Characterization of a monoclonal antibody that recognizes a lymphocyte surface antigen for the cetacean homologue to CD45R.

As part of our current efforts to develop assays and reagents to study the immune system of marine mammals, and in view of the effort currently made to develop monoclonal antibodies to cell surface proteins of lymphocyte subsets in different species, the present paper reports on the characterization of a monoclonal antibody against the homologue of CD45R on cetacean lymphocytes. The specificity of this antibody has been characterized on the basis of immunoprecipitation of the antigen it recognized, immunoperoxidase staining on cetacean lymph node and thymus sections, as well as one and two-colour flow cytometric analysis of cetacean peripheral blood mononuclear cells and single-cell suspensions of thymus, lymph node and spleen. Anticetacean CD45R (F21.H) immunoprecipitated proteins of 180, 200 and 220 x 10(3) MW, with the 180 x 10(3) MW from being predominantly expressed on T cells and the 220 x 10(3) MW form expressed predominantly on B cells and thymocytes F21.H labelled all B cells and a proportion of T cells on single-cell suspensions of spleen cells. CD45R- killer whale peripheral blood lymphocytes expressed a higher density of CD2 than CD45R+, a characteristic of memory T cells. Killer whale T lymphocytes also lost the expression of CD45R upon activation with concanavalin A (Con A) and phytohaemagglutinin (PHA). This is the first report of a monoclonal antibody to CD45R in cetaceans, and this antibody is foreseen as a possible valuable diagnostic and research tool to assess immune functions of captive and wild cetaceans as part of the evaluation of their health status.     

Regulation of Abortion by γλ T Cells

PROBLEM: T cells are present at the feto-maternal interface, but their function during pregnancy has not been fully elucidated. T cells bearing γλ T-cell receptor (TCR) may be particularly important, as some subsets can react to trophoblast cells by producing cytokines, such as interleukin-2 (IL-2). METHOD: We depleted T cells bearing the γλ receptor by injecting monoclonal antibodies (mAB) into females of the abortion-prone animal model CBA x DBA/2. We investigated the percentage and number of γλ T-cell receptor positive (TCR)⁺ cells in decidua and spleen during pregnancy in control and γλ-depleted female mice. Pregnant females were also exposed to ultrasonic sound stress to boost the abortion rate. RESULTS: Stress failed to increase the abortion rate in the γλ TCR-depleted mice. FACScan analysis show that the ratio of cells bearing the γλ TCR dramatically decreased after injection of mAB to the γλ TCR in spleen and decidua, these cells recovered six days after depletion, showing a change in cytokine pattern. Levels of TNF-α in decidual γλ T cells decreased; similar effects of decreasing Th₁ cytokines could be observed in splenic γλ T cells. We further identified increased levels of intracellular TNF-α in the Vλ4 subset in the decidua, compared to spleen. CONCLUSIONS: Trophoblast recognition by the Vλ4 T-cell subset in the decidua may cause the release of abortogenic cytokines such as TNF-α. Depletion of such γλ TCR T cells during early pregnancy may promote successful pregnancy outcome in normal pregnancy and prevent stress-induced abortions.     

Limited yield of hospitalization for the evaluation of syncope in patients presenting to an urban tertiary medical center

Syncope is a frequent presenting complaint in the emergency department and is associated with significant medical costs. We examined the utility of inpatient evaluation of syncope for patients in whom a diagnosis was not established in the emergency department. We retrospectively reviewed consecutive patients presenting with syncope to an urban tertiary care medical center. A diagnosis was not established after initial evaluation in the emergency department in 171 of 230 patients admitted. Inhospital evaluation led to a diagnosis in 26 patients. Acute intervention was required in 2 patients. Our observations suggest that an inpatient evaluation of syncope for patients in whom a diagnosis is not made on initial evaluation is of low yield, and outpatient follow-up may be safe.     

Unique technique to relieve left ventricular assist device electromagnetic interference with an implantable cardioverter defibrillator

We introduced a simple technique to eliminate electromagnetic interference between a left ventricular assist device (LVAD) and an implantable cardioverter defibrillator (ICD). A 43-year-old male with heart failure and a reduced ejection fraction who had an ICD presented with decompensated heart failure and received an LVAD as a bridge to transplant. Remote monitoring showed persistent atrial fibrillation causing an inappropriate ICD shock leading to a decision to disable shock therapies. However, an in-office interrogation was unsuccessful due to electromagnetic interference. Patient was instructed to extend his arm above his head on the ipsilateral side of the ICD, thus increasing the distance between LVAD and ICD, eliminating the interaction to allow reprogramming of the device.     

Cardiac Memory after Radiofrequency Ablation of Accessory Pathways: The Post-ablation T Wave Does not Forget the Pre-excited QRS.

Introduction: Normalization of the pre-excited QRS following ablation is accompanied by repolarization changes but their directional relationship to changes in ventricular activation has not been well characterized.Methods: Accordingly, we measured QRS and T wave vectors and QRS-T angles from 12 lead ECG recordings immediately before and after accessory pathway (AP) radiofrequency ablation in 100 consecutive patients. Patients with bundle branch block, intraventricular conduction defect or intermittent pre-excitation were excluded, leaving a study group of 45 patients: 35 with pre-excitation and 10 with concealed APs.Results: With AP ablation, changes occurred in the QRS and T wave vectors and QRS-T angles that were essentially equal and opposite, so that the newly normalized QRS complex and QRS vector were accompanied by a T wave whose vector approximated that of the pre-ablation QRS vector. This tended to maintain a large QRS-T angle: 72° ± 50° before, and 54° ± 34° after QRS normalization (p = NS). A QRS-T angle >40° was found before and after ablation in 22/35 patients (63%) with baseline pre-excitation; but never in patients with a concealed AP (p = 0.001). The angle between the pre-excited QRS and the post-ablation T wave was 35° ± 37°, and 40° in 25/35 patients (71%). The change in T wave axis with QRS normalization correlated in magnitude with the QRS-T angle before ablation (r = 0.73, p < 0.0001). The change in QRS axis correlated with the QRS-T angle after ablation (r = 0.37, p < 0.03). Shorter AP effective refractory periods (ERPs) correlated with wider QRS-T angles after ablation (r = –0.39, p < 0.03). The ECG leads manifesting these changes depend on AP location.Conclusion: T-wave changes after ablation of APs (1) are dependent on anterograde AP conduction at baseline and are not observed with concealed APs; (2) correlate in magnitude directly with the change in QRS axis and inversely with the anterograde AP-ERP; (3) are related to AP location. With termination of pre-excitation secondary repolarization changes immediately disappear and the post ablation T wave axis approximates that of the pre-excited QRS. Recognition of this sequence may prevent unnecessary clinical interventions.     

Internal transcardiac pericardiocentesis for acute tamponade

If the catheter is still in the pericardium when tamponade is recognized during catheterization or electrophysiologic procedures, it can be used for definitive aspiration and relief of tamponade. This is physiologically beneficial to the patient, and psychologically beneficial to both patient and medical staff.