Assessment of different sources of variation in the antibody responses to specific malaria antigens in children in Papua New Guinea

BACKGROUND

A potential problem for malaria vaccine development and testing is between-host variation in antibody responses to specific malaria antigens. Previous work in adults in an area highly endemic for Plasmodium falciparum in Papua New Guinea found that genetic regulation partly explained heterogeneity in responsiveness. We have now assessed the relative contributions of environmental and genetic factors in total IgG responses to specific malaria antigens in children, and quantified temporal variation within individuals of total IgG responses.

METHODS

Total IgG responses against schizont extract, merozoite surface protein-1, merozoite surface protein-2, ring-infected erythrocyte surface antigen, and SPf66 were measured by ELISA. Variance component analysis was used to estimate the variation explained by genetic and environmental factors in these antibody responses. Intra- and inter-class correlations of antibody responses within relative pairs were estimated. We adjusted for age, P. falciparum density, sex and village differences either within or prior to the analysis.

RESULTS

For all malaria antigens, temporal variation in the total IgG response was the predominant source of variation. There was substantial familial aggregation of all IgG responses, but it remained unclear how much this clustering was attributable to genetic factors and how much to a common environment in the household. The remaining variance, which could not be explained by either of the above, was very small for most of the antigens.

CONCLUSIONS

Temporal variation and clustering of immune responses to specific malaria antigens need to be taken into account when planning, conducting and interpreting immuno-epidemiological and vaccine studies.

Humoral immunity status in neonates born to pre-eclamptic toxaemia mothers

A prospective study on 90 neonates born to age matched normal mothers (set I) and mothers (set II) with pre-eclamptic toxaemia (PET) was undertaken to assess and compare the humoral immunity status of the neonates. All of them had normal vaginal delivery. IgG, IgA and IgM were estimated by radial immunodiffusion technique from cord blood of neonates. It was observed that IgA and IgM levels were insignificant in the cord blood. IgG level was low in normal birth weight (NBW) neonates born to PET mothers, when compared to that of NBW neonates born to normal mothers. Again low birth weight (LBW) babies of both the sets showed lower values of IgG than that of NBW babies. Apgar scoring showed direct relationship with IgG levels e.g., higher the Apgar score higher the level of IgG. Thus the IgG level was directly related to the birth weight of the neonates of the respective sets as well as with the Apgar scoring of the neonates.

Brazilian report on primary immunodeficiencies in children: 166 cases studied over a follow-up time of 15 years

One hundred sixty-six cases of primary immunodeficiency diseases (PID) (95 males, 71 females), diagnosed according to WHO criteria, have been registered at the Children's Hospital, University of São Paulo, Brazil. The following frequencies were found: predominantly humoral defects, 60.8% (n = 101); T cell defects, 4.9% (n = 8); combined ID, 9.6% (n = 16); phagocyte disorders, 18.7% (n = 31); and complement deficiencies, 6% (n = 10). IgA deficiency was the most frequent disorder (n = 60), followed by transient hypogammaglobulinemia (n = 14), chronic granulomatous disease (n = 14), and X-linked agammaglobulinemia (n = 9). In comparison to other (national) reports, we observed higher relative frequencies of phagocyte and complement deficiencies. Recurrent infections were the cause of death in 12.7%. Allergic symptoms were observed in 41%, mainly in IgA-deficient, hypogammaglobulinemic, or hyper-IgE patients, and autoimmune disorders in 5%, predominantly in IgA and complement deficiencies. Five patients suffered from BCG dissemination; two of them died. This is the first Brazilian report on PID over an observation time of 15 years.

Immunohaematological findings in healthy and HIV-1 infected adults in Dar es Salaam, Tanzania

In order to assess the prognostic value of lymphocyte subsets and immune activation markers in HIV-1 infected Tanzanian patients, peripheral white blood cell(WBC) count, total lymphocytes, CD4+ and CD8+ T-lymphocytes and Beta-2 microglobulin (B-2M) concentrations were determined among healthy HIV-1 seronegative Tanzanian blood donors and in infected Tanzania individuals in different clinical stages of HIV-1 infection. CD4+ T-lymphocytes, CD8+ T-lymphocyte percentages, CD4:CD8 lymphocyte ratios and the concentrations of B-2M were strongly correlated with the clinical stages of HIV-1 infection. These results suggest that B-2M could be a useful prognostic marker in HIV-1 infection in settings where T-lymphocyte subset determinations cannot be done.

Serum immunoglobulin levels during contraceptive use of depot-medroxyprogesterone acetate in Indian women: a preliminary study

This study was conducted to determine the effect of depot-medroxyprogesterone acetate (DMPA) as a contraceptive on levels of serum immunoglobulins, total protein and albumin in Indian users. The recommended dose of 150 mg of DMPA by deep intramuscular injection was given to twenty parous women. Levels of serum immunoglobulins, total protein and albumin were measured prior to, and at one and three months after the injection. The levels of total protein and albumin remained unaffected. No significant changes were observed in the levels of IgA and IgM. IgG levels were increased in the first and third month after DMPA injection, and the increase in the first month was statistically significant (p = 0.019). While the serum levels of IgA, IgM, total protein and albumin were unaffected, the raised levels of IgG were indicative of improved humoral immunity in Indian DMPA users.

Comparative study of immunoglobulin G and immunoglobulin M among neonates in caesarean section and vaginal delivery

The present study comprised 50 cases of normal vaginal delivery and 50 cases of caesarean section. The cord blood level of immunoglobulin G was significantly higher in normal vaginal delivery cases than in caesarean section cases (mean level is 1653.2 +/- 443.1 mg/dl and 898.3 +/- 415.6 mg/dl respectively). The immunoglobulin G was low in cord blood but had higher concentration in all the 7 cases in study group who had fever with rigor in antenatal period. Thus the babies delivered with caesarean section had lower immunoglobulin level than normal vaginal delivery.

Safety and immunogenicity of oral killed whole cell recombinant B subunit cholera vaccine in Barranquilla, Colombia

In January and February 1992, an assessment was conducted of the safety and immunogenicity of two doses of a new oral cholera vaccine prepared from the recombinant B subunit of the toxin and from killed whole cells (rBS/WC) in 1,165 individuals between the ages of 12 months and 64 years in Barranquilla, Colombia. This was a randomized, double-blind placebo-controlled study. Participants received two doses of either the vaccine or a placebo (killed Escherichia coli K12) over a two-week interval. Few symptoms were detected during the three days following administration of the initial dose and even fewer following the second. Sera obtained upon administration of the first dose and two weeks after administration of the second were tested for Vibrio cholerae 01 Inaba vibriocidal antibodies and antitoxins. Geometric mean titers (GMT) of vibriocidal antibodies were found to increase two-fold in subjects receiving the vaccine. In the paired samples taken from vaccinated subjects, two-fold or greater increases were observed in 44% and four-fold or greater increases were observed in 34%, as compared to similar increases in 9.2% and 2.2% of the sera taken from those receiving the placebo (P < 0.05). The GMTs of IgG and IgA antitoxins, as determined by ELISA, increased by factors of 4 and 3.2, respectively, in those receiving the vaccine, as compared to factors of 1.1 and 1.1 in those given the placebo (P < 0.001 for IgG, P < 0.01 for IgA). Approximately 80% of the paired samples from the vaccinated group showed an increase of both IgG and IgA antitoxins > or = 1.5, as compared to only about 20% of those in the placebo group (P < 0.000001). Belonging to the O blood group did not significantly affect the immune response. Children under age four tended to show a weaker vibriocidal antibody response and a stronger antitoxin response than older subjects. The two doses of oral vaccine were found to be safe and without attributable side-effects. The vibriocidal antibody and antitoxin responses were similar to those obtained previously with the conventional oral killed whole cell B subunit cholera vaccine.

Immuno-epidemiology of Schistosoma mansoni infections in a recently exposed community in Senegal

Schistosoma mansoni was introduced in the Senegal basin around 1988, due to man-made ecological changes. Since 1991, we investigate a recent but very intense focus, Ndombo, a village near the city of Richard Toll where the outbreak was first described. Four cohorts, each a random sample (+/- 400 subjects each) from this community, were examined and followed up after treatment, starting at 8 month intervals over a 2-year period. Each cohort is examined parasitologically (Kato-Katz), clinically, serologically (circulating antigen and antibody profiles); treated with praziquantel 40 mg/kg; followed up 6-10 weeks, one and two years after treatment; and monitored for water contact patterns and local snail densities. In the first cohort, the prevalence was 91%, with a mean egg count of 663 epg. Prevalences are near 100% in all age groups, but egg counts decline strongly in adults. Antigen detection in serum and urine confirmed that the egg counts genuinely reflect variations of worm burdens, not e.g. of worm fecundity. This is surprising, as in this focus acquired immunity in adults should not have yet developed according to current hypothesis. The antigen detection assays (CAA/CCA) showed high sensitivity and quantitative power, and promising perspectives as a research tool and possibly as a method for non-invasive diagnosis and screening in urine. Epidemiological in subsequent cohorts were highly similar, although seasonal variations were observed possibly due to transmission fluctuations. Anti-AWA and anti-SEA IgE levels increased with age, while IgG4 peaked in the age-group 10 years and correlated well with egg counts.(ABSTRACT TRUNCATED AT 250 WORDS)

IgG2 associated hypergammaglobulinaemia in some Nigerians with HIV infection

Concentrations of immunoglobulins (IgA, IgG and IgM) were measured in Nigerians with (HIV) infection. Considerable elevations up to two-fold the reference values were observed for IgG and IgM in the patient group as a whole but elevations in IgA concentration were least marked albeit significantly different from the healthy subjects. Elevation of a particular isotype was not always concomitant with elevation of the other major classes in the same patient. Overall, these elevations were observed in both symptomatic and asymptomatic infected subjects. Further analysis of IgG hyperglobulinemia showed that increases in this major class may be due to increased IgG2 subclass concentrations. It is suggested that elevation of IgG2 subclass in Nigerians with HIV infection and not IgG1 or IgG3 may be due to genetic and environmental factors rather than variation in the strain of the virus.

[Allergy to latex: an underestimated problem]

Three patients who showed an allergic reaction to latex products are described. By means of history, skin tests, measurement of IgE antibodies against latex and challenge tests the diagnosis could be established. To prevent the spread of infectious diseases the use of latex gloves and condoms is increasing. Therefore, the incidence of allergic reactions to latex may also rise. Latex allergy should be considered when evaluating 'idiopathic' anaphylaxis during an operation. Moreover, latex allergy may be the cause of occupational rhinitis and asthma.

Humoral aspects of anti-HIV immune responses in Zairians with AIDS: lower antigenemia does not correlate with immune complex levels

Serological patterns of anti-HIV immune responses of 150 HIV-infected (65 asymptomatic, 19 ARC, 66 AIDS) and 150 HIV-negative healthy Zairians were studied to determine the clinical significance of p24 antigen, and anti-p24 antibody, particularly in relation to p24 relative binding capacity (RBC) and circulating immune complexes (CICs). Levels of p24 antigen, anti-p24 antibody titers, and p24 RBC were evaluated by means of enzyme-linked immunosorbent assay (ELISA). Circulating immune complexes were measured by C1q-binding assay. Human immunodeficiency virus CICs were detected by polyethylene glycol (PEG) precipitation followed by 6 M guanidinium lysis, ELISA, Western blot, or radioimmunoprecipitation of the lysed precipitates. Immunoglobulin levels for IgG, IgM, IgA, and beta 2-microglobulin (beta 2-M) were quantified in all study participants by laser nephelometry and ELISA. All immunoglobulin levels were significantly elevated among HIV-positive vs. HIV-negative individuals. Immunoglobulin levels correlated well with disease progression among infected patients. Similarly, beta 2-M levels were significantly higher in HIV-positive vs. HIV-negative individuals and correlated well with progression to AIDS. Free p24 antigen in serum was detected in 1.33% of all patients. However, p24 reactivity increased to 6% (9 of 150 cases) after PEG precipitation and CIC dissociation. There was a good correlation between p24 reactivity and disease development. High titers of anti-p24 antibody (> 44,100) occurred in at least 80% of all patients, and did not correlate with disease stage. Similarly, more than 60% of patients had high levels of p24 RBC.(ABSTRACT TRUNCATED AT 250 WORDS)

Severe vitamin A deficiency in a rural village in the Hararge region of Ethiopia

A total of 240 children were examined for vitamin A deficiency in a village in Hararge region of Ethiopia. Night blindness, Bitot's spots, corneal xerosis, corneal ulceration and corneal scars were observed in 69, 16, 2, 15 and 14 children, respectively, based on the most severe eye signs. Blood was collected from 76 children with eye signs and 9 other children selected at random. The concentration of retinol (vitamin A) in serum was < 0.35 mumol/l in 30.2% of children and the median serum retinol-binding protein, iron, transferrin saturation and ferritin levels were low while the parameters of iodine status, total triiodothyronine, total thyroxine and thyrotropin, were all within the normal range. Levels of IgG and IgM were elevated in 78.8% and 82.4% children, respectively, while C-reactive protein levels were elevated in 42.4% of children. There was a higher prevalence of wasting (33%) than stunting (10%) with an additional 8% of children being both stunted and wasted. In the 2 years prior to the study, there were 74 deaths of which 17 were reported to be associated with ruptured corneas. The community had been dependent on relief food aid for the previous 6 years.

[Immunologic profile of HIV-2 seropositive African individuals (follow-up)]

In the geographic distribution of HIV-2, it is known that this infection is most prevalent in West Africa. Since 1986 we have studied seropositive and seronegative clusters, in Guinea-Bissau with follow-ups in 1988, 1989, 1990 and 1991. Analysis of the results show the high incidence of this infection. 8.51% of the 4,372 people of the general population studied were seropositive, showing the high predominance of HIV-2 infection. Only 4 cases were exclusively reactive to HIV-1 and a slow evolution of HIV-1 infections. In the seroconversions of HIV-2 infections the antibodies appeared first to the core components and secondly to the surface glycoproteins. Some of the laboratory parameters affected in the evolution of the infection include a gradual increase in immunoglobulins and a decrease in CD4 lymphocytes and in the CD4/CD8 ratio. A comparison of these variations in HIV-2 infected people, with or without cross-reactivity to HIV-1, reveals that they are much more evident in exclusively HIV-2 positive people. This fact can indicate that the variants responsible for the cross-reactions are less pathogenic and phylogenetically less developed.

Idiometric assay, the third way: a noncompetitive immunoassay for small molecules

A novel, noncompetitive immunoassay applicable to the measurement of small molecules including ovarian steroids is described. Using monoclonal antibodies with the ability to recognize both beta-typic and alpha-typic binding sites, a new simplified, sensitive, and specific immunoassay system has been developed. The initial work of this development is presented, along with preliminary results for a novel immunoassay for estradiol.

Prevalence of Giardia lamblia antibodies in serum and milk in lactating women from different social classes in Egypt

Prevalence and levels of systemic and milk antibodies to G. lamblia in the different social classes of the population were studied using the IFAT and nor-partigen immunoglobulin plates. Blood and milk samples were collected simultaneously from lactating women in urban (Cairo) and rural (Benha) areas. Serum IgG was present in 90% of rural low standard mothers, 58% of urban moderate standard mothers, and 25% or urban high standard mothers (P less than 0.01, P less than 0.001 and P less than 0.01). Antilog of mean of antibody titers was significantly higher in the low standard rural mothers than in the urban moderate and high standard ones. Specific secretory IgA antibody in milk was found in 71% of rural low standard mothers, 31% of urban moderate standard mothers, and 16.6% of urban high standard mothers (P less than 0.001, P less than 0.01 and P greater than 0.05). The antilog of mean S-IgA titers was also higher in the low standard rural mothers. The titer levels of S-IgA in the three classes did not show any correlation with the quantitative levels of total IgA in milk, while specific IgG showed a positive correlation with the total serum IgG in the low standard rural mothers only (P less than 0.05). This study documented the widely different antibody response to G. lamblia in individuals living in different social classes.

Impaired cell-mediated immunity in Papua New Guinean infants

Immune function was studied in Papua New Guinea highland infants with pneumonia, healthy highland controls and expatriate controls under the age of 15 months. Delayed-type hypersensitivity to tuberculin was depressed in highland pneumonia patients and highland controls as were CD4/CD8 T-lymphocyte ratios. The differences between highland and expatriate infants were more pronounced after 6 months of age, suggesting an environmental effect. Serum immunoglobulin and complement concentrations were higher in highland infants than in expatriate controls. Indices of nutritional status were similar in highland and expatriate infants but iron deficiency was more common in the highland infants in the study.

Infection with Pneumocystis carinii is prevalent in healthy Gambian children

Pneumocystis pneumonia is rarely identified in the many immunosuppressed individuals with acquired immune deficiency syndrome (AIDS) and malnutrition in Africa. To test whether infection with Pneumocystis carinii occurs in the continent we conducted a comparative serological study, measuring by enzyme-linked immunosorbent assay antibodies to the parasite in 150 healthy young individuals from both Britain and the Gambian savanna. The prevalence of significant titres of antibody to P. carinii steadily increased with age and included more than 70% of both populations by 8 years of age. Infection with P. carinii is, therefore, common in the Gambia. Thus opportunistic pneumocystis pneumonia may be an important but largely unrecognized disease in the continent, though its impact is probably diminished by the prevalence of fatal tuberculous infection, particularly in the AIDS population.

Immunological status of women with prolonged oral contraceptives and occurrence of giardiasis

Immunological status of 14 women taking oral contraceptive for prolonged period (more than 6 months, low dose pill) was studied. Phytohaemagglutinin induced lymphocytes stimulation (PILT) was found to be significantly depressed in these subjects though T-lymphocyte subpopulation was found to be normal. Serum IgA and IgG levels in these cases were found to be normal but IgM level was increased. Though incidence of G lamblia infection was reported to be high in immunocompromised subjects, it was found only one out of 14 subjects taking oral contraceptive harboured the protozoa.

Humoral immunity in oral contraceptive users. II. In vitro immunoglobulin production

The worldwide acceptance of steroid-based oral contraception makes it imperative that the effect of these agents on the immune system is understood. Nevertheless, information regarding the effect of steroid-based oral contraception on humoral immunoregulation is limited. In this report the in vitro production of IgG and IgM is measured following stimulation with either the T-dependent activator pokeweed mitogen (PWM) or the T-independent activator fixed/killed Staphylococcus aureus Cowan I (StaCw). No significant differences are observed between the in vitro IgG or IgM levels following stimulation with PWM or StaCw for females taking steroid-based oral contraceptives and females not taking steroid-based oral contraceptives. We conclude that humoral immunoregulation is unaltered in steroid-based oral contraceptive users.

Humoral immunity in oral contraceptive users. I. Plasma immunoglobulin levels

The worldwide acceptance of steroid-based oral contraception makes it imperative that the effect of these agents on the immune system is understood. Nevertheless, information regarding the effect of steroid-based oral contraception on plasma immunoglobulin (Ig) levels is often conflicting. In this report immunoglobulin levels in the plasma of females taking steroid-based oral contraceptives are measured in a novel manner using an enzyme-linked immunosorbent assay (ELISA). No significant alterations in the levels of IgG or IgM are reported.

In-vitro production of HIV-specific antibody in children at risk of AIDS

To improve on the early diagnosis of human immunodeficiency virus (HIV) infection, 37 children born to HIV-infected mothers and 22 controls were investigated for in-vitro synthesis of IgG antibody directed against HIV components. For 14 of 16 infected children western blot showed HIV-specific IgG in the supernatants of cultures of their peripheral blood lymphocyte cultures. HIV-specific IgG synthesis was detected in cultures from 4 out of 17 seropositive children aged under 15 months with no clinical or laboratory evidence of infection. No HIV-specific IgG production was observed in cultures from 4 uninfected children or 22 controls. The results show that the demonstration of in-vitro production of HIV-specific IgG may help in the early diagnosis of HIV infection in children.

The incidence of fetomaternal haemorrhage following elective termination of first-trimester pregnancy

Alphafetoprotein (AFP) levels were determined in 62 patients undergoing termination of first-trimester pregnancy in order to ascertain the incidence of fetomaternal haemorrhage. The apparent frequency of this phenomenon (58%) was higher than that previously reported. There was no evidence of fetomaternal haemorrhage associated with simple bimanual examination.

Proliferative and secretory activity in human breast during natural and artificial menstrual cycles

Events of cell proliferation have been assessed by thymidine labeling index (TLI) in morphologically normal breast lobules from women of reproductive age. TLI is higher during the second half of the menstrual cycle both in women with natural menstrual cycles and in those with artificial cycles due to oral contraceptive (OC) use. TLI varies between 0.04% and 5.7% and declines with increasing age. There is no difference in mean TLI between OC users and nonusers if correction is made for the difference in age distribution between these two groups. Immunohistochemical detection of immunoglobulin A (IgA), secretory component (SC), and alpha-lactalbumin shows more frequent positive staining during artificial than natural menstrual cycles, and positive staining tends to be associated with higher TLI values. No significant variation in staining with cycle phase is detected in natural or artificial cycles. These results show that breast tissue does not resemble endometrium in the relationships that exist between proliferation, secretion, and menstrual cycle phase.

Syphilis in women of reproductive age in Mogadishu, Somalia: serological survey

In Mogadishu, Somalia 223 women of childbearing age, including prostitutes, were tested for serum markers for syphilis by the Venereal Disease Research Laboratory (VDRL) test and the Treponema pallidum haemagglutination assay (TPHA). Sera reactive in either of these tests were tested for IgM antibodies by solid phase haemadsorption assay (SPHA). Three per cent of sera from 67 pregnant women and none of those from 71 educated women gave positive results that were confirmed with the TPHA. In contrast, 58% of sera from 85 prostitutes were confirmed as being positive, 26% of which were SPHA positive, which indicated active syphilis. The proportion of TPHA positive sera increased with age among the prostitutes. As venereal syphilis is highly prevalent in prostitutes in Mogadishu, a strategy of intervention based on screening followed by treatment seems to be indispensable.

Serum concentrations of immunoglobulins and complement components in women using an intra-uterine contraceptive device (IUCD)

Immunoglobulins A, G and M and the complement components C3, C4 and CI-INH were quantified in sera from 59 women using an intra-uterine contraceptive device (IUCD). Most of the women were using a Cu IUCD, and the mean duration of use was 7.3 years. No differences in the concentrations were detected compared with control subjects. Our data, however, do not exclude a possible temporary change in the concentrations of immunoglobulins and complement components.

Intra-blood-brain-barrier synthesis of HTLV-III-specific IgG in patients with neurologic symptoms associated with AIDS or AIDS-related complex

Intra-blood-brain-barrier production of virus-specific antibody is good evidence of infection within the blood-brain barrier. Patients with the acquired immuno-deficiency syndrome (AIDS) have an increased incidence of neurologic abnormalities--i.e., unexplained, diffuse encephalopathy manifested clinically as chronic progressive dementia. To define the role of human T-cell lymphotropic virus Type III (HTLV-III), the etiologic agent of AIDS, in the pathogenesis of neurologic dysfunction, we compared cerebrospinal fluid and serum from patients with neurologic symptoms associated with AIDS and the AIDS-related complex for the presence of antibodies directed against HTLV-III. Antibodies directed against HTLV-III antigens were detected by four immunologic tests: a fixed-cell immunofluorescence assay, an enzyme-linked immunosorbent assay, immunoblots of viral lysates, and immunoprecipitation of cellular lysates. All patients were seropositive, and 22 of 23 (96 per cent) had HTLV-III-specific antibodies in their cerebrospinal fluid. Unique oligoclonal IgG bands were detected in the cerebrospinal fluid, and the rate of IgG synthesis within the blood-brain barrier was elevated. In eight of nine patients tested, the enzyme-linked immunosorbent assay showed that the percentage of HTLV-III-specific IgG in cerebrospinal fluid was higher than in serum, suggesting that HTLV-III infection of neurologic tissue occurs in the majority of patients with neurologic disease associated with AIDS or its related complex.

Immunopathogenesis of the acquired immunodeficiency syndrome

Many abnormalities of humoral and cellular immunity associated with the acquired immunodeficiency syndrome can be explained by the preferential infection of the T4 lymphocyte subset with the etiologic retrovirus. Severe alterations in specific T4 functions, such as inadequate immune responsiveness to specific antigen, result in devastating morbidity and mortality. On the basis of accumulated scientific knowledge, we outline the immunopathogenesis of this syndrome.

The acquired immunodeficiency syndrome in infants and children

The classification of the pediatric acquired immunodeficiency syndrome (AIDS) is based on epidemiologic, immunologic, and virologic data. Persons at risk include mothers who use intravenous drugs, infants who have received blood transfusions from subjects with risk factors, patients receiving factor VIII therapy, and infants born to heterosexual mothers with bisexual husbands. A distinct immunologic phenotype, rarely seen in other immunodeficiency disorders, is associated with pediatric AIDS consisting of polyclonal hypergammaglobulinemia and T-cell immunodeficiency. Detection of antibody to the AIDS retrovirus or isolation of virus are essential in establishing a diagnosis. During early infancy, viral isolation is essential as passive transfer of material IgG may occur. Primary immunodeficiency diseases, in particular adenosine deaminase and purine nucleoside phosphorylase deficiency, should be excluded. A diagnosis of pediatric AIDS may be established in a patient who has a risk factor associated with AIDS, polyclonal hypergammaglobulinemia, T-cell immunodeficiency, and antibody to the AIDS retrovirus or isolation of virus.

Defective humoral immunity in pediatric acquired immune deficiency syndrome

Specific antibody production was assessed in six young children with the acquired immune deficiency syndrome (AIDS). All patients were immunized with bacteriophage phi X 174, a T cell-dependent neoantigen. In addition, antibody responses to pneumococcal vaccine and tetanus toxoid, lymphocyte responses to mitogens, and serum immunoglobulin levels were determined. Polyclonal hypergammaglobulinemia was documented in three patients. Responses to bacteriophage phi X 174 were abnormal in all patients: primary responses were blunted, secondary responses were markedly decreased, and the class switch (IgM-IgG) was absent in five of six patients. Antibody formation to pneumococcal vaccine and tetanus toxoid was also diminished. Lymphocyte mitogenic responses to phytohemagglutinin, concanavalin A, pokeweed mitogen, and staphylococcal Cowan A were generally decreased. These findings confirm that pediatric patients with AIDS have significant abnormalities in humoral immunity. Dysfunction of both T cells and B cells plays a role in the resultant poor specific antibody production.

Effect of early postpartum use of the contraceptive implants, NORPLANT, on the serum levels of immunoglobulins of the mothers and their breastfed infants

Ten breastfeeding women had the contraceptive implants NORPLANT inserted between days 30 and 39 postpartum. The immunoglobulins IgG, IgM and IgA were measured in the serum of the mothers and the infants before insertion and five months later. A control group of breastfeeding mothers who did not use any contraception or used local barrier methods were similarly studied. Although there were changes in the immunoglobulin levels with time in both mothers and infants, there were no group differences; this indicates that the use of NORPLANT does not influence these factors of humoral immunity.

Immunoglobulin levels in the serum and cervical mucus of tailed copper IUD users

Immunoglobulin levels were measured by agar gel single radial immunodiffusion in the serum and cervical mucus of 50 tailed copper IUD users, 20 combined oral contraceptive users and 20 women not using contraception (controls). IgG, IgA and IgM levels were significantly higher in the copper IUD users compared to the other two groups. It is not known whether this was related to the small numbers of bacteria found in the uterine cavity of tailed IUD users or to the foreign body reaction of the device.

The clinical relevance of classes of immunoglobulins on spermatozoa from infertile and vasovasostomized males

Following reversal of vasectomy, conceptions occur even when antisperm antibodies are present in the seminal plasma, but this is most unusual in men with similar titers of such antibodies who are spontaneously infertile. To clarify the differences between antisperm antibodies occurring in infertile men and those associated with vasectomy reversal, we have studied 23 spontaneously infertile men and 22 men who underwent vasectomy reversal, all of whom had antisperm antibodies detected in seminal plasma by the same tray agglutination test. The class of antibody on spermatozoa was defined by a double-antibody technique using diluted rabbit anti-human IgG, IgM, or IgA or secretory component, followed, after washing, by 125I-labeled donkey anti-rabbit Ig. The results have shown that similar amounts of IgG and IgM were present on the spermatozoa, but infertile men had significantly more IgA and especially more secretory component than men who underwent vasectomy reversal. This was associated with significantly greater impairment of penetration of cervical mucus in the former group. It appears that the type of antibody on the spermatozoa may vary according to the stimulus for its production.

Human antisperm monoclonal antibodies constructed postvasectomy

Sperm and spermatogenic cell antigens, escaping the blood-testis/blood-epididymal barrier, elicit an autoimmune response in patients following vasectomy. In this study, antisperm antibody-positive sera and peripheral blood lymphocytes were obtained 6-9 mo following vasectomy. Serum antisperm antibody levels were assessed by enzyme-linked immunosorbent assay (ELISA) and indirect immunofluorescence. Lymphocyte-myeloma hybridomas were constructed by fusing peripheral blood lymphocytes, harvested from antisperm antibody-positive sera, with a hypoxanthine guanine-phosphoribosyltransferase (HGPRT)-negative mouse myeloma line. Immunoglobulin-secreting colonies surviving drug selection were detected by ELISA and screened for antisperm activity. Antisperm antibody-producing cultures were cloned and expanded for bulk antibody production both in culture and as ascites in athymic nude mice. Eight mouse-human fusions yielded 205 hybridomas secreting human monoclonal antibody, of which 11 demonstrated antisperm reactivity by ELISA. Two of these hybridomas are described in detail: HAS-1, which secretes human immunoglobulin M (IgM, kappa)-recognizing epitopes located on the sperm midpiece, and HAS-2 (IgM, lambda), which secretes monoclonal antibody-recognizing epitopes located on the entire sperm tail. The results indicate successful capture of human antisperm autoantibody from the postvasectomy autoimmune state using somatic cell hybridization techniques.

Use of interleukin-2 in patients with acquired immunodeficiency syndrome

Twelve patients with acquired immunodeficiency syndrome were treated with a natural product, highly purified human interleukin-2. Doses ranged from 250 to 250,000 units. No clinical responses were seen. Minimal toxicity was noted and consisted of mild prolongation of partial thromboplastin time and proteinuria. Immunologic changes during the study included a decrease in the number of circulating T8 lymphocytes, increased skin test reactivity, and a decline in serum immunoglobulin levels.

Thrombin inhibitors in women on oral contraceptives

Progressive antithrombin activity and the immunological levels of antithrombin III, alpha 2-macroglobulin, and alpha 1-antitrypsin were measured in women at various intervals during treatment with oral contraceptives and in a group of untreated women. No significant changes were observed in any of the above parameters. In both control and treated women, there was a positive statistical correlation between progressive antithrombin activity and antithrombin III immunological levels, whereas no correlation was found between the former and alpha 1-antitrypsin or alpha 2-macroglobulin immunological levels. This study questions the possibility of thrombin inhibitors being selective signs of hypercoagulability during treatment with oral contraceptives.