Presence of circulating antibodies to a disease-specific antigen on cultured human dermal microvascular endothelial cells in patients with Behçet's disease.

Behçet's disease is a chronic, multisystem disorder characterized by a recurrent inflammatory reaction. Antiendothelial cell antibodies have been detected in the serum from patients with autoimmune diseases with presenting vasculitis and it is assumed that they can induce damage to the endothelial cells. In this study, we detected antiendothelial cell antibodies in the serum from patients with Behçet's disease using an enzyme-linked immunosorbent assay, electrophoresis and immunoblotting. The cytolysis of human dermal microvascular endothelial cells (HDMEC) was measured using a cytotoxicity assay. The serum from 37.4% of Behçet's disease patients showed IgM antibodies against unstimulated HDMEC while the serum from 18.4% of patients showed an increase in IgM antibody titer after IFN-gamma pretreatment. The frequency of vasculitis was higher in the IgM-positive Behçet's disease patients than in the IgM-negative patients. In Western blotting, IgM-positive Behçet's disease serum reacted with the 44 kDa HDMEC surface antigen, whereas IgM-positive systemic lupus erythematosus serum reacted with the 81 kDa HDMEC surface antigen. The reactivity to the 44 kDa protein band was also observed in cultured human umbilical vein endothelial cells but not in fibroblasts, A431 cells or SK-MEL-2 cells. Serum from Behçet's disease patients incubated with human complement or mononuclear cells produced no significant lysis of HDMEC, and cultured HDMEC were resistant to antibody-dependent cell-mediated cytotoxicity. The results suggest that antibodies against antigens on the surface of endothelial cells may play a role in inducing vasculitis in Behçet's disease, not through a direct toxic effect of an antiendothelial cell antibody but by an indirect effect involving the activation of endothelial cells to produce cytokines.

The effects of monoclonal antibodies against iC3b receptors in mice with experimentally induced disseminated candidiasis.

CR3 (iC3b receptor), composed of CD11b/CD18, is a beta 2 integrin. A protein that shares antigenic and structural homology with the alpha-chain of CD11b/CD18 has been isolated from the surface of Candida albicans. This molecule is thought to be essential in the pathogenesis of disseminated candidiasis. To evaluate the effects of anti-iC3b receptor antibodies on adhesion between human dermal microvascular endothelial cells (HDMEC) and C. albicans, and in treatment of candidal infection, a binding assay of C. albicans to cultured HDMEC was performed in vitro. An anti-iC3b receptor-specific monoclonal antibody was administered to mice infected with C. albicans. The mice were monitored for mortality and renal involvement by culture and histopathological findings. Flow cytometric analysis demonstrated surface expression of iC3b receptor on C. albicans. The adherence of C. albicans to HDMEC was significantly decreased by treatment with anti-iC3b receptor antibodies. Anti-iC3b receptor antibodies significantly increased the survival time and rate while lowering the renal fungal burden. The iC3b receptors are involved in the adherence of C. albicans to vascular endothelial cells and are likely to be involved in the pathogenesis of disseminated candidiasis. The increased survival in mice infected with C. albicans after treatment with anti-iC3b receptor antibodies indicates that this modality may be beneficial for future development of a new therapy for candidiasis.

Clinical characteristics of progressive vitiligo.

BACKGROUND: Vitiligo is an acquired hypopigmentary disorder with a progressive clinical course. Various clinical characteristics and their significance in the progression of vitiligo were evaluated. METHODS: A clinical study was carried out on 400 patients who had visited the Vitiligo Special Clinic of Severance Hospital, Yonsei University College of Medicine. Questionnaires were completed regarding progression, sex, family history, clinical type, onset age, duration of disease, Koebner's phenomenon, leukotrichia, and mucosal involvement, and the results were recorded. RESULTS: Progression of vitiligo was seen in 355 patients (88.8%); 45 patients (11.2%) did not show progression. No difference in sex, onset age, or leukotrichia was noted between the two groups; however, patients with positive family histories, nonsegmental clinical type, longer duration, Koebner's phenomenon, and mucous membrane involvement showed more progression of vitiligo. CONCLUSIONS: Clinical characteristics such as family history, clinical type, duration of disease, Koebner's phenomenon, and mucous membrane involvement, may be relevant in predicting the progression or prognosis of vitiligo.

The progression of nonsegmental vitiligo: clinical analysis of 318 patients.

BACKGROUND: Vitiligo is an acquired disorder with destruction of melanocytes and is characterized by cutaneous depigmentation with a progressive clinical course. We attempted to evaluate whether there was a relationship between the initial site and ultimate progression of nonsegmental vitiligo. METHODS: Three hundred and eighteen nonsegmental vitiligo patients were examined. Questionnaires regarding age, sex, duration of disease, family history, distribution of initial lesions, progression, and clinical type were recorded from personal interviews and case notes. RESULTS: Two hundred and eighty nine (90.9%) of the 318 patients showed progression of vitiligo at the time of examination. When the initial sites were the posterior trunk, hands, or feet, there was more progression of vitiligo to other body areas. The progression pattern was usually contiguous to the initial site. When the hands were the initial site, however, vitiligo most commonly progressed to the face. CONCLUSIONS: There may be a possible relationship between the initial site and ultimate progression of nonsegmental vitiligo. The progression pattern is usually contiguous to the initial site.

Antiphospholipid syndrome associated with progressive systemic sclerosis.

We report a case of secondary antiphospholipid syndrome (APS) occurring in a progressive systemic sclerosis (PSS) patient who took herbal medication. Clinical findings compatible with APS included positive IgM anticardiolipin antibody (ACL), thrombocytopenia, and obstruction of the left radial artery on digital subtraction angiography (DSA). Clinical findings compatible with PSS included sclerodactyly and digital ulcers, Raynaud's phenomenon, pulmonary fibrosis and pulmonary hypertension, proteinuria and renal mesangial reaction, and myocarditis.

Ecthyma gangrenosum associated with aplastic anemia.

Ecthyma gangrenosum is a characteristic skin lesion of systemic infection due to Pseudomonas aeruginosa. It has a high incidence in patients with chronic disease and impaired defense mechanisms. Early diagnosis and appropriate systemic antibiotic therapy is crucial since its mortality rate is very high. We report a case of ecthyma gangrenosum in aplastic anemia.

The changing patterns of liver abscess during the past 20 years--a study of 482 cases.

The diagnostic and treatment modalities of liver abscess have developed rapidly over the past few years but morbidity and mortality has not been markedly reduced. A total of 482 cases of liver abscess admitted to the Yonsei Medical Center over the past 20 years (Jan. 1971-Dec. 1990) were divided into 261 cases from the 1970s and 221 cases from the 1980s and the clinical and laboratory parameters were analyzed comparatively to determine if the clinical features, therapies and prognosis of liver abscess had changed. The proportion of amebic relative to pyogenic liver abscess decreased. Transbiliary infections increased in pyogenic liver abscess of the 1980s. Clinical signs such as jaundice and hepatomegaly and symptom duration before admission decreased. Abnormal laboratory features including hypoalbuminemia and elevation of alkaline phosphatase decreased and increased, respectively, in the 1980s. Ultrasonically guided percutaneous aspiration was the choice of treatment instead of surgical drainage in the 1980s. Despite diagnostic and therapeutic advances in the management of liver abscess, the prognosis has not improved in the 1980s as compared to the 1970s. This may reflect an increase in the incidence of liver abscess in old aged patients and patients with diabetes mellitus or underlying malignancy in the 1980s.