Lymphocyte cyclic AMP levels antepartum and postpartum as an indirect assessment of the immune system during pregnancy.

The literature dealing with the immunological state of the pregnant woman has been conflicting. The concentrations and activity of a number of hormones and proteins which modify lymphocytic activity have been measured both in vivo and in vitro during pregnancy. Most of the differences between reported studies can be reconciled to technical or experimental variations. In some instances, the purported suppressive effects of embryonic proteins such as HCG have actually been caused by the impurity of the preparation studied. We have attempted to approach the question of whether or not the pregnant woman is immunosuppressed by studying a regulatory material in the lymphocytes. It is known that cAMP is a mirror of lymphocytic activity and that low levels of cAMP may indicate a high degree of reactivity, while high levels are present when lymphocyte reactivity is low. In an initial study, ten women volunteered to have blood drawn in the last trimester and two months postpartum. Cyclic AMP was extracted from lymphocyte-enriched leukocytes and stored until all samples were available from all patients so that the analysis could be made simultaneously. Five samples were obtained from healthy nonpregnant women in the same age range. Postpartum and nonpregnant women were found to have significantly elevated levels of cAMP as compared to the lymphocytes obtained in the third trimester of pregnancy. The experiments were then repeated using seven more patients. The same significant increase in postpartum lymphocyte cAMP concentrations were found. The precise reason(s) for this is not known, but may be due to increased suppressor cell activity.

Chemotherapy of advanced ovarian epithelial carcinoma with melphalan and levamisole: a pilot study of the Gynecologic Oncology Group.

Twenty-three patients with Stage III, Stage IV, or recurrent epithelial ovarian cancer were treated with a combination of melphalan and levamisole to determine a tolerable dosage schedule, possible adverse effects, and a general estimate of response rate and duration. In seven patients with measurable disease there were four complete responses (57%) with a median duration of 75 weeks. Two of the complete responders have had negative second-look laparotomies while the other two patients have had subsequent progression. Of 16 patients with nonmeasurable disease two have had negative second-look laparotomies and two remain progression free. Thus 8 of 23 patients (35%) had complete responses or remain progression free whereas 4 of 23 patients (17%) have had negative second-look laparotomies. No serious toxicity was encountered. Immunologic monitoring did not indicate significant immunologic reconstitution in these immunosuppressed patients.

Evaluation of the shake test to predict respiratory distress syndrome.

An analysis of the relationship of amniotic fluid shake test titers and the subsequent fetal lung maturity as evinced by the development of the respiratory distress syndrome (RDS) has been conducted. Over a four-year period, 131 amniotic fluid samples were tested within 48 hours of delivery. RDS was diagnosed in 16 infants. When the shake test was positive at a 1:2 dilution, one child developed a mild case of RDS (2.3%). If the test was postivie at a 1:4 dilution, none developed RDS. RDS occurred in 15% of the cases with a positive test at a 1:1 dilution and in 30% of the cases with a negative test. This test has proved to be an excellent screening method for predicting fetal lung maturity if it is positive at 1:2 or greater. If the result is positive at a 1:1 dilution, or negative, other methods must be used for assessment. Its advantages are its rapidity, simplicity, and low cost.

Studies of lymphocyte populations in pre-eclampsia-eclampsia.

The possibility that the etiology of toxemia might be immunologic has been held for over 70 years. In the past decade, numerous studies have been instituted in attempts to verify the possible role of the immune system in this disease. The present study was undertaken as a probe to determine if a gross difference in the numbers of T and B cell lymphocyte populations might exist between pre-eclamptic and normally pregnant women. Twenty-five normally pregnant women in the third trimester were compared to 25 pre-eclamptic women, and significant differences were noted. If, indeed, there is an immunologic basis for pre-eclampsia, it is more subtle than the methodology used in this study is capable of detecting.

Phagocytosis and erythroblastosis. I. Modification of the neonatal response by promethazine hydrochloride.

Phagocytic cells were obtained from children at ages comparable to those at which the disease is most commonly seen during pregnancy. The effect of P-HCl on the phagocytic action of these cells on opsonized red blood cells was studied in vitro.

Purification of naturally occurring antibody to human placental lactogen by affinity chromatography.

Antibodies against human placental lactogen (HPL) were isolated from maternal postpartum sera and nonpregnant female sera by the technique of immunoadsorption (or affinity chromatography). HPL was linked to Sepharose gel by cyanogen bromide activation and the resultant chromatographic resin was used in a repetitive column procedure to absorb and fractionate naturally occurring antibodies to HPL. The antibody to HPL was concentrated after elution from the column with a chaotropic ion, and tested for immunologic acitivity. It was determined to be an IgG molecule, and only radioimmunoelectrophoresis was sensitive enough, among the several tests performed, to show specific anti-HPL activity after treatment.

Localization of anti-HPL in fetal, placental, and maternal renal tissues.

Anti-human placental lactogen (HPL) was given to pregnant rats. An analysis of various tissues including lung, muscle, placenta, kidney and fetal localizes the heterologous antibody at the placenta. It is presumed that whatever destructive effect it has takes place there.