Interphase cytogenetic analysis of cervical intraepithelial neoplasia.

The aim of this study was to detect numerical chromosomal aberrations that may be involved in the progression of cervical intraepithelial neoplasia (CIN) toward cervical carcinoma. Therefore, cervical lesions (five CIN 1, seven CIN 2, six CIN 3, six invasive carcinomas, and six normal samples) were studied by in situ hybridization (ISH) on serial 3-microm-thick paraffin tissue sections, using a panel of eight centromeric DNA probes for chromosomes 1, 3, 6, 7, 8, 11, 17, and X. An estimation of the percentage of dysplastic epithelium with abnormal ISH signals per nucleus was made. Chromosome aneusomy could be detected in all persisting and high-grade CIN lesions and invasive carcinomas. In most cases, when one of the chromosomes showed aneusomy then all studied chromosomes showed numerical changes. Interestingly, the abnormal ISH signals were found only in a varying part of the morphologically dysplastic epithelium, the remainder showing no such changes. In aneuploid regions of the CIN 1 lesions the mean chromosome index for all chromosomes was 1.97+/-0.03 with a range of 1.92 to 2.00. The chromosome index ratios of chromosomes 1, 7, and X showed a significant positive correlation with CIN grade (r > or = 0.74; P < or = 0.006). It is concluded that chromosome aneusomy of chromosomes 1, 7, and X may be involved in the progression of CIN lesions.     

Studies on the differentiation of T lymphocytes in sheep. II. Two monoclonal antibodies that recognize all ovine T lymphocytes.

Two mouse monoclonal cytotoxic antibodies (ST-1a and ST-1b) recognize an antigen present on the large majority of thymocytes and all T cells in the periphery, but not B cells or other haemopoietic cells in sheep. Examination of frozen sections of various fetal tissues revealed that the cells expressing this antigen first appeared in the thymus, and these cells markedly increase in numbers in the peripheral lymphoid tissues after mid-gestation. Large accumulations of positive cells were located in the paracortex of lymph nodes, the periarteriolar lymphoid sheath of the spleen, and interfollicular areas of jejunal Peyer's patches, all of which are known to be T-dependent areas. Treatment of lymphocytes with ST-1a and complement resulted in the abrogation of T-proliferative responses, but the response to a B-cell mitogen, lipopolysaccharide, was not reduced. Neither ST-1a nor ST-1b cross-reacted to lymphocytes obtained from other species of animals (man, monkey, mouse, rat, guinea-pig, chicken, frog, pig, horse, goat and cattle). Based on these findings, it was concluded that the expression of the antigen recognized by ST-1a and ST-1b is restricted to the T-cell lineage of sheep, and that all ovine T cells express this antigen. Furthermore, ST-1a and ST-1b were determined to recognize the same antigen by reciprocal blocking experiments.     

Malakoplakia and immunosuppressive therapy. Reversal of clinical and leukocyte abnormalities after withdrawal of prednisone and azathioprine.

Malakoplakia is a chronic granulomatous inflammatory disorder. It is suspected clinically by the presence of chronic infection and diagnosed by histologic examination of affected tissues. Studies of 4 patients with malakoplakia--2 renal transplant recipients, 1 patient with systemic lupus erythematosus, and 1 patient with polymyositis--are reported. All patients were receiving prednisone and azathioprine at the time of diagnosis and had an infection caused by Escherichia coli. Leukocytes from all patients failed to kill Staphylococcus aureus and E coli normally in vitro. Cholinergic agonists had no apparent effect on bacterial killing in vitro or in vivo in the 2 patients examined. Clinically, malakoplakia improved significantly when immunosuppressive therapy was tapered or discontinued, and leukocyte function returned to normal in all 4 patients. The cases reported here and those documented previously suggest that the pathogenesis of malakoplakia and its treatment may not be the same for all patients. Malakoplakia may be more common than previously thought, particularly with the increased use of immunosuppressive therapy.     

Interleukin-1 alpha as a factor in occlusive vascular disease.

The purpose of this study was to examine the recognized ability of interleukin-1 alpha (IL-1 alpha) to alter the functional properties of endothelial cells and to induce replication of smooth muscle and fibroblasts. Such changes could potentially link IL-1 alpha pathogenetically to the myointimal proliferation of vascular sclerosis. Using a peroxidase-immunoperoxidase immunohistochemical method, saphenous veins and internal mammary arteries were examined for the presence of IL-1 alpha before their implantation as aortocoronary bypass grafts. Occluded saphenous vein grafts requiring replacement because of recurrent angina pectoris also were similarly examined. Interleukin-1 alpha, deposited as a scarlet immunoprecipitate, was seen on the luminal surface, in the subintima, and on the spindle cells and infiltrating macrophages in the media of 13 phlebosclerotic veins before surgical insertion. The remaining 30 unchanged veins did not contain IL-1 alpha. Similarly, IL-1 alpha was not identified in any of the 43 sampled internal mammary arteries that were all considered structurally intact. All the 55 bypass grafts, which were examined by biopsy during revascularization and demonstrated diverse histopathologic abnormalities consisting of reduced luminal patency, myointimal proliferation, mononuclear cell infiltration, mural collagenization, and luminal-mural hemorrhage, also contained widely distributed IL-1 alpha. The observation that IL-1 alpha was absent in all of the internal mammary arteries concomitant with maintenance of normal microanatomic structure may help explain, in part, their recognized resistance to reduction in luminal patency and their improved clinical survival when used as coronary artery bypass grafts. Alternatively, the consistent presence of IL-1 alpha in all vessels with sclerotic histopathologic changes suggests that this cytokine may be an important in situ indicator of and a potential participant in vascular injury. Interleukin-1 alpha may be a pathogenetic factor in the complex processes leading to vascular occlusion.     

Antibodies defining rat endothelial cells: RECA-1, a pan-endothelial cell-specific monoclonal antibody.

We have been searching for antibodies reactive with rat endothelial cells. Two monoclonal antibodies (mAb), named RECA-1 and RECA-2 were produced and tested in immunoperoxidase staining on frozen sections of various rat tissues. Staining patterns were compared to those obtained with the mAbs OX-2, OX-26, OX-43, and the polyclonal antibody to von Willebrand Factor (vWF), which all have been described to react with rat endothelial cells. The RECA-2 mAb showed staining patterns similar to those obtained with OX-2. RECA-1 showed to be the only antibody reactive with all vascular endothelium in the tested tissues. In addition, RECA-1 was endothelial cell-specific whereas all other antibodies crossreacted with one or more other cell types. No reactivity of RECA-1 was found in various tested species other than rat. The RECA-1 antibody was successfully applied in staining of paraformaldehyde fixed, plastic embedded tissue material. Immunofluorescence staining of viable endothelial cells demonstrated that RECA-1 recognizes a cell surface antigen. This was supported by intravenous injection of RECA-1, which showed the antibody to localize along the endothelium lining the vasculature in various organs tested. No reactivity of the antibody was seen when applied in immunoblotting of PAGE-run lysates from endothelial cell cultures and stromal cell preparations. We believe RECA-1 to be a promising antibody for rat endothelial cell studies, and in particular for further defining nature and function of endothelial cell-specific antigens.     

A study of retinitis pigmentosa in the City of Birmingham. I Prevalence.

Using multiple sources, an attempt was made to ascertain all symptomatic cases of retinitis pigmentosa living in the City of Birmingham in June 1978. These methods revealed a prevalence for all ages of 1 in 4869 and a prevalence in the age group 45 to 64 years of 1 in 3195. There was a higher prevalence than expected among young Muslims with consanguineous parents. However, the most accurate prevalence of uncomplicated retinitis pigmentosa among adults was considered to be that found in an outpatient clinic serving adult diabetics, namely, six patients in a clinic population of 8000 to 10 000.     

Mechanism of T cell activation. I. A screening of "step one" ligands

A number of ligands which bind to T cell surfaces were screened on murine spleen cells for their functional ability to induce either of the two necessary steps in the process of T cell triggering: (a) expression of growth receptors by T lymphocytes and (b) production of T cell growth factors in cultures containing both T cells and accessory cells. Among four lectins tested, concanavalin A was found to induce both responses but is primarily a “step 2” ligand, in particular at low concentrations; leucoagglutinin was the most potent “step 1” ligand with very limited “step 2” activity; wheat germ agglutinin and soybean lectin were inactive. Direct mitogenicity of the lectin to normal spleen cell cultures was limited by the poorest of these two functional properties. A number of rabbit anti-lymphocyte antisera, anti-Thy-1 alloantisera, anti-H-2 and anti-Ia monoclonal antibodies, as well as complexes of rabbit IgG, were all found to be devoid of “step 1” activity, and consequently, non- mitogenic for spleen cells. In contrast, a rabbit anti-mouse brain antiserum, although also devoid of mitogenicity, was found to be capable of “step 1” induction. These results suggest that not all rearrangements of T cell surface membrane components upon binding of a ligand result in the functional expression of growth receptors. This appears to be the result of selective interactions with specific sites which include structures binding to concanavalin A, leucoagglutinin and rabbit anti-mouse brain antibodies.     

Genetic susceptibility to vaginal candidiasis.

To enable future studies on host resistance factors and therapy, inbred and outbred mouse strains were tested for susceptibility to vaginal candidiasis. Groups of mice were given 0.5 mg estradiol 3 days before and 4 days after intravaginal challenge with a suspension of Candida albicans. On day 1 after challenge, a swab was used to quantitate infection in all groups and to assure equivalent infection levels. On day 6, this was repeated and the experiment was terminated. BALB/c, the reference strain in repeated experiments, was susceptible, showing persistent infection with levels of cfu at day 6 falling within a range between a twofold decrease and a fourfold increase in relation to day 1 levels. CD-1 outbred mice were markedly resistant, with day 6 cfu levels showing a 74- to 87-fold decrease with respect to day 1 levels, whereas other outbred strains (CF-1, SW, ICR) were susceptible. A BALB/c substrain (ByJ) was also susceptible. With exception of CBA/J, which showed modest resistance, all inbred strains were similarly susceptible, including DBA/2, AKR/J, C3H/HeN, A/J and C57BL/6. The differences between CD-1 and BALB/c mice were also seen with a second C. albicans isolate. Our results show susceptibility to vaginal candidiasis is independent of the major histocompatibility locus H2 haplotype and any effect ascribable to use of particular commercial mouse suppliers. Differences among mouse strains in susceptibility to C. albicans, as seen in previous studies involving nonvaginal challenge routes, are not reflected in this vaginal candidiasis model; in general, such resistance patterns appear specific to the route of challenge administration. The resistance seen in mouse strain CD-1 is of particular interest in that CD-1 is known to be resistant to endocrine disruption by estrogen. Our results suggest this estrogen insensitivity may have broad-ranging effects on processes other than gametogenesis, including vaginal susceptibility to candidiasis.     

PCR identification of Mycobacterium bovis BCG.

The attenuated bacillus Calmette-Guérin (BCG) vaccine strain is derived from a virulent strain of Mycobacterium bovis. BCG is difficult to differentiate from other strains of M. bovis and other members of the M. tuberculosis complex by conventional methods. Recently, a genomic region designated RD1 was found to be present in all virulent M. bovis and M. tuberculosis strains tested but deleted from all BCG strains tested. With this information, a multiplex PCR method was developed to detect the RD1 deletion. A large collection of BCG and other M. tuberculosis complex strains from diverse host and geographic origins was tested. RD1 was deleted in 23 of 23 BCG strains. RD1 was present in 129 of 129 other M. tuberculosis complex strains. This multiplex PCR method can be used as a tool for the rapid and specific identification of BCG.     

Amylase-producing multiple myeloma.

We managed a case of amylase-producing multiple myeloma with extensive extramedullary spread. We reviewed five cases of amylase-producing multiple myeloma, including this case. This type of multiple myeloma has shown unique clinicopathologic features. (1) A distinct elevation of the serum amylase activity was demonstrated in all five patients. The amylase isozyme was of the S type without exception. (2) Extensive extramedullary spread with extramedullary tumors and/or myelomatous pleural effusions or ascites was seen in all five patients during the course of illness. (3) In three of four cases in which it was mentioned, extensive destruction of multiple bones was demonstrated roentgenographically. (4) In four patients, excepting one with a solitary bone lesion, the survival from the initial therapy was shorter than 1 year. (5) Myeloma cell lines were established in three cases. A common feature of these three cell lines was a translocation of chromosome 1, which supplied the amylase gene. This finding may be pathogenetically related to this entity.     

Immunopathological aspects of Plasmodium berghei infection in five strains of mice. I. Immune complexes and other serological features during the infection.

The development of circulating immune complexes was studied in mice of the BALB/c, A/J, OF1, CBA and C57B1 strains infected with P. berghei. Complexes were evaluated in relation to levels of parasitaemia, soluble antigen, specific antibody and C3. Susceptibility to infection was greatest in BALB/c, A/J and OF/a mice. The maximum parasitaemia was 30% in CBA and 70% in all other strains. Levels of soluble antigen paralleled those of parasitaemia. Specific antibody was detected in all strains, but the titre continued to rise throughout the infection only in CBA mice. Circulating immune complexes occurred in mice of all strains from day 6; the level fell after day 9 in C57B1 whereas it was maintained in CBA mice. The development of immune complexes was associated with marked depression of C3 levels in all except CBA mice, in which a transient reduction was followed by recovery. Partial characterization of the complexes showed that IgM-containing complexes appeared earliest and reached highest levels in BALB/c mice while in CBA mice, IgM complexes were found in lesser amounts and the level fell in late infection. IgG complexes rose throughout infection in CBA and fell in later stages in BALB/c and C57B1 mice. In nude BALB/c mice, immune complexes were usually not detectable and only low levels of antibody of IgM class were produced. Differences in mortality pattern could not be related to any single serological factor.     

Immunohistochemical detection of NRSA on small cell lung cancer with a monoclonal antibody (MAG-1) that recognizes the carboxyl terminus of provasopressin.

A single monoclonal antibody (MAG-1) directed against the C-terminal 18-amino acid region (VAGc18) of provasopressin was examined as an agent for recognizing the tumor-specific NRSA marker common to small cell lung cancer (SCLC) in formalin-fixed tissues with ABC immunohistochemistry. SCLC tumors were obtained from several tissue locations and included primary, metastatic, and recurrent disease. Positive staining was found in 91% of cases (53/58). All five of the unreactive tumors were of the lungs or chest wall, and there did not appear to be an association of this negativity with disease stage, age, or sex. Alternatively, almost all primary lesions, almost all metastatic lesions, and all recurrent lesions examined gave a positive reaction with MAG-1. For this study, vasopressin-producing cells of the human anterior hypothalamus served as a positive control, while negative controls comprised normal lung tissue, tumor that received MAG-1 in the presence of an excess of antigen (VAGc18 peptide), or tumor reacted with a commercial IgG1 isotype as primary antibody. All of the results indicate that MAG-1 can be effectively used to selectively identify the NRSA marker on almost all SCLC tumors, at all disease stages, and at all locations. Since all four tumors tested showing no reactivity with MAG-1 gave a positive reaction for synaptophysin, it is proposed that a combined use of MAG-1 with synaptophysin antibodies could allow all SCLC tumors to be detected by ABC immunohistochemistry.     

The generation of memory cells. V. Preferential priming of IgG1 B memory cells by immunization with antigen IgG2 antibody complexes.

We have studied the effects of priming mice with complexes of dinitrophenylated (DNP)-haemocyanin (KLH) and anti-DNP antibody on the generation of DNP-specific B memory cells producing IgG1 or IgG2 antibodies. Immunization with DNP-KLH alone (with or without adjuvant) induced roughly equal proportions of IgG1 and IgG2 memory cells, at all times after priming. In sharp contrast, immunization with DNP-KLH polyclonal anti-DNP antibody complexes induced 80%--90% IgG1 memory cells, especially early after priming. Further studies using conventional and hybridoma anti-DNP antibodies showed that this effect was induced by complexes containing IgG2 antibodies, and not by those made with IgG1 antibodies. The latter induced roughly equal proportions of IgG1 and IgG2 memory cells. Priming for preferential IgG1 memory was not induced by complexes made with (Fab')2 fragments of IgG2a antibody, nor was it seen in T cell-deprived mice immunized with antigen IgG2a complexes. The mechanisms involved in this phenomenon are unknown, but presumably reflect the well established capacity of immune complexes to concentrate in lymphoid follicles, which seem to be sites of B memory-cell generation.     

Immunological activity of a T hybrid line. I. Production of an H-2-related suppressor factor with specificity for sheep red blood cells.

T lymphocyte hybrid lines have been produced by fusion of the thymoma BW 5147 with spleen cells of C57BL/10 mice primed to sheep red blood cells (SRBC). The supernatant (culture fluid) of a T hybrid designated A 1 was able to suppress the primary (IgM) and secondary (IgM and IgG) antibody responses to SRBC in vitro. The suppressive activity of supernatants could be titrated to 50% end points at final dilutions of up to 1 : 270. The suppression affected only SRBC and haptens coupled to SRBC, except when used at high concentration when some nonspecific suppression was observed. Absorption of the A 1 supernatant with SRBC removed all activity, while several other species of red cells failed to do so. The suppressor factor present in A 1 supernatant was not removed by anti-Ig adsorbents, but was removed by anti-H-2 antibodies reacting specifically with the haplotype of the spleen cells used in the fusion (H-2b). The cellular target of action of the factor was apparently a B cell, based on absorption with different cell populations. No genetic restrictions in the activity of the factor were found. A 1 cells carried H-2 and Thy-1 alleles of both parental cells and formed rosettes with SRBC.     

Identification of a surface antigen of Trichomonas vaginalis.

A major surface antigen of Trichomonas vaginalis was purified by using three independently derived monoclonal antibodies (two immunoglobulin M and one immunoglobulin G1) prepared against T. vaginalis PHS-2J. A 115,000-molecular-weight antigen and one or more components with a molecular weight of 58,000 to 64,000 were recovered when any of the three antibodies was used as an immunoadsorbent. The purified antigen reacted with all three monoclonal antibodies in an enzyme-linked immunosorbent assay, indicating that the antibodies recognized the same antigen but not necessarily the same determinant. The purified antigen was sensitive to both pronase digestion and periodate oxidation. The antigen was shown to be on the external surface of some but not all T. vaginalis isolates by agglutination of live organisms with the monoclonal antibodies.     

Sputum cytology: a limited role.

AIMS: To determine the cost and sensitivity of sputum cytology in routine use and to determine when sputum cytology is most appropriate. METHODS: A retrospective study, based on all sputum cytology requests received in five histopathology/cytopathology laboratories in Yorkshire from 1 January to 31 December 1993. Cytology findings were correlated with histological diagnosis or clinical outcome, and related to the speciality of the referring clinician. RESULTS: Laboratory practice and performance was similar in all five centres. The average laboratory cost of sputum cytology was 26.93. The mean absolute sensitivity was 36% and the specificity was 99.6%. The majority of specimens was submitted by general physicians or geriatricians. The largest proportion of positive specimens were submitted by chest physicians. CONCLUSIONS: Often sputum cytology is used inappropriately as a screening investigation on, or soon after, admission. In addition, it is used inappropriately before bronchoscopy. Sputum cytology should be limited to individuals in whom a histological diagnosis is desired, but in whom bronchoscopy is inappropriate or unsuccessful.     

Analysis of type II collagen-reactive T cells in the mouse. I. Different regulation of autoreactive vs. non-autoreactive anti-type II collagen T cells in the DBA/1 mouse.

The T cell reactivity against type II collagen (CII) was analyzed in the collagen-induced arthritis-susceptible mouse strain DBA/1. It was shown that the proliferative response in lymph node cells from rat CII-immunized mice was mainly directed against a foreign determinant present on all heterologous CII tested but not on autologous CII. A T cell line with this reactivity reacted with high sensitivity with CII and the determinant was mapped to the CB11 fragment of CII. A weak autoreactive response could be detected in the primary cultures using high concentrations of mouse CII and this reactivity remained after several stimulations with high concentrations of rat CII but not with low concentrations of rat CII. A similar response against mouse CII but with only limited cross-reactivity to rat CII was seen when culturing the cells with mouse CII as antigen. The optimal concentration for the autoreactive response was always more than 100-fold higher than for the response of the T cells specific for heterologous CII. An anti-CII T cell response could also be detected in spleen cells from unimmunized mice and the strongest response was obtained using autologous CII. These results suggest that T cells recognizing self CII are normally activated in the DBA/1 mouse and possibly as a consequence exhibit a clonal anergy pattern with a weak proliferative response only at high concentrations of CII.     

Immune response against two epitopes on the same thymus-independent polysaccharide carrier. 1. Role of epitope density in carrier-dependent immunity and tolerance.

Immunogenicity and tolerogenicity of two epitopes (alpha 1-6 and FITC) on the same dextran B 512 carrier were investigated. The following conclusions were made: (1) Both epitopes were thymus-independent and immunogenic and tolerogenic as well. (2) The marked dose differences between the two epitopes with regard to tolerance induction were found to be a consequence of the affinity and the heterogeneity of the responding B cells as well as the epitope density employed for detecting the PFC in a predictable way. (3) The alpha 1-6 response, in contrast to the anti-FITC response, was homogeneous and of low affinity and the number of precursor B cells was low. (4) Different mouse strains were found to be high-, low- or non-responders to alpha 1-6, but all the strains tested responded to the FITC epitope coupled to dextran. (5) Dextran and FITC-dextran were polyclonal B cell activators in the strains tested, irrespective of their ability to respond to the alpha 1-6 epitope. The findings indicate that epitope density and mol. wt of the immunogen as well as Ig receptor affinity for the epitope on the B cells are variables which markedly influence the binding of the immunogen to the specific B cells and therefore affect the delivery of the non-specific triggering signal.     

Syphilitic lymphadenopathy. Histology and human immunodeficiency virus status.

Few reports on syphilitic lymphadenopathy have appeared in 20 years, and none have compared findings in patients with and without human immunodeficiency virus (HIV) infection, despite the recent epidemic spread of syphilis and HIV. Twelve cases of syphilitic lymphadenopathy were studied and grouped according to HIV status. Patients were 21 to 62 years old (median, 29 years); 7 were men, 5 were women. Biopsy sites were cervical (7 cases), inguinal (4), and axillary (1) lymph nodes. All patients had evidence of syphilis. Rapid plasma reagin titers ranged from 1:32 to 1:512. Treponemal hemagglutination was positive in all cases tested. Spirochetes were found with Steiner staining in 2 cases. HIV testing was positive in 4, negative in 2, and unknown in 6 cases. Lymph nodes were enlarged and often fragmented due to capsular fibrosis and chronic inflammation, with focal obliteration of the subcapsular sinus. Follicular and interfollicular hyperplasia was seen in all cases and was usually marked, with prominent vascular proliferation, plasma cells, immuno-blasts, histiocytes, and occasional neutrophils. Follicle lysis and granulomas suggestive of unconfirmed toxoplasmosis were each seen in 1 case, and Kaposi sarcoma in 2, all in HIV-positive patients. Lymphoplasmacytic infiltration was marked, especially in interfollicular areas, with peri-vascular plasma cell cuffing in all cases and obliterative endarteritis in about half (7 of 12, 56%). Immunostaining for CD45RO (UCHL-1), CD20 (L26), kappa, lambda, and CD68 (Kp-1) revealed a mixed population of T cells, polyclonal B cells, and interfollicular histiocytes. Distribution of T and B cells (immunoarchitecture) was essentially normal and similar in all cases, regardless of HIV status. Syphilis produces essentially identical findings in lymph nodes in both HIV-positive and HIV-negative patients. The morphologic findings described should prompt evaluation for infection with Treponema pallidum and, in light of the current epidemic, HIV.     

Sequential changes of traumatic vertebral compression fracture on MR imaging.

The purpose of this study was to evaluate the sequential signal intensity changes in post-traumatic vertebral compression fractures of varying ages. Sixty-six patients with 115 post-traumatic vertebral compression fractures underwent MR imaging. The ages of fractures at the time of MR images ranged from 1 day to 6 years. Sequential follow-up MR imagings were obtained in 4 patients for 2 years after initial MR examination. The fracture sites in all 52 fractures with traumatic events less than 3 months prior were hypointense on T1-weighted images and hyperintense on T2-weighted images (type I). A type I fracture could be subdivided into 3 patterns depending on its morphologic appearance: diffuse (type Ia); patchy (type Ib); and bandlike (type Ic). In 12 fractures of 3 to 5 months after trauma, six showed focal hypointensity (type II) in all pulse sequences, and six showed isointensity (type IV). Four of 51 fractures with trauma over 5 months showed focal hyperintensity on T1-weighted images and isointensity on T2-weighted images (type III); and the remaining 47 fractures showed isointensity on all sequences (type IV). In conclusion, MR imaging is useful in predicting the age of known traumatic compression fractures, so familiarity with these sequential MR findings would be helpful in distinguishing benign from malignant fractures.