Search

The clinical, parasitological, hematological, and serological evolution of visceral leishmaniasis in Brazilian patients was assessed during treatment with human recombinant interferon-gamma (rIFN-gamma; 0.1 mg/m2 i.m. days 1-14) followed by pentavalent antimony (Sbv; 10 mg/kg days 22-28). At day 30, 6 patients had improved, 2 had slightly improved, and 1 patient had deteriorated. IFN-gamma was well tolerated in the dose tested and may be very effective as an adjunct to conventional therapy with antimony.

Granulomatous inflammation is a specific type of chronic inflammation in which macrophages and T-cell-mediated immunity to the inciting agent play a pivotal role. In the present study, granulomatous hepatitis was induced in rats by the administration of a single intravenous dose of porcine intestinal alkaline phosphatase. The cellular composition of the hepatic granulomas was analyzed in-situ with a number of recently developed mouse anti-rat monoclonal antibodies to cells of the monocyte-macrophage lineage and lymphocyte subsets. Well-developed granulomas consisted of aggregates of macrophages with central modification into epithelioid cells, a peripheral rim of T- and B-lymphoid cells, including considerable numbers of immunoblasts and plasma cells. In addition, the periphery of the granulomas contained many fat storing cells, a sinusoidal cell type thought to play a central role in hepatic fibrosis. Moreover, intense immunostaining for the extracellular matrix proteins fibronectin and collagen type III was observed at the periphery of the lesions. The granulomas persisted for long periods without eliciting liver cirrhosis. Alkaline phosphatase induced hepatic granulomas in the rat may help to elucidate the contribution of cells of the B-lineage to chronic granulomatous inflammation.

Formaldehyde treated albumin (F-HSA) was found to consist of a monomeric and a polymeric fraction. Both fractions were primarily endocytosed by rat liver sinusoidal cells. However, immunohistochemical staining of endocytosed material showed that the relative contribution of the endothelial and Kupffer cells in uptake of the monomer and the polymer differed significantly, with the monomer mainly having an endothelial cell- and the polymer predominantly having a Kupffer cell pattern of distribution. To directly confirm these heterogeneous patterns, we injected in vivo the 125I-labeled F-HSA fractions and isolated the endothelial and Kupffer cells by centrifugal elutriation. 73.7% of the monomeric F-HSA was found in endothelial cells and only 14.9% was found in Kupffer cells. In contrast, the polymeric F-HSA (1500 kD) was mainly endocytosed by Kupffer cells (71%), whereas the endothelial cells contributed only for 24% in hepatic uptake. In vivo studies and isolated perfused rat liver experiments showed that endocytosis of both monomer and polymer was inhibited by co-administration of polyinosinic acid, a well known inhibitor for scavenger receptors, indicating that these receptors on endothelial and Kupffer cells are mainly involved in this uptake process.

The role of TNF-alpha in visceral leishmaniasis is ambivalent, the eventual outcome of this infection, cure or generalization, being determined by the relative amounts of cytokines produced in vivo. Since release, by monocytes/macrophages, of TNF-alpha and interleukins 1 beta (IL-1 beta) and IL-6 is important in both the induction and effector phases of the immune responses, these mediators were determined in sera and cell culture supernatants of seventeen L. donovani infected patients in Brazil. The results are compared to those of a local control group. Circulating immunoreactive TNF-alpha in patients (median, 140 pg ml-1) was increased ten-fold over controls (median 16 pg ml-1, p less than or equal to 0.0001). In contrast, serum IL-1 beta was less than 20 pg ml-1 in all patients, although detectable in sera of 3/16 Brazilian controls (chi 2 = 3.5, p less than 0.1). Mitogen induced in vitro release of IL-1 beta and IL-6 by patients' circulating mononuclear cells was significantly reduced, and the capacity of patients' peripheral monocytes for H2O2 generation in response to opsonized zymosan was significantly diminished. In the patients, serum TNF-alpha levels were inversely related to IL-1 beta release in vitro (rho = -0.57, p less than or equal to 0.01).

The pulmonary nodule CT reference phantom is widely used in the evaluation of nodules 2 cm or less in diameter. It is used to detect benign patterns of calcification that are not visible on thin-section CT scans. Since 1986, the reference nodules have been manufactured with a nominal composition of 185 H. The multicenter study published in 1986 used nodules with a nominal composition of 264 H, 100 H more than the threshold value reported by Siegelman et al. in 1980. In the multicenter study, one of 37 nodules diagnosed as benign with the phantom proved to be malignant. The purpose of this study was to determine the misdiagnosis rate with the 185-H phantom and to ascertain whether the malignant tumors predicted to be benign actually contained calcification. We retrospectively reviewed 296 cases in which examinations had been performed with the 185-H nodules since 1986. Eighty-five nodules were diagnosed as benign by comparison to the reference phantom. These 85 contained no visible calcification on thin-section CT scans. Ten of the 85 cases were shown to be malignant tumors. Eight were diagnosed as having a high probability of benignity. Two were diagnosed as having a moderate probability of benignity. Calcium was present in the tissue of all six nodules available for review. Fifty-nine of the 85 nodules were still clinically indeterminate at the time of this review. Even if all of the clinically indeterminate nodules are benign, the misdiagnosis rate would be significantly higher than in most previous studies. Although analysis by using the reference phantom with 185-H nodules may indicate a high probability of benignity, close radiologic follow-up is necessary.

In a randomized prospective trial N-methyl-glucamine antimoniate (Glucantime) and human recombinant interferon-gamma were infiltrated around lesions of cutaneous leishmaniasis caused by Leishmania tropica in Syria. A previous trial had shown that intradermal application of interferon-gamma promoted the healing of similar lesions in the study area. Twenty patients with 38 lesions received 1-3 ml Glucantime and 20 patients with 37 lesions received 25 micrograms of interferon-gamma intradermally once weekly for 5 consecutive weeks. While all lesions treated with Glucantime were free of parasites after the third injection, only 69% of those treated with interferon-gamma were parasitologically cured by week 10. Within 10 weeks, lesions treated with Glucantime healed completely in 29/38, and partially in 9/38, cases, whereas 1/37 and 13/37 lesions treated with interferon-gamma healed completely and partially, respectively. Perilesional application of Glucantime was highly effective and superior to interferon-gamma for treatment of cutaneous leishmaniasis caused by L. tropica.

We synthesized several para-aminophenyl (pap-) mannose-terminated albumins with varying sugar density (Man7-HSA, Man22-HSA, and Man40-HSA) and compared hepatic uptake with (thio-)mannose-terminated bovine serum albumin (Man-43-AI-BSA) The rate of uptake in isolated perfused rat livers was found to be positively correlated with the sugar density (Man40-HSA = Man22-HSA greater than Man7-HSA greater than HSA). Immunohistochemical staining of liver sections showed for both types of neoglycoproteins that uptake occurred in nonparenchymal cells only. Competition experiments with a 500-fold excess of mannan, a known ligand for the mannose/N-acetylglucosamine receptor, that is predominantly localized in endothelial cells, showed complete inhibition of the (thio-)Man43-AI-BSA uptake. In the case of (pap-)mannose-terminated albumins, however, the extent of inhibition by mannan was moderate and decreased markedly with increasing sugar density, being only 20% for (pap-)Man40-HSA. Therefore, we hypothesized that one or more additional removal systems contributed to the clearance of these (pap-)mannose glycoproteins. We found that net negative charge of the (pap-)mannose albumins clearly increased with increasing sugar density, as shown on fast protein liquid chromatography anion-exchange chromatograms. To determine whether the scavenger receptor system that is also mainly present on endothelial cells is involved, we performed competition studies with strongly negatively charged substrates, such as dextran sulfate and formaldehyde-treated human serum albumin (fHSA). An excess of dextran sulfate (500 kDa), indeed blocked the (pap-)mannose-albumin uptake for more than 95%. Dextran sulfate completely inhibited the hepatic uptake of mannan as well, indicating that the polyanion does not discriminate between the scavenger system and the mannose receptor system and should be regarded as an aspecific inhibitor of receptor-mediated endocytotic pathways. Surprisingly, a 500-fold excess of fHSA only moderately (20%) inhibited the clearance of (pap-)Man40-HSA in spite of its high affinity for the scavenger receptor. However, a combination of mannan and fHSA strongly inhibited the uptake of (pap-)Man22-HSA (90%) and to a lesser extent (pap-)Man40-HSA (80%), indicating that a third uptake mechanism may exist that recognizes both mannose groups (or other sugars) and net negative charge. This so far unnoticed receptor system apparently is strongly affected by dextran sulfate and, as shown by immunohistochemistry, is mainly localized on Kupffer cells rather than on the endothelial cells of the liver.

Accumulating evidence points toward an antagonism between TH1 and TH2 focused immune responses decisive for the outcome of parasitic infections with leishmaniae. Interferon-gamma (IFN-gamma) and interleukin 4 (IL4), the principal cytokines involved in these pathways, as well as IgE and the IgG subclasses differentially modulated by these cytokines, were therefore assessed in 18 Brazilian patients with visceral leishmaniasis. The results are compared to those of a local control group. IL4 was detected in all patient sera but in only one control. Low concentrations of IFN-gamma where detectable in 50% of the Brazilian controls but in only two patients. While group medians of mitogen-induced in vitro synthesis of IL4 and IFN-gamma were similar, release of these lymphokines correlated inversely in patients (Spearman's rho = -0.84). Elevations of serum IgE complement the lymphokine data to indicate prominent TH2 type responses in clinical infections with Leishmania donovani.

We have developed an immunohistochemical method for the in vivo and in vitro detection of glycosyl receptors in rat spleen and lymph nodes by using neoglycoproteins. The receptor in both organs recognized mannose coupled to bovine serum albumin (mannose-BSA), fucose-BSA, N-acetylglucosamine-BSA and to a lesser extent glucose-BSA, but not galactose-BSA or N-acetyl-galactosamine-BSA. In vitro neoglycoprotein-receptor binding was Ca2+ dependent and could be inhibited by mannan but not by mannose. Simultaneous staining with the monoclonal antibodies ED1, ED2 or ED3 revealed that only ED1- and ED3-positive macrophages were involved in the binding of neoglycoproteins. In the spleen, the marginal-zone macrophages and a subpopulation of the marginal metallophils possess glycosyl-binding receptors. In the lymph nodes, the medullary sinus macrophages and a subpopulation of the outer-cortex macrophages are able to bind neoglycoproteins.

The application of an immunohistochemical method in the detection of replicating cells, that have incorporated 5-bromodeoxyuridine (BrdUrd), was studied on frozen and plastic embedded sections of different rat tissues. Hydrolysis conditions employed in the Feulgen procedure are essential in making the incorporated BrdUrd accessible to the monoclonal anti-BrdUrd antibodies. To demonstrate the incorporated BrdUrd in plastic embedded sections a subsequent etching with xylene and digestion with protease is necessary. Data obtained with this method are completely comparable with those found by the tritiated thymidine method. In comparison with the thymidine method, the BrdUrd method is much less time consuming and does not require precautions in working with radioactivity. The BrdUrd-method enables a more precise localization as is especially shown in the plastic embedded sections.

Spatial resolution of gratings of different orientation has been evaluated in 39 patients, by means of projected slides and by laser interference fringes. Both methods reveal a significantly higher resolution (about 12%) for vertical or horizontal bars compared to oblique ones. The similarity of findings for both methods is indicative of the neuronal origin of this orientation-dependent effect and exclude an optical origin.

A series of 320 German i.v. drug abusers (32.2% female, 67.8% male) were tested in a cross-sectional study for antibodies against HIV. Seroprevalence increased from 0 in those who discontinued i.v. drug abuse before 1982 to 37.2% in those who stopped injecting drugs in 1985/1986 or who were still addicted. Antibodies to HIV were significantly associated with lymphadenopathy and clinical symptoms (fever, weight loss, diarrhea, fatigue, night sweat, dermal lesions) and with markers of hepatitis A and hepatitis B virus infection. Participants of the study admitted in 92.5% of cases to "needle sharing" and in 83.1% of cases to sexual contacts among drug abusers. Prostitution and drug abuse in prison were significantly correlated with seropositivity. No antibodies to HIV infection were detected in 131 subjects of a control group of household contacts.

In this study a double immunohistochemical staining procedure is described for the simultaneous visualization of antigen expressing cells and replicating cells. Cell surface antigen expression was marked with a monoclonal antibody against I a (His 19) or a monoclonal antibody against a membrane component of the cells of the monocyte-macrophage lineage (ED2). Replicating cells were detected by the incorporation of 5-bromodeoxyuridine. The method was applied sequentially. On frozen sections two peroxidase labeled reagents were used with two different substrates yielding a red and a dark-blue black reaction product. On plastic-embedded sections a peroxidase and an alkaline phosphatase labeled reagent were applied resulting in a brown and a blue reaction product.

In this study a double immunohistochemical staining procedure is described for the simultaneous demonstration of antigen expressing cells and replicating cells in rat thymus. As markers for cell surface antigen expression a monoclonal antibody against Ia-expressing cells (His 19) and a monoclonal antibody against cells of the monocyte-macrophage lineage (ED2) were used. Replicating cells were demonstrated by the incorporation of 5-bromodeoxyuridine (BrdUrd). Tissue pieces were fixed in a periodate-lysine-paraformaldehyde fixative and embedded in glycol methacrylate. To demonstrate Ia-expressing cells or ED2-positive macrophages in plastic embedded sections a digestion with trypsin is necessary. The staining procedure was applied sequentially and was performed with a peroxidase and an alkaline phosphatase labeled reagent yielding respectively a brown and a blue reaction product. Results with this staining procedure on plastic embedded sections of rat thymus, an organ with a high DNA synthesizing capacity, showed incorporation of BrdUrd predominantly in the cortex. ED2-positive macrophages were only found in the cortex. The Ia-positive epithelial reticular cells demonstrated extremely well their stellate form.

Intravenously injected immune complexes (ICx) composed of bovine serum albumin (BSA) and rabbit anti-BSA were taken up by the liver. Insoluble complexes, made in antibody excess, were rapidly taken up by Kupffer cells and were metabolized within 24 h. Soluble complexes, made in antigen excess, were only partly taken up by Kupffer cells. In addition these complexes were bound, taken up and metabolized by endothelial cells. Until 2 h after injection soluble complexes could also be observed along the microvilli of hepatocytes. No signs of endocytosis in hepatocytes could be observed. It is concluded, that ICx can be taken up by Kupffer cells as well as by endothelial cells. The physical state of the complexes, soluble or insoluble, determines the cell type in which uptake occurs.

The clinical and immunological evolution of lesions in cutaneous leishmaniasis was assessed after treatment with human recombinant gamma interferon (rIFN-gamma). 3 weeks after rIFN-gamma treatment of lesions due to Leishmania braziliensis guyanensis, 12/13 had become smaller compared with 6/13 control lesions; only 4 treated lesions were free of parasites. 9 of 13 L tropica lesions treated with rIFN-gamma resolved completely within 4-8 weeks of treatment. An acute inflammatory reaction around treated lesions was more common in lesions due to L tropica. There were no other local or systemic adverse reactions. Histological and immunohistochemical studies indicate that local application of rIFN-gamma enhances cell-mediated immune responses and thus promotes healing of cutaneous leishmaniasis.

Peripheral blood T cell phenotypes, CD3-induced mitogenesis and soluble IL 2 receptor and CD8 in sera were studied in intestinal and hepatosplenic Schistosomiasis mansoni before and three to six months after therapy with praziquantel. Fifteen pairs matched for intensity of infection were analyzed and compared with local, non-infected age-matched controls. CD3+ cell counts were lower in untreated hepatosplenic schistosomiasis (median 1040 cells/microliters; 95% confidence interval 608-1269) compared to controls (1534; 1264-1620). This difference was largely accounted for by immature CD1+/CD3-cells circulating in these patients (median 388/microliters, 252-474). The frequency of CD1+ T cells in circulation decreased drastically after chemotherapy. Similar, but less marked, alterations were seen in intestinal schistosomiasis. Lymphocyte proliferation initiated by agonistic anti-CD3 monoclonal antibody was severely impaired in hepatosplenic patients, who had suffered haemorrhagic complications, but not in the cases of incipient hepatomegaly. Soluble CD8 antigen circulated in increased amounts in hepatosplenic schistosomiasis. Remarkably, a negative correlation between CD3-induced mitogenesis and circulating levels of CD8 was noted in these patients. Whereas CD3-induced mitogenesis in hepatosplenic schistosomiasis normalized after therapy, circulating IL 2R and CD8 antigen in hepatosplenic patients still exceeded control levels. The results demonstrate disturbances of CD3 and CD8 expression and/or T cell maturation in hepatosplenic schistosomiasis. Imbalanced CD4/CD8 ratios and an increased IL 2R/CD8 turnover may reflect an inhibitory circuit within the T cell compartment.

Peripheral blood cholyglycine and procollagen-III-peptide were measured in 22 Zairean patients with hepatomegaly caused by S. mansoni before and after treatment with praziquantel. Circulating T-cell subsets and cutaneous in vivo delayed type hypersensitivity were assessed; serum neopterin and beta 2-microglobulin served as indicators for macrophage/lymphocyte activation. The results were compared to age and sex matched patients with S. mansoni infection limited to the intestinal tract and schistosomiasis free controls with equal socioeconomic background. Abnormal serum cholyglycine and neopterin levels and alterations of circulating T-cell subset frequencies were associated with hepatomegaly in schistosomiasis. Normalization of these parameters reflected a regression of egg-induced immunopathology as early as two months after specific chemotherapy. Serum procollagen-III-peptide concentrations rose significantly after treatment, suggesting release of propeptide previously incorporated without cleavage into tissue collagen. The combination of these biochemical and immunological parameters may allow assessment of the pathophysiological mechanisms responsible for liver disease in individual patients.

To demonstrate the presence and localization of Fc receptors, rat liver cryostat sections were incubated with heterologous and autologous immune complexes (ICx) and immunoglobulin (Ig) aggregates. Binding was demonstrated using the immunoperoxidase technique. Autologous and heterologous ICx as well as aggregates from human and rat Ig appeared to bind to the sinusoidal wall. ICx bind in preference to aggregates. Monomeric Ig and aggregated Ig from swine and rabbit did not bind. The results demonstrated that ICx and rat and human Ig aggregates were bound via an Fc receptor. This Fc receptor was still intact in livers from carbontetra chloride and galactosamine treated rats. The receptor could also be demonstrated on spleen macrophages and on kidney interstitial cells. This method turned out to be an useful functional histochemical method to localize Fc receptors and to demonstrate their affinity and species specificity in tissues.

The in vivo uptake in hepatocytes of intravenously injected colloidal gold granules with a diameter of 17 nm or 79 nm and coated with bovine serum albumin or with polyvinyl-pyrrolidone was studied. Irrespective of coating only the 17 nm granules were taken up in hepatocytes. Perivenous hepatocytes did take up much more gold granules than periportal hepatocytes. The gold granules were found in lysosomes around bile canaliculi. Two hours after injection hepatocytes contained the maximal amount of granules. At least a portion of the granules was discharged into the bile. The observed zonal gradient in the uptake of 17 nm gold granules might be caused by the greater supply of granules to the perivenous hepatocytes as a combined result of the higher porosity of the endothelial lining and the smaller number of Kupffer cells with a low endocytic activity in this zone.

As a physical disinfection method without chemicals required the ultraviolet irradiation was tested for disinfection of drinking water. The survival was measured as a function of exposure to radiation for S. enteritidis, E. cloacae, C. freundii, S. marcescens, E. coli, K. pneumoniae und S. faecium. The bacteria were grown in trypton soya broth until they were well into the exponential phase. Two different UV-disinfection units were tested. Both consist of cylindrical shaped chambers with one low-pressure mercury-discharge lamp with their longitudinal axis parallel to the chambers. With 10(6) cfu/ml the experiments were done with three different rates of flow of 7,2 m3/h, 4,0 m3/h and 2,0 m3/h. The minimum exposures to radiation necessary to cause a 99.999% reduction were 10-86 mWs/cm2 depending on the test bacterium and on the UV-disinfection unit. The minimum doses ranged for S. enteritidis up to 13 mWs/cm2, for E. coli up to 21 mWs/cm2, for K. pneumoniae up to 39 mWs/cm2, for S. faecium up to 42 mWs/cm2, for E. cloacae up to 43 mWs/cm2, for C. freundii up to 72 mWs/cm2, and for S. marcescens up to 86 mWs/cm2.