Hepatitis B Virus Reactivation in a Patient With Chronic GVHD After Allogeneic Peripheral Blood Stem Cell Transplantation

We report a patient with fatal hepatitis B virus (HBV) reactivation after treatment for chronic graft-versus-host disease (GVHD) following allogeneic peripheral blood stem cell transplantation to treat chronic myelogenous leukemia. The presence of antibodies to hepatitis B surface antigen (HBsAb) prior to transplantation indicated previous HBV infection. Liver damage first developed 8 months after transplantation with the disappearance of HBsAb. Hepatitis B antigen was first noted during an examination of liver damage that occurred 22 months after transplantation. Retrospective examination of serum by real-time detection polymerase chain reaction (RTD-PCR) revealed HBV in both the first and second episodes of liver damage (89 copies/mL and 2 x 10(6) copies/mL, respectively). HBV may have been reactivated, leading to fatal liver damage in this HBsAb-positive patient. We propose that RTD-PCR-based analysis should be performed to diagnose liver dysfunction after hematopoietic stem cell transplantation.     

Traumatic disruption of bilateral vertebral arteries and internal carotid arteries: case report

A case of traumatic disruption and dissection of the bilateral vertebral arteries and internal carotid arteries is reported. Ligation of bilateral arteries was performed for active bleeding. Anticoagulant therapy was selected to prevent thromboembolism and thrombotic occlusion of the dissected internal carotid arteries.     

Effect of mercurials on lymphocyte functions in vitro

The effect of in vitro treatment with mercurials on several functions of mouse lymphocytes was studied. When lymphocytes were cultured in the presence of mercurials, DNA synthesis induced by mitogen (concanavalin A, phytohemagglutinin-P, lipopolysaccharide) and polyclonal B cell activation induced by lipopolysaccharide were strongly inhibited by methylmercuric chloride at the concentration of 10(-6) M, but mercuric chloride inhibited these functions by 50% at 10(-5) M. Furthermore, 10(-7) M methylmercuric chloride and 10(-6) M mercuric chloride inhibited mixed lymphocyte reaction by 80%. Thus, the inhibitory effect of methylmercuric chloride was 10 times stronger than that of mercuric chloride when the mercurials were present in the culture throughout the incubation. On the other hand, DNA synthesis once induced by mitogens was not significantly affected when 10(-6) M methylmercury was added during the last 3 h of the incubation. Pretreatment with 10(-6) M methylmercury for 1 h, however, showed 50% inhibition of thymidine incorporation into DNA and also reduced the rate of metabolism of phosphatidyl inositol by 50%. These results indicate that methylmercury may act on mouse lymphocytes at an early stage of transformation induced by the mitogens, while inorganic mercury failed to cause the pronounced difference in its potency of inhibition on the functions of lymphocytes by the different treatments of the cells under the various conditions used.     

Experimental study on vascularized bone allografts for reconstruction of massive bone defects

To study the healing mechanism of vascularized bone allografts under short-term as well as long-term immunosuppression with cyclosporin A, experimental vascularized intercalary bone allograft transplantation was carried out between inbred rats using the tibiofibula graft model. Bone scintigram and radiographs were used as an indicator for early detection of rejection after transplantation and bone union. In vascularized bone allografts under long-term immunosuppression with cyclosporin A, early bone union and continuous incorporation were similar to that observed in vascularized bone autograft transplantation. When administration of cyclosporin A was discontinued before completion of bone union, the graft was rejected and bone union was delayed. Apparent swelling on the operated limb associated with a decrease in bone scintigram uptake suggested the occurrence of rejection of the allograft. Vascularized bone allograft transplantation is useful for reconstruction of massive bone defects only if immunosuppressants are used and maintained at least until bone union is obtained. © 1994 Wiley-Liss, Inc.     

Attenuated humoral response against SARS-CoV-2 mRNA vaccination in allogeneic stem cell transplantation recipients

Antibody persistence several months after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) mRNA vaccination in allogeneic stem cell transplantation recipients remains largely unknown. We sequentially evaluated the humoral response to two doses of mRNA vaccines in 128 adult recipients and identified the risk factors involved in a poor response. The median interval between stem cell transplantation and vaccination was 2.7 years. The SARS-CoV-2 S1 Ab became positive after the second vaccination dose in 87.6% of the recipients, and the median titer was 1235.4 arbitrary units (AU)/ml. In patients on corticosteroid treatment, the corticosteroid dose inversely correlated with Ab titer. Multivariate analysis identified risk factors for poor peak response such as an interval from stem cell transplantation ≤1 year, history of clinically significant CMV infection, and use of >5 mg/day prednisolone at vaccination. Six months after vaccination, the median titer decreased to 185.15 AU/ml, and use of >5 mg/day prednisolone at vaccination was significantly associated with a poor response. These results indicate that early vaccination after stem cell transplantation (<12 months) and CMV infection are risk factors for poor peak response, while steroid use is important for a peak as well as a persistent response. In conclusion, although humoral response is observed in many stem cell transplantation recipients after two doses of vaccination, Ab titers diminish with time, and factors associated with persistence and a peak immunity should be considered separately.     

Nephritogenicity and α-chain composition of NC1 fractions of type IV collagen from bovine renal basement membrane

Nephritogenicity (anti-GBM-nephritis-inducing activity) and -chain composition of globular-domain (NC1) fractions of type IV collagen from bovine renal, pulmonary, and placental basement membranes (BMs) was examined by injecting these fractions with adjuvant into WKY/NCrj rats and by Western blotting using epitope-defined monoclonal antibodies to the six different chains of type IV collagen. A purified nephritogenic fraction from renal BM contained 1–6(IV)NC1, whereas a non-nephritogenic fraction contained only 1–2(IV)NC1. Renal and pulmonary NC1 had strong nephritogenic activity; placental NC1 had weak activity. The renal and pulmonary fractions contained 1–6(IV)NC1, and the placental fraction had a large amount of 1–2(IV)NC1 and a very small amount of 3–6(IV)NC1. Immunohistochemical study of bovine renal BM with the monoclonal antibodies revealed that bovine glomerular BM contained 1–5(IV) chains, but not the 6(IV) chain. The absence of 6(IV) chain in glomerular BM in bovine and in humans indicates that 6(IV) chain is not a target antigen of anti-GBM nephritis. Nephritogenicity is apparently a property of 3–5(IV)NC1.