Humor as the focal point of treatment for forensic psychiatric patients.

Framed as a qualitative case study based on constructivist notions, the research being reported evaluates the Humor Group, a unique treatment modality evoking therapeutic change by engaging male forensic psychiatric patients and nursing students in humorous activities. The group's meaning for patient health was investigated by cross-analyzing data collected from patient and student questionnaires, in-depth patient interviews, and naturalistic observations made by the researcher during the group's 4-year tenure. The Humor Group structure and format are offered as guides for undertaking similar attempts to rein in humor's healing potential in other settings and with other populations.

Immunoreactivity of a 10-kDa antigen of Mycobacterium tuberculosis.

Identification of Ag of Mycobacterium tuberculosis recognized by T cells is essential to understanding the pathogenesis of tuberculosis and mechanism(s) of resistance to infection. Previous studies evaluating the immunoreactivity of nitrocellulose transfers of M. tuberculosis Ag separated by SDS-PAGE indicated that a high proportion of M. tuberculosis-reactive T cell lines proliferate in response to a 10-kDa Ag. We therefore purified this Ag from M. tuberculosis culture filtrates and evaluated its immunoreactivity in patients with tuberculous infection. Proliferative responses of PBMC to the 10-kDa Ag were similar to those induced by whole M. tuberculosis and greater than those elicited by other proteins isolated from culture filtrate. Furthermore, in patients with tuberculous pleuritis, proliferative responses to the 10-kDa Ag were higher in pleural fluid mononuclear cells than in PBMC, indicating that T cell reactivity to this Ag is enhanced at the site of disease. The first 15 amino acids of the 10-kDa Ag were identical to those defined previously for Bacillus Calmette-Guérin-a (BCG-a), and a T cell clone recognized the 10-kDa Ag and a peptide of BCG-a, indicating that the 10-kDa Ag corresponds to BCG-a. This Ag elicited IFN-gamma production by pleural fluid mononuclear cells and by PBMC from healthy tuberculin reactors, suggesting that the 10-kDa Ag can enhance macrophage activation and resistance to mycobacterial infection. Our findings indicate that the 10-kDa Ag of M. tuberculosis is highly immunoreactive and should be evaluated for its capacity to elicit protective immunity.

Determination of antigenic binding sites in antibodies directed against a mycobacterial peptide by deletion and substitution of single amino acids.

A component of Mycobacterium bovis (BCG) was previously isolated using a monoclonal antibody to BCG and affinity chromatography. It was designated BCG-a. The sequence of N-terminal residues of BCG-a was used to synthesize a 13 amino acid peptide designated BCG-a-P which elicited immunologic responses. The present study was undertaken to identify which amino acid residues were critical for the immunologic characteristics of BCG-a-P. By virtue of analogues synthesized with either amino acid deletions or substitutions along the BCG-a-P sequence, it was possible to identify the regions of the peptide which were responsible for the recognition and binding by antibodies directed to BCG-a-P. In both direct and competition ELISA systems, the deletion of single amino acids caused a change in the binding of BCG-a-P by an antiserum directed to BCG-a-P. Similar results were evident when the amino acid phenylalanine was substituted for individual residues along the sequence of BCG-a-P. The residues responsible for antibody binding had the highest localized hydrophilic index of any hexapeptide stretch of the BCG-a-P sequence. These findings indicate that the activity expressed by BCG-a-P was due to a defined region of the peptide. The techniques used here may have applications in identifying the regions within other mycobacterial antigens which are involved in antibody binding.

The Victim Care Service: a program for victims of sexual assault.

Sexual victimization is a singularly traumatic event. At times, however, the implicit danger of the trauma experience itself gets exaggerated. For the victim the more lasting damage frequently stems from how he or she was treated by friends, family, health care providers, and public authorities following the incident. Treating the victimized patient as quickly and sensitively as possible is essential to minimizing the potential for further victimization. The Emergency Department at Boston City Hospital is frequently the site for the acute management of sexual assault victims. The Victim Care Service is designed to prevent secondary traumatization of such victims. The five-phase program and the fundamental assumptions upon which the phases are based are presented.

A chemically synthesized peptide which elicits humoral and cellular immune responses to mycobacterial antigens.

Monoclonal antibodies directed to Mycobacterium bovis BCG (BCG) and to M. tuberculosis H37Rv (H37Rv) were used in conjunction with affinity chromatography to prepare a mycobacterial component which was designated BCG-a. A synthetic peptide antigen was prepared based on the amino acid sequence of BCG-a and was designated BCG-a-P. Significant immunological similarities were found between BCG-a-P and antigens in extracts of BCG and H37Rv but not between BCG-a-P and antigens of nontuberculous mycobacteria. An enzyme-linked immunosorbent assay detected antibodies to BCG-a-P in sera from rabbits that had been immunized with BCG and H37Rv sonicates. In Western blot analysis, antibodies to BCG-a-P reacted to 10,000-molecular-weight components of extracts of BCG and H37Rv. Delayed cutaneous hypersensitivity reactions to BCG-a-P were elicited in guinea pigs immunized with sonicates of BCG and H37Rv but were weak or nonexistent in unimmunized animals or in animals immunized with sonicates of nontuberculous mycobacteria. This study points out the feasibility of using monoclonal antibodies to prepare and characterize synthetic mycobacterial peptides with a potential for immunodiagnostic purposes.

Comparison between murine natural antibodies and natural killer cells: recognition of separate target structures as revealed by differential in vitro expression and dependence on glycosylation.

The specificity of complement-fixing, cytotoxic antibodies against the YAC lymphoma in sera of normal young adult (A X C57BL)F1 mice was studied. In vivo-maintained, immunoselected sublines of the YAC lymphoma expressed low amounts of the natural antibody (NAb) target structure. These cell lines were also resistant to natural killer (NK) cell-mediated lysis. After 2-3 weeks of in vitro culture the immunoselected cell lines became NK sensitive, but they remained resistant to NAb. When several independently derived variants selected for low NK sensitivity were tested for their ability to absorb NAb, the degree of absorption varied considerably among the variants. NAb could be inhibited by purified C-type virus particles and also by bacterial sonicates and various glycoprotein preparations. Treatment of target cells with tunicamycin, an inhibitor of asparagine-linked glycosylation, decreased the sensitivity to NAb lysis but had no impact on NK sensitivity. Thus the results indicated that a) NAb and NK cells recognized separate target structures and b) the target structure(s) for NAb but not for NK cells were saccharides of the N-glycosidic type.

Immunological evaluation of a component isolated from Mycobacterium bovis BCG with a monoclonal antibody to M. bovis BCG.

A component of Mycobacterium bovis BCG referred to as BCG-a was isolated through the combined use of monoclonal antibody directed to BCG and affinity chromatography. Analysis of BCG-a by sodium dodecyl sulfate-polyacrylamide gel electrophoresis revealed a single prominent band with a molecular weight of ca. 10,000. Structural characterization of BCG-a consisting of amino acid composition and amino-terminal sequence determination was carried out. The intact BCG-a antigen was bound by neither the lectin from common lentils nor concanavalin A, implying that BCG-a does not carry any asparagine-linked oligosaccharides. Immunoprecipitation of 125I-labeled BCG-a with polyclonal and monoclonal antibodies directed against BCG resulted in bands having the same mobility on sodium dodecyl sulfate-polyacrylamide gel electrophoresis as did free 125I-BCG-a. In radioimmunoassays 125I-BCG-a was bound by the monoclonal antibody and by polyclonal antibodies from rabbits that had been immunized to BCG and to Mycobacterium tuberculosis H37Rv. Antibodies to nontuberculous and to nonacid-fast bacteria bound BCG-a poorly or not at all. The binding of 125I-BCG-a by the monoclonal antibody was readily inhibited by extracts of BCG and H37Rv, but it was not as readily inhibited by extracts of nontuberculous mycobacteria and was not at all inhibited by extracts of nonacid-fast bacteria. Considerable inhibition was similarly observed by surface antigens of nonviable, intact BCG organisms. Delayed cutaneous hypersensitivity reactions to small concentrations of BCG-a were elicited in guinea pigs that had been immunized with BCG or H37Rv antigens, but such reactions were not elicited in unimmunized animals.

Enhanced immunogenicity of line 10 guinea pig hepatocarcinoma cells after culture.

Line 10 hepatocarcinoma cells derived from ascites in a strain 2 guinea pig were tumorigenic when transferred intradermally. After they had been cultured in vitro for 20 days or more in medium enriched with 10% fetal bovine serum (FBS), they became immunogenic. Injections of immunogenic cells did not cause lethal tumors, and recipients were resistant to subsequent challenges with tumorigenic line 10 cells. Resistance was specific since growth of line 1 cells, a syngeneic but antigenically distinct tumor, was not affected. Cells cultured in medium enriched with 10% calf bovine serum or 10% normal guinea pig serum or in reduced concentrations of FBS were less effective in inducing resistance. When cultured line 10 cells were injected ip into normal guinea pigs, ascites tumors developed that were tumorigenic. The growth rate of line 10 cells in culture was considerably decreased as determined by reduced [3H]thymidine incorporation and mitotic indices. The mechanism(s) responsible for enhancement of immunogenicity in cultured line 10 cells is discussed but was not determined.

A solid-phase radioimmunoassay to detect antibodies produced by hybridomas to antigens derived from human melanoma cells.

A solid-phase radioimmunoassay to detect antibodies that react with antigens derived from human melanoma cells is described. A soluble preparation derived from Nonidet P-40 lysates of tissue-cultured melanoma cells was dried on the surfaces of wells of polyvinyl chloride microtiter plates and fixed with 0.02% glutaraldehyde. Antibody preparations were added and incubated for 18 h at 4 degrees C. The wells were washed and bound antibodies were detected using radioactive Staphyloccoccal protein A (125I-SpA). Optimal conditions are described for all the steps employed. Concentrations of antigen selected, the amount of 125I-SpA employed and the duration of incubation of antibodies with antigen were found to be critical. The assay was sensitive and reproducible, and lent itself to the simultaneous evaluation of many individual antibody samples in a short period of time. The assay was particularly valuable for rapid screening of hybridoma supernatants for antibodies to antigens derived from melanoma cells and from a panel of other tumor and normal cells.

The use of cellular immunoadsorbents to prepare polyclonal antibodies that distinguish between antigens derived from human melanoma cells and autologous lymphocytes.

Cellular immunoadsorbents were employed to isolate xenogeneic antibodies that reacted with a restricted group of antigens on human melanoma cells. Melanoma cells and autologous lymphoid cells were grown in tissue culture. Cellular immunoadsorbents were prepared by coupling formalin-treated melanoma and lymphoid cells to diethylaminoethyl cellulose. Rabbits were immunized with melanoma cells and antisera were passed sequentially through immunoadsorbents made of fetal bovine serum, and lymphoid cells. Unbound effluents were then passed through an immunoadsorbent prepared with melanoma cells. Antibodies binding to melanoma cells were eluted and their reactivity to melanoma-derived antigens was tested using a solid-phase radioimmunoassay. Antigens for this assay were NP-40 lysates of melanoma and lymphoid cells and fetal bovine serum. Radioactive Staphylococcal protein A was used to detect binding by the antibodies to the test antigens. The effects of formalin-fixation and storage of melanoma and lymphoid cells were studied. Storage of fixed melanoma cells for periods up to 4 months did not affect their capacity to bind antibodies. A single exposure of formalin-fixed cells to a low-pH elution buffer which was followed by neutralization did not affect binding by these cells. Antibodies isolated in this manner were of the IgG class and reacted with antigens derived from melanoma cells but not from autologous lymphocytes or fetal bovine serum. This study demonstrated the feasibility of using cellular immunoadsorbents to prepare xenogeneic polyclonal antibodies with a high degree of reactivity to antigens derived from human melanoma cells.

Immunotherapy of the guinea pig line 10 hepatocarcinoma with a variety of nonviable bacteria.

A variety of heat-killed bacteria were tested for their capacity to induce regressions of established line 10 hepatocarcinomas in syngeneic guinea pigs. Multiple intralesional injections of heat-killed Escherichia coli, Streptococcus mutans, Listeria monocytogenes, and Propionibacterium acnes resulted in complete regression of the tumor in a majority of guinea pigs. Repeated injections of heat-killed Mycobacterium bovis strain Bacillus Calmette-Guérin caused no regressions. Surviving animals were immune to subsequent challenge with line 10 cells but not L2C cells, another syngeneic tumor.

Suppression and immunotherapy of the guinea pig line 10 hepatocarcinoma mediated by heat-killed disrupted Mycobacterium bovis strain Bacillus Calmette-Guérin.

Heat-killed Mycobacterium bovis strain Bacillus Calmette-Guérin cells were sonically disrupted, and their antitumor effects against the line 10 hepatocarcinoma in strain 2 guinea pigs were evaluated. When injected together with viable line 10 cells, there was complete suppression of tumor growth. Growth of tumor was also suppressed when line 10 cells were injected contralaterally at the same time as the vaccine mixture. Multiple intratumor injections of sufficient disrupted M. bovis strain B. Calmette-Guérin were therapeutically effective against 74% of 7-day-old tumors and against 40% of 14-day-old tumors. Surviving animals were usually resistant to subsequent rechallenges with line 10 cells but not to syngeneic L2C leukemia cells. By means of a competitive radioimmunoassay, antigenic determinants were detected that were expressed by disrupted but not by intact bacteria.

Immune complexes and antibodies to BCG in sera from patients with mycobacterial infections.

We have examined the prevalence of circulating immune complexes in sera from patients with mycobacterial infections. Sera from 68 percent of patients with active M. tuberculosis and 58 percent of patients with M. intracellulare infections had significantly elevated Clq binding activity (Clq-BA). In general there was a fall in Clq-BA with treatment. Only 15 percent of M. tuberculosis patient with a bacteriological cure, 22 percent of non-tubercular patients with chronic obstructive pulmonary disease, and 3 percent of normal individuals had an elevated Clq-BA. Antibodies to a BCG-derived antigen were demonstrated in most of the individuals studied in all groups but, significantly elevated levels were seen only in patients with mycobacterial infections. In certain patients there appeared to be an inverse relationship between Clq-BA and BCG binding, suggesting that perhaps BCG-related antigens participated in the immune complexes found. Other possible antigen-antibody complexes are discussed.

The use of cellular immunoadsorbents to prepare antibody that distinguishes between syngeneic surface antigens on two guinea pig hepatocarcinomas.

Xenogenic antibodies with reactivity for surface determinants of the guinea pig line-10 hepatocarcinoma were isolated by using cellular immunoadsorbents prepared by coupling formalin-treated line-10 cells to diethylaminoethyl cellulose. Antibodies prepared in this manner exhibited a high degree of reactivity for line-10 surface determinants. These antibodies also reacted with surface determinants of the syngeneic line-1 hepatocarcinoma. Further specificity of antibody reactivity to the line-10 hepatocarcinoma was accomplished by passage of the antibodies through cellular immunoadsorbents prepared with syngeneic line-1 hepatocarcinoma cells. By direct binding studies, these antibodies showed significantly reduced reactivity for line-1 cells and no reactivity for guinea pig spleen cells or for the unrelated murine EL-4 lymphoma. By a competitive radioimmunoassay, these antibodies reacted only with determinants expressed on the surfaces of line-10 cells and not on syngeneic line-1, L2C, spleen, thymus; or xenogeneic EL-4 cell surfaces. In a similar manner, line-10-associated antigens were detected in ascites fluid derived from line-10 tumor-bearing animals. The sequential use of immunoadsorbents made of antigenically distinct but syngeneic tumor cells made it possible to prepare antibodies with restricted reactivity for line-10-associated antigens and should be applicable to the isolation of "tumor-specific" antibodies in other systems.

Heterogeneity of binding of human IgA subclasses to protein A.

The ability of human IgA myeloma immunoglobulins to interact with protein A-containing Staphylococcus aureus was examined. Some IgA1 and IgA2 immunoglobulins bound to S. aureus although others of both subclasses failed to do so. These results were obtained by using both direct binding of radiolabeled immunoglobulins to S. aureus and with inhibition-type assays. Binding was dependent on the Fc fragment of IgA since there was no binding to S. aureus by an F(ab')2 fragment of IgA1. Nonprotein A-containing bacteria did not bind these immunoglobulins and isolated protein A interacted with radiolabeled immunoglobulins. This strongly suggested that protein A was responsible for the observed binding to S. aureus. These data indicate, in contrast to previous reports, that there is no simple relationship between IgA subclass and the capacity to bind to protein A.

Purification of antibodies to bacterial antigens by an immunoadsorbent and a method to quantify their reaction with insoluble bacterial targets.

A combination of procedures was employed to develop a radioimmunoassay which quantified the binding of antibodies to antigens of either intact Propionibacterium acnes or to antigens of insoluble extracts derived from the bacteria. Reactive antibody populations were purified by use of bacterial immunoadsorbents which were prepared by coupling P. acnes to diethylaminoethyl cellulose. Binding of antibodies was detected with [125I]staphylococcal protein A ([125I]SpA) and optimal conditions for the assay defined by varying the amounts of antibodies, bacterial antigenic targets and [125I]SpA. In antibody excess, 100% of available [125I]SpA was bound by the target-antibody complexes. However, when antibody concentration was limiting, a linear relationship was demonstrated between per cent specific binding of [125I]SpA and antibodies bound to bacterial targets. These results were achieved only with immunoadsorbent-purified antibody populations and not with hyperimmune sera or IgG. The radioimmunoassay detected subtle antigenic differences and similarities between P. acnes, P. acnes extracts and a variety of unrelated microorganisms.