Complement-activating ability of leucocytes from patients with complement factor I deficiency.

Previous studies from this laboratory have shown that normal peripheral blood B cells are capable of activating complement via the alternative pathway (AP), that the activation is associated with complement receptor type 2 (CR2) expression, and that erythrocytes at normal blood levels partially inhibit the activation. The purpose of the present study was to investigate whether factor I (FI) deficiency, which leads to continued formation of the AP convertase (C3bBb) resulting in the consumption of factor B and C3 and large scale generation of C3b fragments, affects the phenotype and/or function of the patients' B cells. Using flow cytometry, peripheral blood leucocytes (PBL) from two FI-deficient patients were investigated for expression of complement receptors and complement regulatory proteins, in vivo-deposited C3 fragments and in vitro complement-activating ability. CR1 levels on B cells were significantly lower in FI-deficient patients than in normal individuals, whereas CR2 levels were found to be reduced, although not to a significant extent. CR1 levels on monocytes and polymorphonuclear leucocytes (PMN) were found to be normal or slightly raised. All leucocyte subpopulations were found to be covered in vivo with C3b fragments. AP activation on B cells from FI-deficient patients in homologous serum was significantly reduced compared with that for normal individuals, whereas no in vitro activation was seen in autologous serum. In addition, the in vivo-bound C3b fragments were degraded to C3d,g when the patients' PBL were incubated in homologous serum containing EDTA. Finally, the patients, erythrocytes failed to exert any inhibition on AP activation in homologous serum.     

Familial deficiency of complement factor 7: association with bacterial meningitis. Apropos of 3 recent cases

Three recent cases of inherited deficiency of the seventh component of complement (C7) associated with recurrent infectious meningitis are described. Two cases were associated with meningococcal meningitis, the third is the first case report of C7 inherited deficiency associated with Haemophilus parainfluenzae meningitis. Family studies are consistent with inheritance and non-HLA-linked, autosomal codominant trait of the C7 deficiency. The three patients have remained well, following antibiotic treatment.     

A new family with congenital factor XIII deficiency showing a deficit of both subunit A and B. Type I factor XIII deficiency

In this study we present a new case of Factor XIII deficiency. The proposita, a 34 year old woman, showed a deficiency of both subunit a and subunit b, and a moderate bleeding tendency. Because of the concomitant decrease of subunits a and b the proposita is considered to be an example of Type I disease. Factor XIII levels were less than 10% both as activity and antigen. Several family members showed intermediate levels of both subunit a and b and were asymptomatic. They were considered to be heterozygotes. The hereditary pattern is autosomal incompletely recessive. Type I disease appears much less frequent than Type II.     

Adenosine kinase deficiency: Three new cases and diagnostic value of hypermethioninemia

Adenosine kinase (ADK) deficiency is characterized by liver disease, dysmorphic features, epilepsy and developmental delay. This defect disrupts the adenosine/AMP futile cycle and interferes with the upstream methionine cycle. We report the clinical, histological and biochemical courses of three ADK children carrying two new mutations and presenting with neonatal cholestasis and neurological disorders. One of them died of liver failure whereas the other two recovered from their liver damage. As the phenotype was consistent with a mitochondrial disorder, we studied liver mitochondrial respiratory chain activities in two patients and revealed a combined defect of several complexes. In addition, we retrospectively analyzed methionine plasma concentration, a hallmark of ADK deficiency, in a cohort of children and showed that methionine level in patients with ADK deficiency was strongly increased compared with patients with other liver diseases. ADK deficiency is a cause of neonatal or early infantile liver disease that may mimic primary mitochondrial disorders. In this context, an elevation of methionine plasma levels over twice the upper limit should not be considered as a nonspecific finding. ADK deficiency induced-liver dysfunction is most often transient, but could be life-threatening.     

Solid-pseudopapillary neoplasm of the pancreas: Three cases with a literature review.

Solid-pseudopapillary neoplasm of the pancreas is a very rare tumor. It most commonly occurs in young women and has unique pathologic features. Previous immunohistochemical studies demonstrated that most solid-pseudopapillary neoplasms were immunoreactive with antibodies directed against vimentin and neuron-specific enolase. Recently, expression of CD10 and CD56 in this tumor has been reported. In this report, we expanded the demographic profile, highlighting 3 cases of solid-pseudopapillary neoplasm of the pancreas that presented in an elderly woman, a young man, and a young woman and further characterized them histologically and immunophenotypically. Grossly, all 3 tumors were well circumscribed and had a variable degree of cystic formation, necrosis, and hemorrhage. Microscopically, these tumors were characterized by a pseudopapillary pattern of epithelioid cells arranged around a delicate fibrovascular core with sheets of bland epithelioid cells filling cystic spaces. Hyaline globules, cholesterol granulomas, and foamy cells were all seen to be common findings. Although these 3 tumors were strongly immunoreactive for vimentin, alpha-1-antitrypsin, alpha-1-antichymotrypsin, neuron-specific enolase, CD10, CD56, and progesterone receptor, they demonstrated only variable "positivity" for epithelial membrane antigen and broad-spectrum cytokeratin, but were being consistently nonreactive for synaptophysin, insulin, glucogon, chromogranin A, and estrogen receptor. Interestingly, 2 of the 3 tumors were S-100 protein and melanin A reactive but were nonreactive for HMB45.     

Three cases of acquired factor VIII: C inhibitors in non-hemophilic patients

Summary During the last ten years we observed three non-hemophilic patients with factor(F) VIII: C inhibitors (2 women aged 68 and 80 and a man aged 51).In all three cases, a sudden bleeding tendency was observed shortly after an injury or surgery. Coagulation tests showed a prolonged aPTT and a decreased F VIII: C level. Other deficiencies of blood-clotting factors and acquired or hereditary von Willebrand's disease could be excluded. Therapy with F VIII: C concentrate, cryoprecipitate, or fresh-frozen plasma did not produce the expected increase in F VIII: C. Measurement of F VIII: C inhibitor levels (Bethesda Units, BU) revealed values in the range between 9 and 64 BU. The two patients subjected to long-term therapy with a combination of prednisone (initially 2–3 mg/kg BW) and azathioprine (2–3 mg/kg BW) responded positively; the F VIII: C concentration increased. The third patient, treated only with a low dose of prednisone (30 mg/day), did not show any reaction at all. Since hereditary hemophilia A could be excluded, the inhibitors apparently were acquired. Malignant tumors did not appear. In conclusion, long-term therapy of an acquired F VIII: C inhibitor with a combination of prednisone and azathioprine may lead to complete disappearance of the inhibitor, normalization of the coagulation tests, and complete remission of the bleeding tendency.Abbreviations aPCC activated prothrombin complex concentrate - aPTT activated partial thromboplastin time - BU Bethesda Units - BW body weight - CP cryoprecipitate - DIC disseminated intravascular coagulation - F III: C factor VIII procoagulant activity - FEIBA factor eight inhibitor bypassing activity - FFP fresh-frozen plasma     

Studies on rheumatoid factor: I. The effect of rheumatoid factor on the clearance of preformed immune complexes in mice.

The blood clearance of passively transferred immune complexes (IC), preformed at different antigen-antibody ratios, was measured in mice with LPS-induced rheumatoid factor (RF) and in normal controls. RF had a differential effect on IC clearance, significantly enhancing clearance of complexes formed in antibody excess and slight antigen excess but inhibiting the clearance of complexes formed in moderate (x10) antigen excess. The results are discussed with regard to the mechanisms of IC clearance and suggest that RF may play an important role in governing the behaviour of immune complexes in vivo.     

Genetic,molecular and functional analyses of complement factor I deficiency

Complete deficiency of complement inhibitor factor I (FI) results in secondary complement deficiency due to uncontrolled spontaneous alternative pathway activation leading to susceptibility to infections. Current genetic examination of two patients with near complete FI deficiency and three patients with no detectable serum FI and also close family members revealed homozygous or compound heterozygous mutations in several domains of FI. These mutations were introduced into recombinant FI and the resulting proteins were purified for functional studies, while transient transfection was used to analyze expression and secretion. The G170V mutation resulted in a protein that was not expressed, whereas the mutations Q232K, C237Y, S250L, I339M and H400L affected secretion. Furthermore, the C237Y and the S250L mutants did not degrade C4b and C3b as efficiently as the WT. The truncated Q336x mutant could be expressed, in vitro, but was not functional because it lacks the serine protease domain. Furthermore, this truncated FI was not detected in serum of the patient. Structural investigations using molecular modeling were performed to predict the potential impact the mutations have on FI structure. This is the first study that investigates, at the functional level, the consequences of molecular defects identified in patients with full FI deficiency.     

A protease-like permeability factor in guinea pig skin: immunologic identity with plasma Hageman factor.

Vascular permeability enhancement activity of the protease-like permeability factor derived from guinea pig skin and of active guinea pig Hageman factor (beta HFa) were both inhibited by anti-guinea pig Hageman factor rabbit F(ab')2 antibody. The permeability activity of both factors was also absorbed on anti-Hageman factor F(ab')2-Sepharose beads. The latent form of the permeability factor derived from skin extracts produced a single immunoprecipitation line with anti-Hageman factor and gave a reaction of identity with a precipitation band developing between purified Hageman factor and anti-Hageman factor. The latent permeability factor in the fraction corrected the clotting activity of Hageman-factor-deficient human plasma. The clotting activity was also blocked by anti-Hageman factor F(ab')2 antibody. From these results, it was concluded that the skin permeability factor was immunologically and functionally indistinguishable from Hageman factor of plasma. Extracts were obtained from skin of guinea pigs given intravenous injections of 125I-guinea pig Hageman factor immediately before sacrifice to calculate the amount of Hageman factor in the extravascular tissue space of the skin. The pseudoglobulin fractions of the extracts containing a concentration of Hageman factor of approximately 9 microgram of Hageman factor per gram of skin. This was determined both by immunologic means and procoagulant activity. Only 4% of the Hageman factor in the extract was obtained from the intravascular plasma volume of the skin.     

Three cases of cardiospasm treated successfully with psychotherapy. Catamnestic remarks.

3 cases of cardiospasm successfully treated by psychotherapy are reported and some catamnestic conclusions and remarks are given after a follow-up of the patients for 10, 9 and 8 years, respectively. Unlike the clinical symptomatology, which was almost identical in all 3 cases, the precipitating factors, the deeper meaning and the unconscious symbolism of the symptoms were quite different but specific for each one of the patients. Some more thoughts are also given in the paper with reference to the clinical criteria to be considered when evaluating the final therapeutic results of the technique of the therapy applied.     

Mitochondrial complex I deficiency of nuclear origin I. Structural genes

Complex I (or NADH-ubiquinone oxidoreductase), is by far the largest respiratory chain complex with 38 subunits nuclearly encoded and 7 subunits encoded by the mitochondrial genome. Its deficiency is the most frequently encountered in mitochondrial disorders. Here, we summarize recent data obtained on architecture of complex I, and review the pathogenic mutations identified to date in nuclear structural complex I genes. The structural NDUFS1, NDUFS2, NDUFV1, and NDUFS4 genes are mutational hot spot genes for isolated complex I deficiency. The majority of the pathogenic mutations are private and the genotype-phenotype correlation is inconsistent in the rare recurrent mutations.     

Mechanisms of target cell destruction by alloimmune peritoneal macrophages: I. The effect of treatment with sodium fluoride

Sodium fluoride (NaF), an inhibitor of membrane activity, was used to investigate the mechanisms by which alloimmune macrophages kill target cells and produce plaques in monolayers of specific target cells. When target cells were treated with 0.02 M or 0.002 M NaF and washed before adding alloimmune macrophages to establish loci of cell interaction, plaque formation was not affected. However, when interacting alloimmune macrophages and target cells were initially exposed for 30 minutes or 1 hour to 0.02 M or 0.002 M NaF plaque formation was markedly suppressed. Comparative studies with NaF and the inhibitor of protein synthesis, Puromycin, showed that protein synthesis by macrophages was not affected by treatment with 0.002 M NaF. Results obtained by subjecting interacting cells to 1 hour exposure to NaF at various intervals indicated that the destruction of target cells by immune macrophages was irreversibly initiated in large measure during the first hour of cell interaction. It is postulated that the membrane activity of immune macrophages responsible for target cell killing involves the release or secretion of a cytoxin.