Immunoglobulins and complement in migraine

In 54 patients with migraine and 70 persons comprising the control group, the total complement level (CH50) was evaluated together with its C3 and C4 fraction level and the level of IgG, IgA and IgM immunoglobulins. It was found that the average C3 fraction level was significantly decreased, while the C4 fraction level and total complement activity remained in the normal range. The immunoglobulin level did not show any statistically significant alterations except for the IgA level, which was lowered in migraine patients. On this basis, i.e. lowering of the C3 fraction level with normal C4 fraction level and total complement activity and lack of elevation of IgA, it is felt that the alternative pathway of complement system may be activated in migraine.     

Structure and Function of Immunoglobulins

Five classes of human immunoglobulins are now recognized, but new classes and subtypes of humoral antibodies will probably be discovered. The classes differ not only in antigenic structure but also in certain physicochemical properties, distribution, turnover, quantity, and probable biologic function. The actual serum levels of immunoglobulins reflect to a large extent the antigenic experience of the host.     

Immunoglobulins and complement in splenectomised and autotransplanted subjects

Serum immunoglobulins and complement factors were investigated retrospectively in 35 splenectomised (n = 28) and autoreplanted (n = 7) patients following trauma. The main deficiency of the immune system following splenectomy was a reduction in the concentrations of serum IgM, C3, and Factor B with normal IgG, IgA and C4 values. These changes were not correlated with the time elapsed after splenectomy. However, patients who had splenic tissue autoreplantation had normal values of immunoglobulins and complement factors compared with healthy controls. Splenic replantation may be able to stop a fall in immunoglobulin and complement factor values after splenectomy.     

Oxidative metabolism in sepsis and sepsis syndrome

The high mortality associated with sepsis syndrome and multiple organ dysfunction syndrome has persisted despite extraordinary research efforts in the laboratory and the intensive care unit. These syndromes produce systemic tissue damage that is likely to result from widespread inflammation and subsequent endothelial injury. This article reviews the oxidative metabolic effects and responses to sepsis syndrome at several levels: the oxygen transport system, the cell, and the mitochondrion. Specifically, aerobic metabolism of carbon substrates and oxygen is altered in sepsis. As a result of systemic inflammation and nonmetabolic oxygen use, oxidative stress may occur both outside and inside the cell. The consequences of these oxidative processes during sepsis may be ongoing cell damage mediated by reactive oxygen and nitrogen oxide species that culminates in multisystem organ failure.     

Immunoglobulins and immunogenicity of pneumococcal vaccination in preschool asthma

Pneumococcal vaccination is advocated for asthmatics. Although routinely performed, data supplying evidence for this recommendation are limited. We examined the immunological background of 215 asthmatic children (2-5 year old) at a university children's hospital and compared the immunogenicity of the recommended pneumococcal vaccines. Testing encompassed serum immunoglobulins, immunoglobulin G (IgG)-subclasses, and pneumococcal antibodies against serotypes 4, 6B, 9V, 14, 18C, 19F and 23F. An infection-prone subgroup received one dose of 23-valent pneumococcal polysaccharide vaccine (PPV-23; n = 38, median age 45 months) or of 7-valent conjugate vaccine (PCV-7; n = 23; median age 35 months). Pneumococcal antibodies were determined again after 4 weeks. Low immunoglobulin- and/or IgG-subclass levels were found in 27 subjects (14 infection-prone). Prevaccination pneumococcal antibody levels ranged from 0.36 to 1.06 microg/ml, depending on the serotype. The percentage of subjects with putative protective antibody levels > or =1.0 microg/ml ranged only from 19.9% to 54.1%, over all. Postvaccination, antibody geometric mean concentrations increased significantly higher in PCV-7 vaccinees for serotype 14 (p < 0.01) and 23F (p < 0.05). Now the percentage of putatively protected subjects ranged from 40.9% (serotype 6B) to 90.9% (serotype 19F) following PCV-7 compared with 31.6% (serotype 6B and 23F) to 81.6% (serotype 19F) in PPV-23 vaccinees. Our data give further evidence for pneumococcal vaccination of asthmatic children. PCV-7 is at least as immunogenic as PPV-23. Moreover, for children suffering from persistent asthma, PCV immunisation should be considered.     

Obesity and sepsis

Obesity has reached epidemic proportions over the last few decades. Obesity is associated with increased morbidity and mortality in hypertension, cardiovascular diseases, stroke, and cancer and is feared to decrease overall life expectancy over the next few decades. There is a growing body of evidence suggesting that obesity is a chronic inflammatory disease. Obesity is becoming a cause of concern in critically ill patients as well. Sepsis is the number one cause of morbidity and mortality in noncoronary artery disease critical care units all over the world and is associated with a high cost of care. An increase in morbidity in obese septic patients compared with lean people is a cause of growing concern. Laboratory evidence suggests that there is exaggeration in the inflammatory and prothrombogenic phenotype assumed by obese compared with lean septic animals. The exact mechanisms underlying this phenomenon are unknown. This article reviews some of the pathophysiological processes responsible for the underlying inflammation in obesity and sepsis and reviews the literature for the association of the two.     

Immunoglobulins and IgG subclasses in children following severe head injury

Objective To study immunoglobulin production after severe blunt head trauma in children.Design Serum for IgG, IgM, IgA, IgE, and IgG subclasses were drawn from 10 children admitted with severe head injury (ISS 31.2, GCS 5.4) on day 1, 7, 14 and 21 after injury.Results 5 of the 10 patients developed infection between 7 and 14 days and 2 died of complications of pneumonia. On day 1, IgM levels averaged 95.6% of the mean of the age-specific normal controls. By day 7, IgM levels averaged 383% (p<0.01). While all patients were within the age-specific normal range (± 2 SD) on day 1, 7 of 10 patients were above the normal range by day 7. There was no difference in IgM levels between infected and non-infected patients. Five patients were below the age-specific normal range for IgG on day 1, with 3 still low on day 7. By day 21, IgG levels averaged 141% of the mean of the age-specific normal controls. IgG subclasses followed a pattern similar to total IgG levels. Marked increases in IgE were seen in 3 patients.Conclusions IgM levels increased dramatically in all patients within seven days of the injury. While 50% of these children had a deficit of IgG in the first week, total IgG and IgA levels increased after injury, but not as rapidly as IgM levels. Unlike pediatric burn patients, there is no persistent hypogammaglobulinemia following severe blunt trauma in children.Supported by a grant from Sandoz Pharmaceuticals, East Hanover, New Jersey, USA     

Synthesis of Immunoglobulins and 15 Other Proteins by Diseased Human Kidneys

Summary. In an effort to determine the synthetic capacity of human kidneys for serum proteins, pieces of both kidneys removed at operation prior to transplantation were placed in organ culture. Incubation with ¹⁴C labelled amino acids and subsequent radioimmunoelectrophoresis with antisera to all five classes of immunoglobulins showed synthesis of IgG by all 5 pairs of kidneys of IgA and IgE by 4, and of IgM by 2. None synthesized IgD. Radioimmunoelectrophoresis with specific antisera to 15 non-immunoglobulin proteins revealed synthesis of lactoferrin and uromucoid while several other serum proteins, such as al antitrypsin and α2 macroglobulin, known for their binding properties, showed apparent synthesis. No evidence for secretory component synthesis was seen despite positive immunofluorescent localization in the tubular cells. Further, Zn α2 and β₂GP I also showed positive immunofluorescence but negative synthesis. It seems possible that these latter proteins may not be synthesized by the tubular cells but rather may be actively excreted or reabsorbed by them.