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Subacute thyroiditis (SAT) is an extremely rare complication of influenza vaccination. Several infectious agents have been related with SAT. It is also well known the association between HLA-B35 and the development of SAT. We describe a case of subacute thyroiditis and dyserythropoesis occurring shortly after administration of an influenza vaccine in a 55-year-old man with history of diabetes and psoriasis, family history of autoimmunity without clinical evidence of acute viral infection prior to the onset of symptoms. We propose that, the events occurring in the patient may be explained as result of complex interactions between the individual genetic background and environmental exposure to infectious agents that generated a pro-inflammatory status, where the vaccine was the trigger for the subsequent alterations in thyroid and bone marrow. These findings highlight the importance of immunogenetic factors involved in response to vaccination that is the central theme in the growing field of 'vaccinomics'.

The mutational escape of HIV-1 from established CTL responses is becoming evident. However, it is not yet clear whether antigenic variations of HIV-1 may have an additional effect on the differential antiviral effectiveness of HIV-specific CTLs. Herein, we characterized HIV-specific CTL responses toward Pol, Env, and Nef optimal epitopes presented by HLA-B*35 during a chronic phase of HIV-1 infection. We found CTL escape variants within Pol and Nef epitopes that affected recognition by TCRs, although there was no mutation within the Env epitope. An analysis of peptide-HLA tetrameric complexes revealed that CD8 T cells exclusively specific for the Nef variant were generated following domination by the variant viruses. The variant-specific cells were capable of killing target cells and producing antiviral cytokines but showed impaired Ag-specific proliferation ex vivo, whereas wild-type specific cells had potent activities. Moreover, clonotypic CD8 T cells specific for the Pol variant showed diminished proliferation, whereas Env-specific ones had no functional heterogeneity. Taken together, our data indicate that antigenic variations that abolished TCR recognition not only resulted in escape from established CTL responses but also eventually generated another subset of variant-specific CTLs having decreased antiviral activity, causing an additional negative effect on antiviral immune responses during a chronic HIV infection.

Purpose: Spondyloarthropathy includes the subcategory of reactive arthritis (ReA). Spondyloarthropathies are commonly associated with certain human leukocyte antigen (HLA) alleles. Because we identified bacteria associated with ReA within the temporomandibular joint (TMJ), we now evaluate the frequency of HLA alleles in patients with TMJ pathology., Patients and Methods: HLA typing of 129 patients (121 females and 8 males) performed by standard microcytotoxicity technique. Thirty patients had only class I (HLA-A and -B loci) evaluated. Ninety-nine patients had both class I and class II (HLA-DR loci) evaluated. Identification of alleles at the C locus was not performed. The antigenic frequency in the study group was compared to US white control subjects using a 2-tailed Fisher's exact test with a Bonferroni multiple comparison adjustment., Results: The following class I HLA alleles, -A1 (32%), -A2 (50%), -A3 (33%), -B7 (23%), -B14 (14%), -B35 (20%), and -B44 (36%), including the B7 cross-reactive group (CREG) (49%) and class II alleles -DR1 (25%) and -DR4 (34%), were found to have an increased frequency in our patient group., Conclusions: Our study shows an increased frequency of several alleles that have been previously associated with arthropathy, and the alleles of the B7 CREG, in patients with TMJ pathology. Patients with these alleles may have an increased risk for the development of internal derangement of the TMJ as a consequence of the bacterial/infectious agents and host interactions with the subsequent cytokine/inflammatory response being influenced by their HLA phenotype., (Copyright 2002 American Association of Oral and Maxillofacial Surgeons)

In scleroderma patients, isolated pulmonary hypertension (PHT) has been associated with selected HLA haplotypes, severe impairment of the diffusing capacity for carbon monoxide and the diagnosis of CREST. Most patients with CREST have a late-age onset of the disease, corresponding to the perimenopausal or postmenopausal period. We conducted a retrospective cohort study to determine the role of post-menopause and of the other known clinical and biological markers in the development of isolated pulmonary hypertension in Italian patients with systemic sclerosis. 189 female patients with scleroderma who had no ecographic signs of pulmonary hypertension (PHT) and radiographic signs of lung fibrosis at the first visit and did not develop significant pulmonary fibrosis during the observation time were included. Sixty-three out of 189 patients (33.3%) presented isolated pulmonary hypertension. A severe impairment of diffusing capacity for carbon monoxide at admission was found to be an early predictive element for its development. An increased risk was associated with postmenopausal condition (RR = 5.2, p = 0.000), CREST syndrome (RR = 2.8, p = 0.001) and haplotype HLA-B35 (RR = 2.8; p = 0.002). A significant positive interaction between postmenopausal condition and either HLA-B35 (RR = 15.2; p = 0.000) or the diagnosis of CREST (RR = 14.1; p = 0.000) was found. Postmenopausal condition alone or in combination with HLA-B35 and CREST syndrome is the main risk-factor for developing primary pulmonary hypertension in scleroderma patients. This suggests that hormonal replacement therapy could play a role in preventing isolated PHT in patients with systemic sclerosis.

Hepatitis C virus (HCV)-specific CD8(+) T cells in peripheral blood mononuclear cells (PBMCs) from patients infected with HCV were quantitatively analyzed by flow cytometry using an HLA-B*3501-HCV epitope tetrameric complex. In chronic hepatitis C, tetramer(+)CD8(+) T cells were detected at frequencies ranging from 0.05% to 0.12% of total CD8(+) T cells. The number of tetramer(+)CD8(+) T cells in acute phase PBMCs from patients with acute hepatitis C was about 3 to 5 times higher than in recovery phase PBMCs from the same patients and in PBMCs from patients with chronic hepatitis C. Expanding tetramer(+)CD8(+) T cells in PBMCs from patients with acute hepatitis C express a CD28(+)CD45RA(-) memory T-cell phenotype. In contrast, tetramer(+)CD8(+) T cells in PBMCs from patients with chronic hepatitis C did not predominantly express this phenotype. These tetramer(+)CD8(+) T cells did not have perforin in their cytoplasma. The present study visually showed that a high number of circulating HCV-specific CD8(+) T cells in acute phase PBMCs from patients with acute hepatitis C are mostly memory T cells.

Objective: To study the association of human leucocyte antigen and osteosarcoma in Chinese Han nationality., Methods: The frequencies of HLA-A,B,DR,DQ locus antigens were tested in a group of 25 osteosarcoma patients and in a control group of 250 healthy persons by using complement-dependent microlymphocytoxity technique. The members of both groups were of Chinese Han nationality. Their results were compared statistically., Results: The frequency of HLA-B35 was 0.400 in patient group and 0.048 in the control group. The relative risk of suffering from osteosarcoma in persons carrying HLA-B35 was 13.220 times as high as that in those without this antigen (P < 0.01). Patients with HLA-B13 had 12.048 fold increase in relative risk with poor prognosis compared to those without this antigen (P < 0.05). A tendency of worst prognosis was seen in patients who carried both HLA-B13 and HLA-B35, but patients with HLA-B40 had 7.057 times better relative safety for good prognosis than those without that antigen (P < 0.05)., Conclusion: HLA-B35 is in close linkage to osteosarcoma susceptible gene in Chinese Han nationality. HLA-B13 and HLA-B40 may be separately related to the malignant and resistant genes of osteosarcoma.

HLA-A and -B antigens were determined in a group of 76 Greek asthmatic patients: 35 children (1.5-15 years) and 41 adults (18-73 years). The results were compared to those of 400 healthy unrelated controls from the same population. The standard NIH lymphocytotoxicity test was applied. When all 76 patients were compared to the controls, a statistically significant lower frequency of HLA-B5 and -B35 antigens was noted. When adults were analysed alone, an increased frequency of HLA-B8 was found. On the other hand, in the asthmatic children sub-group, the HLA-A10 antigen was significantly higher and the HLA-B5 was significantly lower than in the controls. These data imply that different HLA antigens may be involved in the pathogenesis of several clinical forms of asthma and that, in order to study the role of immunogenetic factor(s) in the pathogenesis of this disease, more adequate grouping criteria are needed.

Objective: To evaluate the outcome of patients with remitting seronegative symmetrical synovitis with pitting oedema (RS3PE)., Methods: In a retrospective chart review study, we identified all the patients presenting with polyarthritis and pitting oedema in the past 20 years. We tried to recall the 24 patients with characteristics of RS3PE according to McCarty et al. Two patients had died and four could not be traced. Five could not be seen after the initial period of follow up; relevant data were obtained from their practitioner. For the remaining 13 patients, clinical, radiological, and biological evaluation was performed in our department, with the last assessment in 1993., Results: The follow up period was from one to 18 years (mean 4.6 (SD 4.5) years). Eleven patients developed one or several recurrences of articular manifestations consisting of mild oligoarthritis (n = 8), definite spondyloarthropathy (n = 2), and rheumatoid arthritis (n = 1). The delay of the first recurrence was 18 months to 12 years after the first attack. Thirteen patients had no recurrence, but three of them developed remarkable features: rheumatoid factor, antinuclear antibodies (1/2000), Sjögren's syndrome. HLA B typing was performed in nine patients and revealed B7 (n = 2), B27 (n = 2) and B22 (n = 2). Isolated HLA B27 typing was performed in two other patients and was positive in one., Conclusion: The long term outcome of RS3PE can lead to different rheumatic diseases. RS3PE appears to be a syndrome related to the elderly onset of the rheumatic diseases, including spondyloarthropathy and rheumatoid arthritis, rather than a specific entity.

Previous reports have shown an increased frequency of certain HLA antigens in association with erythema multiforme, including HLA-B15(B62), HLA-B35, HLA-A33, HLA-DR53 and, more recently, HLA-DQB1*0301. A strong association with HLA-DQ3 has been documented in patients with recurrent erythema multiforme. We have performed HLA typing in 39 patients with recurrent erythema multiforme, of whom 33 were associated with herpes simplex virus infection. The results were compared with 309 controls. In the recurrent erythema multiforme patients there was a statistically significant increase in HLA-B62 and HLA-B35. An increase in HLA-DR53 was also found, although this did not reach statistical significance. There was no increase in HLA-A33. The presence of HLA-DQ3 in the study population approached that in the controls. Finally, the study population demonstrated a trend towards a reduction in the HLA antigens A1, B8 and DR3. The study confirms the previously reported associations with HLA-B62 (B15), HLA-B35 and HLA-DR53. We have been unable to confirm an association of HLA-A33 or HLA-DQ3 with erythema multiforme. The HLA antigens A1, B8, and DR3 are associated with autoimmune disease, reflecting an increased host response to tissue self antigens. Their absence in patients with recurrent erythema multiforme (REM) may be an indicator of a poor host response to an antigen, which in the case of REM is the herpes simplex virus.

Objective: To describe causality, morphology, course, and risk factors of mucocutaneous reactions to gold., Methods: A prospective study of 74 patients with rheumatoid arthritis starting with gold thioglucose., Results: Thirty-nine patients experienced an episode of gold dermatitis. Sixteen patients continued gold treatment. The estimated treatment withdrawal at 1 year was 26%. The clinical picture was variable and nonspecific. Gold dermatitis was associated with HLA-B35 and disease duration., Conclusion: Mucocutaneous reactions to gold are nonspecific, therefore a causality assessment is necessary. Incidence is high, but treatment can often be continued with dose reduction and local steroids. The predictive value of risk factors is low.

We and others have reported an increased incidence of chronic lymphocytic leukemia (CLL) among Ashkenazi (ASH) Jews of European origin. We performed HLA Class I typing on all 50 CLL patients seen by us and compared them with 3886 controls consisting of healthy blood donors from the New York Blood Center. Thirty of our CLL patients were ASH Jews, 17 of whom (57%) expressed the B35 antigen compared with 462 ASH controls (26%). Seven (39%) of the CLL Caucasian patients expressed the B35 antigen compared with 305 (14.5%) of the Caucasian controls. Combining the information from the ASH Jews and the Caucasians the difference is highly significant, (p = 0.0001). The summary odds ratio was 3.7. These results indicate an increased incidence of the antigen B35 amongst ASH and Caucasian patients with CLL.

It has been established that HLA antigens are susceptibility factors for different cancers, including thyroid tumors. However, the diversity and sometimes weak and contradictory associations found have frequently led to the view that the HLA and tumorigenesis links might be the result of statistical errors. However, it has recently been established that it is indeed a currently complex and unexplained but real phenomenon, which may be crucial in preventing several types of cancer. In the present work we have found in a relatively large series of thyroid cancer patients (n = 161) that both HLA class I (B35) and class II (DR11) antigens are susceptibility factors only in the papillary tumor group of patients, B35 association p value is found at the limit of significance (pc(120) = 0.05); the follicular group did not show any HLA association, suggesting that the etiopathogenesis of each type of cancer is different. HLA-B35 and DR11 are not working together to induce tumorigenesis and each of them seems to confer susceptibility by using different pathways or by being markers of distinct neighboring susceptibility genes. DR4 has also been found in 86% (n = 6) of Hürthle cell carcinoma. No association has been found between HLA and disease activity. HLA mechanisms of association to cancer are discussed and a world-wide HLA/tumorigenic study is proposed to obtain a clear picture of the puzzling and controversial susceptibility markers found in different tumors and in different ethnic groups.

Objective: Following the chance observation of congenital adrenal hyperplasia in a patient with Turner's syndrome we decided to evaluate the incidence of 21-hydroxylase deficiency (21-OHD) in patients with Turner's syndrome and in their relatives., Subjects: Fifty-two patients with Turner's syndrome (mean age +/- SD 14.7 +/- 5.6 years) and 26 relatives were studied., Measurements: 17-Hydroxyprogesterone (17-OHP) serum levels before and after i.m. administration of 0.25 mg of ACTH(1-24) were evaluated in patients with Turner's syndrome and relatives. In Turner patients basal testosterone and dehydroepiandrosterone concentrations were determined. The results of ACTH tests were analysed according to HLA class I and II alleles of subjects., Results: The baseline 17-OHP was in the range of the classical form of 21-OHD in one Turner patient, who had severe clitoral enlargement since birth. In 11 patients the stimulated 17-OHP serum level was higher than in normal controls and similar to that found in 21-OHD heterozygous subjects. Clitoral enlargement was significantly more frequent in patients with high stimulated 17-OHP levels (P < 0.001). The frequency of heterozygous-type responses was higher in Turner subjects (1:4.6) than in the Italian population (1:47 for the classic form and 1:9.5 for the non-classic form of the disease). In our patients the frequencies of HLA antigens and haplotypes, usually associated with 21-OHD, were different compared to the controls. HLA-B8, which is negatively associated to 21-OHD, was less frequent in Turner patients than in controls and absent in those with an elevated 17-OHP level. HLA-B14, B22 and B35 were more frequent, though not significantly so, in Turner patients than in controls and even more so in the group with an elevated 17-OHP level. The same investigations performed in 26 relatives of the Turner patients showed a high frequency of carriers of 21-OHD and three subjects with the cryptic form of the disease., Conclusions: Although in the literature there are only two reports of the association of Turner's syndrome and 21-OHD, on the basis of our experience this association was more frequent, in the Italian population. Since some of the typical signs of 21-OHD (short final stature, varying degrees of virilization, menstrual irregularities, amenorrhoea, infertility) in patients with Turner's syndrome could also be attributed to the chromosomal abnormality, it is therefore more difficult to diagnose 21-OHD in Turner subjects. Adrenal function should be assessed, at least in the presence of clitoral enlargement, in patients with Turner's syndrome, particularly if their karyotype does not contain a Y chromosome. The hypothesis of the presence of cryptic Y chromosome material in these patients should also be considered.

Certain maternal/infant pairs, as well as other high-risk adults, develop a host-response HIV-1 infection characterized by circulating and tissue infiltrative CD8 T-cell lymphocytosis, termed Diffuse Infiltrative Lymphocytosis Syndrome (DILS). DILS primarily occurs in the salivary glands, lungs, renal interstitium, and gastrointestinal tract. DILS differs from Sjogren's syndrome in the degree of salivary gland enlargement, high frequency of extraglandular manifestations, paucity of autoantibodies, and distinct immunogenetic associations. Salivary gland B-cell lymphoma is a complication common to both conditions. The circulating CD8 T cells in DILS have a memory phenotype. Egress into target tissues involves adhesion molecule receptor-ligand interactions, apparently in response to the local presence of HIV-1. Immunogenetic predisposition involves interaction between both MHC classes I and II loci. This disease appears to reflect a specific host response that leads to persistence of monocyte-tropic, rather than T-cell-tropic, HIV-1 strains, in an analogous fashion to Visna Maedi virus disease in sheep. The development of DILS in children appears to be regulated in a dominant fashion by maternally or paternally inherited MHC class II alleles in response to transplacentally or perinatally acquired maternal HIV-1 strains.

The clinical features, laboratory findings, infection stimuli and HLA phenotypes of five young adults with recurrent episodes of Henoch-Schönlein syndrome (HSS) are reported. We define recurrences as the reappearance of the characteristic purpuric rash and associated symptoms more than 8 weeks after the onset of the original episode of purpura. All patients had documented evidence of a bacterial or viral infection before one or more of the relapses, the periods between which varied from 1 to 13 years. Four of our five patients possessed the HLA B35 phenotype and two of these four patients were also HLA B18 antigen positive. Those with the HLA B35 haplotype had recurrent episodes of purpura with nephritis triggered by minor pharyngeal (viral or bacterial) infections. The HLA B35 haplotype has a frequency of 4% in the indigenous Scottish population and has previously been linked with single episodes of the Henoch-Schönlein syndrome with nephritis in German, Slavic and French patients. It has not previously been related to recurrent episodes of the syndrome. We postulate that patients who are HLA B35 positive may be genetically more susceptible to recurrent episodes of HSS with nephritis, stimulated by a heterogeneous group of infective stimuli and resulting in a protracted illness with significant renal involvement.

Actual knowledge on the HLA relationship with the primary glomerulopathies, with particular reference to steroid - sensitive nephrosis of childhood, is surveyed. Occurrence of HLA B-8 and B-35 in this nephropathy has been investigated. The studies involved 47 patients aged between 3 and 15 years and 117 healthy children from Lower Silesian region. It has been showed, that HLA B-8 is present more frequently in sick children, than in healthy controls. The situation is reverse in case of HLA B-35 antigen. However, the difference is statistically insignificant. A probability of the lipid nephrosis sensitivity to corticosteroids can not be predicted on the base of the presence of these HLA antigens.

This report describes two unusual cases of subacute thyroiditis from which Graves' disease with hyperthyroidism developed seven to eight years after complete recovery. The first case is a 45-year-old woman who developed hyperthyroidism seven years after recovering from subacute thyroiditis. This patient had a genetic predisposition to both subacute thyroiditis HLA-BW35 and Graves' disease (HLA-BW46). The second case is a 60-year-old woman who developed hyperthyroidism eight years after the episode of subacute thyroiditis; her HLA showed neither BW 35 nor BW 46. It has been reported that if hyperthyroidism is to develop following subacute thyroiditis it occurs within one year. Our observation indicates that it may occur seven or eight years later.

In this preliminary study, children with chronic HBV hepatitis, as was also previously shown for adults, respond to interferon therapy in an HLA class I antigen dependent manner. If this can be confirmed on a large scale, HLA typing may serve as a useful indication of interferon-therapy responders.

We performed HLA typing for class I antigens on five Japanese patients with acute polyneuropathy following Campylobacter infection, all of whom showed axonopathy causing pure motor dysfunction associated with IgG anti-GM1 antibodies. We demonstrated a statistically significant association between the disease and the HLA-B35 antigen.

Subacute thyroiditis is thought to be virally induced in genetically predisposed individuals because a strong association has been suggested recently between HLA-B35 and patients in whom subacute thyroiditis has developed. Two identical twin brothers were seen at our clinic with the same symptoms and date of onset of hyperthyroidism and enlargement and tenderness of the thyroid, which gave us a unique opportunity to study the genetic predisposition and treatment of this thyroid disease. Diagnostic criteria for subacute thyroiditis were met in both twins, including hyperthyroxinemia, suppression of thyroidal 123I uptake, increased erythrocyte sedimentation rate, transient painful goiter, and absence of antimicrosomal antibodies. Twin B was treated with corticosteroids, and a nonsteroidal anti-inflammatory agent was prescribed for Twin A. The mode of treatment used did not make a difference in affecting the course of the disease. The erythrocyte sedimentation rate was normal after 2 months from onset of symptoms. Results of viral studies were inconclusive. The same HLA typing was found in each twin: A3, B18, B35, Cw4, DR2, DRw10, DQw1. Thus, each was heterozygous for HLA-B35. We reviewed the literature and found a strong association between HLA-B35 and subacute thyroiditis in various ethnic groups tested. Our experience with these identical twins provides additional evidence to suggest that HLA-35 and perhaps Cw4 confer genetic susceptibility in acquiring subacute painful thyroiditis in a possible dominant mode of inheritance.

The study was undertaken to examine 80 children with congenital heart and vessel malformations, their parents (50 married couples), and 100 families with healthy children. The antigen typing of the HLA system was accomplished by using the Terasaki microlymphocytotoxic test. A statistically significant correlation was found between B35 antigens and septal malformations, vascular diseases, and congenital cardiomyopathies. The unfavorable obstetric history was shown to play a role in the occurrence of developmental malformations. The data of an analysis of HLA antigens in the parents of the children with congenital malformations suggest that a marked HLA antigen compatibility of married couples is one of the cause of pregnancy complications and developmental malformations in their offspring.

Human CTL clones discriminating serologically closely related HLA-Bw52, B51, and B35, which belong to HLA-B5 crossreacting group (CREG), were established from peripheral blood lymphocytes by repeated in vitro stimulations. Five HLA-Bw52-specific CTL clones from an individual with HLA-B5 CREG antigens and four CTL clones from another individual with HLA-B51 were generated. The specificity of these CTL clones was ascertained by their lysis of EBV-transformed B cells with HLA-Bw52, but not those with HLA-B51 or B35, and Bw52-transfected Hmy2CIR cells but not HLA-B51 or B35 transfectants. Conversely HLA-B51-specific clones were generated from the HLA-B5 CREG-negative individual, as well as another individual with HLA-Bw52. Their specificity was determined in a similar fashion. Since HLA-B51 differed from HLA-Bw52 only by two amino acid substitutions on the alpha helical region of the alpha 1 domain, these results demonstrated that allospecific CTLs can be produced and discriminate the epitopes formed by the subtle difference in the structure of these HLA class I molecules. Furthermore, three HLA-B35-specific CTL clones were generated from the HLA-B5 CREG-negative individual that discriminated HLA-B35 from HLA-Bw52 and B51. Taken together these results demonstrated that human CTL clones could definitively discriminate the three serologically related HLA-B5 CREG specificities.

We observed HLA associations in patients with nasopharyngeal carcinoma from northern China. There was an increased risk of nasopharyngeal carcinoma associated with HLA-B35 and a difference in the HLA association between patients with early- and late-onset disease. The frequency of B35 was significantly higher in patients than in control subjects, especially in early-onset patients (less than 30 years old). Late-onset patients had a higher frequency of DR2 as compared with normal subjects.

We prospectively studied and classified 152 cases of endogenous uveitis treated at the Ophthalmological Clinic in Split, Yugoslavia, according to clinical presentation, several immunologic parameters including HLA subtyping, and the presence of an associated systemic disease. Using our diagnostic criteria we successfully classified 91.4% of patients. Anterior uveitis was the most common form of clinical presentation (94 patients, 61.8%), whereas an intermediate uveitis was present in only 5.3% of patients (8 patients). By HLA typing we found that 115 patients (75.7%), were positive for HLA-B27 (57 patients, 50%), B5 (30 patients, 26%) and B35 (28 patients, 24%) risk antigens. Of these patients 96 (83%) had an associated systemic illness. In the 8.6% of cases (13 cases) in which the etiology of an endogenous uveitis was not determined, none were associated with an HLA-B risk antigen. Our study emphasizes the association of HLA-B risk antigens and concurrent systemic disease in patients with endogenous uveitis.

HLA-A and HLA-B antigens were determined in 16 unrelated subjects orginating from Veneto affected by idiopathic haemochromatosis (IH). HLA-A3 was found in 13/16 patients vs. 300/1,348 controls (p less than 0.00005). Prevalences of A3,B35 haplotype were 0.4375 in patients vs. 0.0816 in controls (p less than 0.0005). Linkage disequilibrium analysis proved the existence of a positive third-order linkage disequilibrium among IH, HLA-A3 and HLA-B35 alleles. Our data confirm the close association of IH and HLA-A3 and prove the peculiar association of the disease with A3,B35 haplotype in north-eastern regions of Italy. The positive third-order linkage disequilibrium suggests a remote event (mutation, recombination or immigration) as origin for IH and A3,B35 association.

As a result of a comprehensive clinical and functional examination of 217 patients with bronchial asthma, including study of HLA-antigen composition of their tissues, a relationship between B13, B21 and B35 antigen carriers and susceptibility to bronchial asthma as well as associations with the form of the disease, its severity and some features of its course were found. Clinical examples confirming these arguments are illustrated. Possibilities of individual prognosis at a clinic are grounded.

A 55-year-old woman with common variable immunodeficiency and mild chronic obstructive lung disease received 3 units of plasma as immunoglobulin replacement therapy. During the administration of the final unit, her temperature rose 1 degree C, with no other observable symptoms. Fifteen minutes later she developed shortness of breath without nausea, vomiting, rash, or pruritus. In 30 min she lost consciousness, was breathless, and cyanotic. Resuscitative efforts failed. Autopsy failed to pinpoint a cause of death. There was no evidence of ABO or Rh incompatibility, bacterial contamination, or hemolysis. There were no neutrophil, platelet or IgA antibodies detectable in the patient or the 3 plasma donors. There were no lymphocytotoxic HLA antibodies in the patient or two of the plasma donors. The third donor had HLA-B35 lymphocytotoxic antibodies that did not agglutinate or aggregate neutrophils. The patient's HLA type was A2, A3; B35, B40. Lymphocytotoxic crossmatches using lymphocytes of the patient were positive with plasma from the third donor but negative with the other two. An eluate prepared from post-mortem lung parenchymal tissue was cytotoxic to 7 of 8 panel lymphocytes positive for the HLA-B35 antigen but not with cells lacking B35. The implicated plasma donor was healthy with a history of 6 pregnancies. This case report illustrates the potential hazard of transfusion of plasma containing HLA antibodies.

The authors present results of investigation of antigens of the HLA system in primary mitral valvular prolapse. The investigated group of patients was formed by 23 not related patients with primary mitral valvular prolapse. (15 women, 8 men, aged 18-55 years) where HLA antigens of loci A, B and C were assessed. They found a significantly increased frequency of antigen HLA-B35 in the patients (56.52%), as compared with the population (18.33%, x2 = 18.48, Pcorr less than 0.01). The measure of the observed relationship is expressed by the relative risk value--RR = 5.81. The difference in the frequency of the other HLA antigens was not statistically significant.

The distribution of 24 histocompatibility antigens in 88 Azerbaijani patients with leprosy was determined and compared with those of 125 normal, ethnically matched individuals. HLA-BW35 was increased in frequency among the Kurdish patients as compared to the controls; HLA-A1, however, displayed decreased frequency in patients with the lepromatous form of the disease. Among the Turks, diminished frequency of HLA-BW15 was noted in the total patient population. None of these comparisons, however, reached statistical significance when corrected for the number of antigens tested. Across the two ethnic groups, differences in the frequencies of HLA antigens between the patients and the controls were only marginal.