Sialolith crystals localized intraglandularly and in the Wharton's duct of the human submandibular gland: an X-ray diffraction analysis.

The exact cause of the formation of sialoliths is unknown. Detailed knowledge of pathogenesis of sialolithiasis and composition of sialoliths is necessary to define new therapeutic procedures. The crystalline components of 23 sialoliths of human submandibular gland were investigated by X-ray powder diffraction analysis. All of the sialoliths localized in the ducts in the submandibular gland consisted of hydroxylapatite. However, in the sialoliths in the Wharton's duct, hydroxylapatite as well as whitlockite and brushite could be found in all except one case. Whitlockite was observed more often in the nucleus of the sialoliths and it was a common co-phase along with hydroxylapatite. The nucleus in one sialolith consisted of brushite and the cortex showed a co-phase of hydroxylapatite and brushite. The occurrence of whitlockite in the sialoliths in Wharton's duct may be due to a higher concentration of calcium and phosphate in saliva in this duct.

[Iloprost administration over 21 days as an effective therapy in systemic scleroderma--case report and review of the literature]. / Iloprostgabe über 21 Tage als wirksame Therapie bei der progressiven systemischen Sklerodermie--Fallbeschreibung und Literaturübersicht.

A 57-years old female patient with systemic sclerosis underwent a prolonged intravenous therapy during 21 consecutive days with iloprost, a stable analogue of prostacyclin. Beginning with 0.5 ng/ kg/minute the dose was increased every 2 days up to 2 ng/kg/minute. At the end of follow up, Iloprost was shown to enhance the perfusion of the finger and to improve pulmonary-function tests including the diffusion-capacity. Furthermore, the Erythrocyte Sedimentation Rate and the C-reactive protein decreased. The case report shows the necessity of a controlled study of prolonged iloprost therapy.

Postural vascular response vs. sympathetic vasoconstriction in human skin during orthostasis.

Sympathetic activation and local vascular smooth muscle reactions to vessel distension contribute to the increase in vascular resistance in the skin during orthostasis. The relative contribution of these two mechanisms to the changes of skin blood flow along the body axis on standing was investigated in healthy male subjects by laser-Doppler (LD) fluxmetry. Compared with recumbency, LD flux (LDF) in the standing subjects was reduced by -19.6 +/- 7.2% at the forehead and by -69.6 +/- 9.6% in the leg. In the absence of hydrostatic pressure changes, the LDF changes on standing averaged -29 +/- 13%, independent of skin region, reflecting the effect of vasoconstriction due to sympathetic activation. The postural vascular response, elicited by lowering the arm or the leg from heart level, was significantly attenuated in orthostasis compared with recumbency. The vessel reaction to local alteration of transmural pressure was studied in the skin of the forehead and lower leg by application of external pressure in supine subjects. No difference in vessel responsiveness to changes of transmural pressure was found between these skin sites. The findings suggest that the changes of skin perfusion in orthostasis result from a nonadditive interaction of height-dependent and -independent mechanisms.

Postural vascular response in human skin: passive and active reactions to alteration of transmural pressure.

Laser-Doppler (LD) fluxmetry was performed in the palmar finger skin of healthy subjects to study the mechanisms contributing to the postural vascular response. Local transmural pressure in the skin blood vessels of the region studied was altered for 1 min in two experimental series either by passive movement of the arm to different vertical hand positions relative to heart level or by application of external pressure (-120-180 mmHg) to the finger. Heart and respiratory rate, arterial blood pressure, and LD flux in the contralateral finger (kept at heart level) were measured. The measurements suggest a compound reaction of local (myogenic) and systemic (neurogenic) mechanisms: the local regulatory component appears as a graded active vascular response elicited by passive vessel distension or compression. A systemic component, associated with a single deep inspiration, is frequently observed during the actual movement of the arm. In addition, prolonged holding of the test hand in a given vertical position also elicits a delayed vascular response in the control hand at heart level, which may be generated by volume receptors in the intrathoracic low-pressure system.

A new approach to intravital videomicroscopy of rat spinotrapezius muscle.

A modified preparation of the rat spinotrapezius muscle is described in which optimal conditions for intravital microscopy can be achieved while the supplying blood vessels are left fully intact, and mechanical stress to the muscle during preparation is reduced to an unavoidable minimum. The viability of the preparation is demonstrated using the response of arterial microvessels to endothelium-dependent and -independent dilators and to changes of ambient PO2, the presence of spontaneous vasomotion, and histochemical analysis of pertinent enzyme systems. The preparation is viable for much longer experimental time periods (up to 10 hours) than reported previously, provided the intensity of illumination is kept at a very low level. If the latter prerequisite is met, tissue edema, maximal vasodilation, and the associated loss of responsiveness to vasoactive stimuli of arterioles is reliably avoided.

Immune complex binding to erythrocyte-CR1 (CD 35), CR1 expression and levels of erythrocyte-fixed C3 fragments in SLE outpatients.

Erythrocytes (E) from a cross-sectional group of 22 outpatients with systemic lupus erythematosus (SLE) and/or mixed connective tissue disease (MCTD), the majority without active disease (n = 14), were analyzed for CR1 antigen expression and capacity to bind complement opsonized, radiolabelled immune complexes (IC). Furthermore, E-bound C3 fragments and the plasma C3d concentration were determined. E-bound C3b/iC3b fragments were not elevated in patients with SLE, whereas E from 11 out of 22 SLE patients had increased C3d levels which correlated with the plasma C3d concentration (Rs 0.73, p less than 0.001). E-fixed C3d fragments did not affect the binding of Mab or preopsonized IC to E-CR1 and were not correlated with disease activity or medical treatment. Antigen expression of E-CR1 measured by ELISA or agglutination showed positive correlation with the IC binding capacity of E-CR1 (Rs 0.92 and 0.72 respectively, p less than 001). The IC binding capacity of E-CR1 from SLE patients was significantly reduced (p less than 0.005), whereas the antigen expression of CR1 (ELISA) on E from the patients did not differ from that of E from healthy donors (p greater than 0.1). E-CR1 antigen was measured by Mab reacting with an epitope outside the IC-binding site of E-CR1. E-CR1 antigen expression or IC binding showed no correlation either with disease activity or prednisolone treatment. However, 4 og 5 patients with MCTD and 4 of 5 patients receiving Imurel were found to have low E-CR1 expression and capacity to bind IC. Thus, measurement of antigenic E-CR1 in a cross-sectional group of SLE outpatients by use of Mab reacting with an epitope outside the ligand-binding region of CR1 did not reveal a significantly reduced CR1 expression. However, an assay for CR1-mediated IC binding showed a clearly reduced E-CR1 function.

Zinc ions inhibit factor I-mediated release of CR1-bound immune complexes and degradation of cell-bound complement factors C3b and C4b.

ZnCl2 exerted a dose-dependent inhibition of citrate-phosphate-dextrose (CPD) plasma-induced release of 125I-labelled BSA-anti-BSA immune complexes (IC) bound to complement receptor type 1 (CR1, CD35) in human whole blood. Maximal inhibition was observed at 10 mM of ZnCl2. Furthermore, the release of IC bound to erythrocyte (E)-CR1 by purified factor I, factor I-deficient serum plus purified factor I, or normal human serum was reduced by approximately 90%, 64%, and 52%, respectively, in the presence of 10 mM ZnCl2. The effect of ZnCl2 on factor I-mediated degradation of cell-bound C3b/C4b was also investigated employing CPD blood or E from a factor I-deficient donor. These cells expressed covalently bound C3b and C4b as demonstrated by a simple agglutination technique. Upon incubation of CPD whole blood with purified factor I, or of E with purified factor I or normal CPD plasma, the C-fragments were cleaved and the cells were no longer agglutinated by antibodies to C3c and C4c. The presence of ZnCl2 prevented this factor I-mediated degradation of C3b and C4b, as evidenced by the unaffected agglutination of the cells by the antibodies. We conclude that ZnCl2 inhibited factor I activity since: (1) release of complement-preopsonized IC from E-CR1 by purified factor I was markedly inhibited (90%) in the presence of ZnCl2, (2) preincubation of the cells with ZnCl2 caused only a moderate inhibition (32-38%) of the IC release, and (3) degradation by purified factor I of covalently cell-bound C3b and C4b was abrogated in the presence of 10 mM ZnCl2.

Enhanced binding of immune complexes processed by erythrocyte CR1 (CD 35) receptors to purified CR2 (CD 21) receptors from tonsillar mononuclear cells.

The binding of immune complexes (IC) opsonized by serum complement (C) and IC processed by CR1 (CD 35) receptors on human erythrocytes (E) to purified CR2 (CD 21) receptors was compared. Soluble CR2 was prepared from tonsillar mononuclear cells and purified by antibody affinity chromatography. Solid phase CR2 as well as CR2 subjected to PAGE and blotted onto nitro-cellulose membranes bound 125I-labelled BSA anti-BSA IC which had been opsonized by C and processed by CR1 up to ten times more efficiently than IC reacted with serum only. Radiolabelled monomeric C3d also bound to solid phase CR2. The binding of IC to purified and solid phase bound CR2 could be inhibited by anti-CR2 antibodies or by preincubation of the IC with polyclonal antibodies reacting with C3d or C3b/iC3b. Thus, both C3dg and iC3b appeared to mediate binding of IC to CR2. Preincubation of solid phase CR2 with purified monomeric C3d did not inhibit the subsequent binding of E-CR1 processed IC. The data indicate that E-CR1 have an important role in generating IC which bind effectively to CR2 receptors on B lymphocytes.

Reduced erythrocyte CR1 (CD 35) receptor function and complement opsonization in factor I-deficient patients is restored by plasma infusion.

Erythrocytes (E) from three factor I-deficient patients were investigated for surface-bound complement factors and CR1 (CD 35) expression and function. The E were coated with C4b, C3b, and factor H. Following plasma infusion or in vitro incubation of the patients' E with normal human serum (NHS) or purified factor I, cell-bound C4b and C3b could no longer be detected. The E now expressed C3d, and factor H was unaffected, indicating that factor H was bound to the C3d part of the C3b molecules, providing the co-factor for effective cleavage of E-bound C3b when purified factor I was added. The binding of monoclonal anti-CR1 antibodies (M710) to the patients' E was markedly reduced compared with control E, and was not normalized by treatment with NHS, probably because covalently bound C3d/factor H interfered with the binding of M710. By contrast, the reduced ability of the patients' E-CR1 to bind complement-opsonized immune complexes (IC) was normalized after plasma infusion. This shows that the impaired CR1 function was acquired and emphasizes the importance of performing functional CR1 assays. Complement opsonization of IC for binding to normal E was severely compromised in the patients' sera due to consumption of factor B and C3. After plasma infusion the opsonization capacity of the patients' sera was restored. Thus, two mechanisms of importance for normal clearance of IC were compromised in factor I-deficient patients: (1) the opsonization of IC for binding to E-CR1, and (2) the capacity of E-CR1 to bind opsonized complexes. Both dysfunctions were temporarily corrected by plasma infusion.

Quantification by ELISA of erythrocyte-bound C3 fragments expressing C3d and/or C3c epitopes in patients with factor I deficiency and with autoimmune diseases.

A sensitive ELISA assay for quantifying erythrocyte (E) bound C3 fragments was developed. The assay employs a double-antibody sandwich technique, using polyclonal anti-C3d or anti-C3c antibodies to quantify C3 fragments, expressing C3d and/or C3c epitopes in washed, detergent-solubilized E. The assay detected 50-120 molecules of C3d per E in healthy individuals. Antigens reacting with anti-C3c antibodies were also detected on E from normal individuals, but the density of C3c-epitopes was 0.9-2.4 times lower than that of C3d-epitopes. In 2 patients with congenital factor I deficiency significantly increased density of E-bound C3c- as well as C3d-antigen was observed. Plasma infusion in one of the patients induced a loss of E-bound C3c-antigens, indicating cleavage of E-bound C3b to iC3b and further to C3c and E-bound C3d. Loss of C3c-antigens also occurred following in vitro treatment with normal human serum of E from one of the patients. Two thirds of 22 patients with systemic lupus erythematosus (SLE) and of 18 patients with rheumatoid arthritis had significantly increased density of E-bound C3d, the highest density being 490 C3d molecules/E in an SLE patient. The density of E-bound C3d correlated with the plasma-C3d concentration, indicating that the coating of E with C3d reflects the degree of complement activation.

Three cases of factor I deficiency: the effect of treatment with plasma.

Three patients with congenital factor I deficiency associated with different clinical manifestations are described. Case 1 had one single episode of meningococcal disease, case 2 experienced four episodes of meningococcal disease and several other severe infections, whereas case 3, without known predisposition for infections, died from a subacute immune-complex mediated syndrome, resembling polyarteritis nodosa. Family studies in cases 1 and 2 revealed healthy individuals with factor I concentrations below the lower reference limit, indicating heterozygous carriers. The pedigree analyses were consistent with autosomal codominant inheritance. The estimated minimal frequency of the deficient gene was 0.002. Pedigree analysis was not performed in case 3 but the father and sister was found to be probable heterozygous carriers. Cases 2 and 3 were treated with infusions of freshly frozen plasma (FFP) (40 and 27 ml/kg bodyweight) during acute illness and the immunochemical complement profile was monitored. Following plasma infusion factor I was cleared from the circulation with a half-life of 29-45 h. The plasma infusions induced generation of C3d and C4d, increase in native factor B and C3 concentrations and disappearance of Ba split products. Native C3 and C4 increased to normal concentrations and remained normal till 16 days after the plasma infusions, whereas native factor B decreased to preinfusion levels 8 days after plasma infusion. It is concluded, that congenital factor I deficiency can present with different clinical manifestations and may be more prevalent than hitherto anticipated. Furthermore, infusion of blood products containing small amounts of functional factor I can partly normalize the complement profile, with a more prolonged effect on C3 and C4 than on factor B metabolism.

Enhancing effect of autologous human erythrocytes on generation of C3 cleavage products beyond iC3b.

The in vitro formation of C3d and C3c in fresh normal human serum (NHS) after addition of five different activators of the complement (C) system was studied. Following C-activation in NHS (n = 53) by Sephadex G-200 beads, the conversion of C3 was found to proceed to iC3b with a variable but restricted generation of C3d. Similar results were obtained by use of heat-aggregated IgG, Escherichia coli, zymosan, and cobra venom factor. However, comparing the C3d concentration following activation in the presence and absence of autologous red blood cells (RBC) at 37 degrees C the generated C3d was found to be 2- to 3-fold higher in the presence of RBC after 30, 60, and 210 min. Preincubation of RBC with polyclonal anti-CR1 antibodies resulted in a dose-dependent reduction of the amount of C3d generated. C-activation induced by Sephadex G-200 beads, in the absence of RBC, generated iC3b without a significant production of C3d. After removal of the activator beads, addition of RBC resulted in a decrease of iC3b and a clear increase in the C3c and C3d concentration within 3 h. Western blotting analysis of the C3d produced in the presence of RBC showed that the molecular weight (36 kilodaltons) was similar to that of C3d formed in vivo.

Quantification of C3dg/Epstein-Barr virus receptors on human B cells and B cell lines.

The expression of C3dg/Epstein-Barr virus receptors (CR2) on human peripheral blood and tonsillar B lymphocytes and Raji cells was quantified by measuring binding of unlabeled monoclonal anti-CR2 antibody (OKB7 and HB-5) in an indirect immunoenzymatic assay. Scatchard analysis of saturation binding curves revealed that Raji cells on the average express about 22,000 and 17,000 binding sites, with mean affinity constants of 9.9 X 10(10) and 8.7 X 10(10) M-1 for OKB7 and HB-5, respectively. Tonsillar mononuclear cells (TMC) expressed 16,700 and 17,600 binding sites for OKB7 and HB-5, respectively, with a significantly lower affinity constant for HB-5 (3.2 X 10(10) M-1) than for OKB7 (9.0 X 10(10) M-1). On the average 34% of E- peripheral blood mononuclear cells (PBMC) from healthy donors and 49% of TMC expressed the CR2 antigen. When correcting for the fraction of CR2-positive cells, the mean CR2 density was 12,600 on E- PBMC (n = 10) and 34,000 on TMC (n = 4).

Influence of processing by erythrocyte C3b/C4b receptors (CR1) on binding of immune complexes to Raji cells and polymorphonuclear granulocytes.

The binding of 125I-labelled bovine serum albumin (BSA)-anti-BSA immune complexes (IC) to Raji cells and polymorphonuclear (PMN) cells in vitro was studied. The IC were reacted for 1 h at 37 degrees C with normal human serum (NHS) diluted 1:2 in the presence or absence of human erythrocytes (E) before presentation for Raji cells or PMN cells. The IC showed a two to three fold increased binding to C3d, g receptors (CR2) on Raji cells, when E-CR1 had been present during the reaction with NHS, compared to IC similarly reacted with NHS only. Blocking of the E-CR1 by a polyclonal anti-CR1 antibody reduced the subsequent binding of IC to Raji cells to the same level as that obtained with IC reacted with serum only. Binding to PMN granulocytes of IC reacted with NHS in the presence of E-CR1 showed a 60% reduction compared to the binding of IC reacted with NHS only. It is concluded that interaction of complement-reacted IC with CR1 on erythrocytes leads to a more efficient generation of CR2-binding C3d, g-containing IC with reduced reactivity to PMN cells.

Interaction of complement-solubilized immune complexes (IC) with CR1 receptors on human erythrocytes. Polysulfated compounds inhibit IC binding and induce IC-release from CR1.

The effect of the polysulfated compounds heparin, dextran sulfate, chondroitin sulfate and suramin, and non-sulfated poly-, oligo-, and monosaccharides on binding and release of complement-solubilized 125I BSA-anti BSA immune complexes (IC) reacting with complement C3b receptors (CR1) on human erythrocytes (E) was investigated. Following presolubilization of IC in normal autologous human serum (NHS) a clear dose-dependent inhibition of IC-binding to E-CR1 was obtained by addition of polysulfated compounds. The inhibitory effect was dependent on the sulfate content of the reagents used but independent of their anticoagulant activity as heparin preparations with high and low affinity for antithrombin III inhibited IC binding to E-CR1 to approximately the same extent. Dextran sulfate caused a stronger inhibition than heparin while chondroitin sulfate was inhibitory only at high concentrations. The inhibitory effect was exerted at the IC-C3b level as normal IC-binding occurred following preincubation of E with the polysulfated compounds. Non-sulfated saccharides showed no inhibition of IC binding to E-CR1. All polysulfated compounds, apart from chondroitin sulfate, induced a dose-dependent release of E-CR1 bound IC in the absence of NHS. No release was obtained by use of non-sulfated saccharides. Heparin induced IC-release was rapid (40-45% after 3 min) and incubation beyond 30 min caused only an insignificant further release of IC from E-CR1. Following release of IC the E-CR1 retained full binding capacity for freshly added IC-C3b.

Release of immune complexes bound to erythrocyte complement receptor (CR1), with particular reference to the role of factor I.

The release of 125I-bovine serum albumin (BSA)-anti-BSA immune complexes (IC) bound to human erythrocyte complement receptors (E-CR1) was studied. IC were complement-solubilized in normal human serum (NHS), and reacted with human erythrocytes at conditions optimal for binding of the IC to E-CR1. E-CR1-bound IC could be released by the addition of NHS or purified factor I. Factor I-deficient or I-depleted serum mediated no release, and addition of purified factor I restored the release. Factor H was not required for the release of IC. The kinetics of IC release was influenced by the NHS concentration, the presence of EDTA, and the time of prior storage of the erythrocytes at 4 degrees C. NHS (1:5 to 1:10) in the presence of EDTA caused nearly maximal release within 10-20 min at 37 degrees C. In the absence of EDTA the NHS-induced IC release was markedly slower. IC released within the first 30 min showed significant rebinding to new E. The release of IC was not associated with loss of the IC binding activity of E-CR1. The NHS-mediated release of IC could be inhibited by rabbit anti-CR1 and by a mixture of protease inhibitors. Release induced by purified factor I was also inhibited by protease inhibitors. The affinity of IC binding to E-CR1 was reduced after cleavage of CR1-bound C3b-IC to iC3b-IC by factor I.

Interaction of complement-solubilized immune complexes with CR1 receptors on human erythrocytes. The binding reaction.

The binding of complement (C)-solubilized 125I bovine serum albumin (BSA) anti-BSA immune complexes (IC) to CR1 receptors on human red blood cells (RBC-CR1) was studied. The binding of IC to CR1 was strongly dependent on the molar antigen to antibody ratio, and IC formed in moderate antigen excess showed no binding. IC solubilized in 50% human serum in the presence of autologous RBC bound rapidly to RBC-CR1, with maximal binding within less than 1 min at 37 degrees C. Release of CR1-bound IC under these conditions occurred slowly, requiring more than 30 min. Only binding of 'partially' solubilized, e.g., anti C3c (C4c), and conglutinin-reactive IC occurred, whereas fully solubilized complexes (IC-C3dg, C4d) showed virtually no binding. Solubilization of IC in the presence of Mg-EGTA or in C2-deficient serum resulted in a markedly delayed binding of IC to RBC, indicating the importance of an intact classical pathway in preparing the IC for binding to RBC-CR1. C-solubilized IC could be absorbed to solid-phase conglutinin or antibody to C3c and C4c, and these ligands were able to inhibit the binding of solubilized IC to RBC. Heparin also exerted a marked, dose-dependent inhibitory effect on the binding of presolubilized IC to RBC-CR1, whereas the binding was unaffected by the addition of monosaccharides or by the concentration of Ca2+ or Mg2+ ions.

Complement-mediated solubilization of immune complexes and their interaction with complement C3 receptors.

Some of the molecular events in the complement (C)-mediated solubilization of immune complexes (IC) have been clarified in recent years. The solubilization is primarily mediated by alternative C pathway proteins whereas factors in the classical pathway accelerate the process. Components of the membrane attack complex do not participate in the reaction. Besides affecting the size and solubility of circulating IC the interaction with C factors influences the reactivities of the complexes towards fluid phase reactants and mediates the reversible binding of IC to cellular C3 receptors. Our knowledge of the cellular localization, expression and structure of the C3 receptors, especially the C3b (CR1) receptor, has been considerably extended in the last few years, whereas our understanding of the physiological role of these receptors is still fragmentary. However, it is becoming increasingly evident that impaired solubilization of IC in patients with compromised C function may permit the complexes to deviate from their normal pattern of interaction with C3 receptors probably influencing both the organ distribution and clearance of IC and thereby also their phlogistic potentials.

Solubilization of immune complexes in complement factor deficient sera and the influence of temperature, ionic strength and divalent cations on the solubilization reaction.

The complement-mediated solubilization (CMS) of immune complexes (IC) and the initial kinetics (IKS) of this reaction in human sera depleted of or deficient in C2, C3, C8, factors B, P and I were investigated. Sera depleted of B or P and those lacking native C3 or factor I showed virtually no CMS whereas the IKS and CMS capacity of a C8-deficient serum were within the reference range. The IKS of a C2-deficient serum was markedly retarded while the CMS capacity was normal. Addition of C2 normalized the kinetics of the reaction. There was a good correlation between the kinetics of CMS determined by a radioassay and kinetic data for the binding of C3b to preformed immune complexes. The CMS capacity reached maximum at 39-41 degrees C and at an ionic strength of approximately 0.20 mu. Selective chelation of Mg2+ completely abolished the CMS of IC. Maximal CMS was observed at Mg2+ concentration of about 2mM. Chelation of Ca2+ in serum by Mg2+-ethylene glycol tetraacetic acid reduced the CMS capacity by up to 50% and the IKS was markedly retarded. Varying the Zn2+ or Mn2+ ion concentrations in serum influenced neither the IKS nor the CMS capacity.