Serological screening of West Nile virus among blood donors in northern Cyprus

BACKGROUND

West Nile virus (WNV) is a neurotropic arbovirus that can also be transmitted through blood transfusion. Even though its geographic distribution has been expanding, there has not yet been any epidemiological data on WNV in northern Cyprus. The aim of our study is to fill this gap by using donated blood samples.

METHODS

Samples collected from the main government hospital blood bank in Nicosia were analyzed by anti-WNV enzyme-linked immunosorbent assay (ELISA) (immunoglobulin M [IgM] and immunoglobulin G [IgG]). Seropositive samples were subjected to plaque reduction neutralization test (PRNT) for confirmation and analyzed by ELISA IgG avidity test and reverse transcription real-time polymerase chain reaction (rRT-PCR).

RESULTS

Of the 760 sera samples, 2 (0.3%) were IgM+ and 31 (4.1%) were IgG+. Neutralization activity was detected in none (0.0%) of the IgM+ and 26 (83.9%) of IgG+ donor specimens. ELISA IgG avidity test reported high avidity in 21 (67.7%) and low avidity in one (3.2%) IgG+ sample. PRNT-confirmed anti-WNV IgG+ samples exhibited only borderline (19.2%) or high avidity (80.8%) values. rRT-PCR results were negative for both IgM+ and IgG+ samples.

CONCLUSION

Anti-WNV antibodies were detected in northern Cyprus among blood donors. The establishment of preventive measures and evaluation of the geographic extent of the WNV in northern Cyprus are highly recommended.

Molecular identification of sulfadoxine-pyrimethamine resistance in malaria infected women who received intermittent preventive treatment in the Democratic Republic of Congo

Background

Point mutations in Plasmodium falciparum dihydrofolate reductase (Pfdhfr) and dihydropteroate synthase (Pfdhps) genes which confer resistance to sulfadoxine-pyrimethamine (SP) occur at increasing rates. The present study aimed to identify Pfdhfr and Pfdhps mutations in P. falciparum isolates recovered from women who received two doses of SP during pregnancy in Bandundu, the Democratic Republic of Congo (DRC).

Methods

A total of 48 women with confirmed P. falciparum infection were enrolled in the study. Finger-prick blood samples that were collected on filter paper at the time of delivery were used for DNA isolation. Pfdhfr and Pfdhps genes were amplified by a nested PCR protocol. DNA sequencing was performed on both strands, and the point mutations were analysed.

Results

All of the 48 (100.0%) P. falciparum isolates carried at least one polymorphism in both genes. The wild-type haplotypes of Pfdhfr (CNCSI [C50, N51, C59, S108, I164]) and Pfdhps (SAKAA [S436, A437, K540, A581, A613]) were not observed in the study. In Pfdhfr, N51I (85.4%), C59R (60.4%), and S108N (100.0%) polymorphisms were detected. Triple mutation (CIRNI) (mutant amino acids are underlined) was the most prevalent (47.9%) Pfdhfr haplotype. In the study, all P. falciparum isolates (100.0%) harboured the A437G allele in Pfdhps gene. Also, K540E and A581G polymorphisms were observed in one (2.1%) isolate. Single mutant haplotype (SGKAA) was detected in 97.9% of the isolates. Mutant Pfdhfr and Pfdhps allele combinations revealed quintuple (CICNI-SGEGA; 2.1%), quadruple (CIRNI-SGKAA; 47.9%), triple (CICNI-SGKAA; 35.4%, CNRNI-SGKAA; 12.5%), and double (CNCNI-SGKAA; 2.1%) haplotypes.

Conclusions

In the study, the rate of SGEGA haplotype was low (2.1%). Although K540E and A581G alleles are more common in Eastern Africa, a distinct lineage of SGEGA is also present in the DRC, which is located in Central Africa. This haplotype is associated with decreased efficacy of SP in pregnant women and infants, therefore, it should be carefully considered in the DRC and SP resistance should be routinely monitored.

Epidemiology and Prevalence of Blastocystis spp. in North Cyprus

AbstractThis study was conducted to investigate the prevalence of Blastocystis spp. and its subtypes (STs) in North Cyprus; and to evaluate the presence of this parasite and its STs with respect to demographic, socioeconomic, and epidemiological factors, as well as gastrointestinal symptoms. Stool samples were collected from 230 volunteers. Each participant also filled out a questionnaire. The samples were examined microscopically by native-Lugol and trichrome methods and further tested by polymerase chain reaction (PCR) and sequencing. Prevalence of Blastocystis spp. infection was found to be 10.5%, 10.5%, and 27.8%, by direct microscopy, trichrome method, and PCR, respectively. No other parasites were detected in the specimens except Giardia spp. (n = 2; 0.8%) and Entamoeba coli (n = 1; 0.4%). The most common Blastocystis STs were ST3 (20; 31.2%), ST2 (18; 28.2%), ST1 (8; 12.5%), and ST4 (7; 11%); whereas other STs were identified as ST6 (3; 4.7%), ST7 (2; 3.2%), and non-ST (6; 9.4%). Presence of Blastocystis spp. and its STs was not significantly related to any of the demographic, socioeconomic, and epidemiological factors. Furthermore, no significant association of Blastocystis spp. and its STs with gastrointestinal symptoms was found. This study is the first investigation of the epidemiology of Blastocystis spp. in North Cyprus. Distribution of Blastocystis spp. and its STs among demographic, socioeconomic, and epidemiological factors showed complete homogeneity. Presence of the parasite and its STs was not significantly related with the gastrointestinal symptoms among symptomatic and asymptomatic individuals. These findings suggest that Blastocystis spp. may be part of the intestinal flora in humans.

Is "dried stool spots on filter paper method (DSSFP)" more sensitive and effective for detecting Blastocystis spp. and their subtypes by PCR and sequencing?

PCR and DNA sequencing are currently the diagnostic methods of choice for detection of Blastocystis spp. and their suptypes. Fresh or frozen stool samples have disadvantages in terms of several aspects such as transportation, storage, and existence of PCR inhibitors. Filter paper technology may provide a solution to these issues. The aim of the present study was to detect Blastocystis spp. and their subtypes by employing two different preservation methods: conventional frozen stool (FS) and dried stool spots on filter paper (DSSFP). Concentration and purity of DNA, sensitivity of PCR, and DNA sequencing results obtained from the two methods were also compared. A total of 230 fecal samples were included and separated into two parts: one part of the fecal samples were directly frozen and stored at -20 °C. The remaining portion of the specimens were homogenized with saline and spread onto the filter papers as thin layer with a diameter of approximately 3 cm. After air-dried, the filter papers were stored at room temperature. DSSFP samples were collected by scraping from the filter papers. DNA were extracted by EURx Stool DNA Extraction Kit from both samples. Concentration and purity were measured with Nano-Drop, then PCR and sequencing were conducted for detection of Blastocystis spp. and its genotypes. Pure DNA was obtained with a A260/A280 ratio of 1.7-2.2 in both methods. DNA yield from FS was 25-405 ng/μl and average DNA concentration was 151 ng/μl, while these were 7-339 and 122 ng/μl for DSSFP, respectively. No PCR inhibition was observed in two methods. DNA from DSSFP were found to be stable and PCR were reproducible for at least 1 year. FS-PCR- and DSSFP-PCR-positive samples were 49 (21.3 %) and 58 (25.3 %), respectively (p = 0.078). The 43 specimens were concordantly positive by both FS-PCR and DSSFP-PCR. When the microscopy was taken as the gold standard, sensitivity of DSSFP-PCR and FS-PCR was 95.5 and 86.4 %, while specificity of both tests was 99.4 and 98.3 %, respectively. DNA sequencing results of 19 microscopically confirmed cases were strictly identical (concordance 100 %) in both methods, and ST2:6, ST3:8, ST4:3, and ST6:2 were the detected subtypes. Among the 230 fecal samples, the most predominant subtypes were ST3, ST2, ST4, and ST1 by both FS and DSSFP methods. Concordance of DNA sequencing results obtained from the two methods was noted to be 90.7 %. To our knowledge, this is the first study that demonstrates DNA extraction from DSSFP is more sensitive and effective than the FS method for diagnosis of Blastocystis spp. and their subtypes by PCR and DNA sequencing.

High Emergence of ESBL-Producing E. coli Cystitis: Time to Get Smarter in Cyprus

Background: Widespread prevalence of extended-spectrum βeta-lactamase producing Escherichia coli (ESBL-producing E. coli) limits the infection therapeutic options and is a growing global health problem. In this study our aim was to investigate the antimicrobial resistance profile of the E. coli in hospitalized and out-patients in Cyprus.

Results: During the period 2010–2014, 389 strains of E. coli were isolated from urine samples of hospitalized and out-patients in Cyprus. ESBL-producing E. coli, was observed in 53% of hospitalized and 44% in out-patients, latest one being in 2014. All ESBL-producing E. coli remained susceptible to amikacin, carbapenems except ertapenem (in-patients = 6%, out-patients = 11%).

Conclusion: High emerging ESBL-producing E. coli from urine samples in hospitalized and out-patients is an extremely worrisome sign of development of untreatable infections in the near future on the island. We therefore emphasize the immediate need for establishment of optimal therapy guidelines based on the country specific surveillance programs. The need for new treatment strategies, urgent prescription habit changes and ban of over-the-counter sale of antimicrobials at each segment of healthcare services is also discussed in this research.

Suppression of Natural Killer Cell Activity onCandida Stellatoideaby a 50 Hz Magnetic Field

Exposure to electromagnetic fields (EMF) is ubiquitous for almost all individuals living in industrialized countries. Epidemiological and laboratory studies suggest that exposure to Extremely Low Frequency (ELF) EMF increase cancer risk. The immune system functions as one of the body's main protective mechanisms, and Natural Killer (NK) cells are a subset of lymphocytes that can destroy several types of tumor cells. In this study, we investigated, NK cell activity after exposure to a 50 Hertz (Hz), 2 mT magnetic field generated by a Helmholtz Coil. Nineteen male, 10-12 week old guinea pigs were used, and NK cytotoxic activity of splenocytes was measured in vitro by natural anticandidial colorimetric index. The Mann-Whitney U test was applied for statistical analysis. NK cell cytotoxic activity was decreased in exposed compared to controls. Our data suggests that part of the immune system, the NK cell, can be suppressed by a 50 Hz magnetic field.

Determination of the expression of lymphocyte surface markers and cytokine levels in a mouse model of Plasmodium berghei

This study aimed to determine the changes in lymphocyte surface markers and cytokine profiles during a malarial infection in a mouse model of malaria. Mononuclear cells obtained from the spleens of the mice infected with Plasmodium berghei (P. berghei) were stained with anti-mouse CD3, anti-mouse CD4, anti-mouse CD8, anti-mouse CD19, anti-mouse CD152, anti-mouse pan natural killer (NK), anti-mouse CD80 monoclonal antibodies and expression of surface markers was evaluated by flow cytometry. In the serum samples of the mice, the levels of tumor necrosis factor alpha (TNF-alpha), interferon gamma (IFN-gamma), transforming growth factor-1beta (TGF-1beta), and interleukin (IL)-4, IL-10, and IL-12 cytokines were determined by ELISA method. The expressions of all the surface markers of lymphocyte evaluated were statistically significantly lower in the infected mice than in the healthy control mice (p < 0.05). However, except for the level of TGF-1beta, the levels of all the other cytokines evaluated were statistically significantly higher in the infected group than in the control group (p < 0.001). No significant differences were determined between the TGF-1beta levels of the study and control groups (p > 0.05). In this study, T, B, and NK lymphocyte responses were inhibited and cytokine profiles changed in the course of malarial infection. Thus, interventions to increase the Th1 lymphocyte response may be beneficial in the prevention of malarial infection.

Differential immunomodulatory activity of soluble beta glucans from barley and yeast in antigen specific humoral immune responses (45.21)

The main difference in chemical structure of (1 →3)-β-D-glucans from yeast cell wall and barley is the branching side chains. Yeast cell wall contains (1→3),(1→6)-β-D-glucans whereas barley contains (1→3),(1→4)-β-D-glucans. The purpose of this study was to compare adjuvant effects of two soluble beta-glucans from barley and yeast (Saccharomyces cerevisiae) in antigen specific humoral immune responses. In a conalbumin-immunized mouse model, mice were immunized by conalbumin at a relatively lower concentration (10 μg/mouse) in the presence of beta glucans. Anti-conalbumin antibodies in the serum specimens of immunized and control mice were quantified by ELISA.

At high doses, both glucans were effective in increasing circulating conalbumin-specific antibodies of IgM, IgG, and IgA types. However, 1 μg of â-glucan from barley resulted in lower yield in IgG1, IgG2a, IgG2b, and IgGA levels in comparison to the yeast-derived glucan at the same dose. We also found that antigen specific antibody levels enhanced by the β-glucan from yeast were always higher than those of the glucan from barley.

In conclusion, yeast-derived glucans might have better immunomodulatory or adjuvat activity in induction of antigen specific humoral immune responses over barley-derived glucans.β

Effects of recombinant interferon-γ on cytokine secretion from monocyte-derived macrophages infected with Salmonella typhi

Salmonella typhi (S. typhi) is an important pathogen which causes typhoid fever. The cytokines released from the macrophages, playing a role in the host defense against Salmonella infection, are crucial in the defense against the infection. IFN-gamma provides a protection against Salmonella infection by developing macrophage activation in different mechanisms. This study was designed to investigate the effect of the recombinant IFN-gamma (rIFN-gamma) on the cytokines secreted from S. typhi stimulated macrophages. Macrophage isolation was done in the heparinized blood samples obtained from healthy people, and following the priming with rIFN-gamma for 72h the cells were stimulated by S. typhi and then the cytokine levels in culture supernatants were determined by enzyme-linked immunosorbent assay. It was observed that rIFN-gamma reversely increased the levels of IL-1, IL-2 the levels of which were decreased by S. typhi and that it increased TNF-alpha levels while suppressing the levels of antiinflammatory cytokines such as IL-10 and TGF-beta the levels of which were increased by S. typhi. Consequently, rIFN was observed to increase protective Th1 response by affecting the secretion of cytokine during S. typhi infection and it was considered to be a good target especially to prevent and treat invasive Salmonella infections.

Expression of cell surface markers on methicillin resistant Staphylococcus aureus stimulated lymphocytes

BACKGROUND & OBJECTIVE

Methicillin-resistant Staphylococcus aureus (MRSA) has gradually been increasing, new strategies in the treatment of MRSA infections are required. This depends on the understanding of the infection pathogenesis and the immune response. This study was therefore designed to determine the immune response which develops during MRSA infection and the role of chemokines in this response, and also to compare the results with the changes occurring after MSSA infection.

METHODS

The expression of the surface markers of human lymphocytes stimulated by heat-killed MRSA or MSSA was analysed by flow cytometry. The chemokine levels in the lymphocytes culture supernatants stimulated or not stimulated by microorganisms were determined by ELISA.

RESULTS

Human peripheral blood mononuclear cells (PBMCs) stimulated by MRSA the levels of CD4(+)CD25(+) regulatory T cells, CD69 expressions in the activated T lymphocytes, CD3(-)CD16(+)CD56(+) NK cells and the levels of MIP-1alpha, MIP-1beta, MCP-1 chemokines increased as compared to the cells not stimulated by MRSA. Although stimulation by MSSA caused an increase in CD25 expression after 24 h, the increase was found to be lower than the one caused by MRSA stimulation. The increase in CD69 expression was statistically significant compared to the cells stimulated by MRSA. Different from the cells stimulated by MRSA, no change was observed in the expressions of CD54 and CD3(-)CD16(+)CD56(+) NK cells in the cells stimulated by MSSA.

INTERPRETATION & CONCLUSION

Our findings showed that cellular as well as humoral immunity are critical in MRSA infection and that T cell activation and the increase in chemokines may play a role in the regulation of immune response.

Effects of Saccharomyces boulardii on cytokine secretion from intraepithelial lymphocytes infected by Escherichia coli and Candida albicans

Saccharomyces boulardii (S. boulardii) is a probiotic and used in the prevention or treatment of diarrhoea. Saccharomyces boulardii has many mechanisms to protect the host against diarrhoeal pathogens. It might modulate the immune system. In this study, the influence of S. boulardii on the secretion of cytokines from intraepithelial lymphocytes (IELs) infected with Escherichia coli (E. coli) and Candida albicans (C. albicans) was investigated in vitro. Cytokine levels were determined by enzyme-linked immunosorbent assay. The secretion of proinflammatory cytokines such as interleukin (IL)-1beta was decreased in the infected IELs incubated with S. boulardii, but different from it, anti-inflammatory cytokine levels such as IL-4 and IL-10, however, were found to be higher. These findings demonstrated that S. boulardii may have protective effects against diarrhoeal pathogens by reducing the proinflammatory response.

The relationship between cervical human papillomavirus infection and apoptosis

Purpose: Cervical carcinoma is the second most common cancer among women worldwide. Viral infections, especially human papillomavirus (HPV) infections, are important factors in its etiology. Changes in apoptotic regulation are considered to have an important role in the carcinogenesis development. In this study, the relationship between apoptosis and HPV infection was investigated. Methods: HPV DNA and HPV DNA type 16 positivity were detected in 110 cervical smear samples with Real Time PCR and sequencing was performed for HPV DNA type 18. The presence of apoptosis was investigated using TUNEL and Annexin V staining methods and analyzed by fluorescence microscope and flow cytometry. Results: HPV DNA type 16 was detected in 9 samples (8.1%), HPV DNA type 18 positive in 6 samples (5.4%) and HPV types other than HPV type 16 and HPV type 18 in 9 samples (8.1%). A decrease apoptosis was found in HPV DNA positive samples compared with controls (P < 0.05). Conclusion: The decrease of apoptosis during HPV infection might cause cellular immortality and then malignant transformation.

Omeprazole inhibits natural killer cell functions

This study was designed to determine the possible effects of omeprazole on human natural killer cells. Peripheral venous blood samples were taken from 20 peptic ulcer patients before and at the 14th and the 28th days of omeprazole treatment. Mononuclear cells were removed from blood and their capability of making conjugation with K562 target cells and lysing K562 target cells was evaluated. A significant decrease was found (P < 0.001) in the 14th and the 28th days compared with the basal value of the capability of the mononuclear cells to conjugate with the K562 target cells and to lyse them. This study demonstrated that omeprazole significantly reduces natural killer cell functions. This finding suggests that omeprazole may also have some effects on the other systems in addition to parietal cell acid secretion.

The effects of fluconazole and cytokines on human mononuclear cells

Candida infections are common infections and fluconazole is one of the most frequently administered antifungal agents in their treatment. The resistance developed against antifungal agents has necessitated the improvement of new treatments. This study focuses on the investigation of the effect of fluconazole and cytokines such as interferon-gamma (IFN-gamma), tumor necrosis factor-alpha (TNF-alpha), granulocyte-macrophage colony-stimulating factor (GM-CSF) on chemokine production and anticandidal activity of human monocytes. In the study it was observed that GM-CSF caused an increase in candidacidal activity of monocytes. Anticandidal activity of GM-CSF + IFN-gamma combination was not found to be more effective than GM-CSF or IFN-gamma alone. The presence of cytokine and fluconazole caused an increase in the levels of CCL3 and CCL4 chemokines. Accordingly, it was considered that chemokines could contribute to the efficacy of fluconazole in C. albicans infections. Besides, in order to strengthen the immune system some cytokines might be used in addition to antifungal agents for the treatment.

Evaluation of the natural killer cytotoxicity and the levels of cytokines in rats with type I diabetes mellitus

Type I diabetes mellitus (insulin-dependent DM = IDDM) is a chronic disease characterized by specific destruction of pancreatic beta cells, resulting in an absolute lack of insulin. Immune mechanisms, genetic susceptibility, and environmental factors are all implicated in the pathogenesis of Type 1 diabetes. This study was aimed at determining the efficiency of cytokines, natural killer (NK) cells in the pathophysiology of IDDM. Therefore, we evaluated the plasma levels of cytokines by specific enzyme-linked immunosorbent assay (ELISA) and the cytotoxicity activity of NK cells by anti-candididal index in rats with type I diabetes. We found that the cytotoxicity activity of NK cells in IDDM groups significantly decreased compared to the control groups. The levels of interferon-gamma (IFN-gamma) in IDDM groups were slightly higher than in healthy controls. These results indicate that the changes of T H1 type cytokines such as IFN-gamma and NK cell activity can play a role in the etiology of IDDM. The data may provide new strategies for the treatment of IDDM.

Natural killer cell activity, serum immunoglobulins, complement proteins, and zinc levels in patients with psoriasis vulgaris

The role of the immune system in patients with psoriasis vulgaris (PV) was investigated. The genetic and immunological basis for psoriasis is still unknown. Because of the reports of immunological defects in this disease, we investigated serum levels of immunoglobulins IgG, IgM, IgA, complement proteins C3, C4, serum zinc (Zn) levels and natural killer (NK) cell activities. Skin lesions of the psoriatic patients involved in the study comprised less than 10 % of the total body and the disease was in a stationary period. Zn levels were measured by atomic absorption spectrophotometry. NK cell activity was measured by 51Cr (Na2 51CrO4). IgG, IgA, IgM, C3 and C4 assays were done by liquid-phase immunoprecipitation assay with nephelometric endpoint detection. IgG, IgA, C3 and C4 levels were significanty higher in patients with PV than in healty controls (p < 0.05). However, NK cell activity, serum Zn and IgM levels did not show significant differences between these two groups. There are changed immunological responses, which may play an important role in the pathogenesis of the disease. Many controversial results have been related to immunological parameters in psoriatic patients. Therefore, more detailed studies in this field need to be done to determine the relationship between psoriasis and the immune system.

Development of a rapid, single-step procedure using protein G affinity chromatography to deplete fetal calf serum of its IgG and to isolate murine IgG1 monoclonal antibodies from supernatants of hybridoma cells

Fetal calf serum (FCS) was depleted of its immunoglobulin G (IgG) in a rapid procedure using protein G affinity chromatography. 20 ml of FCS was depleted of its IgG in less than 80 min by applying 5 ml of FCS to a 1 ml HiTrap protein G Sepharose column followed by appropriate elution. Various concentrations of IgG-depleted FCS (G-FCS) were used in RPMI-1640 medium to grow the mouse hybridoma cell lines CAy-G (anti-HBs IgG1 mAb producing hybridoma cell) and CAy-M (anti-HBs IgM mAb producing hybridoma cell), which secreted hepatitis B virus surface antigen (HBsAg)-reactive IgG1 and IgM monoclonal antibodies (mAbs), respectively. Antibody production and cell growth were used as indices to compare the efficacy of RPMI/G-FCS with that of RPMI/FCS and serum/protein-free Hybri Max (Sigma, MO, USA) hybridoma medium. MAb production and cell growth of CAy-G and CAy-M hybridoma cell lines in RPMI/G-FCS were similar to culture in RPMI/FCS and significantly better than culture in Hybri Max. We found that G-FCS was superior to whole FCS as a culture supplement for the purification of IgG1 mAbs. IgG1 mAbs were isolated in a single-step procedure using protein G affinity chromatography, from the supernatant of CAy-G hybridoma cells cultured in RPMI/10% G-FCS (RPMI-1640 medium supplemented with 10% G-FCS). SDS-PAGE analysis revealed that the purity of IgG isolated from the supernatant of CAy-G cells cultured in RPMI/10% G-FCS was more than 99%.

Proliferative response of peripheral blood lymphocytes and lymphocyte subpopulations in n-Hexane, toluen, and methyl ethyl ketone co-exposed workers

To estimate the quantitative relation between chronic co-exposure to airborne n-hexane, toluen, methyl ethyl ketone (MEK) and various markers of immune function such as proliferative response of peripheral blood lymphocytes and lymphocyte subpopulations, a group of workers employed in a shoe factory were examined and compared with the unexposed controls. A significant increase was observed in the proliferative response of the peripheral lymphocytes to 2.5 and 5 μg PHA in the exposed group compared with that of the control group. There was no significant change in the percentage of circulating CD3(+), CD4(+), CD8(+), CD19(+), CD16(+) lymphocytes even in those workers with 3.3-fold higher mean levels of urine 2,5-hexanedione (2,5-Hxdn) and approximately twofold higher mean levels of urine hippuric acid (HA) as compared to controls. No difference was also observed between the mean granulocyte, monocyte, lymphocyte percentages of the groups, but a significant increase was observed in mean serum C3 level of the workers. Our results suggest that while lymphocyte subpopulations and leucocyte percentages are not affected, the proliferative response of the peripheral lymphocytes is stimulated after chronic co-exposure to n-hexane, toluen and MEK at the defined levels.

Effects of occupational chronic co-exposure to n-hexane, toluen, and methyl ethyl ketone on NK cell activity and some immunoregulatory cytokine levels in shoe workers

1. To evaluate the effects of occupational long-term co-exposure to n-hexane, toluen, and methyl ethyl ketone (MEK) on NK cell activity and serum IL-2, gamma-IFN levels, we studied a group of workers employed in a shoe factory where the jobs include use of glues and adhesives containing mainly n-hexane, and at low concentrations, toluen and MEK. 2. No differences were found in these parameters even in those workers with 3.3-fold higher mean levels of urine, 2,5-Hxdn and approximately twofold higher mean levels of urine hippuric acid as compared to controls. 3. We conclude that chronic co-exposure to n-hexane, toluen, and MEK at these levels is not associated with an impairment on either NK cell activity or serum IL-2 and gamma-IFN levels.

Comparison of the effects of Salmonella minnesota Re595 lipopolysaccharide, lipid A and monophosphoryl lipid A on nitric oxide, TNF-alpha, and IL-6 induction from RAW 264.7 macrophages

Lipopolysaccharide (LPS) exhibits a wide variety of bioactivities. Although it was generally proposed that the lipid A component represented the active center responsible for most of the bioactivities of LPS, a variety of lipid A partial structures and analogues were reported to have different properties. Lipopolysaccharide of the Re595 mutant of Salmonella minnesota is lack of O and part of the core polysaccharide (2 keto-3-deoxyoctanate (KDO) left on lipid A). Re595 lipid A (LA) and Re595 monophosphoryl lipid A (MPLA) differ in structure from Re595 LPS by lacking KDO and KDO plus phosphoryl group respectively. Whether these lipid A-common Re595 LPS preparations differed in activities, we investigated their effects on nitric oxide (NO), TNF-alpha, IL-6, and IL-12 induction from murine macrophage cell line RAW 264.7. RAW 264.7 cells (2 x 10(5) cells ml(-1)) were stimulated with these LPS preparations at 1 microg ml(-1) for 48 h. Re595 LPS, Re595 LA and Re595 MPLA significantly induced NO, TNF-alpha and IL-6 production; NO, TNF-alpha and IL-6 inducing capacities were in the order of LPS = LA > MPLA, LPS = LA = MPLA, and LPS = LA > MPLA respectively. However, these preparations did not induce IL-12 production from RAW cells even when stimulated in combination with IFN-gamma (20 U ml(-1)). IFN-gamma itself also induced NO, TNF-alpha and IL-6 production from RAW 264.7 cells. When RAW 264.7 cells were stimulated with IFN-gamma plus any of these preparations, effects were additive and synergistic for NO and IL-6 responses respectively. But TNF-alpha responses of RAW cells against these preparations were almost equal when cultured alone or in combination with IFN-gamma. Pre-treatment of RAW cells either with LPS, LA or MPLA at low concentration (0.1 microg ml(-1)) for 60 min before pulsing with IFN-gamma (20 IU ml(-1)) plus LPS (1 microg ml(-1)) for an additional 48 h, significantly (P < 0.01) decreased NO response. Although to a lesser extent, TNF-alpha and IL-6 responses were also decreased. Complete inhibition of NO inducing effect of these LPS preparations was achieved with polymyxin B at 40 microg ml(-1). But the concentration of polymyxin B to get a significant (P < 0.05) inhibitory effect on LPS was four times higher than that for LA or MPLA. Unexpectedly, polymyxin B also inhibited INF-gamma-induced NO production from RAW cells in a dose-dependent fashion. These findings suggested that effect of LPS was dependent, at least in part, on both the LPS polysaccharide chain length and the hydrophilic portion of LPS. In addition, not only LPS but also LA and MPLA exert either enhancing or suppressive effects, depending on their concentrations and the timing of their addition with respect to co-stimulators.

Involvement of the Fas/Fas ligand pathway in activation-induced cell death of mycobacteria-reactive human gamma delta T cells: a mechanism for the loss of gamma delta T cells in patients with pulmonary tuberculosis

Although the identity of T cells involved in the protection against Mycobacterium tuberculosis (Mtb) in humans remain unknown, patients with pulmonary tuberculosis (TB) have reduced numbers of Mtb-reactive, V gamma 9+/V delta 2+ T cells in their blood and lungs. Here we have determined whether this gamma deltaT loss is a consequence of Mtb Ag-mediated activation-induced cell death (AICD). Using a DNA polymerase-mediated dUTP nick translation labeling assay, 5% or less of freshly isolated CD4+ alpha beta or gamma delta T cells from normal healthy individuals and TB patients were apoptotic. However, during culture Mtb Ags induced apoptosis in a large proportion of V gamma 9+V delta 2+ peripheral blood T cells from healthy subjects (30-45%) and TB patients (55-68%); this was increased further in the presence of IL-2. By contrast, anti-CD3 did not induce any significant level of apoptosis in gamma delta T cells from healthy subjects or TB patients. Mtb Ag stimulation rapidly induced Fas and Fas ligand (FasL) expression by gamma delta T cells, and in the presence of metalloproteinase-inhibitors >70% of gamma delta T cells were FasL+. Blockade of Fas-FasL interactions reduced the level of Mtb-mediated gamma delta T cell apoptosis by 75 to 80%. Collectively, these findings demonstrate that Mtb-reactive gamma delta T cells are more susceptible to AICD and that the Fas-FasL pathways of apoptosis is involved. AICD of gamma delta T cells, therefore, provides an explanation for the loss of Mtb-reactive T cells during mycobacterial infection.

Involvement of the Fas/Fas Ligand Pathway in Activation-Induced Cell Death of Mycobacteria-Reactive Human γδ T Cells: A Mechanism for the Loss of γδ T Cells in Patients with Pulmonary Tuberculosis

Although the identity of T cells involved in the protection against Mycobacterium tuberculosis (Mtb) in humans remain unknown, patients with pulmonary tuberculosis (TB) have reduced numbers of Mtb-reactive, Vγ9+/Vδ2+ T cells in their blood and lungs. Here we have determined whether this γδ T loss is a consequence of Mtb Ag-mediated activation-induced cell death (AICD). Using a DNA polymerase-mediated dUTP nick translation labeling assay, 5% or less of freshly isolated CD4+ αβ or γδ T cells from normal healthy individuals and TB patients were apoptotic. However, during culture Mtb Ags induced apoptosis in a large proportion of Vγ9+/Vδ2+ peripheral blood T cells from healthy subjects (30–45%) and TB patients (55–68%); this was increased further in the presence of IL-2. By contrast, anti-CD3 did not induce any significant level of apoptosis in γδ T cells from healthy subjects or TB patients. Mtb Ag stimulation rapidly induced Fas and Fas ligand (FasL) expression by γδ T cells, and in the presence of metalloproteinase-inhibitors &gt;70% of γδ T cells were FasL+. Blockade of Fas-FasL interactions reduced the level of Mtb-mediated γδ T cell apoptosis by 75 to 80%. Collectively, these findings demonstrate that Mtb-reactive γδ T cells are more susceptible to AICD and that the Fas-FasL pathways of apoptosis is involved. AICD of γδ T cells, therefore, provides an explanation for the loss of Mtb-reactive T cells during mycobacterial infection.

Alpha interferon treatment in myasthenia gravis: effects on natural killer cell activity

The efficacy of recombinant interferon-alpha (rIFN alpha), on natural killer (NK) cell cytotoxic activity, CD3+, CD4+, CD8+, CD56+, HLA-DR+ lymphocyte counts, anti-acetylcholine receptor antibody (AChR Ab) levels, single fibre electromyography findings (SFEMG) and clinical course were evaluated in patients with myasthenia gravis (MG). During the IFN alpha treatment (3 mu, subcutaneous, 3 times a week), NK cell cytotoxicity and CD4+/8+ ratio increased, NK cell count remarkably decreased, and no significant clinical or SFEMG changes were observed. This preliminary open study in MG patients has demonstrated enhanced NK activity per unit NK cell after IFN alpha therapy. Although lymphocyte phenotypes and NK function approached normal levels during therapy, a higher dose of IFN alpha may be required for a significant clinical response. It has been also concluded that 6 months of IFN alpha therapy seems to be safe in MG, though in patients with malignancy, IFN alpha may cause increased autoimmunity, AChR positivity and MG.

Effect of a Staphylococcus epidermidis-extracted slime factor on human natural killer cell activity

A slime factor produced by Staphylococcus epidermidis was a complex glycoconjugate extracted by the phenol extraction method. The potential stimulatory or inhibitory capacity of the phenol-extracted slime (PES) was tested on human natural killer cell cytotoxic activity. Various concentrations of the PES preparation were incubated with the effector cells 30 min before and during the assay period. The PES factor inhibited natural killer cell cytotoxic activity at a concentration of 250 micrograms/ml and at higher concentrations (p < 0.05). The inhibition of natural killer cell cytotoxic activity may probably be related to the complex composition of the slime substance.

Effects of some antigenic fractions of Leishmania major on nitric oxide production and IL-12 secretion by murine peritoneal macrophages

Nitric oxide (NO) and IL-12 are important mediators of the immune response to Leishmania major. In this study, the effects of L. major promastigotes, crude antigenic fraction (CAF) and its subfractions on NO production and IL-12 secretion by BALB/c mice peritoneal macrophages is investigated. The subfractions of CAF, namely, fractions 1, 2 and 3, that were in the molecular weight range of 97.4-66, 66-45 and below 45 kDa, respectively, were separated by SDS-PAGE. NO production was determined by using Griess reagent and IL-12 was measured by ELISA. It was found that NO production was stimulated by promastigotes but not by CAF or its subfractions. IL-12 secretion was stimulated by promastigotes, CAF and fraction 1 while fractions 2 and 3 did not have any effect.

Effects of occupational lead and cadmium exposure on some immunoregulatory cytokine levels in man

The levels of serum interleukin-1beta (IL-1beta), interleukin-2 (IL-2), tumor necrosis factor alpha (TNF-alpha) and gamma-interferon (gamma-IFN) were assessed in the workers who were occupationally exposed to lead and cadmium. The values were compared with the age-matched control group. Blood lead and cadmium levels were significantly raised. Our findings suggest that chronic lead and cadmium exposure in humans resulted in significant suppression of the serum IL-1beta level, but did not alter IL-2 and TNF-alpha levels. The gamma-IFN level was also reduced in lead workers. In contrast, a significant enhancement was observed in the cadmium-exposed group. We conclude from these results that lead and cadmium exposure at chronically high level may affect some cytokine levels in humans.

Aqueous transforming growth factor-beta-I levels in rabbit eyes after excimer laser photoablation

Transforming growth factor beta (TGF-beta) plays an important role in anterior segment wound healing, by controlling the cell proliferation and differentiation, angiogenesis, extracellular matrix composition and mediating the immunosuppressive properties of the aqueous humor. The present study was undertaken to clarify the possible changes of aqueous humor TGF-betaI levels after excimer laser photoablation. Twenty-eight New Zealand rabbits were divided into four groups of 7 rabbits each. Group 1 served as control, the central 7 mm of corneal epithelium was removed in groups 2, 3 and 4. We performed 50-microm corneal photoablation in group 3, and 100-microm ablation in group 4. After 48 h we measured the TGF-betaI levels of the aqueous humor by ELISA method. The mean TGF-betaI value of the aqueous humor was found to be 162.94+/-13.73 pg/ml in the control group. Mechanical deepithelialization did not change the TGF-betaI levels of the aqueous humor (p > 0.05). There was no significant difference between the 50-microm photoablated group and the controls (p > 0.05), but the TGF-betaI levels of the 100-microm photoablated group were found to be significantly higher than those of both the control group and 50-microm photoablated group (p < 0.05). Many factors and cytokines may induce corneal haze and myopic regression after excimer laser photoablation; our study demonstrated that TGF-betaI is one of these factors and there is a positive correlation between the depth of corneal photoablation and aqueous TGF-betaI concentrations.

Simultaneous effects of lead and cadmium on NK cell activity and some phenotypic parameters

Lead and cadmium are common environmental contaminants that alter the immune response. Natural killer cell (NK) cytotoxicity and phenotypic parameters are crucial immune responses, but little is known about the effects of these metals on these responses. In the present paper, we investigated the simultaneous effects of lead and cadmium on NK cell activity and CD4+, CD20+ cell percentages in the workers and compared the data with control and lead-exposed groups. We conclude that simultaneous exposure to lead and cadmium is not associated with an impairment of either NK cell function of CD4+ cell percentage. On the other hand, CD20+ cell percentage was found higher in lead+cadmium exposed group than controls.

Effects of high-level exposure to lead on NK cell activity and T-lymphocyte functions in workers

1. NK and T cell functions were measured in peripheral blood lymphocytes of workers occupationally exposed to lead. 2. No differences were found in these functions even in those workers with higher levels of blood and urine lead and urinary delta-ALA than the currently accepted biological limit values as compared to controls. 3. We conclude that high chronic exposure to lead is not associated with an impairment or either T- or NK cell functions in man.

Defibrotide augments the anticandidial activity of NK cells

1. The mechanism of action of Defibrotide, a fibrinolytic agent on Natural Killer (NK) cell cytotoxicity, was investigated through verapamil, TMB-8 cells and pertussis toxin. 2. Defibrotide increased the activity against Candida albicans cells (anticandidial activity), and it is determined that the calcium channels have a role in this effect. 3. Blockage of calcium channels reduced the anticandidial effect by 39.2%. Pertussis toxin led to a 10.7% inhibition, whereas the application of TMB-8 resulted in the stimulation of anticandidial activity. 4. It is concluded that defibrotide is a potent activator of NK cells.

Effects of crude antigenic fractions of Leishmania major on natural killer cell cytotoxicity, interferon-gamma and interleukin-4 secretion from peripheric blood lymphocytes of unexposed individuals

The crude antigenic fraction (CAF) isolated from Leishmania major was fractionated into three subfractions by sodium dodecyl sulphate-polyacrylamide gel (SDS-PAGE). The effects of CAF and its subfractions on NK cell cytotoxicity is investigated by chromium release assay. These subfractions designated as fractions 1, 2 and 3 correspond to 97.4-66 kD, 66-45 kD and 29 kD and below respectively. Although both CAF and its subfractions have inhibited the cytotoxicity of natural killer (NK) cells, the effects of fractions 2 and 3 were more pronounced. The effect of the fractions on the Interferon-gamma (IFN-gamma) and Interleukin-4 (IL-4) secretion by peripheric blood lymphocytes was also analyzed. It was found that CAF and fraction 1 induce IFN-gamma secretion while on the other hand IL-4 secretion was mostly suppressed by fraction 2. Therefore, further research is being executed which focuses on the effects of CAF, fractions 1 and 2 on macrophage effector functions.

Disease-specific changes in gammadelta T cell repertoire and function in patients with pulmonary tuberculosis

Although gammadelta T cells are known to contain the highest frequency of mycobacteria-reactive cells in humans and numerous studies have suggested that they play an important role in the initial immune response to Mycobacterium tuberculosis (Mtb), very few studies have attempted to analyze these cells in patients with active pulmonary tuberculosis. The aim of the present study was therefore to evaluate the consequences of infection on the number and activity of mycobacteria-reactive gammadelta T cells. Three-color flow cytometric analysis of blood and bronchoalveolar lavage gammadelta T cells of patients diagnosed with active pulmonary tuberculosis showed that compared with normal healthy subjects and patients with the unrelated pulmonary granulomatous diseases sarcoidosis and berylliosis the size of the mycobacteria-reactive Vgamma9+/Vdelta2+ gammadelta T cell subset in both the blood and lung was dramatically reduced. In addition, the Vgamma9+/Vdelta2+ cells left intact in patients with tuberculosis were refractory to in vitro stimulation by Mtb Ags, which are potent stimuli for these cells in normal subjects. Our results demonstrate for the first time a strong correlation between the absence or loss of the major Vgamma9+/Vdelta2+ Mtb-reactive subset of gammadelta T cells and manifestations of disease, consistent with the hypothesis that these gammadelta T cells play a role in the protective immune response to Mtb infection.

Effect of allergen specific immunotherapy (IT) on natural killer cell activity (NK), IgE, IFN-gamma levels and clinical response in patients with allergic rhinitis and asthma

Allergen specific immunotherapy (IT) has been widely used for many years as a specific treatment of allergic diseases. A variety of changes in immunological parameters have been described but it still remains uncertain as to which of them is responsible for the improvement of symptoms. The aim of our study was to evaluate the effect of IT on natural killer (NK) cell activity, IL-4, IFN-gamma, IgE levels and skin test reactivity in addition to clinical efficacy. Thirty-one patients with allergic rhinitis and asthma were selected according to positive history, skin prick tests to Dermatophagoides pteronyssinus (Der p) or grass pollens, presence of specific IgE antibodies in sera and clinical findings, and were submitted to one year of placebo-controlled IT. Total IgE, specific IgE, IL-4 and IFN-gamma levels were measured by using ELISA method. Standard chromium 51 release assay was used to measure NK cell cytotoxic activity against the human leukemic cell line, K562 target cells. Mean symptom and medication scores, skin test reactivity and histamine sensitivity were significantly decreased in the patients given IT at the end of the first year when compared with the placebo group. However, there was neither a significant reduction in total and specific IgE levels nor a significant increase in IFN-gamma levels at the first year of IT. IL-4 levels were only measured at the beginning of the study because of the very low levels. A decrease in NK cell activity was found in patients treated with grass pollen extracts after 12 months when compared with Der p and placebo group. No signs of major local or systemic side effects due to IT were seen in patients during the study. Although significant clinical efficacy of specific IT with standardized extracts has been demonstrated in allergic rhinitis and asthmatic patients at the end of the first year of IT, no significant changes in immunological parameters were observed. However we conclude that a decrease in NK cell cytotoxic activity during IT has to be taken into account in the follow-up of patients.

Disease-specific changes in gammadelta T cell repertoire and function in patients with pulmonary tuberculosis

Although gammadelta T cells are known to contain the highest frequency of mycobacteria-reactive cells in humans and numerous studies have suggested that they play an important role in the initial immune response to Mycobacterium tuberculosis (Mtb), very few studies have attempted to analyze these cells in patients with active pulmonary tuberculosis. The aim of the present study was therefore to evaluate the consequences of infection on the number and activity of mycobacteria-reactive gammadelta T cells. Three-color flow cytometric analysis of blood and bronchoalveolar lavage gammadelta T cells of patients diagnosed with active pulmonary tuberculosis showed that compared with normal healthy subjects and patients with the unrelated pulmonary granulomatous diseases sarcoidosis and berylliosis the size of the mycobacteria-reactive Vgamma9+/Vdelta2+ gammadelta T cell subset in both the blood and lung was dramatically reduced. In addition, the Vgamma9+/Vdelta2+ cells left intact in patients with tuberculosis were refractory to in vitro stimulation by Mtb Ags, which are potent stimuli for these cells in normal subjects. Our results demonstrate for the first time a strong correlation between the absence or loss of the major Vgamma9+/Vdelta2+ Mtb-reactive subset of gammadelta T cells and manifestations of disease, consistent with the hypothesis that these gammadelta T cells play a role in the protective immune response to Mtb infection.

Anti-candidial activity of natural killer (NK) and lymphokine activated killer (LAK) lymphocytes in vitro

The natural cytotoxic effects of peripheral blood lymphocytes (PBL) on Candida stellatoidea and several other Candida species were examined by a colony forming inhibition (CFI) assay. Peripheral blood mononuclear cells (PBMC), were incubated with C. stellatoidea yeast cells. After the incubation period the colony-forming ability of the yeast was significantly reduced. In similar experiments, six different Candida species (C. albicans, C. krusei, C. stellatoidea, C. tropicalis, C. pseudotropicalis, C. guillermondii) were used as target cells. There was no statistically significant difference in the anticandidial activities of PBL against the Candida species used. It was demonstrated that a fraction of lymphocytes, natural killer cells (NK), had the major natural anti-candidial activity by using anti-Leu M1 (CD 15) and anti-Leu 11b (CD 16) monoclonal antibodies (mAbs) plus complement (C'). It was observed that inhibition of colony-forming ability of C. stellatoidea was significantly (78-96%) reduced when anti-Leu 11b plus C' were used. In addition, the colony formation inhibition capacity of NK cells was increased by recombinant human interleukin-2 (rhIL-2) while anti-interferon-gamma (IFN-gamma) had no effect. Besides the fact that NK cells are among those responsible for natural immunity against Candida species, this colony-forming inhibition assay performed with C. stellatoidea yeast cells as target and monocyte-depleted PBMC as effector cells, is a simple method to assess NK cell activity.

Tumor necrosis factor (TNF) induction from monocyte/macrophages by Candida species

Candida albicans was studied for its capacity to induce TNF production from mouse peritoneal macrophages (PM phi). TNF activities in the culture supernatants of Candida-stimulated PM phi and human peripheral blood monocytes were assessed by L 929 bioassay and ELISA respectively. C. albicans induced TNF production from PM phi and human peripheral blood monocytes in a dose-dependent manner. Although the capacity was lesser than live form, heat-killed C. albicans was also found to be capable of stimulating PM phi to induce TNF. The filtered supernatant of 24 h cultured live C. albicans had no effects on TNF production from PM phi. Saccharomyces cerevisiae-extracted mannan, a yeast cell wall antigen, induced TNF production from PM phi in a dose-dependent manner. Thus, the effect of C. albicans on TNF production from PM phi was seemed to be directly related to the presence of the yeast cell wall itself. Compatible with these data, when various candida species (C. albicans, C. tropicalis, C. pseudotropicalis. C. lusitaniae, C. krusei, C. parapsilosis, C. guilliermondii, C. stellatoidea, C. glabrata) and S. cerevisiae were compared to each other, at a concentration of 2 x 10(6) yeast cells/ml from each species, it was observed that TNF inducing capacities varied. Among the species used in this study, C. guilliermondii and C. glabrata, of which the yeast cell size were the smallest ones, were found to be less potent than that of others to induce TNF from PM phi.

The effect of omeprazole on human natural killer cell activity

1. Omeprazole, an antiulcer drug, inhibits the gastric acid pump via blocking the parietal cell (H+ + K+)-ATPase. Omeprazole was also reported to have an inhibitory action on polymorphonuclear neutrophil activities. In the present study the potential effect of omeprazole on human natural killer cell (NK) activity was investigated. 2. Omeprazole decreased NK cytotoxic activity in a dose-dependent manner. 3. Degraded omeprazole showed a similar action. 4. In vitro NK inhibitory action of omeprazole and its acid-degraded form was observed at the concentrations equal and higher than 18 microM (micromolar). 5. NK inhibitory action of omeprazole was recovered to 75% by washing away of the agent. 6. Omeprazole decreased the conjugate formation of effector and target cells by 50% at the concentration of 288 microM

Decreased natural killer (NK) cell activity in zinc-deficient rats

1. In the study, the effect of zinc deficiency, a natural killer (NK), and lipopolysaccharide (LPS) activated NK cell activity were investigated. 2. Rats were fed with zinc-deficient and normal diet for 3 weeks. 3. NK and LPS activated NK cell activity was 7.2 +/- 1.8%/10(6) cells (n = 10) and 9.5 +/- 4.3%/10(6) cells (n = 10), respectively, in the zinc deficient group. In the control group fed with normal diet, NK and LPS activated NK cell activity was 22.2 +/- 3.3%/10(6) cells (n = 10) and 32.5 +/- 3.5%/10(6) cells (n = 10), respectively. 4. Plasma zinc concentration was 131.7 +/- 8.8 micrograms/dl in the zinc-deficient group and 206 +/- 17.7 micrograms/dl in the control group. 5. The results suggest that decreased NK and LPS activated NK cell activity is associated with zinc deficiency.

Natural cellular cytotoxicity in Behçet's disease

This study evaluated the cytotoxic activity of natural killer cells in the active and inactive stages of Behçet's disease (BD) and attempted to develop a new explanation for its immunopathogenesis. Blood samples were taken from 16 BD patients and compared with 11 healthy individuals. The lymphocyte fraction was separated and diluted in RPMI-1640. Candida as a target cell (T) was mixed with lymphocytes (E) (effector cells) in ratios of T:E 1/5 and T:E 1/25. After the numbers of colonies were counted with controls, the anticandidal index (natural cytotoxicity) was calculated. Natural cytotoxicity relatively decreased in the active stage and increased in the inactive stage of BD. Although the difference between the mean value of natural cytotoxicity in the active stage and in the inactive stage was significant, the difference between the averages of active stage and the control group was insignificant. However, the difference between inactive stage and the control group was remarkable. The increase of the natural cytotoxic activity in the inactive period of the disease may play a role together with other immune mechanisms in the aetiopathogenesis of BD.

The effect of inosiplex in subacute sclerosing panencephalitis: a clinical and laboratory study

The immunomodulatory action of inosiplex, a drug frequently used in subacute sclerosing panencephalitis (SSPE), varies according to its dose and the subjects' immune status. In order to assess its effect in children and adolescents with SSPE, inosiplex (25-50 mg/kg/day) was given to 9 patients aged 7-17 years. Their clinical and immunologic status was evaluated before and after 2 months' treatment. Lymphocyte mitogenic response decreased in 6 cases. These patients were clinically stable or improving during this period. Changes in cytotoxicity (increased in 5/6 patients) and suppressor cell function (increased in 4/8 and decreased in 4/8) were not significant nor associated with any particular clinical course. Our results suggest that inosiplex at this dose is more likely to suppress lymphocyte proliferation in SSPE and this is not due to advancing disease. Longer follow-up of clinical and laboratory findings seems to be indicated in therapeutic trials in SSPE.