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Blood donors in Canada are asked to volunteer their history of drug ingestion within the previous 24 hours. The authors analysed 400 serum samples from blood donors for acetylsalicylic acid (ASA) and acetaminophen, two commonly used nonprescription drugs. Although 16 of the samples contained ASA and 10 acetaminophen (2 contained both drugs), none of the donors had volunteered that they had ingested those medications before donating blood. The possible role of these drugs in some of the unexplained reactions to transfusions is considered.

It is possible to generate high levels of lymphokine-activated killer (LAK) activity in short-term culture from cells enriched for natural killer (NK) activity. To determine whether LAK activity can also be generated from non-NK cells, we have depleted peripheral blood lymphocytes (PBL) of NK cells prior to culture with IL-2. NK activity in PBL is correlated with the intensity of staining with the lysosomotropic vital dye quinacrine. Quinacrine dim PBL, which are devoid of lytic NK cells, are capable of developing LAK activity following culture with IL-2. We have also separated PBL using the NK-associated NKH-1 marker. Depleting NKH-1+ cells eliminates NK activity but the ability to develop LAK activity is retained. NKH-1-depleted cells generate less LAK activity than unseparated or NKH-1-positive cells and do not proliferate as well as unseparated cells to IL-2. When NK-depleted cells are subsequently examined for the expression of the NKH-1 antigen, this marker is absent from most cells at Day 3 of IL-1 culture, but is expressed on an increasing number of cells by Days 6-8. These results suggest that LAK derived from non-NK cells is functionally and phenotypically similar to LAK from PBL-containing NK cells, and may be the result of the activation of an NK precursor population.

A mouse monoclonal antibody raised against the human osteogenic sarcoma cell line 791T has been covalently coupled to purified human lymphoblastoid interferon alpha (IFN alpha). Conjugation does not interfere with antibody function, as the product binds to 791T cells and mediates complement-dependent tumour cell lysis to a degree equal to that of free antibody. The IFN activity, assessed by augmentation of natural killer (NK)-cell-mediated lysis, is reduced, but the conjugate does augment the killing of 791T and other tumour targets by peripheral blood NK cells. In admixture experiments the conjugate, when bound to unlabelled osteogenic sarcoma cells, also augments the killing of radiolabelled bystander cells. Neither free antibody nor the conjugate mediate antibody-dependent cellular cytotoxicity (ADCC), and augmented tumour cell lysis is a function of NK cell activation. This product provides for an alternative approach to cancer therapy via the activation of infiltrating hose effector cells using specifically targeted lymphokines.

In the absence of antigenic or mitogenic stimulation, certain peripheral blood lymphocytes exhibit proliferative and lymphokine-activated killer (LAK) cell activities when cultured with recombinant IL-2. Both activities were found to be an exclusive property of lymphocytes expressing type 3 complement receptors (CR3) identified by anti-CD11 monoclonal antibodies. CD11+ lymphocytes were then fractionated into three subsets by two-color flow cytometry. These included CD16+ cells, which display distinctive Fc receptors for IgG (CD16). Using anti-CD5, the CD11+ CD16- lymphocytes were separated into non-T cell and T cell subsets. The two non-T cell subsets (CD11+ CD16+ and CD11+ CD16- CD5-), but not the T cell subset (CD11+ CD16- CD5+), could proliferate in response to IL-2. Both CD11+ non-T cell subsets, but not the CD11+ T cell subset, had the capacity to mediate natural killer cell activity. However, all three CD11+ lymphocyte subsets were capable of generating LAK activity. These findings are consistent with the concept that two signals are required to stimulate T cells to proliferate. However, at least a small subset of blood T cells can be activated by IL-2 to become LAK cells.

The nature of the cytotoxic cells present in the peritoneal cavity of rats treated with Bacille Calmette-Guérin (BCG) or Corynebacterium parvum was investigated using a 6 hr chromium release assay and a quantitative method of analysis based on consideration of target-cell killing as an enzyme-substrate reaction. When the results of cell-fractionation experiments were evaluated in terms of recovery of total lytic units and when appropriate target cells (such as sarcoma Mc7) were used, the simultaneous presence of both cytotoxic macrophages and NK cells in peritoneal exudates could be readily demonstrated. With certain other target cells different results were obtained. Thus, with normal thymocytes, normal hepatocytes, or myeloma P3NSI as targets, NK cells were preferentially detected, whereas with leukaemias L5178Y, P815, and EL4 as targets, cytotoxic macrophages were preferentially detected. These findings resolve the previously conflicting reports concerning the nature of cytotoxic cells in activated peritoneal exudates.

Lymphocytes displaying iC3b (Type 3) complement receptors (CR3) were quantified by flow cytometry in patients with systemic lupus erythematosus. The percentages and absolute numbers were compared to age and sex matched controls. Total CR3+ lymphocytes identified by the monoclonal antibodies OKM1 or Leu 15 were significantly decreased in patients with symptomatic arthritis, serositis or vasculitis and those with lupus nephritis, whereas values for CR3+ lymphocytes in patients with inactive disease were similar to normal donors. The phenotype of CR3+ lymphocytes was markedly different in patients with active SLE. In normals granular lymphocytes bearing Fc receptors for IgG (L cells) comprised two-thirds of CR3+ lymphocytes. However, in SLE this subset was reduced to 20% and there was a corresponding increase in CR3+ lymphocytes co-expressing the T3 marker. Percentages of CR3 T4+ but not CR3+ T8+ lymphocytes were significantly increased in SLE. Although patients with active disease were lymphopenic, absolute numbers of CR3+ lymphocytes co-expressing T cell markers were similar to normal controls. Since L cells are non-specific suppressors of Ig production, the reduction of this subset along with the increase in CR3 T4+ cells could contribute to unregulated antibody production characteristic of SLE.

CD8+ lymphocytes comprise several cell subpopulations that differ phenotypically and functionally. Although the percentage of T cytotoxic/suppressor cells (CD3+ CD8+) is usually increased in patients with active SLE, these lymphocytes are unable to suppress immunoglobulin (Ig) synthesis. However, freshly prepared lymphocytes from patients with SLE contain CD8+ DR+ cells which spontaneously suppress lymphocyte production of mitogen induced interleukin 2 (IL-2). Furthermore, CD8+ Leu 11+ non-T cells which comprise only 5% of total lymphocytes are also potent suppressors of IL-2 production. At the present time it is not known whether CD8+ suppressors of Ig synthesis and CD8+ suppressors of IL-2 production represent different maturation stages of common precursor cells or represent true heterogeneity of CD8+ lymphocytes.

Although antibiotic prophylaxis for patients at risk for bacterial endocarditis has never been scientifcally tested, it is now an accepted practice in medicine. Patients at risk include all individuals with prosthetic valves, congenital or rheumatic heart disease, previous endocarditis, idiopathic hypertrophic subaortic stenosis (IHSS), and mitral valve prolapse with a holosytolic murmur. Dental, upper respiratory tract, genitourinary and gastrointestinal procedures associated with bacteremia are reviewed. New antibiotic regimens utilizing oral agents for shorter periods have recently been published and are outlined here. Patients at high risk of endocarditis (especially those with prosthetic valves) should continue to receive prophylactic antibiotics by the parenteral route.

Human thymocytes cultured in the presence of an interleukin-2 (IL-2) source (the supernatant of the MLA 144 cell line) that contains no lectin or interferon (IFN) activity become cytotoxic to K562 target cells. Inclusion of allogeneic lymphoblastoid cells in these cultures results in the earlier detection of cytotoxic activity. Addition of IFN to the thymocyte cultures has no effect on the development of cytotoxic activity. In contrast, the cytotoxic activity of IL-2 activated thymocytes can be augmented by subsequent exposure to IFN. The specificity and cell surface phenotype of the cytotoxic thymocytes are similar to that of peripheral blood natural killer cells.

Human lymphoblastoid interferon-alpha (IFN-alpha) has been coupled using N-succinimidyl 3-(2-pyridyldithio) propionate (SPDP) to a murine monoclonal antibody (791T/36) which reacts with antigens expressed on human osteogenic sarcomas. The purified conjugates retain antibody activity as defined by their capacity to compete with binding of fluorescein isothiocyanate-labelled 791T/36 antibody to 791T cells. IFN-alpha-791T/36 antibody conjugates synthesized with 125I-trace-labelled IFN-alpha and 131I-trace-labelled antibody also bound to 791T cells, but not to bladder carcinoma T24 cells. The conjugates also retain the capacity of free IFN to activate natural killer cells in human peripheral blood lymphocytes and show specific localization in human osteogenic sarcoma xenografts developing in immunodeprived mice. These findings establish that conjugates containing IFN linked to a monoclonal antibody reacting with osteogenic sarcoma-associated antigens have potential for targeted immunotherapy and in related investigations with antibody has been shown by gamma camera imaging of patients following infusion of 131I-labelled antibody to localize in primary osteogenic sarcomas.

By using the OKM1 monoclonal antibody and the fluorescence-activated cell sorter to identify lymphocytes bearing iC3b (type 3) complement receptors, two principal populations of OKM1+ lymphocytes have been identified in human peripheral blood. One subset exhibited azurophilic granules and Fc receptors for IgG stained by Leu-11. The other population did not display FcR, but was enriched in cells reacting with OKT3 and OKT8 (low intensity). In healthy subjects, approximately 60% of CR3+ lymphocytes were granular FcR-bearing cells and only 18% co-expressed OKT3 determinants. In patients with systemic lupus erythematosus (SLE), CR3+ lymphocytes were predominantly FcR negative cells and 71% lacked granules. Only 33% reacted with Leu-11, but 50% co-expressed OKT3, 44% reacted with OKT8+, and 15% were OKT4+. We tested the hypothesis that agranular OKT3+ Leu-11- lymphocytes, such as those found in SLE patients, contained the precursors of natural killer (NK) cells. Leu-11+ cells were removed from normal lymphocytes by complement lysis, and the remaining cells were treated with recombinant IFN-alpha, IFN-gamma, or IL 2. These procedures were ineffective in generating typical NK effector cells. Our studies do not support the hypothesis that CR3+ Leu-11- lymphocytes are the precursors of granular Leu-11+ NK cells.

High levels of cytotoxic activity against the natural killer (NK) cell-sensitive target K562 and the NK-resistant target UCLA-SO-M14 (M14) can be generated in vitro either by mixed lymphocyte culture (MLC) or by culture of lymphocytes in interleukin 2 (IL2) (lymphokine activated killer (LAK) cells). The purpose of this study was to identify similarities and differences between MLC-LAK and IL2-LAK cells and allospecific cytotoxic T cells. Induction of cytotoxicity against K562 and M14 in both culture systems was inhibited by antibodies specific either for IL2 or the Tac IL2 receptor. Like NK effector cells, the precursors for the MLC-LAK cells were low density large lymphocytes. However these precursors differed from the large granular lymphocytes that mediated NK cytolysis in sensitivity to the toxic lysosomotropic agent L-leucine methyl ester (LME). The resistance of the MLC-LAK precursors to LME indicated that the precursors included large agranular lymphocytes. Although interferon-gamma (IFN-gamma) is produced in MLC and in IL2 containing cultures, it is not required for induction of either type of cytotoxic activity. Neutralization of IFN-gamma in MLC- and IL2-containing cultures with specific antibodies had no effect on the induction of cytotoxic activities. Both allospecific cytotoxic T lymphocyte (CTL) and LAK activities were enhanced by IL2 and IFN-gamma at the effector cell stage. However, the mechanism of cytolysis was different in the two systems. NK- and MLC-induced LAK activities were independent of CD3-T cell receptor complex while CTL activity was blocked by monoclonal antibodies specific for the CD3 antigen. These results suggest that NK and the in vitro induced LAK cytotoxicities are a family of related functions that differ from CTL. Furthermore, MLC-induced and IL2-induced cytotoxicities against K562 and M14 appear to be identical.

The management of common medical problems in pregnancy often requires adjustments in drug therapy to assure a healthy fetus. The management of steroid-dependent bronchial asthma in pregnancy requires oxygen supplementation as well as vigorous treatment of airway obstruction to protect the fetus from maternal hypoxemia. The hypertensive pregnant patient should discontinue dietary sodium restriction and diuretic therapy and should be managed with alphmethyldopa or beta-blocker therapy. Hydralazine may be added if hypertension is severe. Mitral valve prolapse appears to produce no difficulties during pregnancy and the use of prophylactic antibiotics is probably not necessary for routine vaginal delivery, unless complications occur. Digoxin and quinidine are safe to use in pregnancy, provided careful monitoring is maintained. Oral anticoagulants are contraindicated in pregnancy and should be replaced with heparin if pregnancy is desired.

Intracortical injection of iron salts causes lipid peroxidation, focal edema, necrosis, gliosis, and the development of behavioral and electrographic seizures. Tocopherol pretreatment prevents the histopathologic perturbations associated with iron injection, and appears to accelerate the resolution of focal accumulation of peroxidation products. In this experiment, rats were pretreated with 500 mg/kg DL-alpha-tocopherol acetate prior to the injection of 3 microliter of 100 mM FeCl2 into the dorsal hippocampus, or induction of convulsive seizures by s.c. injection of 0.8 mg/100 g bicucullin. Tocopherol pretreatment prevented the occurrence of convulsive seizures in a significant number of iron-salts injected animals. Lipid peroxidation measured in the dissected hippocampus was significantly increased in untreated rats developing iron-induced seizures and in rats treated with tocopherol, but developing convulsive seizures. Tocopherol failed to prevent bicucullin-induced seizures. Further, convulsive seizures induced by bicucullin failed to alter hippocampal fluorescence levels. Hence, we concluded that the epileptogenic effects of hippocampal injection of iron salts appear to be related to the induction of peroxidation of neural lipids within the injection site.

Human blood lymphocytes that express Type 3 complement receptors (CR3) can be divided into a major subset with high density Fc receptors for IgG (FcR) identified with the monoclonal antibody Leu 11 and two minor subsets which display either CD8 (Leu 2) or CD4 (Leu 3) markers. We isolated CR3+ lymphocyte subsets and examined them for regulatory effects on pokeweed mitogen (PWM) stimulated cells. The FCR CR3+ cell suppressed PWM-induced proliferation and Ig production. Pretreatment of these lymphocytes with immune complexes was required to suppress proliferation, but not IgG production. The CR3+ Leu 2+ FCR- subset also had suppressive activity, but this effect was not observed unless the CR3+ Leu 3+ enriched subset was removed. In fact, the CR3+ Leu 3+ enriched subset enhanced IgG synthesis. Brief exposure of CR3+ lymphocytes to recombinant interleukin 2, recombinant alpha-interferon, but not gamma-interferon, markedly enhanced the inhibitory effect. Time course studies and a comparison of inhibition of Ig synthesis with natural killer cell activity suggested that CR3+ lymphocytes act shortly after lymphocytes are exposed to PWM and that Ig production was regulated by suppression rather than cytotoxicity. These CR3+ lymphocyte subsets may have broad antigen non-specific effects on immunoglobulin synthesis.

The elimination of theophylline is decreased after vaccination against influenza. In three patients receiving 200 mg of oxtriphylline (equivalent to 128 mg of theophylline) every 6 hours by mouth the serum theophylline levels rose after vaccination, and in four healthy volunteers given the same dose of oxtriphylline 24 hours after vaccination the half-life of theophylline increased by an average of 122%. Two of the three patients showed signs of a toxic reaction to the drug. These results suggest that the elimination of theophylline is impaired to a clinically important degree after influenza vaccination and that the resulting levels of the drug can be toxic even when conventional therapeutic doses of theophylline are given.

Human peripheral blood lymphocytes cultured for 4 days in the interleukin 2 (IL-2)-containing cell-free supernatant of the MLA144 cell line (MLA144CM) are cytolytic to NK-susceptible and NK-resistant tumor target cells. This lymphokine-activated killer (LAK) activity is dependent on IL-2 as development of LAK activity is inhibited in the presence of a monoclonal antibody (MoAb) reacting with the IL-2 receptor (anti-Tac). Addition of cyclosporin A (CyA) to mixed lymphocyte cultures inhibits the development of allospecific cytotoxic activity and inhibits the development of IL-2 responsiveness. However, development of LAK activity is unaffected by the inclusion of CyA in the cultures, showing that the LAK precursor can be functionally distinguished from the allospecific cytotoxic precursor cell. Development of LAK activity does not require mature NK cells as shown by the generation of LAK activity from NK inactive human thymocytes and lymph node cells. In addition, depletion of NK activity from human PBL does not impair the development of LAK activity.

Beta-adrenergic blocking agents are an increasingly important class of drugs to the family physician. Diseases such as ischemic heart disease, hypertension and hyperthyroidism have responded dramatically to beta-blocking therapy. This article summarizes some of the current knowledge on the beta-receptor, the indications for beta-receptor blocking therapy, and the properties of the five beta-blocking agents currently available to Canadian physicians.

Human thymocytes are devoid of NK cells but develop lymphokine-activated killer (LAK) activity after culture with recombinant interleukin-2 (rIL-2). The most active precursor for this activity appears to be a CD3-negative cell. The purpose of these studies was to compare the phenotype and functional activities of thymocyte and peripheral blood lymphocyte (PBL) LAK cells. Following culture, rIL-2-activated thymocytes resemble PBL-generated LAk and PBL NK cells. For each of these populations, lytic activity is highest in NKH-1-positive cells. Two-color fluorescence of each population also indicates that NKH-1+ cells are highly granular, as measured by staining with the lysosomotropic vital dye quinacrine. PBL, PBL-derived LAK cells, and thymus-derived LAK cells have a portion of cells that express both CD3 and NKH-1. However, approximately 60-80% of NKH-1+ cells lack detectable CD3. This suggests that both CD3+ and CD3- cells may be capable of LAK activity. Thymic-derived LAK cells respond to interferon in a manner very similar to NK and PBL-derived LAK cells, but lack the NK-associated CD16 antigen. Thus, despite the absence of NK cells in the thymus, it is possible to generate thymocyte LAK activity which bears a strong resemblance to LAK activity derived from peripheral blood lymphocytes.

The elimination of a single oral dose of theophylline was studied in 12 healthy subjects before and after 250 mg erythromycin every 8 hr for 10 days. Serum theophylline elimination half-life rose from 4.79 +/- 0.43 hr before to 7.53 +/- 0.71 hr after erythromycin. Theophylline clearance decreased from a mean of 91.6 +/- 27.0 to 54.8 +/- 10.0 ml/kg/hr after erythromycin and the mean apparent volumes of distribution were much the same before and after the antibiotic. The excretion of theophylline and its metabolites was studied in the urine of three of the subjects. In each case the amount of 3-methylxanthine and 1,3-dimethyluric acid decreased after antibiotic. Adjustments of the theophylline dosage may be necessary for patients who take theophylline and erythromycin concurrently to minimize the risk of theophylline toxicity.

IL-2 production by peripheral blood mononuclear cells (PBM) is decreased in patients with systemic lupus erythematosus (SLE). This defect can be reversed by the removal of CD8+ lymphocytes. The purpose of these studies was to determine whether the CD8+ IL-2 suppressor cells comprise a specific subset or whether all CD8+ cells have this activity. Lymphocyte subsets were identified and separated by two-colour flow cytometry prior to a 48 h mitogen stimulation. The CD8+ cells that suppressed IL-2 production co-expressed HLA DR and were radiosensitive. Other markers co-expressed by CD8+ cells which are found on suppressor cells such as Leu 15 (CD11), Leu 11 (CD16), and Leu 7 were also found on the CD8+ IL-2 suppressor cell population in SLE. In healthy subjects, removal of CD16+, but not of CD8+ cells markedly elevated the production of IL-2. The CD8- CD16+ non-T cell subset suppressed IL-2 production by normal and SLE PBM in autologous and allogeneic combinations. This subset may be a human equivalent of the murine natural suppressor cells. These results demonstrate that the cells that suppress IL-2 production in SLE are heterogeneous, and suggest that they belong to more than one lineage.

1. O-Acetylated 4-O-methylglucuronoxylans were isolated from sweet chestnut and wych elm, either green or incubated at 48 degrees and 100% relative humidity for 36 weeks. 2. The chlorine-ethanolamine method of delignification resulted in a 50% loss of O-acetyl groups from green wych elm compared with an 18% loss from green sweet chestnut. 3. The acid-chlorite method gave an acceptable loss of O-acetyl groups in three cases, but incubated sweet chestnut showed a 44.6% loss. However, it is believed that this is due to the loss of simple O-acetylated xylose sugars resulting from glycosidic hydrolysis, rather than removal of O-acetyl groups by direct hydrolysis. Assuming that this occurs in a random manner, it is unlikely to have much structural significance. 4. Dimethyl sulphoxide extraction of chestnut holocellulose and elm holocellulose, green and incubated, yielded O-acetyl glucuronoxylans containing 10.2, 3.8, 13.1 and 7.7% O-acetyl groups respectively. 5. The location of these O-acetyl groups was determined by Bouveng's method in which phenyl isocyanate is used as a blocking group.

1. O-Acetylated polysaccharides were obtained from green wood of both sweet chestnut and wych elm by treatment of the residue remaining after dimethyl sulphoxide extraction with water at 98 degrees . This gives a mixture of polysaccharides containing xylose, galactose, glucose and uronic acids. Analysis of these and their fractionated products suggest that only xylans in green sweet chestnut and green wych elm are O-acetylated. 2. The isolated O-acetylated xylans are not representative of the total O-acetylated xylans occurring in sweet chestnut and wych elm. 3. Application of the method developed by Bouveng for the location of O-acetyl groups to all four O-acetylated xylans obtained in this series of investigations by dimethyl sulphoxide extraction showed that those from sweet chestnut and wych elm, under the same conditions of incubation, lost: 74.2 and 43.4% of acetyl groups respectively, at C-2; 58.0 and 28.5% of acetyl groups respectively at C-3; 41.8 and 82.2% of acetyl groups respectively at C-2 and C-3. 4. A consideration of electronic and steric factors indicates that there does not appear to be a purely chemical reason for the difference in loss of O-acetyl groups between sweet chestnut and wych elm. It is suggested that the location of O-acetylated xylans in the wood cell walls and the presence of extractive may play some part in this difference.