[Cellular immune deficiency in patients with chronic glomerulonephritis]. / Kletuchen imunen defitsit pri bolni s khronichni glomerulonefriti.

In our previous work we found quantitative changes in peripheral blood lymphocyte subpopulations (decrease in total T lymphocytes, increase in T suppressor cells and monocytes) in patients with idiopathic chronic glomerulonephritis (CGN). The aim of this study was the functional state of the immune response (lymphocyte proliferation and cytokine secretion in vitro) in order to characterize the cellular immune defects and their changes under immunomodulatory therapy. We studied 34 patients with active CGN, divided in groups treated by IVIG or combined corticosteroid and immunosuppressive therapy. We found decreased proliferative ability of PBMNC to mitogen as well as to antigen. There were increased basal production of TNF and sIL-2R and lack of increase of LPS-induced IL-1 in vitro. These deviations suggest a deficiency in cellular immune response in patients with chronic GN which was influenced by immunomodulatory therapy alongside with beneficial clinical effect.

Immune mechanisms of the occupational sensitization with methylen-dyphenyl diisocyanate (MDI).

The aim of this study was to objectify and to clarity some mechanisms of the immune response of the professional sensitization with MDI. 26 workers were tested for sensitization of immediate type (ST with a broad set of indoor allergens and serum MDI-IgE) and of delayed type (ST with a standard battery of antigens for cellular immunity and with MDI), also the lymphocyte sub-populations and their functional state by flow cytometric analysis. The most frequent allergic complaints were: rhinits (70%), skin manifestations (53%), conjunctivitis (35%) and initial bronchial asthma in two cases (12%). We found indoor sensitization in 41% and normal cellular immune reactivity in all the workers tested. Specific MDI sensitization of immediate type was found in 28.5% of the workers and of delayed type--in 70% of the workers with allergic complaints. The laboratory immune indices suggest prevalence of cell--mediated mechanisms for the workers with allergic symptoms--production of INF gamma, responding to stimulation and deficient or insignificant production of IL-4, as well as linear correlation between the data for CMI, INF gamma, and IL-4. Our results suggest the participation of more than one mechanism of immune injury in the clinically manifested allergic reactions.

[Tylosin-specific proliferation in vitro of the peripheral blood mononuclear cells in occupational tylosin allergy]. / Tilozin-spetsifichna proliferatsiia in vitro na periferni kruvni mononuklearni kletki pri profesionalna allergiia kum tilozin.

Tylosin-specific lymphocyte proliferation in vitro and its restriction of HLA class II antigens have been investigated in 21 allergic workers exposed to tylosin. Nine workers from tylosin industry without allergic symptoms and five nonexposed nonallergic subjects served as controls. The results showed a significantly higher lymphocyte proliferative response to tylosin in allergic workers compared to control groups. Lymphocyte proliferation was observed in five workers with allergic complaints but negative skin tests. The tylosin concentration leading to maximal proliferative response varied from 10 to 1000 micrograms/ml among individuals. Six from seven workers with maximal response to the lowest concentration of tylosin carried HLA-DQ2 antigen. Lymphocyte from most control subjects did not respond in vitro to tylosin. Weak proliferative response to tylosin was observed in two workers without clinical symptoms of allergy. No association was found between lymphocyte reactivity to PHA and tylosin in the three studied groups. In conclusion, tylosin leads to a specific activation of T lymphocytes in occupationally sensitized workers. Possibly, the T cell recognition of the hapten/protein complex is restricted by HLA-DQ2 antigen in tylosin occupational allergy. Lymphocyte stimulation test can be used for the diagnosis of tylosin occupational allergy, as well as for the detection of latently sensitized workers.

[Changes in the humoral immune response in occupational exposure to metal aerosols]. / Promeni v khumoralniia imunen otgovor pri professionalna ekspozitsiia na metalni aerozoli.

The object of the study is to screen the state of the humoral immune response in the workers at the chemical plan Khimko AD-Vratsa who are in professional contact with metal aerosols, containing Cr, Ni, Cu, Fe, Zn, Mn, Al, nitric oxides, ammonia, carbon oxide and dust. 60 workers have been covered (exposed group) with working experience of 9.89 +/- 4.07 years and the control group consisted of 60 persons from the same region working at two other plants. A comparatively high rate was established of infections of the upper respiratory ways (rhinitis, laryngitis, chronic bronchitis, rhinopharyngitis and conjunctivitis) in the both groups: in the exposed group-in 12 persons (20%) and in the control group-in 5 (8.3%) persons. The study of the humoral immune response showed activated immune defence, expressed in increasing of the serum IgG and IgA (18.56 +/- 4.79 g/l and 3.64 +/- 1.32 g/l respectively) and of C3-fraction of the complement (1.14 +/- 0.25 g/l) in comparison to the control group 0.96 +/- 0.21 g/l, p < 0.00003). In 32 (53%) exposed workers an increased values of serum IgG have been found out. This rate is considerably higher than the one of the control group (33%, p < 0.05). An increased level of HBsAg-11.7% (7/60) and 8.3% (5/60), respectively in the exposed and control groups is reported. The authors have not found convincing evidence for autoimmune response in the exposed group of workers. These facts can be hardly interpreted at this stage as trace reaction resulting from frequent infections. It is possible that this activation of the humoral immunity is related to the environment-polluting metal aerosols which influence the immune system.

Role of fibronectin in immune glomerulonephritis.

There is already a considerable amount of evidence suggesting that fibronectin (Fn) plays an important role in the pathogenic process in some forms of glomerulonephritis (GN). It has been postulated that Fn may participate in the progression or regression of glomerular diseases. The Fn is presented in the kidney as a normal component of the mesangium, and it is increased in the expanded mesangium in various forms of GN. This paper reports our efforts to investigate the role of Fn in plasma and kidney in patients with GN. Using monoclonal antibodies against human Fn in the ELISA and immunohistoperoxidase techniques to evaluate Fn, we investigated its quantity in connection with clinical state and morphological findings. We studied 93 patients with GN and 26 renal biopsies. The patients with active forms of mesangial proliferative, membranoproliferative and membranous GN showed increased plasma Fn, and the highest levels were in patients with nephrotic syndrome. Increased tissue Fn correlated with mesangial expansion and with IgG and C3 deposits. We speculate on possible mechanisms of the involvement of Fn in human chronic GN.

[Treatment of chronic glomerulonephritis with high doses of intravenous immunoglobulin]. / Lechenie na khronichnite glomerulonefriti s visoki dozi intravenozen imunoglobulin.

The initial results of the treatment of 8 patients with idiopathic and lupus glomerulonephritis with immunovenin intact are reported. Previously the patients had been treated for a long time with combinations of corticosteroids, immunosuppressors and anticoagulants without effect. All patients had an well expressed nephrotic syndrome, 6 patients had initial chronic renal failure. The immunovenin intact treatment was carried out in three day courses of 85 mg/kg/24 h (a total of 250 mg/kg for one course). All patients received two courses of treatment. The patients were followed up for 3 to 30 months (mean 10.0 +/- 3.29). In 4 patients a full clinical remission was achieved. Two patients, after a satisfactory effect of the treatment, died from non-renal causes. The mechanisms of action of immunovenin intact are discussed.

[Fibronectin and its clinical significance in patients with osteoarthrosis, psoriatic arthropathy and chronic prostatis with a joint syndrome]. / Fibronektin i negovoto klinichno znachenie pri bolni s osteoartroza, psoriatichna artropatiia i khronichen prostatit sus staven sindrom .

The differential diagnostic importance of plasma fibronectin in rheumatology is still undecided. Its role as opsonin is being discussed at present. The fibronectin plasma level is discussed in relation to the severity of the disease, characterized by morphologic and quantitative radionuclide indices, in 30 patients with osteoarthrosis, 10 patients with psoriatic arthropathy, 32 patients with chronic urethroprostatitis and joint syndrome and in 34 healthy controls. The results for plasma fibronectin (controls--382.0 +/- 91.0, osteoarthrosis I stage--266.0 +/- 40.1, osteoarthrosis II stage--400.6 +/- 38.7, osteoarthrosis III stage--550.7 +/- 48.2, psoriatic arthropathy I stage--322.6 +/- 35.3, psoriatic arthropathy II stage--443.3 +/- 41.4, psoriatic arthropathy III stage--471.5 +/- 36.7, chronic bacterial prostatitis--287.6 +/- 86.0, non-bacterial prostatitis--360.0 +/- 83.8, chronic trichomonas prostatitis--447.6 +/- 67.0 g/ml) are reliable supplement which characterized the destructive--reparative joint reaction and the features of the joint syndrome in chronic urethroprostatitis which takes place in opsonin deficit.

[The diagnostic significance of antibodies to lipid A in patients with chronic kidney infections]. / Diagnostichno znchenie na antitelata sreshtu lipid A pri bolni s khronichni infektsii na bubretsite.

The interest in antilipid A antibodies increases in recent years. By means of an immunoenzyme test developed by the authors the frequency, quantity and characteristic of these antibodies were studied in 46 patients with chronic renal infections and in 36 healthy controls. The frequency of antilipid A antibodies class IgM is 5.7% and of class IgG it is 2.8% in the control group (healthy persons) and it is 41.3% and 19% respectively in the renal patients group. Most frequently their presence and quantity correlate with an active infection or with the convalescent period following antibiotic treatment (62.5%). This allows the use of antilipid A antibodies as a confirming marker for the presence of a heavy Gram negative infection and as a possible index for evaluation the efficacy of the treatment.

[Cell subpopulations of pyelonephritis patients studied using monoclonal antibodies]. / Kletuchni subpopulatsii, izsledvani chrez monoklonalni antitela pri bolni s pielonefriti.

The paper is devoted to a very important problem of immune mechanisms participation in the origination and maintenance of the inflammatory processes in kidneys and urinary ducts. The results from the study of lymphocyte subpopulations, making use of monoclonal antibodies in patients with clinical-laboratory data about chronic pyelonephritis without chronic renal insufficiency, as compared with healthy controls, are reported. Significantly reduced total T-lymphocyte (OKT1+) were established as well as T-helpers lymphocytes (OKT4+) and increased number of monocytes (OKM5+). The values are presented as weighted geometrical mean. A likely interpretation of those data is rather difficult at the present stage.

[Lymphocyte subpopulations in mesangial immunoglobulin A glomerulonephritis]. / Limfotsitni subpopulatsii pri mezangialen imunoglobulin-A-glomerulonefrit.

Lymphocyte subpopulations in peripheral blood were studied in 30 patients with IgA-glomerulonephritis and 24 healthy subjects via application of specific monoclonal antibodies. The following deviations were established: reduced number of OKT11 + cells (37.83 +/- 13.34, p less than 0.01): increased number of OKT8 + cells (25.89 +/- 6.70, p less than 0.01), no change in the number of OKM4 + cells, increased number of peripheral monocytes--OKM1 + cells (19.26 +/- 6.63, p less than 0.001). No significant correlations were established between the deviated parameters and arterial pressure, serum creatinine and serum IgA levels.

[Immunoglobulins in the serum of chronic pyelonephritis patients]. / Imunoglobulini v seruma na bolni s khronichen pielonefrit.

The authors studied the serum levels of immunoglobulins G, A and M in 72 patients with chronic pyelonephritis and 77 clinically healthy subjects. In spite of the high biological variability of the indices studied, high serum levels of IgG and IgA were established in the patients with active urologic infection and with advanced renal insufficiency. Significantly higher values of IgG were established in active pyelonephritis, caused by E. coli and Proteus and of all immunoglobulins--in infection with Enterococcus. The serum level of immunoglobulins in chronic pyelonephritis should be complexly interpreted, together with the other clinical and laboratory data.

[Immunological studies of glomerulonephritis]. / Imunologichni prouchvaniia pri bolni s glomerulonefriti.

The serum levels of immunoglobulins G, A and M, C3, HBsAg and E rosettes were studied in 101 patients with various histologic forms of glomerulonephritis. The cell-conditioned immunity to antigens of glomerular basal membrane and RTE antigen were studied in 39 patients with glomerulonephritis and 53 patients with Balkan endemic nephropathy. Significantly increased serum levels of IgG, IgH and IgM were found as well as a decrease of the serum values of C3 in 40,6 per cent of the patients and circulating immune complexes in 47.5 per cent of them; 7 per cent of the patients were positive to HBsAg in serum. E-rosettes were significantly lower as compared with those of the healthy, in 46.5 per cent of the patients being under the norms. The cell conditioned immunity to GBM antigen was found in 53.8 per cent of the patients with chronic glomerulonephritis examined and to RTE antigen in 58.5 per cent of the patients with BEN. The changes found were interpreted as a disturbance in immune responses, characterized by the inhibition of T and activation of B cells, the presence of CIC, C3 reduction and high HBsAg percentage being an expression of that.

[Current trends in the treatment of chronic glomerulonephritis]. / Süvremenni nasoki pri lechenieto na khronichnite glomerulonefriti.

The results from the long-term combined anticoagulant, immunesuppressive and corticosteroid treatment of 36 patients with various histological forms of idiopathic and lupus glomerulonephritis are reported. Twenty five of them are with preserved or slightly disturbed renal function, and 11 - with chronic renal insufficiency. The treatment was carried out with heparin, acenocoumarol, azathioprin and to the patients with lupus glomerulonephritis - corticosteroids in the course of 4 to 50 months. The results were "very good", "good", with "no change" and "deterioration" according to clinical and laboratory indices. Very good and good effect was obtained in 18 patients (72%) of the group with preserved or slightly disturbed renal function (25 patients). Five patients were with no change (20%) and 2 patients died of complications in connection with corticosteroid treatment. Very good results was obtained in 2 patients with rapid progressive glomerulonephritis from the group with chronic renal insufficiency (11 patients) and the rest were without effect. The adverse effects are not frequent and are mainly due to corticosteroids. The combined anticoagulant and immunosuppressive treatment is concluded to be indicated in patients, with idiopathic and lupus nephritis with preserved or slightly disturbed renal function, in patients with rapidly-progressive glomerulonephritis but not in case of manifested chronic renal insufficiency. The considerable duration and the systematic follow-up control are of essential importance for the treatment success.