NHS PSYCHOTHERAPY - PAST, FUTURE AND PRESENT

ABSTRACT The paper considers whether the ideal of a‘national psychotherapy service'is a realistic or desirable possibility. In its origins community psychiatry was inextricably linked with psychoanalysis and group psychotherapy. Today the links between community psychiatry and psychotherapy are much more tenuous, despite the evidence for the effectiveness of many psychological interventions in psychiatric disorders. Future psychotherapies will explore the links between brain and mind, integrate the different psychotherapeutic modalities, consider the wider costs of not providing psychotherapy, and be more client responsive. How will this come about? Authority in the field depends partly on seniority, partly on evidence, partly on popular appeal, and partly on psychotherapeutic narratives which accurately reflect the needs of society and those who suffer from psychological distress.     

CHARACTERIZATION OF BOVINE MHC CLASS II POLYMORPHISM USING THREE TYPING METHODS: SEROLOGY,RFLP AND IEF

Various methods, with different strengths and weaknesses, are currently used to define polymorphism of the bovine major histocompatibility complex (MHC) class II genes. A more complete characterization of bovine lymphocyte antigen (BoLA) haplotypes can be achieved by combining several of these methods. In this study BoLA class II polymorphism was characterized using three typing methods: serology, restriction fragment length polymorphism (RFLP), and isoelectric focusing (IEF). Twenty six Holstein-Friesian and 15 Angus cattle that carried an array of serologically defined BoLA haplotypes were selected for the study. The panel included 12 BoLA complex homozygotes. The three class II typing methods recognized polymorphism associated with the same or very tightly linked genes in the DQ-DR class II subregion. In total 25 BoLA-A locus (class I) —DQ-DR subregion (class II) haplotypes were defined. Three of the serological class II specificities, Dx1, Dx3, and Dx4, were associated with more than one RFLP defined DQ-DR haplotype. The other 4 class II specificities behaved as private specificities. One BoLA haplotype was found in both Holstein and Angus cattle. Two other BoLA haplotypes defined here have previously been described in other breeds. This suggests that these haplotypes exist in strong linkage disequilibrium.     

HLA CLASS II POLYMORPHISM AND IDDM SUSCEPTIBILITY IN THE GREEK POPULATION

The frequencies of HLA-DQA1, DQB1 and DRB1 alleles were compared between 50 Insulin-Dependent Diabetes Melitus (IDDM) patients and 49 healthy controls in the Greek population. Statistically significant difference in the frequencies of HLA-DQA1*0501-DQB1*0201 (P = 10^-4), DQA1*0301-DQB1*0201 (P= 0.01) and DQA P0301-DQB 1*0302 (P= 0.001) were observed. The DRB1*0405-DQA1*0301-DQB 1*0201 was the only DR, DQ combination significantly associated with the disease. The unexpected increase of DRB1*0405 observed in the Greek IDDM may suggest as reported in Chinese and Japanese IDDM a contribution of DRβ and DQα in susceptibility. Moreover, in contrast to the Asians, in the Greek, the DRβ, DQα are found with the usual DQβ 57-ve.     

REPORT FROM THE HLA CLASS II TYPING BY PCR-SSP MULTICENTRE STUDY

Results from 360 HLA-DR and -DQ ‘low-resolution’ typings with polymerase chain reaction sequence-specific primers (PCR-SSP), performed by nine laboratories, were analysed for their overall utility in routinely defining the HLA-DR1–DR18, DR51–DR53 and DQ1–DQ9 specificities in less than 2.5 h. Thirty EDTA blood samples and 10 DNA samples were distributed and analysed by each laboratory. DNA was extracted using a rapid bromide salt extraction protocol. Complete HLA-DR and -DQ typings were performed, three by three, on pre-aliquoted 96-tube PCR trays. When compared with reference typing, 351/360 (98%) correct DR typings were obtained, whereas 320/360 (89%) of the DQ phenotypes were correctly assigned. The time for three complete HLA-DR and -DQ ‘low-resolution’ typings, including DNA extraction, ranged from 2.0 h to 2.3 h. Unfortunately, an unusually high level of PCR amplification failures was observed (3%), probably due to diffusion and a significant volume loss from some of the pre-aliquoted primer mixes. Consequently, only 52% of the typings were without any amplification failure, and 0–2 amplification failures where found in 88% of the PCR-SSP typings performed. The number of HLA-DR–DQ retypings needed was 7 and 8%, respectively, reflecting the low number of typings where allelic identification was directly affected by the relatively high level of amplification failures in this study. Thus, a 91–98% success rate of correctly identified HLA-DR and -DQ alleles could be maintained, even under suboptimal typing conditions.     

HLA CLASS I NUCLEOTIDE SEQUENCES, 1992

The HLA Class I sequences included in this compilation are taken from publications listed in the papers: Nomenclature for factors of the HLA system, 1991 (Bodmer et al., 1992), Nomenclature for factors of the HLA system, 1990 (Bodmer et al., 1991) and factors of the HLA system, 1989 (Bodmer et al., 1990). Due to the increased number of sequences we have only included sequences for exons 2, 3, and 4 in this compilation. Where discrepancies have arisen between reported sequences, the original authors have been contacted where possible, and necessary amendments to published sequences have been incorporated into this alignment. Future sequencing may identify errors in this list and we would welcome any evidence that helps to maintain the accuracy of this compilation. In the sequence alignments, identity between nucleotides is indicated by a hyphen (-). An unavailable sequence is indicated by a period (.). Gaps in the sequence are inserted to maintain the alignment between different alleles showing variation in amino acid number.     

HLA CLASS I NON-CODING NUCLEOTIDE SEQUENCES, 1992

We present a compilation of the nucleotide sequences of the non-coding regions of the human HLA class I genes which complements previously published information on exon sequences. The listing includes the 5’and 3’untranslated (UT) regions, and introns 1–7. The HLA class I loci and their alleles from which non-coding sequences were derived are listed in Table 1, together with source references. Where possible, locus and allele designations follow the Nomenclature for factors of the HLA system 1991(Bodmer et al.,1992). In aligning sequences, nucleotides which are conserved between all class I genes are specified only by the consensus sequence, and are indicated by a hyphen (^-). To maintain the alignment between different alleles, an asterisk (*) is inserted where there is a gap in the sequence. An unavailable sequence is indicated by a period (.). Regions of sequence too diverse to be accurately compared are represented by an exclamation mark (!). Sequence motifs previously classified as having an important role in HLA class I regulation or processing, such as enhancer sequences, are identified at the bottom of the sequence comparison. It is not our intention in this paper to present an analysis of the many features revealed by this compilation. However, we hope that the information will provide important reference material for studies of HLA class I mRNA processing (Cianetti et al., 1989), promoter regulation (David-Watine et al., 1990) and in the design of allele, locus or region specific PCR primers (Summers et al., 1991). We hope to update this compilation in due course, and we would welcome sequence information not included in this publication, as well as comments and corrections that help to maintain the accuracy of the information.     

MICROBICIDES IN INDIA- PRESENT AND FUTURE

India continues to wage a battle against the human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) epidemic. Despite an array of preventive and control efforts directed against the disease, it continues to finds its way from the high risk groups to the general population. Women are more vulnerable to HIV/AIDS because of biological as well as socio-cultural factors. Microbicides appear to provide an attractive option as a means of protection to be used by women. At present, microbicide trials are in study phases I and II in India. The development of an ideal microbicide candidate which would be effective and confirms to user satisfaction poses a major challenge to researchers.     

HLA CLASS II TYPING IN A MICROTITRE PLATE FORMATE USING DIGOXIGENIN-LABELLED AMPLIFIED DNA AND BIOTIN-LABELLED OLIGONUCLEOTIDE PROBES

We describe a new, non-radioactive microtitre plate assay for the analysis of genetic variations at the DNA level. The new method combines hybridization of oligonucleotides with PCR amplified DNA in liquid phase with detection in solid phase using an elisa -reader. Genomic DNA is labelled with digoxigenin during PCR using a nucleotide mix containing DIG-11-2′-deoxy-uridine-5′-triphosphate (DIG-11-dUTP) DIG labelled, amplified genomic DNA is hybridized in solution with an oligon de which is labelled with one biotin at its 3′-end, using biotin-16,2′,3′-dideoxy ine-5′-triphosphate (BIO-16-ddUTP) and DNA deoxynucleotidylexo-transferase (TdT). The hybridized complex is immobilized in a streptavidin (SA) coated microtitre plate via the biotin and detection of digoxigenin is performed using anti-digoxigenin horseradish peroxidase, fab fragments (anti-DIG-POD), and the colorimetric substrate 2,2′-Azino-di-(3-ethylbenzthiazolinsulfonat[6]) (ABTS®). The resulting absorbtion of the assay is analysed in a microtitre plate reader. This method results in highly specific and sensitive hybridization signals and with the 15 oligonucleotides chosen, allows the typing of DR1-DR10.     

AN ANALYSIS OF HLA CLASS II GENE POLYMORPHISM IN BRITISH AND GREEK IDIOPATHIC MEMBRANOUS NEPHROPATHY PATIENTS

Fifty-two British and 29 Greek idiopathic membranous nephropathy (IMN) patients were analysed for DRB, DQA1, DQB1 and DPB1 gene polymorphism using second exon amplification and sequence-specific oligonucleotides (SSO). In addition 100 British and 92 Greek controls were analysed. A highly significant increased frequency of the DRB 1*0301 allele was found in IMN patients from Britain (80%), when compared to controls (27%, OR 10.6, P= 0.000004). A lower frequency of DRB 1 *0301 was observed in Greek IMN patients (33%), but this was just significant before correction, when compared to Greek controls (15%, OR 3, P= 0.02). The DRB3 allele most often associated with DRB 1 *0301 was DRB3*0101 (OR 4.2, P= 0.00025) in British patients and DRB3*0201/2 (OR 11, P=0.006) in Greek patients. In Greek IMN patients a decrease in DR16 was found (OR 0.08, P=0.004), and the overall incidence of DR2 was significantly lowered when both sets of IMN patients were combined (OR 0.21, χ² 17.6, P= 0.00013). The incidence of DQA1 *0501 was raised in both Greek (96%vs. 66%, OR 9.7, χ² 6.9, P= 0.009) and British IMN (85%vs. 45%, OR 7.4, χ² 20, P= 0.00007) patients. This gives some support to a proposal for a major role for this allele in IMN. However, DQB1 *0201 was also raised in both Greek (50%vs. 21%, OR 3.6, χ² 8.1, P= 0.005) and British (90%vs. 44%, OR 10, χ² 21.7, P=0.00004) IMN patients. The DQA1*0102 allele was significantly lowered in Greek IMN patients (15%vs. 32%, OR 0.05, 12.2, P=0.0008), probably reflecting a lowering in the DR16 haplotype. No significant difference was observed in the frequencies of DPB alleles in patients and controls. It is concluded that DRB 1*0301 has the strongest association with British Caucasoid IMN. The Greek Caucasoid IMN association with DRB 1*0301 is weaker, and a role for other alleles has not been eliminated.     

FINGERPRINTING OF HLA CLASS I GENES FOR IMPROVED SELECTION OF UNRELATED BONE MARROW DONORS

The degree of matching of HLA genes between the selected donor and recipient is an important aspect of the selection of unrelated donors for allogeneic bone marrow transplantation (UBMT). The most sensitive methods currently used are serological typing of HLA class I genes, mixed lymphocyte culture (MLC), IEF and molecular genotyping of HLA class II genes by direct sequencing of PCR products. Serological typing of class I antigenes (A, B and C) fails to detect minor differences demonstrated by direct sequencing of DNA polymorphic regions. Molecular genotyping of HLA class I genes by DNA analysis is costly and work-intensive. To improve compatibility between donor and recipient, we have set up a new rapid and non-radioisotopic application of the ‘fingerprinting PCR’ technique for the analysis of the polymorphic second exon of the HLA class I A, B and C genes. This technique is based on the formation of specific patterns (PCR fingerprints) of homoduplexes and heterodu-plexes between heterologous amplified DNA sequences. After an electrophoretic run on non-denaturing polyacrylamide gel, different HLA class I types give allele-specific banding patterns. HLA class I matching is performed, after the gel has been soaked in ethidium bromide or silver-stained, by visual comparison of patients’ fingerprints with those of donors. Identity can be confirmed by mixing donor and recipient DNAs in an amplification cross-match. To assess the technique, 10 normal samples, 22 related allogeneic bone marrow transplanted pairs and 10 unrelated HLA-A and HLA-B serologically matched patient-donor pairs were analysed for HLA class I polymorphic regions. In all the related pairs and in 1/10 unrelated pairs, matched donor-recipient patterns were identified. This new application of PCR fingerprinting may confirm the HLA class I serological selection of unrelated marrow donors.     

POSSIBLE SEX-CORRELATED TRANSMISSION OF MATERNAL CLASS I HLA HAPLOTYPES

Forty-seven alleles of class I HLA-AB loci (14 for locus A and 33 for locus B) were identified in 787 participants in two groups of unrelated families. Group I included parents and children typed for bone marrow transplantation. Group II included families typed for renal transplantation. Before statistical evaluation, the A locus alleles were grouped into eight classes according to broad specificity, and the B locus alleles were grouped according to HLA epitopes into two classes. Significant differences in HLA-AB haplotype frequencies were found between male and female offspring. When families with children of both sexes were analysed, the frequencies of maternally inherited HLA-AB haplotypes were found to be significantly different in brothers and sisters. The results suggest the possibility that the transmission of specific AB haplotypes from mother to offspring may be correlated to children’s sex. The major histocompatibility complex has been shown to be involved in the expression of H-Y male-specific minor histocompatibility antigens. The possible selection in the transmission of specific maternal HLA-AB haplotypes to male offspring may contribute to the avoidance of maternal cytotoxic reactions toward the male foetus.     

STUDY OF HLA CLASS I/II AND T LYMPHOCYTE SUBSETS IN KUWAITI VITILIGO PATIENTS

HLA polymorphisms of class I and class II MHC were investigated in 40 Kuwaiti vitiligo patients and in 40 controls using microcytotoxicity assay. HLA-B21, Cw6 and DR53 were increased significantly in patients compared to controls (P= 0.00001, 0.00001 and P= 0.0053 respectively) while HLA-A19, DR52, were significantly decreased (P= 0.00236,0.05, respectively). Total T-cells, T4 and T8 were measured as CD2, CD4 and CD8 respectively by flow cytometry. Vitiligo patients showed significant increase in CD4 compared to controls (P= 0.03). Our findings suggest that HLA-B21 and Cw6 and DR53, are susceptible genes of vitiligo, while A19 and DR52 are protective genes in the Kuwaiti population.     

GENETIC POLYMORPHISM OF THE FOURTH COMPONENT OF HUMAN COMPLEMENT: POPULATION STUDY AND PROPOSAL FOR A REVISED NOMENCLATURE BASED ON GENOMIC PCR TYPING OF RODGERS AND CHIDO DETERMINANTS

The fourth component of human complement (C4) is coded for by two homologous genes, C4A and C4B, located in the class III region of the major histocompatibility complex (MHC). Genetic typing of C4A and B alleles is routinely carried out by high-voltage agarose gel electrophoresis. The electrophoretic C4 polymorphism can be further subdivided by the Rodgers (Rg) and Chido (Ch) blood groups, which are antigenic determinants of the C4A and B alpha-chains, respectively. We have used a recently described direct PCR typing method using sequence-specific primers (PCR-SSP) in combination with electrophoretic C4 typing as well as genomic RFLP analysis to determine the frequency of C4 allotypes, Rg/Ch subtypes and C4A-B haplotypes in a family study of the German population. As the current C4 allele designation does not provide any information about the presence or absence of Rodgers and Chido antigens, we have developed an extension to the existing C4 nomenclature. This revised allele designation combines the exisiting numerical allotypes defined by electrophoretic mobility with eight subtypes (01–08) based on Rg/Ch PCR genotyping results. Using this approach, most electrophoretic allotypes could be subdivided. Among the C4A allotypes, the most common allele was A*0301 (59.9%), and the most common subtype among all electrophoretic allotypes was 01 (85.1%; = Rg1,2-positive, Ch-negative). For C4B, the most common allele was B*0101 (64.3%), and the most common subtype was 01 (79.6%; = Ch1,2,3,4,5,6-positive, Rg-negative). The subtypes 03, 04, 07 and 08 of the C4A allotypes, and the subtypes 03, 07 and 08 of the C4B allotypes, were not detected in this study. The analysis of duplicated C4 alleles revealed considerable heterogeneity of their subtypes. The results demonstrate that all known C4 allotypes can now be assigned unambiguously, which facilitates the identification of MHC haplotypes relevant for transplantation and disease association studies.     

HLA CLASS II NUCLEOTIDE SEQUENCES, 1992

The HLA Class II sequences included in this compilation are taken from publications listed in the papers: Nomenclature for factors of the HLA system, 1991 (Bodmer et al., 1992), Nomenclature for factors of the HLA system, 1990 (Bodmer et al., 1991) and Nomenclature for factors of the HLA system, 1989 (Bodmer et al., 1990). Where discrepancies have arisen between reported sequences, the original authors have been contacted where possible, and necessary amendments to published sequences have been incorporated into this alignment. Future sequencing may identify errors in this list and we would welcome any evidence that helps to maintain the accuracy of this compilation. In the sequence alignments, identity between residues is indicated by a hyphen (-). An unavailable sequence is indicated by an asterisk (*). Gaps in the sequence are inserted to maintain the alignment between different alleles showing variation in amino acid number.     

洛阳地区汉族HLA—DRB1^＊04等位基因的PCR—SSO分型

对河南洛阳地区汉族进行了ＨＬＡ－ＤＲＢ１＊０４等位基因的ＰＣＲ－ＳＳＯ分型，采用第１２届国示组织相容性专题讨论会推荐的引物和序列特异性寡核苷酸探针，可检测１７个ＤＲＢ１＊０４组特异性等位基因，在１１６份无血缘关系健康人ＤＮＡ村洒中有１６份为ＤＲＢ１＊０４，其中１份为纯合，ＤＲＢ１＊０４的基因频率为０．０７１５。ＤＲＢ１＊０４等位基因分布于５个不同的型别，分别是ＤＲＢ１＊０４０１、０４０３、０４０４