HBeAg prevalence was seen in the past 6 years.

Sharing of human leukocyte antigens in couples with unexplained infertility affects the success of in vitro fertilization and tubal embryo transfer

OBJECTIVE

The purpose was to test further our hypothesis that genes, or genetic defects, linked to the major histocompatibility complex affect reproduction by correlating human leukocyte antigen sharing with the success or failure of in vitro fertilization and tubal embryo transfer in couples having unexplained infertility.

STUDY DESIGN

Seventy-six couples with unexplained infertility who failed superovulation and intrauterine insemination at least three times were typed for human leukocyte antigens and treated by in vitro fertilization and tubal embryo transfer. The results were correlated with the sharing of human leukocyte antigens in the couples.

RESULTS

Thirty-four of the women had successful pregnancies, 36 did not become pregnant, and six became pregnant but aborted shortly thereafter. There was a highly significant excess of human leukocyte antigen sharing in the couples who failed treatment: three of the A, B, DR, and DQ antigens (p = 0.015) or two of the B, DR, and DQ antigens (p = 0.015). No specific human leukocyte antigen alleles were present in excess.

CONCLUSIONS

Genes, or genetic defects, linked to the major histocompatibility complex significantly affect the success of in vitro fertilization and tubal embryo transfer just as they affect the prevalence of recurrent spontaneous abortion, cancer, and congenital anomalies. It appears as if the critical genes, or genetic defects, are located in the B-DR-DQ region of the major histocompatibility complex.

Association of HLA-DR14-DR52 with low responsiveness to hepatitis B vaccine in Chinese residents in Taiwan

To determine the HLA-linked immune response gene that controls low responsiveness to hepatitis B surface antigen (HBsAg), HLA typing was performed in 33 initial non-responders (male:female = 23:10, age 1.5-46 years) who had poor antibody response (anti-HBs < 10 mIU ml-1) after four doses of plasma-derived hepatitis B vaccine. Of 33 initial non-responders, 26 received two additional doses of either the same vaccine (n = 18) or recombinant hepatitis B vaccine (n = 8) and returned for anti-HBs measurement. At 1 month after the sixth dose, anti-HBs was still < 10 mIU ml-1 in 20 cases and 10-20 mIU ml-1 in three cases. Analysis of HLA antigen frequencies in these 23 ultimate low responders revealed that nine (39%) were positive for DR14, a statistically significant association of low responsiveness to hepatitis B vaccine with HLA-DR14. In addition, 26% of the ultimate low-responders were positive for DQ3, a frequency significantly lower than the expected rate in the general population. Among the nine ultimate low-responders with DR14, seven were heterozygous for this allele, while the other two cases had a single isolated DR14; and all nine were in association with DR52. These results suggest that a DR14-DR52 association, probably dominantly expressed, may be involved in the low immune responsiveness to hepatitis B vaccine of the Chinese population in Taiwan.

Monoclonal gammopathies and the related autoimmune manifestations in Taiwan

A total of 50,000 patients were surveyed for the presence of monoclonal immunoglobulins during the past two decades. There were 411 cases of monoclonal gammopathies including 243 cases of plasma cell neoplasms and 168 cases of secondary plasma-cell dyscrasia. Among the 227 cases of multiple myeloma and Waldenström's macroglobulinemia, there were 49.3% IgG class, 22.9% IgA class, 9.7% IgM class and 13.2% light chain type. In addition, there were 1.3% of nonexcretory myeloma including an IgM type. A relatively high frequency (4.8%) of IgD M-proteins was detected but heavy chain disease was not encountered in the present series. Purified M-components from patients with possible autoimmune manifestations were subjected to immunofluorescence studies. Autoimmune activity of M-proteins was found in a patient of Waldenström's macroglobulinemia with peripheral neuropathy, and another patient of cryofibrinogenemia with recurrent purpura and gangrene. In conclusion, a high frequency of IgD myeloma is found in Chinese patients of this area. M-components may have autoimmune activity resulting in unusual clinical manifestations.

Autoantibodies and related immunity of leprosy patients from leprosarium in Taiwan

Autoantibodies and related immunological examinations were measured in 60 leprosy patients from a leprosarium in Taiwan. Thirty-one lepromatous type, 24 tuberculoid type and 5 borderline type patients were identified. The measured autoantibodies included antinuclear antibodies, anti-nDNA, anti-cardiolipin and rheumatoid factor. Serum protein electrophoresis and immunofixation were also performed to detect the monoclonal and polyclonal status of immunoglobulins. Circulating immune complex and complements were also quantitated. Delayed type skin tests were performed during patients' visits. A higher frequency of autoantibodies, especially the antinuclear antibodies and anticardiolipin antibodies, were detected in lepromatous type patients. Higher levels of circulating immune complex and frequency of polyclonal and monoclonal gammopathy were also noted in lepromatous type patients. Anergy skin tests were only noted in lepromatous type patients. It was concluded that the more impared cell-mediated immunity in leprosy patients, with lepromatous type in particular, the greater the production of autoantibodies.

Evaluation of the A-60 IgG ELISA serodiagnostic test for tuberculosis in Taiwan

To assess the applicability of a serologic test of specific IgG antibody for tuberculous infection in the Taiwan population, serum samples obtained from 118 subjects were analyzed by an ELISA test using mycobacterial antigen 60. There were 50 patients with a documented active infection caused by Mycobacterium tuberculosis (39 pulmonary tuberculosis, five pleurisy, three cervical lymphadenitis and three miliary tuberculosis with extrapulmonary involvement). Of these 50 patients, 42 (84%) showed a positive ELISA test (titer > 200 U). Of the 19 patients with inactive pulmonary tuberculosis, seven (37%) had a positive titer. Of the 22 patients with pulmonary disease other than tuberculosis, four (18%) showed a false-positive. In eight patients with autoimmune diseases, only the patient with rheumatoid arthritis had a positive reaction. One of the 19 healthy controls (5.3%) showed a false-positive result. The overall false-positive rate for the nontuberculous group was 12%. Follow-up examinations in 20 patients with active tuberculosis one month after treatment revealed that seven had an elevation in titers (three of them were initially negative and became positive later), five remained high and eight decreased in titers. Further examinations in six patients two months after treatment showed a decrease in titers. We conclude that this ELISA assay of specific IgG antibody is a valuable serologic test for diagnosis of M. tuberculosis infection. It may be useful in areas with a high prevalence of M. tuberculosis infection.

[A comparative study of antinuclear antibody measurement using different cells as nuclear substrates]

In an attempt to evaluate possible variations in the antinuclear antibody (ANA) titers resulting from nuclear substrate difference, we measured the ANA titer of 104 normal subjects using substrates from mouse liver cell (MLC) and HEp-2 cell (CSI, USA). We also performed similar experiments on 50 sera from 50 patients with rheumatic disease using mouse liver cell, HEp-2 cell (CSI), HEp-2 cell (AFT, Japan), and HEp-2 cell (AI, USA) as substrates. The ANA titer assay using HEp-2 cell (CSI), which is routinely used in our laboratory, was regarded as the reference method. The results showed that when HEp-2 (CSI) was used, 98.1% normal subjects had ANA titer lower than 1:320, therefore a cut-off value of 1:320 was used. While using the MLC method, 96.2% normal subjects had ANA titer lower than 1:80, and the cut-off value was set at 1:80 accordingly. The geometric mean ANA titers of the 50 sera from 50 rheumatic disease patients were 676 for HEp-2 cell (CSI), 503 for HEp-2 cell (AFT), 368 for HEp-2 cell (AI), and 265 for MLC, respectively. Although statistically significant difference (p less than 0.05) in geometric mean titer existed between reference method and the other 3 methods, the latter 3 methods still had good sensitivity (97.2% for HEp-2 cell (both AFT and AI); 91.7% for MLC), and specificity (100% for HEp-2 cell (both AFT and AI); 71.4% for MLC) for selecting out sera with abnormal ANA titer. We also evaluated the relationships between ANA titer and anti-double stranded DNA antibody (anti-dsDNA) concentration in another 210 sera from 151 patients with rheumatic disease. Statistically, there is no distinct correlation between anti-dsDNA and ANA of all fluorescence staining patterns except for peripheral pattern, in which case a significant correlation could be demonstrated.

Prevalence of antibody to hepatitis C virus in pregnant Taiwanese

To assess the prevalence of an antibody to hepatitis C virus (anti-HCV) in pregnant women in Taiwan, and elucidate whether or not there is superinfection of the hepatitis B virus (HBV) in such cases, we investigated two independent groups of pregnant women. Group A included 294 without serum alanine aminotranferase (ALT) screening, and group B included 171 pregnant women with an abnormal ALT level (greater than 45 IU/L) who were recruited from 9,523 pregnant women screened for ALT. Blood samplings were taken at early gestation and each serum sample was tested with an HCV EIA kit for anti-HCV. The results showed that 1 woman in group A (0.34%) and 4 women in group B (2.3%) were anti-HCV-positive. However, all 5 cases showed positive antibodies to both the hepatitis B surface and core antigens, but were negative for the hepatitis B surface antigen. Therefore, the prevalence of anti-HCV in pregnant women by current assay in Taiwan is 0.34% without ALT screening, but increases to 2.3% among abnormal ALT cases. The prevalence rate is less than the rates reported in other countries. If confirmed by subsequent study, the results suggest that infection with HCV is low among healthy young females in Taiwan today.

Strong association of HLA-DRw9 in Chinese patients with recurrent oral ulcers

The frequency of HLA-DR and -DQ antigen occurrence was investigated in 80 Chinese patients with recurrent oral ulcers and 107 matched healthy control subjects of the same ethnic group. No significant differences in the presence of HLA-DQ antigens were found. However, the HLA-DRw9 antigen occurs more frequently in patients with recurrent oral ulcers (p less than 0.0001, corrected p less than 0.005) and may be considered as a genetic marker of the disease in the Chinese population.

Association of HLA antigens with myasthenia gravis in Chinese on Taiwan

HLA phenotypes were studied in 82 Chinese patients with myasthenia gravis (MG) and 202 healthy controls, using standard microcytotoxicity assay. The patients showed significant increase in HLA-Bw46 (46.3% vs 17.3%, chi 2 = 25.7, p less than 0.001), HLA-DR9 (56.1% vs 15%, chi 2 = 35.7, p less than 0.001) and HLA-DQw3 (89% vs 63.6%, chi 2 = 15.9, p less than 0.001). The HLA-DR3 was decreased (2.4% vs 32.7%, chi 2 = 27.0, p less than 0.001). Both HLA-Bw46 and -DR9 were increased in all subgroups except the over 40 at age of onset group. In thymectomised patients, no association with HLA antigen was found in the thymoma group, whereas both involuted and hyperplasic thymus groups had HLA DR9 association and only the hyperplasic thymus group showed HLA Bw46 association. No association with HLA antigens was noted in patients with low antibody titer, however, patients with antibody titers between 0.2 to 2 n mole/1, had an association with HLA Bw46 and DR9. The HLA DQw3 was associated with the group of female MG patients, age onset below 10 and with ocular myasthenia. Finally, the HLA A2, Bw46 and DR9 combination was also significantly increased in patients [24.3% (20/82) vs 7.4% (8/107), chi 2 = 10.5, p less than 0.001], especially in the subgroup of male MG, age onset below 10 and with ocular myasthenia.

Human leukocyte antigen (HLA) frequency among patients with nasopharyngeal carcinoma in Taiwan

In order to assess the association between human leukocyte antigens (HLA) and nasopharyngeal carcinoma (NPC), a total of 10 familial and 10 sporadic NPC patients and 171 unrelated healthy controls were studied. HLA typing was performed using commercial trays which defined 30 specificities of HLA-A, B and C loci and 10 specificities of HLA-D locus according to the method of Tiwari and Terasaki. HLA-A2, B16 and DR1 were found to be higher among patients with NPC than unrelated healthy controls with an odds ratio (OR) and a 95% confidence interval of 5.91 (2.1-16.6), 6.00 (2.0-18.0) and 6.89 (1.3-37.5), respectively. Further analysis showed that A2(+) B16(+) haplotype was significantly associated with a much higher risk of NPC (OR = 15.5) as compared with A2(-) B16(-) haplotype. No difference in frequency distributions of HLA-A, B, C and D antigens was observed between familial and sporadic NPC patients.

Evaluation of humoral immunity on leprosy patients in Taiwan: a preliminary report

Twenty-four tuberculoid (T)-type and 31 lepromatous (L)-type leprosy patients from Taiwan Provincial Lo-Sheng Leprosarium were enrolled in this study. Twenty-six age- and sex- matched normal subjects were also studied as a control group. The evaluation of their general and specific humoral immunity included B-cell subpopulations, 3 major classes of immunoglobulin (G, A and M) and antibodies in the IgG class against lepromin suspension and Bacillus Calmette-Guerin (BCG) sonicate. T-type patients showed a larger B-cell percentage than L-type patients (p less than 0.01). In general, patients with leprosy, both T and L types, had higher serum immunoglobulin levels than the control group. T-type patients showed greater antibody levels than the control group (p less than 0.05 for anti-lepromin and p less than 0.0001 for anti-BCG). L-type patients demonstrated a higher anti-BCG IgG level than the control group (p less than 0.0001). The level of anti-BCG IgG was more frequently above the cutoff level than that of anti-lepromin IgG in leprosy patients (p less than 0.01 for T, p less than 0.005 for L). In conclusion, humoral immunity is not impaired in leprosy patients. Discrepancies for T- and L-type patients among B-cell subpopulation, serum immunoglobulin levels and specific antibody levels reflect different aspects of cell-mediated immunity impairment. Though leprosy patients had elevated anti-BCG IgG levels, it is impossible to differentiate L- and T-type patients; specific antigens are needed for serodiagnosis of leprosy patients in Taiwan.

Association of HLA-DR tissue types with Graves' disease in Taiwan

To determine the association of HLA-DR tissue types and Graves' disease (GD) in Chinese residing in Taiwan, we studied HLA-DR antigens on 93 unrelated patients with Graves' disease, and 106 normal persons (N). The prevalence of DR2 (GD: 40.9%, N: 21.7%, pc = 0.028 where pc is the Fisher's probability times the numbers of antigens considered), DR9 (GD: 29%, N: 13.2%, pc = 0.048), DQw1 (GD: 58.1%, N: 39.6%, pc less than 0.003) and DRw53 (GD: 58.1%, N: 41.5%, pc less than 0.002) were significantly increased in patients with Graves' disease, while the prevalence was decreased significantly for DR3 (GD: 16.1%, N: 33.0%, pc = 0.031) and DRw52 (GD: 58.1%, N: 76.4%, pc = 0.01). When the combinations of DR2, DR3 and DR9 were compared with other HLA-DR antigens, DR3 remained less prevalent in GD; DR2/9 heterozygotes were strongly associated with GD; while neither DR2 nor DR9 remained significantly associated with GD when DR2/9 heterozygotes were removed from each. When we separated the patients into subgroups according to the onset of clinical symptoms occurring by the age of 35 years, there was no significant difference in the frequencies of HLA-DR antigens in those two subgroups. Patients with or without exophthalmos, antimicrosomal antibody or antithyroglobulin antibody had similar distribution of HLA-DR types. Our data suggested that in our area DR2 and DR9 played additive roles in the susceptibility of Graves' disease.

Waldenstróm's macroglobulinemia with peripheral neuropathy--the role of IgM M-protein in autoimmune mechanism

A total of 11 cases of Waldenstróm's Macroglobulinemia (WM) have been investigated to study the association of the disease with neuropathy. A 53-year-old female patient (Wu) had a pronounced peripheral neuropathy, in which the role of IgM M-protein could be observed. Sections of Wu's biopsied sural nerve were subjected to light and electron microscopy and direct immunofluorescence (IF). Myelin degeneration with axonal change was found, while fluorescence reaction occurred in epineurium only. Sections of a healthy dog's sciatic nerve were submitted to purified IgM M-proteins from Wu and another WM patient (Kon) without neuropathy, respectively. Indirect IF showed a deposit of fluorescence on the myelin sheath by Wu's, but not by Kon's, M-proteins. It is proposed that an autoimmune mechanism underlies the peripheral neuropathy in the WM patient.

Association of HLA-DRw9 with myasthenia gravis in Chinese

HLA phenotypes were studied in 59 Chinese myasthenia gravis (MG) patients. Unfractionated peripheral blood mononuclear cells were used for typing of HLA-A, B and C, and B-enriched lymphocytes for HLA-DR. Seventy-nine healthy subjects were included as controls. When compared with healthy controls, the patients showed significant increases in HLA-Bw46 (47.5% versus 14%, chi 2 = 18.7, P less than 0.001), HLA-DRw9 (59.3% versus 11%, chi 2 = 35.7, P less than 0.001), while HLA-DR3 was decreased (3.4% versus 32.9%, chi 2 = 18.2, P less than 0.001). Further analysis showed that the primary association was with DRw9 and the increase in Bw46 was secondary to it. Both HLA-Bw46 and -DRw9 were increased in all subgroups except where the age of onset was greater than 40 years. Finally, the HLA-A2-Bw46-DRw9 combination was also significantly increased in patients (25.4% versus 5.1%, chi 2 = 11.5, P less than 0.001), especially in the subgroups of MG with age of onset of less than 10 and males with age of onset of less than 40 years.

Study of peripheral T-cell subpopulations and lymphocyte proliferation in different phases of evolution of alopecia areata

The current hypothesis on the pathogenesis of alopecia areata is immunologically mediated, yet no conclusive data has been documented. To clarify the changes in various phases of disease evolution, analysis of T lymphocyte subpopulations was carried out in the peripheral blood of 34 patients and 27 healthy normal subjects by means of OKT-3, OKT-4, OKT-8 and Ia1 monoclonal antibodies. Study of lymphocyte proliferation in response to various mitogens was further carried out in 27 patients and 25 healthy normal subjects. Significant predominance (p less than 0.01) of OKT-8 positive (cytotoxic/suppressor) cells and diminution (p less than 0.01) of Ia1 positive cells were noted in the whole alopecia group and in various subgroups of disease evolution. Since diminution (p less than 0.05) of OKT-4 positive (inducer/helper) cells was also noted in the stable phase, it was postulated that these activated T cells migrated from circulation to the local site of primary event. Hence, it was evident that the predominance of cytotoxic/suppressor cells was a relative change, and the role of inducer/helper cells in the pathogenesis was implicated. No enhancement of lymphocyte proliferation was observed.

Rheumatic fever recurrences: controlled study of 3-week versus 4-week benzathine penicillin prevention programs

To compare the merits of 3-week versus 4-week injections of benzathine penicillin G in preventing recurrence of rheumatic fever, 179 patients aged 4 to 19 years were assigned to one of the two programs. Age, weight, cardiac status, and streptococcal infections among the patients and their family members studied in each program were comparable. Eight-two patients and their family members were monitored for streptococcal infections. Compliance in the two programs was comparable. Of the 63 patients who stayed in the 4-week program, RF recurred in six, as a result of prophylaxis failure in five and associated with partial compliance in one. Of the 90 patients in the 3-week program, RF recurred in one, associated with partial compliance; no failures occurred (P = 0.01). We recommended that for RF chemoprophylaxis in individuals at great risk, regardless of age, benzathine penicillin injections should be administered every 3 rather than every 4 weeks.

Lymphocyte subsets and EB virus antibodies in nasopharyngeal carcinoma

Lymphocyte subsets and Epstein-Barr virus (EBV)-associated antibodies were studied in 108 patients with nasopharyngeal carcinoma (NPC) and in 34 normal controls. Lymphocyte subsets were identified with monoclonal antibodies (Ortho Co.) by indirect immunofluorescent antibody (IFA) method. The helper T lymphocytes (OKT4+) in NPC patients comprised 38.2 +/- 10.5% which is significantly different from 45.2 +/- 8.0% in controls. The helper/suppressor ratio in NPC patients was 1.33 +/- 0.65 which is significantly different from 1.64 +/- 0.48 in controls, but the ratio was not correlated with disease extent, sex, age, total lymphocyte counts, WBC counts and EBV-associated antibodies of NPC patients. There were no remarkable differences between NPC patients and controls in B lymphocytes (OKIa+), total T lymphocytes (OKT3+), and suppressor lymphocyte (OKT8+) percentages, total lymphocyte counts and WBC counts. The EBV-associated antibodies were titrated by the IFA method using P3HR-1 cells and Raji cells induced by IUdR as target. Mean antibody titers and seropositive rates showed significant increase in NPC patients (1:12-1:502 and 45.4%-68.5%, respectively) compared with controls (1:1-1:87 and 1.0%-5.9%, respectively). The increase in antibodies was positively correlated with NPC disease extent, but was not correlated with the sex, age, total lymphocyte counts, helper/suppressor ratio, and WBC counts of NPC patients.

Altered distribution of lymphocyte subpopulations and augmentation of lymphocyte proliferation in chronic PCB poisoned patients

To clarify the mechanism of immunotoxicity of polychlorinated biphenyls (PCB), delayed type hypersensitivity skin test, lymphoproliferative responses, and lymphocyte subpopulations defined by monoclonal antibodies were performed on 30 patients and 38 age/sex-matched healthy individuals. Three years ago the patients had ingested rice bran oil accidentally contaminated by PCB. Except for lymphocyte proliferation, the chronic effect of PCB and its derivatives upon cell-mediated immunity (CMI) in these patients was not so evident when compared to that found within one year of exposure. Delayed type hypersensitivity skin response to purified protein derivative (PPD) and the numbers of peripheral T and B lymphocytes were within normal range. The enumeration of lymphocyte subsets demonstrated decreased T4 (inducer/helper) cells and increased T8 (cytotoxic/suppressor) cells. The abnormally augmentated spontaneous proliferation and proliferation responses to phytohemagglutinin (PHA), concanavalin A (Con A), pokeweed mitogen (PWM) and PPD implicated that both T and B lymphocytes were functionally affected. This may well be the result of the immunotoxicity rather than the enhancement of cell-mediated immunity by these toxic compounds. While there was no correlation between the results of those assays and blood PCB levels, it appears that the lymphoproliferative assay may be applied as a sensitive test in reflecting the severity of PCB immunotoxicity.

Epstein-Barr virus-associated antibodies and serum biochemistry in nasopharyngeal carcinoma

Nasopharyngeal carcinoma is difficult to diagnose in its early stages. It also has frequent recurrences and/or distant metastases after radiotherapy. Extensive clinical, serological and biochemical studies were done during 1980-1982 on 351 patients to aid in the diagnosis of the disease, especially with recurrence or metastasis. Seropositive rates of the antibody titers against viral capsid antigens (VCA) and early antigens (EA) of Epstein-Barr virus (EBV) in IgG and IgA classes were 41.7%-100%. They ranked, in order of frequency: anti-VCA/IgA, anti-VCA/IgG, anti-EA/IgG, and anti-EA/IgA. Mean total serum IgG and IgA levels were moderately increased in all patients. Serum GOT, GPT, alkaline phosphatase, lactate dehydrogenase and mucoprotein were elevated either alone or in combination in a few patients before treatment, in many patients with recurrence or metastases, and in all patients with liver metastasis.

Anti-HTLV antibodies in cancer patients, hemophiliacs and uremics: a preliminary report

A total of 132 sera were studied for anti-HTLV antibodies using the Biotech ELISA test. Among the HTL group, two were, one, and the other two (+/-). Among 23 hemophiliacs one was. None of the lympho- and myelo-proliferative disorders, chronic uremics and normal controls showed positive results. Our results show that the ELISA anti-HTLV test is quite specific for HTL and related disorders, but the antibody titers may be low in some cases in the late stage. The significance of frequent high ELISA readings in hepatomas and NPCs awaits for further studies. The occurrence of one hemophiliac with definite positive anti-HTLV calls for a routine screening of the blood preparations for HTLV.

[Serological and biochemical studies in late stage of nasopharyngeal carcinoma]

Serological and biochemical studies were done at the National Taiwan University Hospital, on 243 patients with biopsy-proved anaplastic nasopharyngeal carcinoma (NPC) in various clinical conditions. The remarkable elevation of both IgG and IgA antibody titers against EB virus was specific for NPC patients. The seropositive rates ranged from 75% to 100% in various stages of NPC patients. Serum IgG and IgA levels were also increased moderately and nonspecifically in stages II-IV and recurrent patients. Peripheral white blood cell count was also slightly increased in these patients. Peripheral lymphocyte counts were slightly decreased in patients with neck recurrence or distant metastasis. Serum IgM, C3, C4 and Acid phosphatase levels were within normal range in all the patients. Serum GOT, GPT, alkaline phosphatase, and lactate dehydrogenase were elevated in some of patients with distant metastasis and in most of those with liver metastasis. Mucoprotein was elevated in about 10% of stage II-IV patients but in about 50% of patients with recurrent neck metastasis or distant metastasis. in conclusion, serological and biochemical examinations are important in the diagnosis of late stages and recurrence or metastasis of NPC.