Influence of CRF and alpha-MSH on the migration of human monocytes in vitro.

The effects of stress in the modulation of immune responses are increasingly reported by a rapidly growing body of experimental and clinical data. Here we show that corticotropin releasing factor (CRF) stimulates 'in vitro' the migration of human monocytes, the maximum effect being obtained at 10(-14) M. On the other hand, another important neuropeptide of the stress response, alpha-melanocyte stimulating hormone (alpha-MSH), has no significant effect on the migration of monocytes. These findings show that one of the oldest immune responses is directly modulated by a key mediator of the stress response.

ACTH(1-24) stimulates the migration of human monocytes in vitro.

In view of the increasing evidence that a variety of stresses can influence immune responses, the direct effect of adrenocorticotropic hormone on the migration of human monocytes was studied in vitro. ACTH(1-24) significantly increased the number of migrating cells when placed in the same or the opposite compartment of the chemotaxis chamber, maximum activity being obtained at 10(-14) and 10(-8) M. The results indicate that ACTH(1-24) directly and potently stimulates the migration of human monocytes by means of a chemokinetic effect.

In vivo evaluation of cholesterol 7 alpha-hydroxylation in humans: effect of disease and drug treatment.

7 alpha-Hydroxylation of cholesterol is a stereospecific reaction consisting of the replacement of the 7 alpha-hydrogen with a hydroxyl group. When cholesterol labeled with tritium at the 7 alpha position is administered, the hydroxylation of the substrate will result in the loss of tritium which in turn will label the body water. The rate of tritium enrichment of the body water could thus give a quantitative estimate of the hydroxylation rate. This study describes the validation of the procedure with some 21 studies performed on 15 subjects in different conditions. [7 alpha-3H]cholesterol was administered intravenously in 50 ml of plasma and thereafter blood was sampled at timed intervals for 4 to 5 days. The rate of the hydroxylation of cholesterol was calculated from the time course of the specific activities of plasma cholesterol and body water after tracer administration and was expressed as 7 alpha-hydroxycholesterol formed/24 hr. Calculated values of hydroxylation in three control subjects (493 +/- 206), five patients with hyperlipoproteinemia (539 +/- 168), and seven cirrhotic patients (153 +/- 136) are in good agreement with figures reported for bile acid synthesis determined with other techniques. Cholesterol 7 alpha-hydroxylation rate is reduced in patients with cirrhosis, the impairment being related to the severity of the disease. Cholestyramine administered to one subject for 4 weeks produced a threefold increase of the hydroxylation. Administration of chenodeoxycholic acid resulted in a 50% decrease, whereas that of ursodeoxycholic did not produce consistent changes of the hydroxylation rate. The results support the current view that 7 alpha-hydroxylation of cholesterol is rate-limiting in the synthesis of bile acids.(ABSTRACT TRUNCATED AT 250 WORDS)

Glycerol stress and platelet integrity.

Platelet response to glycerol gradient was studied using a few in vitro parameters. These were platelet count, mean platelet size, platelet response to hypotonic stress (PHRS), and collagen-induced platelet aggregation. An equal volume of 1-10% (w/v) glycerol in plasma was added at once to the platelet concentrate resulting in 0.5-5% (w/v) final glycerol concentration. The concentrate was kept at 22 degrees C for 60 min. Platelets were then separated by one centrifugation and resuspended in glycerol-free plasma. A loss in platelet count was observed when the gradient of glycerol was more than 3%. This was associated with an increase in mean cell size and a reduction in aggregability. With 5% glycerol stress, a loss of 30% in cell count, an increase in 18% in cell size, and a 78% loss in aggregability was observed. Declining of PRHS was shown already with a 1% glycerol gradient and 69% of this function was suppressed by 5% glycerol stress. In other experiments, 5% glycerol was first added, them removed in 5 steps with a gradient of 1% each. When time interval between each step was less than 0.5 min, platelet loss and PRHS reduction were 17 and 47% respectively. These values were gradually improved to 4% and 11-20%, respectively, as increasing time interval up to 15 min. It was concluded that a gradient of 1% glycerol and a 15-min interval for each step minimizes the detrimental osmotic stress on platelets while glycerol is added or removed. Our findings may lead up to devising an improved protocol for platelet cryopreservation with glycerol.

Platelet-associated complement C3 in immune thrombocytopenic purpura.

Platelet-associated C3 (PA-C3) was measured with a quantitative immunofluorescence assay. With this assay, PA-C3 levels were determined for 78 normal volunteers, 30 patients with immune thrombocytopenic purpura (ITP), and 20 patients with nonimmune thrombocytopenias. Platelet-associated IgG (PA-IgG) levels were also measured with our standard quantitative immunofluorescence assay. All patients with nonimmune thrombocytopenias and ITP in remission had normal PA-C3 levels. Twenty-four patients with active ITP were classified into 3 groups: 9 (38%) with increased PA-IgG and normal PA-C3 levels, 10 (42%) with elevated PA-C3 and PA-IgG levels, and 5 (20%) with increased PA-C3 values only. A direct correlation was found between PA-C3 and PA-IgG levels. PA-IgG levels were higher in the group of patients with elevated PA-C3 levels than in those with normal values. Platelet survival studied showed reduced survival times of 1.5--2.5 days for the 5 patients with elevated PA-C3 levels only. Elevated PA-C3 levels returned to normal in 7 ITP patients whose platelet counts increased in response to corticosteroid therapy or to splenectomy. Therefore, PA-C3 and PA-IgG assays can be used to identify patients with ITP, to follow their response to therapy, and to classify them into immunologic subgroups similar to red cell classification by Coombs' testing in immune hemolytic anemia.

Inhibition of thrombin-neutralizing activity of antithrombin III by steroid hormones.

Estrogens in high doses have been shown to inhibit, in vitro, the thrombin-neutralizing action of antithrombin III (AT III). In this study we investigate the effect of estrogens on AT III in greater detail. To increase the sensitivity of measurement of AT III activity in the absence of heparin, we have developed an assay system utilizing human platelets, AT III and thrombin. The two proteins derived from human plasma were prepared in high purity. Platelet aggregation was induced by approximately 0.02 NIH U of thrombin. AT III was added in amounts that suppressed 95% of the aggregation-inducing effect of thrombin. Estrogens blocked the thrombin-neutralizing effect of AT III in dose-dependent manner. This effect was shown to be specific for AT III. Neither aggregability of platelets nor aggregating effect of thrombin were affected by the steroid hormone. Evidence for binding of estrogen to AT III was obtained from changes in intrinsic fluorescence of AT III. ACtivity of AT III was also reduced in increasing order of effectiveness by cholesterol, cortisone, testosterone and progesterone. Our studies suggest a direct effect of estrogens and other steroids on AT III, altering its specific neutralization of thrombin.

Primary splenic hairy cell leukemia--remission for 21 years following splenectomy.

A patient with primary splenic hairy cell leukemia is reported. This patient presented with massive splenomegaly and pancytopenia due to hypersplenism. Exploratory laparotomy failed to demonstrate any disease outside the spleen and splenic hilar lymph nodes. Splenectomy was the only form of treatment. During the following 21 years, no recurrent hairy cell leukemia has been found. This case allows speculation that hairy cell leukemia may originate in the spleen and that prolonged survival or cure of the disease after splenectomy alone may be due to removal of stem cells in the spleen.

Selection of donor platelets for alloimmunized patients using a platelet-associated IgG assay.

A quantitative immunofluorescence platelet-associated immunoglobulins (PA-IgG) assay was used to detect alloimmunity to platelets in 8/12 multitransfused patients and to perform platelet crossmatching in the 8 alloimmunized patients. The correct separation of multitransfused patients into alloimmune and nonalloimmune groups was substantiated with chromium-51-labeled platelet survival studies. For 5 alloimmunized patients, compatible and incompatible donor platelets were demonstrated by PA-IgG crossmatching and were confirmed by platelet survival studies. With the other 3 alloimmunized patients, only studies with 5 of these incompatible donor platelets showed markedly reduced survival times on 4 occasions. PA-Igg compatible donor platelets survived 3.5-8.7 days, while PA-IgG incompatible platelets showed survival times of 0.1-2.4 days. Overall, PA-IgG testing correctly indicated survival results on 15/17 occasions (88%), whereas platelet aggregation, serotonin release, and lymphocytotoxicity testing showed correct predictions for only 41%-59% of the survival studies. PA-IgG testing predicted which times, thus indication patients with platelet-specific alloantibodies. the PA-IgG assay provides a sensitive method to detect platelet alloantibodies and to perform platelet crossmatching, which can complement HLA typing in the selection of donor platelets for alloimmunized patients.

Detection of platelet alloimmunity with a platelet-associated IgG assay.

A quantitative immunofluorescence PA-IgG assay was used to detect alloimmunity to platelets. The assay identified serum alloantibodies in 10 out of 14 multitransfused patients and for two of three infants with neonatal thrombocytopenia. The correct separation of all multitransfused patients into alloimmune and nonalloimmune groups by the PA-IgG assay was substantiated with chromium-51--labeled platelet survival studies. The allogeneic nature of the serum antibodies was demonstrated by progressive absorption of the antibody with increasing numbers of allogeneic platelets but not with autologous platelets. The sensitivity of the PA-IgG assay for detection of serum alloantibodies was superior to that of platelet aggregation, platelet serotonin release, and lymphocytotoxicity testing. In dilution experiments with alloimmune serum, elevated levels of serum PA-IgG could still be detected on donor platelets when platelet aggregation and serotonin release tests became negative. Platelet survival studies with selected platelets performed in the 10 alloimmunized, multitransfused patients confirmed the results of the PA-IgG assays, predicting alloimmunity to the donor platelets. In contrast, platelet aggregation, platelet serotonin release, and lymphocytotoxicity testing indicated alloimmunity for 50% or less of the patients. Reduced platelet survival times were also seen with HLA A- and HLA B-matched donor platelets when donor-recipient incompatibility was demonstrated by the PA-IgG assay. Thus the PA-IgG assay provides a sensitive method to detect serum platelet alloantibodies and may offer a technique in platelet crossmatching.

Acute acoustic nerve palsy associated with vincristine therapy.

A 73-year-old woman with non-Hodgkin's lymphoma had two episodes of severe, bilateral, sensori-neural hearing loss after vincristine therapy. Her hearing gradually, then completely returned 2-3 months after the vincristine therapy was discontinued. Bilateral ear infections, central nervous system lymphoma and infection, or other drug-induced neuropathies were excluded as possible etiologies for the deafness. Bilateral acoustic (VIII) nerve palsy in this patient was most likely a manifestation of vincristine neurotoxicity.

Platelet antibody in idiopathic thrombocytopenic purpura and other thrombocytopenias. A quantitative, sensitive, and rapid assay.

Platelet-associated immunoiglobulin weas measured by the use of fluorescent anti-IgG antibody. The method is simple, rapid, and sensitive and provides a precise quantitative assay of bound (direct) and free (indirect) IgG with platelet specificity. We have evaluated this test in 30 normal volunteers and in 50 patients with immune and nonimmune, treated and untreated thrombocytopenias. All patients with immune thrombocytopenias (acute and chronic idiopathic thrombocytopenic purpura and systemic lupus etythematosus) having platelet counts < 100,000/microliter had elevated levels of platelet-bound IgG, and 86% had also positive results in the indirect assay. All patients with nonimmunological thrombocytopenias showed normal results in the direct and indirect assay of platelet-associated immunoglobulin. In patients studied repeatedly during the course of their illness, an inverse relation was found between platelet count and level of platelet-bound IgG. Patients with systemic lupus erythematosus presented clear exceptions to this rule. Investigations of the absorbability of platelet autoantibodies and alloantibodies showed that this assay can readily differentiate between these two antibody species and can also identify specificities of alloantibodies.

Platelets as a source of growth-promoting factor(s) for tumor cells.

Human platelet lysate was shown to contain growth-promoting activity for four well-established malignant cell lines. Platelet lysate was able to support their cell proliferation without plasma or serum, indicating that platelets contained "survival factor" as well as mitogenic factor for these tumor cells. The growth-promoting activity was nondialyzable, heat stable up to 56 degrees, and partially trypsin labile, but it was completely destroyed by periodate oxidation, suggesting that a glycoprotein or glycopeptide may be the active principle. The activity was released from platelets aggregated by thrombin or collagen but not by adenosine diphosphate. This suggests that alpha-granules may be the principle storage site for growth-promoting activity.

Characterization of the platelet-aggregating activity of tumor cells.

Two lines of mouse tumor cells were shown to be capable of aggregating mouse and rabbit platelets in vitro. This process required higher Mg2+ concentrations than were needed by other commonly used platelet-aggregating agents. Platelet-aggregating activity was also found in tumor cell membrane fragments. This membrane-bound platelet-aggregating material contained protein, lipid, and carbohydrate moieties. The presence of all three appeared to be essential for stimulating platelet aggregation. Destruction of any component abolished its activity: protein by trypsin; lipid by phospholipase A2 and non-ionic detergents; and sialic acid by neuraminidase. Platelet aggregation induced by tumor cell membrane fragments was associated with a secretory release reaction. In this process, growth-promoting activity for tumor cells was also released from platelets. These results underline the importance of platelets in establishing tumor metastases.