[Transforming growth factor-beta 1 as a marker in patients with operable breast cancer]

OBJECTIVE AND DESIGN OF STUDY: Determination of TGF-beta 1 levels in plasma of patients with operable breast cancer. The correlation of TGF levels with the stage of disease and other prognostic markers. Prospective study.

METHODS

There were 36 patients fulfilling the entrance criteria included in the study. The blood samples were taken to set the plasma levels of TGF-beta before the operation, with no adjuvant therapy. 27 age matched healthy volunteers served as controls. The study was approved by ethical board and patients signed informed consent regarding blood sampling and results presentation. Differences between groups were determined using the Mann-Whitney U-test.

RESULTS

We proved that TGF-beta 1 levels are elevated in patients with operable breast cancer. Moreover, TGF-beta in plasma of patients with positive sentinel lymph node was significantly higher as compared to patients with negative sentinel node. Most important is the fact that patients involved in our study were in very early stages of disease.

CONCLUSION

TGF-beta 1 is marker correlating with breast cancer disease risk factors, especially with positive sentinel lymph node. We conclude that TGF is one of the early markers which may help define the risk of disease progression already before the operation.

[Role of intestine in immunity mechanisms]

The intestinal mucosa represents important primary interface with the external environment. The mucosal immunity posses the ability to differentiate between non-pathogenic microbial agents (non-inflammatory immune reaction) and pathogens (inflammatory immune response). The defence mechanisms of intestinal mucosa due to extensive nonadaptive and adaptive immune reactions facilitate both inductive and effector side of immune response. The oral tolerance is dependent on the mucous intestinal immunity and modulates the systemic immune reactivity.

[Antibodies against low density oxidized lipoproteins in type 2 diabetics]

Oxidative modification of low density lipoproteins (LDL) is an important factor in the development of macrovascular atherosclerotic complications in patiens with type 2 diabetes mellitus. Recently autoantibodies against oxidized LDL (anti-oxLDL) have been suggested as a potential marker of LDL oxidation in vivo. The purpose of this study was to investigate the presence and levels of anti-oxLDL in patients with type 2 diabetes compared to healthy persons. We determined the serum concentrations of anti-oxLDL in 20 type 2 diabetic patiens with different degree and type of atherosclerotic vascular damage. Two healthy population groups: 20 young blood donors and 20 age and gender matched persons were used as controls. Anti-oxLDL positivity rates were distinctively higher in both control groups. Concentrations of anti-oxLDL were significantly lower in diabetic patients compared to both control groups. The incidence rates and levels of anti-oxLDL in both control groups were similar. Anti-oxLDL levels in the diabetes group did not correlate with the degree of macrovascular damage, serum total cholesterol, LDL cholesterol and triglyceride concentrations. We did not find any significant relationship between anti-oxLDL and other oxidative stress factors (superoxide dismutase, malondialdehyde, C and E vitamins). We suppose that anti-oxLDL may have an antiatherogenic protective role in healthy people but are not applicable to be an in vivo marker of LDL oxidation and macrovascular atherosclerotic vascular damage.

[Endothelial, phospholipid and oxidized LDL antibodies in patients with endogenous hypercortisolism]

Antiphospholipid (APLA), antiendothelial (AECA) and anti-oxidized LDL (anti-oxLDL) autoantibodies are found in vascular disorders. Pathogenetic contingency of atherosclerosis and these autoantibodies is still discussed, the mechanisms of their action in atherogenesis are not quite clear so far. Patients in various stages of endogenous hypercorticism as a model of accelerated atherosclerosis were investigated. We have sought possible correlations between autoantibodies and parameters of atherosclerosis with regard to the influence of endogenous hypercorticism on the inflammation. Low titres of autoantibodies in patients with active forms of disease result from the immunosuppressive effect of steroids. None of investigated group had high titres of APLA. No differences were found in AECA occurrence. No correlation of APLA, anti-oxLDL nor AECA with urinary free cortisol and plasma cortisol was found. There were no significant differences in autoantibody titres between patients with or without carotid stenosis. These results suggest, that autoantibodies may not always influence the development and progression of atherosclerotic lesions.

[Detection of the production of intracellular cytokines by T lymphocytes using flow cytometry--methodologic problems]

The method of assessment of intracellular proteins by means of flow cytometry makes it possible to evaluate the production of different cytokines by a clearly defined cell (sub-population type, state of cell activation). If the method should become a routine functional test, it must be standardized. This was the objective of our work when, based on data in the literature, we detected all controversial points and investigated them experimentally. Quite unequivocally we can recommend only sodium heparin as an anticoagulation agent when examining whole blood. The paper solves problems regarding the selection of mitogens where the marked effect of the use of mitogens on the result and necessity to compare results obtained under equal conditions was demonstrated. The authors tested also the possibility of preserving blood before processing and the selection of suitable combinations of surface signs and cytokines. When seeking the optimal time for cultivation it is necessary to make a compromise between the maximum possible production of cytokines (the kinetics of production of different cytokines is moreover different) and the accuracy of measurement because detection of the CD4 molecule after a prolonged period of stimulation deteriorates. As the optimum the authors recommend 4.5 hour cultivation with phorbol myristate acetate. The results proved a much greater capacity to retain newly formed cytokines in the cell if brefeldin A is used instead of monensine. The outcome of the work is a standard protocol for assessment of intracellular cytokines.

[Diagnostic value of determination of autoantibodies in gluten-sensitive enteropathy]

The study is focused on the immunopathological mechanisms of development of gluten-sensitive enteropathy (coeliac disease). It describes environmental factors and the role of autoantibodies and autoaggressive cells in the bowel inflammation. Attention is paid to the autoantibodies used in routine laboratory diagnosis of coeliac disease. The objective is a summary of rational diagnostic algorithms used in screening, diagnostics, treatment and dispensary care of patients with coeliac disease, especially with latent forms associated with other organ-specific immunopathological diseases. Exploration of anti-gliadin and anti-endomysial antibodies in diabetes mellitus type I were submitted. Furthermore, indications of these tests in the routine laboratory practice was analyzed.

The serologic screening for celiac disease in the general population (blood donors) and in some high-risk groups of adults (patients with autoimmune diseases, osteoporosis and infertility) in the Czech republic

The prevalence of celiac disease (CD) was determined in healthy blood donors and in high-risk groups of adults (a total of 1835 adults--randomly selected 1312 healthy blood donors, 102 patients with primary osteoporosis, 58 patients with autoimmune diseases and 365 infertile women). It was calculated on the basis of a two-step serologic screening method--in the first step IgA and IgG antigliadin antibodies (AGA) and IgA anti-gamma-glutamyltransferase ('transglutaminase') antibodies (ATG) were estimated, in the second step sera positive for IgA AGA and/or IgA ATG were examined for antiendomysial IgA (AEA) antibodies. Immunoenzymic assay (ELISA) was used for determining of AGA and ATG antibodies; immunofluorescence method, performed on human umbilical cord tissue, was used for assaying of AEA antibodies. Total serum IgA level in only IgG AGA positive subjects was measured by routine turbidimetric method. 0.45% of healthy blood donors, 0.98% of osteoporotic patients, 2.7% of patients suffering from autoimmune disease and 1.13% of women with infertility considered as immunologically mediated were found to be positive in both steps of serologic screening (AGA and/or ATG and antiendomysium positive). The presumed high prevalence of seropositivity for CD in apparently healthy Czech adult population was confirmed. In the high-risk groups, the prevalence of seropositivity for CD was approximately 2-4 times higher than in healthy blood donors. The real prevalence of CD in the tested groups, however, can be estimated after performing small intestinal biopsy in the seropositive patients.

[The antiphospholipid syndrome and antiphospholipid antibodies]

Antiphospholipid syndrome is a rate systemic autoimmune disease characterized by widespread arterial and venous thrombosis, recurrent abortion and thrombocytopenia. Laboratory tests reveal antibodies against phospholipids. These antibodies are detected by functional tests for the lupus anticoagulant, the anticardiolipin ELISA, the anti-beta 2-glycoprotein 1 ELISA and ELISA tests for antibodies against other cofactors and phospholipids. Pathogenetic mechanisms of thrombosis are poorly understood. Diagnostic assays for detection of antiphospholipid have not been yet adequately standardized.

[Initial experience with detection of Saccharomyces cerevisiae antibodies in patients with primary nonspecific inflammatory bowel disease]

INTRODUCTION

Inflammatory bowel diseases (IBD), with Crohn's disease (CD) and ulcerative colitis (UC) as the two main disorders, is a heterogeneous group of diseases of unknown etiology. Actually we have no ideal disease marker, to identify people at risk of the disease, which can differentiate CD from UC, be highly specific for CD or UC and easily applicable in routine laboratory praxis.

AIMS

Determine the clinical significance of serological testing p-ANCA and ASCA in patients with IBD.

METHODS

P-ANCA in IgG isotype were detected by indirect fluorescence assay on human ethanol-fixed granulocytes, ASCA antibodies in IgG and IgA isotypes were determined by ELISA with mannan as a target antigen.

RESULTS

P-ANCA and ASCA were studied in a group of 86 patients (38 CD, 26 UC, 3 non-inflammatory gastrointestinal disorder, 19 health controls). P-ANCA was associated with UC in 46%. ASCA was associated with CD in 76%. Specificity of ANCA for UC compared to healthy controls was 100%, specificity of ASCA for CD compared to healthy controls was 89.5%.

CONCLUSION

Although the sensitivity of ASCA and p-ANCA is low, their specificity is high, especially when combining these two markers. We think that combined assay for ASCA and p-ANCA is more useful in IBD.

Influence of cadmium and zinc sulphates on the function of human T lymphocytes in vitro

Substances present in our environment influence the whole organism, including the immune system. Metals are one of the principal parts of these substances. It is generally supposed that they may have stimulating effect on immunity system in low concentrations in comparison with high concentrations in which they are toxic, with variations of each metal. There are differences between for example cadmium and zinc, and cadmium is toxic in low concentrations either. The effect of cadmium on the immune system has not been studied so deeply as the influence of zinc. In our work, we are interested in the study of immunomodulation caused by cadmium in comparison with the influence of zinc. We tested the effect of cadmium and zinc sulphates on human T lymphocytes in vitro. Molar concentrations of salts used in our work were from 10(-2) M to 10(-10) M. The influence of metals on lymphocytes in cell culture was studied by the expression of surface antigen CD69, blast transformation and IL-2 and IL-4 intracellular production after 2, 24 and 72 h cultivation. Cells were analyzed by flow cytometry using monoclonal antibodies. The results show more expressive differences in blast transformation. There are stimulating effects of cadmium in concentrations 10(-3) M, 10(-4) M and 10(-8) M, and zinc 10(-3) M. The most suppressive effect is in concentrations 10(-10) M of cadmium and 10(-8) M of zinc. The highest CD69 expression is in concentrations 10(-4) M to 10(-6) M of cadmium, and 10(-3) M of zinc. There are minimal differences in intracellular cytokine production in CD4+ lymphocytes effected by various metal concentrations used and between cadmium and zinc salts after 2 hours cultivation. There is the elevation of cytokines negative cells after the cultivation lasting 24 hours. Our investigation of metals' influence by different methods shows possibilities for further research.

[The chemiluminescence test in the laboratory evaluation of effects of immunostimulatory therapy]

BACKGROUND

Number of patients treated by general practitioners with various immunomodulatory drugs has recently increased. Effects of such medication on the immune system were not usually monitored. The aim of our work was to evaluate effect of selected immunomodulatory drugs on the phagocytic and metabolic activities of the phagocytes.

METHODS AND RESULTS

51 patients (18 males and 33 females) of the average age 36 years with repeating respiratory, mycotic and herpetic infections were investigated. Immunomodulatory treatment included: Decaris (Lavamizolum), Isoprinosine (Methisoprinolum), Imudon (Lysatum bacteriale mixtum), Biostim (Klebsiella pneumoniae), and Immodin (Leukocyti dialysati lyophylysatum). Before and after treatment all patients underwent basic immunological examination IgG, IgA, IgM, C3, C4 complement components, PEG, CD3, CD4, CD8 and CD19). Phagocytotic activity was estimated by means of FAGO MSHP test with HEMA particles and by chemiluminiscence test. Chemiluminiscence was measured using ML 3000 Microtiter Plate Luminometer (Dynex), 26 healthy individuals of the corresponding age were the controls. Results were statistically evaluated by Student's t-test. Significant increase of the cellular metabolic activity was found in Decaris and Immodin treated patients (P < 0.001).

CONCLUSIONS

Chemiluminiscence test, which evaluates the metabolic activity of phagocytes, can be used for the accurate laboratory monitoring of the effects of some immunomodulatory drugs on the natural immunity of patients.

[Study of leukocyte phagocytic activity using flow cytometry and hydrophilic fluorochrome-labeled microspheric particles]

The phagocytic activity was determined in human polymorphonuclear leucocytes using the flow cytometry technique with microspheric hydrophilic particles labelled with fluorescein isothiocyanate. Non-specific adherence of particles is discussed and normal values of phagocytic activity are presented. The advantages of this method include simplified sample preparation using whole blood, rapidity of the test, precise phagocytosis quantification and possibility of archiving all findings in a computer.

[Risk factors for ischemic heart disease in patients with chronic fatigue syndrome]

Risk factors of coronary artery disease (CAD) between a group of patients suffering of chronic fatigue syndrome (CFS) and a control group of healthy persons (whose exercise activity was not health-limited) were compared. Thirty three patients (27 women, 6 men, average age 39.9 +/- 11.7 years) and the same number of controls matched in age (39.8 +/- 10.3 years), gender and body weight. The Minnesota Questionnaire (by Taylor) and the Compendium of Physical Activities (by Ainsworth) were used to estimate total energetic expenditure in exercise activity as well as in job. The risk factors of CAD in the patients with CFS were not higher than in the control group. Aerobic physical fitness, basic anthropometric data, blood pressure, spectrum of blood lipoproteins, blood uric acid and smoking habits were not different between the compared groups. Patients suffering from CFS had lower total energetic expenditure in exercise activity. Nevertheless, this significant difference in sports activity was not large enough to cause any difference in risk factors of CAD between the CFS patients and the control group.

[The fatigue syndrome in autoimmune thyroiditis with polyglandular activation of autoimmunity]

The authors compared in a group of 118 patients with autoimmune thyroiditis and a positive antibody titre against ovaries the grade of fatigue with the presence of organ specific and non-specific autoantibodies in the peripheral blood stream, antibodies against EBV and CMV, immunoglobulin concentrations, biochemical parameters of the lipid metabolism, glucose tolerance, ion balance and melatonin and serotonin levels. Patients with autoimmune thyroiditis were differentiated according to the degree of fatigue into three groups: 38 with fatigue typical for CFS, 30 with occasional fatigue and 50 without the feeling of fatigue. Fatigue of the CSF type was characterized by a significantly higher incidence of autoantibodies against the adrenals and a higher cholesterol level. Increased fatigue of the patients was associated with a lower melatonin level, a higher serotonin level and a lower M/S ratio as compared with patients without fatigue. In other indicators no differences were found. Fatigue in CFS could be associated, similarly as in autoimmune endocrinopathies, with impaired immunoendocrine regulation. In autoimmune thyroiditis, regardless of the concomitant presence of fatigue, in addition to antibodies against thyroid peroxidase most frequently antibodies against the ovaries were detected.

[Chronic fatigue syndrome]

A great concern is recently given to the chronic fatigue syndrome in the Czech Republic. Unfortunately, published data allow us to state neither the etiologic agent nor the pathophysiology of the disease. Although many authors published various laboratory abnormalities, these changes are inconstant and do not allow to state a diagnosis of the chronic fatigue syndrome by a single laboratory test, and effective therapy is not known either. Psychotherapy, and in some cases antidepressants, are recommended by some authors to alleviate patient's symptoms. Neither immunological nor antiviral therapy showed positive results in controlled trials and are not generally used in most centers.

[CD5-positive B lymphocytes and antinuclear antibodies]

BACKGROUND

The production of natural autoantibodies incl. antinuclear antibodies (ANA) is ascribed to lymphocytes which have a CD5 molecule on their surface. The role of CD5 positive B lymphocytes in the induction of autoimmunity is obscure so far. The authors focused their attention on the incidence of antinuclear antibodies (AA) in subjects with different diseases and sought a relationship with the ratio of CD5 positive B lymphocytes in the peripheral blood stream.

METHODS AND RESULTS

CD5 positive lymphocytes were assessed on a flow cytometer using monoclonal anti CD5 and anti CD19 antibodies. Antinuclear antibodies are detected by indirect fluorescence on a substrate of human leucocytes and HEP-2 cells. In a group of 134 subjects the authors did not provide evidence of a direct relationship between the relative number of CD5 positive B lymphocytes in the peripheral blood stream and the presence of ANA (IgG, IgA, IgM), not even in 33 patients with autoimmune diseases. In 86 patients the authors revealed that antinuclear antibodies type IgM predominate in patients with repeated respiratory infections. In systemic diseases the isotype IgG predominates (p = 0.01). After immunosuppressive treatment with a favourable clinical effect the ANA isotype IgG disappears and isotype IgM is found more frequently. The incidence of the ANA isotype IgM is significantly higher in healthy subjects aged over 60 years than in younger subjects (12.5%/6.1%, p = 0.06), and more frequent in women (p = 0.05).

CONCLUSIONS

The presence of antinuclear antibodies is not associated with the amount of CD5 positive B lymphocyte in the peripheral blood stream.

[Cytokines and adhesion molecules in renal vasculitis and lupus nephritis]

BACKGROUND

Plasma levels and urinary excretion of proinflammatory cytokines and soluble adhesion molecules may be useful parameters of the activity of ANCA-positive renal vasculitis and lupus nephritis.

METHODS AND RESULTS

Plasma levels and urinary excretion of TNF alpha, IL-6, IL-8, ICAM-1 and VCAM-1 were measured by ELISA in 14 patients (pts) with ANCA-positive renal vasculitis (8 active-ANCA-A, 6 in remission ANCA-R), 6 pts with active lupus nephritis (L.N), 15 pts with IgA nephropathy (IgAN) 10 pts with autosomal dominant polycystic kidney disease and 9 healthy subjects (Co). Fractional excretion (FE) of selected cytokines and adhesion molecules was also calculated. Pts with LN had in comparison with controls increased plasma levels of ICAM-1, VCAM-1, IL-6, IL-8 and TNF alpha, increased urinary excretion of VCAM-1, IL-8 and TNF alpha and increased fractional excretion of VCAM-1 and IL-8. Patients with ANCA-A had in comparison with controls increased plasma concentrations of ICAM-1 and VCAM-1, increased urinary excretion of VCAM-1, IL-6 and TNF alpha and increased fractional excretion of VCAM-1, IL-6, IL-8 and TNF alpha. Patients with ANCA-R had in comparison with controls higher plasma levels of ICAM-1, VCAM-1, IL-6 and TNF alpha, increased urinary excretion of VCAM-1 and TNF alpha and increased fractional excretion of VCAM-1, IL-6 and TNF alpha.

CONCLUSIONS

Patients with ANCA-positive renal vasculitis had in contradistinction to pts with active LN increased fractional excretion of IL-6 and TNF alpha. Both cytokines are probably produced in renal vasculitis locally in the kidney. Increased plasma levels of soluble adhesion molecules and increased plasma levels and fractional excretion of proinflammatory cytokines in patients with ANCA-positive renal vasculitis in clinical remission may explain the strong propensity of these patients to develop relapses of the diseases on withdrawal of immunosuppressive treatment.

[Uncertainties and the physician's responsibility in immunopathologic conditions]

Detailed clinical investigations and research revealed that immunopathological conditions are preceded by periods of varying length associated with different non-specific symptoms, sometimes also deviations in the basic and immunological laboratory examination. The progression of these symptoms can finally develop into some nosological unit of autoimmune disease. This prodromal stage is the period when irreversible damage of tissues did not yet occur and the vicious circle of the immunopathological process did not yet develop. This period is the moment when immunosuppressive treatment can prove effective. This approach is, no doubt, courageous if the patient does not meet all criteria of the pathological unit, but it is the only effective approach. Treatment started in a later stage of the disease is only a palliative approach which inhibits and retards for a certain time the manifestations of the process which is essentially incurable.

[Renal vasculitis and glomerulonephritis with anti-neutrophil cytoplasmic antibody positivity]

BACKGROUND

Anti-neutrophil cytoplasmic antibodies (ANCA) define pathogenetically related group of renal vasculitides and glomerulonephritides mostly with serious prognosis. If unrecognized, these life-threatening diseases may cause loss of independent renal function and other dangerous extrarenal complications (e. g. pulmonary haemorrhage). We concentrated on the diagnosis, treatment and log-term follow-up of these patients.

METHODS AND RESULTS

Renal biopsy was performed in 46 ANCA-positive patients. Age and sex distribution, type of ANCA, organ involvement, renal biopsy findings, renal function and effect of therapy were analyzed in these patients. Twenty three patients suffered from renal vasculitis, most commonly Wegener's granulomatosis (14 patients) and microscopic polyarthritis (7 patients). IgA nephropathy (7 patients) and idiopathic necrotizing/crescentic glomerulonephritis (8 patients) prevailed in patients with limited renal involvement. Renal morphology and function was most seriously impaired in patients with Wegener's granulomatosis. Immunosuppressive treatment was able to control the activity of the disease with the negativization of ANCA and improvement or stabilization of renal function in more than 90% of patients.CONCLUSIONS. ANCA-positive renal vasculitis and glomerulonephritis is relatively common. Clinical signs of extrarenal involvement are present in about 50% of patients with ANCA-positive glomerulonephritis. Rapidly introduced immunosuppressive treatment effectively controls renal and extrarenal manifestations of the disease.

[Diagnostic and pathogenic significance of antineutrophil cytoplasmic antibodies in vasculitides]

OBJECTIVES

The study represents a complex report on diagnostic and pathogenic significance of antineutrophil cytoplasmic autoantibodies (ANCA). Our report is founded on the results of our clinical and experimental studies.

METHODS

ANCA was examined by indirect immunofluorescence, or ELISA-anti MPO. The data for evaluation of diagnostic ANCA associations were gained by means of questionnaires. The experimental part involved examination of the impact of sera containing ANCA and monoclonal antibodies (MoAb) against proteinase 3 and control MoaB specific for neutrophils.

RESULTS

Within the course of 1 year we have examined 1010 samples, ANCA was found in 65 patients: 26 cases of systemic vasculitis, 12 cases of other autoimmune diseases, 9 cases of isolated glomerulonephritis, 7 cases of inflammatory intestinal diseases, 6 cases of ophthalmic inflammatory diseases, and 6 cases of other diseases. Vasculitis of small vessels found in our group of patients are concomitted by ANCA positivity in 90% (Wegener's granulomatosis 15/16, Churg--Strauss's syndrome 3/5, MPA 9/9), vasculitis of medium vessels 12% (classical polyarteritis nodosa 1/2, Kawasaki disease 0/2, Henoch--Schönlein's purpura 0/4, Takayasu's arteritis 1/4). The ANCA-containing sera inhibit the candidacidal activity by 65% in average. THe inhibitory impact is yielded by anti-proteinase MoAb, in contrast to the control MoAb.

CONCLUSION

c-ANCA in high concentration is specific for active form of Wegener's granulomatosis, other types of ANCA in low titres are not of diagnostic value for vasculitis. ANCA is concomitted especially by small vessels vasculitis. The proved inhibition of microbicidal PMN activity by ANCA can participate in some clinical signs of immunodeficiencies in vasculitis. (Tab. 5, Ref. 18.).

[Adhesion molecules and cytokines in vasculitides]

Renal vasculitis syndromes include particular characteristic changes in concentrations of some cytokines in plasma or urine. Preliminary results suggest that the systemic lupus erythematodes with affliction of the kidneys is specifically concomitted by the increase in IL-8, both in plasma and urine. ANCA-positive renal vasculitis syndromes appear to coincide with a typical increase in the synthesis of interleukin-6 in the kidneys. We suggest that the monitoring of individual cytokine levels in plasma and urine will enable to study in greater detail the immunopathogenesis of renal vasculitis syndromes and the extent of local production of cytokines which may cause further progression of renal lesions. (Fig. 4, Tab. 1, Ref. 10.).

Antineutrophil cytoplasmic antibody-positive sera inhibit candidacidal activity of granulocytes

Antineutrophil cytoplasmic antibodies (ANCA) are suspected of being involved in the pathogenesis of tissue injury in systemic vasculitis. We have investigated the effect of 10 sera from 8 patients with ANCA-associated diseases on the capacity of neutrophils derived from healthy persons to kill ingested Candida albicans. ANCA-containing sera inhibited candidacidal activity by 55-80% in comparison to control sera. This phenomenon could lead to the depression of antimicrobial resistance of patients with ANCA and could be involved in the pathogenesis of granuloma formation.

[Serum antineutrophil cytoplasmic antibodies inhibit the ability of granulocytes to kill C. albicans]

BACKGROUND

According to several experimental studies, antineutrophil cytoplasmic antibodies (ANCA) are involved in the pathogenesis of tissue injury in some systemic vasculitis and glomerulonephritis by stimulating oxygen radical release and secretion of lysosomal enzymes from neutrophilic granulocytes. In our work, we studied the effect of ANCA-positive sera on the ingestion and killing of C. albicans by granulocytes from healthy persons. METHODS AND RESULTS. Neutrophils isolated from the blood of healthy persons were incubated with live C. albicans in ratio 1:1 in the presence of pooled sera (controls) and 10 sera from 8 patients with ANCA-associated diseases: 6x Wegener's granulomatosis, 1x idiopathic rapidly progressive glomerulonephritis, 1x rapidly progressive glomerulonephritis concomitantly ANCA and anti-GBM (glomerula bas. membrane) positive. ANCA-positive sera did not influence the ingestion of C. albicans, but strongly inhibited killing of C. albicans (55-80% in comparison to controls). Sera from 2 patients in the time of ANCA-negativization showed lower inhibition (5 and 35%, respectively).

CONCLUSIONS

We demonstrated inhibitory effect of ANCA-positive sera on candidacidal activity of neutrophils from healthy persons. This fact could be one of the pathogenetic mechanisms of granuloma formation in Wegener's granulomatosis. Results of our experiment could be an additional rationale for the administration of trimethoprim/sulfamethoxazole as prevention of relapses of systemic vasculitis.

[Chronic fatigue syndrome]

The authors followed up for a period of 1-14 years 52 patients with CFS who met the criteria outlined by Holmes. The group comprised 10 men and 42 women. In 15% of these patients after a mean period of 5.5 years thyroiditis was diagnosed. Complete recovery was recorded in 20%, improvement in 32% of the patients, on average after 7 years. In the course of treatment mainly immunomodulating preparations were used. Indication of these drugs was individual based on immunological examinations. The success was only partial. The clinical condition of the patients did not correlate with serological findings of IgM, IgA and IgG antibodies against VCA nor with antibodies against EA of the EBV virus.

Phagocytic dysfunctions: a proposal for classification

The classification presented here is designed to help clinicians make therapeutic and diagnostic decisions. It is based on the modern view of the phagocytosis process as events involving ligand-receptor interaction, transmission of signal through second messenger systems and activation of effector mechanisms leading to specific cell behaviour. According to the classification proposed here, phagocytic disorders can be divided into extracellular disorders which are caused by abnormalities affecting ligands and cellular disorders caused by a pathological disturbance affecting the phagocytic cell. These cellular disorders are subdivided into defects of membrane receptors, defects of enzymatic equipment and defects of subcellular structures. Laboratory investigations of phagocytic cells make it possible to classify inborn, acquired, permanent and transient disorders into these groups. Examples of disorders in each of these groups are presented.

[Proposal for a classification system for phagocytosis disorders]

The presented classification is based on the modern view to the process of phagocytosis as evenements involving ligand-receptor interaction, transmission of signal through second messenger systems and activation of effector mechanisms leading to the specific cell behavior. According proposed classification, the phagocytic disorders are divided into extracellular disorders which are caused by abnormalities affecting ligands, and cellular disorders caused by pathological process affecting the phagocytic cell. These cellular disorders are subdivided into the defects of membrane receptors, the defects of enzymatic equipment and of subcellular structures. Laboratory investigation of phagocytic cells using several tests make possible to classify inborn, acquired, permanent as well as transient disorders into these groups. Examples of disorders in the each group are presented. This classification helps to clinicians make both diagnostic and therapeutic decisions.

[T-lymphocyte subpopulations in chronic active hepatitis]

In 33 patients with chronic active hepatitis quantitative changes were found in the ratio of different sub-populations of T lymphocytes in the peripheral blood stream which were either associated with treatment or with the presence of HbsAg in serum. A reduction of CD 3 positive lymphocytes was found in patients not treated by immunosuppression. In HbsAg positive patients an increase of CD 4 positive lymphocytes was found, as compared with HBsAg negative patients. Signs of activity of the hepatic process correlated with the presence of sign CD 8.

[The effect of 1,25-dihydroxycholecalciferol on immunity and the clinical state and on parameters of phospho-calcium metabolism in dialyzed patients]

Sixteen months of administration of 1,25-dihydroxycalciferol (Rocaltrol) to twelve patients with chronic renal failure led to a substantial reduction of infectious complications during the investigation period and to improvement of the clinical condition of the patients evaluated with regard to bone and muscle pain. In laboratory indicators of immunity the authors observed an increase of the originally reduced values of phagocytosis of C, albicans and candidacidal after two weeks' administration of the drugs. Changes in the ratio of sub-populations of lymphocytes were apparent also after 16 months therapy: the authors observed a continuous decline of the lymphocyte B and lymphocyte T4 ratio and rise of the cytotoxic suppressor fraction CD8+ of lymphocytes. The different trend of changes of some immunological, biochemical and clinical indicators was apparent when the patients were subdivided according to the aetiology of renal failure.

[The effect of erythropoietin on lymphocyte and granulocyte functions in dialyzed patients]

The authors investigated the influence exerted on some lymphocyte and granulocyte functions during treatment with human recombinant erythropoietin in five female patients with renal failure due to chronic interstitial nephritis, who were included in a regular dialyzation programme. The authors revealed a significant increase of the candidacidal capacity of phagocytizing cells of the peripheral blood stream and an increased capacity of blastic transformation of lymphocytes after stimulation with the mitogen phytohaemagglutinin. In these changes the improved oxygen metabolism may participate by a correction of anaemia, when this preparation is administered, but it cannot be ruled out that erythropoietin interferes by some hitherto unknown mechanism with immune processes.

Antibody response to Epstein-Barr virus antigens in patients with chronic viral infection

We tested antibody titres against Epstein-Barr virus (EBV) antigens in patients suffering from chronic viral disease and compared them with those determined in sex- and age-matched healthy controls. Patient sera showed signs of active EBV infection [antibodies against early antigen (EA) and/or viral capsid antigen (VCA) in the IgM or IgA classes] significantly more frequently than the control group. Correspondingly, geometric mean titres (GMT) of antibodies against all viral antigens were elevated in the patients. The strongest association with EBV was observed in patients whose clinical symptoms closely resembled infectious mononucleosis: 92% of the subjects in this subgroup possessed anti-EA and 41 and 25% had IgM and IgA anti-VCA antibody, respectively. In patients with signs of lymphoproliferation only and in those suffering from frequent respiratory infections the association with EBV was less marked but still significant. Patients with transient defects in humoral and cellular immunity mounted higher titres against VCA in the IgG class than those without immune defects.