Assessment of supplement use (including vitamin D) in Inuvialuit adults in the Northwest Territories, Canada.

BACKGROUND: Inuvialuit of Arctic Canada are at high risk for inadequate vitamin D status as a result of rapid dietary transitions and a lack of solar ultraviolet B exposure. This may have implications for the development of adverse skeletal diseases, cardiovascular diseases and cancers. Data are limited regarding supplement use in Arctic Aboriginal populations. The present study aimed to describe the type and extent of supplement use, emphasising vitamin D, and to identify differences between supplement users and non-users. METHODS: Supplement information was collected from a population-specific quantitative food frequency questionnaire in three communities in the Northwest Territories, Canada, as part of a cross-sectional study. Data were analysed for frequency of supplementation and types of supplements. Users and non-users were compared in terms of age, sex, body mass index, education, marital status, income support, employment and chronic disease diagnosis using nonparametric tests and the chi-squared test. RESULTS: Response rates ranged from 65% to 85%. Included in the analysis were 192 Inuvialuit (45 males, 147 females) with a mean (SD) age of 43.6 (13.9) years. Twenty-three percent reported using a supplement, with multivitamins being the most common. Three percent indicated taking a vitamin D-containing supplement. No significant differences between supplement users and non-users were found. CONCLUSIONS: Despite limited sun exposure for many months of the year, a small proportion of Inuvialuit adults were using supplements, and specifically vitamin D-containing supplements. Future population-based intervention strategies should promote consumption of vitamin D rich foods and encourage the use of vitamin D supplements if diet alone is unable to meet recommendations.

The trouble with friendly faces: skilled performance with a supportive audience.

In 3 experiments, supportive audiences were associated with unexpected performance decrements (i.e., "choking" under pressure). On a difficult, skill-based task, participants were more likely to fail when observed by supportive audiences than when observed by nonsupportive audiences. When the criterion for success was easy, supportive audiences had no effect. With a difficult criterion, supportive audiences elicited cautious, protective strategies that were associated with poor performance: Speed decreased without improving accuracy. Despite impairments caused by supportive audiences, performers found supportive audiences more helpful and less stressful than neutral or adversarial audiences, and participants believed (wrongly) that they performed better with a supportive audience. Results suggest that people are not aware of debilitating effects of supportive audiences and may opt for emotional comfort rather than objective success.

Disease management: legal strategies for the next generation of managed care.

The provision of proper and cost-effective healthcare to chronically ill patients is a crucial aspect of succeeding at managing care. An increasing number of managed care organizations are relying upon specialized outside providers to manage patients with such diseases. In such circumstances, this type of care is "carved out" and given to a specialized disease management organization. The authors discuss the strategies behind such arrangements, provide case studies of many of the specialized organizations providing such disease management, and analyze the legal issues that are likely to arise from such contractual relationships.

Is active skeletal muscle functionally vasoconstricted during dynamic exercise in conscious dogs?

We investigated whether the increase in hindlimb blood flow and vascular conductance in conscious dogs during graded dynamic exercise is functionally restrained by the sympathetic nervous system. Dogs were chronically instrumented to monitor terminal aortic blood flow (TAQ) as an index of hindlimb skeletal muscle blood flow and mean arterial pressure (MAP). The extent of functional sympathetic tone was assessed by measuring the increase in TAQ and terminal aortic vascular conductance (TAC, calculated as TAQ/MAP) in response to intra-arterial infusion of the alpha-adrenergic antagonist prazosin (PZ; 50 micrograms/kg) into the hind-limbs at rest and during steady-state dynamic (treadmill) exercise ranging from mild (3.2 km/h, 0% grade to moderately heavy (8 km/h, 15% grade) workloads. This dose of PZ completely abolished the large hindlimb vasoconstrictor response to phenylephrine (1 microgram/kg ia). At rest, PZ increased TAQ by 0.10 +/- 0.02 l/min and TAC by 1.85 +/- 0.53 ml.min-1.mmHg-1. During exercise, as workload increased and the control levels of TAQ and TAC rose progressively delta TAQ and delta TAC with PZ infusion also increased. At the highest workload, PZ increased TAQ by 0.41 +/- 0.07 l/min and TAC by 4.81 +/- 0.38 ml.min-1.mmHg-1. The increase in TAQ and TAC with PZ were linearly related to the control level of TAQ, indicating that as workload increases progressively greater restraint of muscle vasodilation by the sympathetic nervous system occurs. We conclude that during dynamic exercise in conscious dogs the sympathetic nervous system progressively restrains the normal vasodilation in active skeletal muscle, thereby limiting skeletal muscle perfusion.

Community mobilization to reduce point-of-purchase advertising of tobacco products.

This project was designed to address the problem of point-of-purchase tobacco advertising through media advocacy and community mobilization. Precampaign assessment revealed a considerable amount and density of tobacco advertising and promotions in more than 100 stores sampled in San Jose, California. After sharing the results with community activists and other residents, a community mobilization campaign was instigated to capitalize on an existing sign control ordinance that limits store window coverage and sidewalk signs. Through presentations and media advocacy efforts, community residents were mobilized to file complaints with the city's code enforcement office when neighborhood stores were shown to be noncompliant with ordinance provisions. Relative to the baseline, significant reductions in campaign-related tobacco advertising variables were seen in the San Jose stores after the sign law campaign. No changes were seen in four smaller reference communities. Differences were noted between stores close to and farther away from schools. These results demonstrate that mobilization of community residents to activate enforcement of laws originally designed for other purposes can have a significant impact on one aspect of tobacco point-of-purchase advertising.

Isotype commitment of human B cells that are transformed by Epstein-Barr virus.

Epstein-Barr virus (EBV) can transform a subpopulation of preactivated B cells thus promoting their growth and differentiation into plasma cells. In EBV-transformed clones of IgM-producing cells, the heavy chain constant region (CH) genes on the productive allele are fixed in germ-line configuration, whereas in isotype-switched clones the CH genes proximal to the expressed CH gene are deleted. In order to define more precisely the EBV-susceptible B cells, we sorted subpopulations of B cells on the basis of their cell surface Ig (sIg) isotypes, infected them with EBV, and determined which isotypes they could produce following transformation. Most precursors of IgM-producing plasma cells expressed both IgM and IgD on their surface, while a minority expressed IgM alone. Some B cell precursors of IgG- and IgA-producing cells also expressed sIgM, but surprisingly none expressed IgD. Those precursors of IgG and IgA producers, which bore sIgM, expressed it in relatively low levels, whereas B cells expressing high levels of sIgM were incapable of generating IgG and IgA producers. All of the precursors of IgG and IgA plasma cells expressed these isotypes on their cell surface. Interestingly, precursor B cells capable of producing the IgG3 and IgA2 subclasses could be respectively enriched on the basis of the presence or absence of cell sIgM. These results demonstrate the isotype precommitment of EBV-transformable B cells. They further suggest that residual IgM is transiently expressed on the surface of the IgG- and IgA-committed B cell precursors, whereas sIgD expression is extinguished earlier in the process of isotype switching via CH gene deletion.

Transmembrane ion conductance in human B lymphocyte activation.

Human B lymphocytes were examined to determine whether transmembrane ion conductance plays a role in cell activation. Mitogens (anti-human IgM F(ab')2 fragment (anti-mu) and PMA) were used to stimulate B lymphocytes. Mitogen-induced DNA synthesis was inhibited by tetraethylammonium-Cl (TEA), 4-aminopyridine (4AP), verapamil, and diltiazem in a dose-dependent manner. This inhibition was not due to reduction in cell viability as determined by trypan blue exclusion. Mitogen-induced increases in RNA synthesis were partially inhibited by TEA and 4AP and were more completely inhibited by verapamil and diltiazem. Mitogen-induced cell volume increases were not affected by TEA or 4AP but were completely inhibited by verapamil and diltiazem. B lymphocytes stimulated with anti-mu expressed G1 phase cell surface antigens in the presence of TEA or 4AP, but failed to do so in the presence of verapamil or diltiazem. Substitution of PMA for anti-mu as the mitogen did not alter the effects of TEA or 4AP. However, verapamil inhibited PMA-induced expression of G1 phase cell surface markers although diltiazem did not. The patch clamp technique was used to directly examine plasma membrane ionic currents in whole-cell, cell-attached, and inside-out patch configurations. Activation of B lymphocytes with either anti-mu or the Ca2+ ionophore, A23187, inhibited opening of one type of channel in cell-attached patches. In inside-out patches, this channel type conducted current when the bath [Ca2+] was low (6 X 10(-8) M) but failed to conduct current when the bath [Ca2+] was increased above 1 X 10(-6) M. The results of these experiments are consistent with the hypothesis that activation of B lymphocytes induces alterations in plasma membrane ion conductance. Single channel studies suggest that activation induced increases in [Ca2+]i may directly inhibit a specific set of plasma membrane ion channels as one mechanism by which transmembrane ion flux is altered.

Interleukin 2 production by a marmoset B cell line.

Several B cell lines constitutively secreting interleukin (IL) 2 were derived from the Epstein-Barr virus-positive marmoset B cell line, B95-8. A representative line, KRC-18, was cloned by limiting dilution and found to be 40% surface IgM+, 60% cytoplasmic IgM+, greater than 95% DR+, weakly Tac+ and devoid of T cell, monocyte and NK cell surface antigens. Supernatant from KRC-18 cells supported the long-term growth of an IL 2-dependent murine T cell line, HT-2, and contained 7-8 units/ml of IL 2 activity when compared to recombinant IL 2. The supernatant was fractionated by Sephadex G-75 gel filtration, and maximal proliferation of HT-2 cells was supported by the 20-22-kDa column fraction. The proliferative response of HT-2 cells to KRC-18 supernatant was inhibited by monoclonal antibodies to human IL 2 or the murine IL 2 receptor in a dose-dependent manner, suggesting that the KRC-18 IL 2 has epitopes that are similar to human IL 2, and that its activity is mediated through binding to the IL 2 receptor of the target cell line. When KRC-18 cells were analyzed for cytoplasmic IL 2, greater than 90% of the cells contained intracellular IL 2 in amounts equivalent to, or greater than, mitogen-activated T cells. These data indicate that certain B lineage cell lines are capable of IL 2 synthesis and secretion.

Epstein-Barr virus preferentially induces proliferation of primed B cells.

EBV can induce human B cells to proliferate, differentiate, and undergo transformation into continuously growing lymphoblastoid cell lines. The EBV responsiveness appears to be confined to a very limited subpopulation of B cells, the nature of which is still unclear. In these studies, we sorted tonsillar B cells on the basis of their expression of the early surface activation Ag, Bac-1, and compared their proliferative responses to EBV. Bac-1+ cells responded to EBV with a relatively high level of DNA synthesis, whereas the Bac-1- cells did not. Both large and small Bac-1+ cells were responsive to EBV and the responsiveness was unrelated to the level of Bac-1 immunofluorescence intensity. Bac-1+ cells were relatively enriched for surface IgM and IgD expression. When the Bac-1- population was enriched for IgM+ cells, the proliferative response was still significantly lower than that of the Bac-1+ population. B cells acquire the ability to bind IgM relatively late after activation, and this feature did not distinguish the EBV-responsive B cells. The results suggest B cells become responsive to EBV after an early activation signal.

Virgin and memory T cells have different requirements for activation via the CD2 molecule.

T cells can be divided into unprimed virgin (T0) and primed memory (T') subpopulations by their expression of different isoforms of the leukocyte common antigen. We have separated the CD4+ T cells into T0 and T' subpopulations and examined their capacity to respond to activation signals via the CD2 receptor molecule. On stimulation with a mitogenic combination of anti-CD2 antibodies, the T' population was induced to express IL-2 receptor, increased levels of the 4F2 antigen and to proliferate, whereas the response of the T0 populations was reflected solely by a minimal increase in the 4F2 antigen. The addition of IL-2 or monocytes to T0 cells stimulated with anti-CD2 antibodies did not enhance their expression of the IL-2 receptor or proliferation. However, T0 cells stimulated with the triad of anti-CD2 antibodies, monocytes, and IL-2 responded with high levels of IL-2 receptor expression and proliferation. The T0 subpopulation could also be induced to respond when cultured with anti-CD2 antibodies and phorbol myristate acetate. The results suggest that in order to respond to stimulation via the CD2 molecule, virgin T helper cells require additional signals that can be jointly provided by monocytes and IL-2. In contrast, memory T helper cells can be activated via CD2 signal transduction alone.

Human B cell growth factor enhances proliferation and glial fibrillary acidic protein gene expression in rat astrocytes.

The proliferation and differentiation of astrocytes are fundamental events in the normal development and function of the central nervous system (CNS), and may also contribute to the pathogenesis of a number of neurological diseases. Products of T lymphocytes can stimulate proliferation of astrocytes, but the nature of the T lymphocyte-derived molecule(s) responsible for this response is unknown. The present study was undertaken to examine several well-characterized T lymphocyte-derived factors for their ability to stimulate cultured primary rat astrocytes. While recombinant human interleukin-2 (IL-2), interleukin-3 (IL-3), interleukin-4 (IL-4), interleukin-5 (IL-5), interleukin-6 (IL-6), and rat or human recombinant interferon-gamma (IFN-gamma) have no proliferative effect on astrocytes, a human T cell-derived B cell growth factor (BCGF) does. This BCGF, termed 2B11, had previously been characterized by its ability to enhance the proliferation of anti-mu-stimulated human B cells, while not influencing B cell immunoglobulin synthesis. High performance liquid chromatography (HPLC)-purified 2B11-BCGF (MW approximately 20,000 daltons) stimulates the proliferation of astrocytes in a dose-dependent fashion. Purified 2B11-BCGF also induced morphological differentiation and increased mRNA transcripts for glial fibrillary acidic protein (GFAP) in rat astrocytes. In addition to demonstrating the absence of effect of other known lymphokines, the effect on astrocytes attributed to 2B11-BCGF was confirmed by blocking its activity with a monoclonal antibody specific for 2B11-BCGF. Absorption experiments demonstrated that when BCGF activity was absorbed out by large, activated human B cells, astrocyte-stimulatory activity was also depleted. Rat astrocytes were able to partially absorb out both BCGF and astrocyte-stimulatory activity. These results suggest that 2B11-BCGF is responsible for stimulating astrocyte proliferation, and that human B cells and rat astrocytes may share a similar receptor for BCGF. These findings indicate that the growth and differentiation of astrocytes can be influenced by a T cell-derived lymphokine, 2B11-BCGF, whose activity thus far appears to be distinct from other reported cytokines.

Differential activation requirements for virgin and memory T cells.

Most studies of the activation requirements for T cells have used either T cell lines or populations of normal T cells that consist of a mixture of virgin and Ag-primed T cells. These two subpopulations of T cells can now be distinguished in humans by their reactivity with mAb. The anti-CD45R antibody HB10 identifies virgin T cells (T degrees) that are non-reactive to recall Ag and relatively poor at providing help for B cell differentiation. Conversely, memory T cells (T') that can react to recall Ag and enhance Ig production are non-reactive with anti-CD45R, but can be identified with the UCHL1 antibody. We have used these antibodies to separate the T degrees and T' populations and examine their activation requirements. On activation CD45R+ cells rapidly began to lose the CD45R Ag and express the UCHL1 Ag in increased amounts, whereas the UCHL1+ cells retained this phenotype. Both populations responded to PHA in the presence of monocytes, but when triggered by an antibody to CD3 only the T' cells were induced to express IL-2R, produce IL-2, and to proliferate. The T degrees population of cells remained relatively quiescent by all of these parameters. However, anti-CD3 stimulation conditioned the T degrees cells for IL-2 responsiveness, inasmuch as the addition of rIL-2 resulted in significant IL-2R expression and proliferation. When the CD4+ T degrees and CD4+ T' subpopulations were isolated and examined in the same assays similar results were obtained. The data indicate that fundamental differences exist in the triggering requirements for T degrees and T' cells.

Ig isotypes produced by EBV-transformed B cells as a function of age and tissue distribution.

EBV can transform human B cells giving rise to lymphoblastoid cell lines that produce and secrete Ig. Herein B cells from various tissues of newborns and adults were transformed by EBV and their Ig products were analyzed with isotype-specific mAb. Although IgG- and IgA-bearing B cells were present in the newborn, EBV transformed IgM-producing cells almost exclusively in both newborn blood and breast milk. IgM-secreting cells were derived from IgM+ B cells and IgM- pre-B cells present in neonatal blood, but only from IgM+ cells in adult blood. Whereas in adults most EBV-transformed cells produced IgM, producers of IgG and of IgA were present in frequencies that varied according to the tissue source. Precursors of IgG-producing cells were relatively abundant in blood, spleen, and tonsil, and relatively infrequent in bone marrow and appendix. EBV-inducible IgA producers were relatively concentrated in the appendix and to a lesser extent in tonsils and blood. Differences in the subclass composition of EBV-transformed populations of IgG- and IgA-producers were also observed for the various adult lymphoid tissues. IgG1-producing cells predominated in most tissues, and precursors of IgG2 were largely confined to the circulation. Whereas IgA1-producing cells were predominant in all tissues, a marked enrichment in IgA2-producers was observed in the appendix. These results indicate a remarkable heterogeneity in the isotype distribution pattern of EBV-transformable B cells that is determined both by developmental age and tissue localization. We propose that EBV selectively transforms primed B cells, the isotype commitment of which varies according to tissue origin and age.

Leukotriene C4 produced by a human T-T hybridoma suppresses Ig production by human lymphocytes.

Multiple signals are involved in the regulation of Ig production by human B lymphocytes. Leukotrienes, especially LTB4, have been shown to inhibit Ig production by increasing the number and function of suppressor lymphocytes. Production of leukotrienes has been demonstrated by mast cells, basophils, eosinophils, polymorphonuclear leukocytes, monocytes, and macrophages. In this paper we demonstrate that a human T-T hybridoma grown at 5 x 10(5) cells/ml constitutively produces 5 ng/ml of LTC4. Furthermore, we demonstrate that either the supernatant from this hybridoma containing 0.5 to 10 ng/ml LTC4 or purified LTC4 in the range of 0.5 to 5 ng/ml can suppress 50 to 70% of Ig production by unfractionated human mononuclear cells, by normal human cells stimulated with Staphylococcus aureus Cowan I and B cell differentiation factors, and by the EBV-transformed B cell line SKW.6 in the presence of B cell differentiation factors. Thus, LTC4 can have direct effects on B cells and may have a role in normal B cell regulation.

IgM binding protein expressed by activated B cells.

We have identified an IgM binding protein, a single chain polypeptide of Mr 60,000, that is expressed on the surface of B lymphocytes within 18 hr following their activation with phorbol myristate acetate. The IgM binding protein was also detected on fresh leukemic B cells from individuals with chronic lymphocytic leukemia, and the level of its expression was increased after phorbol myristate acetate activation. Resting and phorbol myristate acetate-activated T cells, monocytes, and polymorphonuclear leucocytes did not express detectable amounts of the IgM binding protein. The 60-kDa protein on activated human B cells could bind secreted IgM molecules of both mouse and human origin, as well as endogenous membrane-bound IgM molecules following their cross-linkage with anti-mu antibodies. The binding of soluble IgM molecules to the surface of activated B cells was also demonstrated by indirect immunofluorescence analysis.

Interleukin-2 effects on human B cells activated in vivo.

While activated B cells, as well as T cells, can express functional interleukin-2 receptors (IL-2R), the physiologic role of IL-2 in B-cell responses is still in doubt. Accordingly, we have examined the role of recombinant IL-2 (rIL-2) in the proliferative response, IL-2R expression, and the terminal differentiation of tonsillar B cells in comparative studies with T cells from the same source. For these analyses of physiologically activated lymphocytes, the B and T cells were first separated, then divided into subpopulations enriched for either resting or preactivated cells on the basis of relative cell density or activation antigen expression. As expected, the relatively low-density fraction of T cells was enriched for IL-2R-positive (Tac+) cells and displayed vigorous proliferative responses to IL-2 along with heightened Tac antigen expression. Moreover, limiting dilution analysis revealed that growth of these activated T cells could be perpetuated with the addition of IL-2. By comparison, relatively few tonsillar B cells expressed the Tac antigen. The addition of rIL-2 to cultured B cells of relatively low density resulted in an increase in Tac+ cells but only a minimal proliferative response. The subpopulation of tonsillar B cells expressing the Bac-1 activation antigen contained most of the IL-2 inducible Tac+ B cells, and rIL-2 induced an efficient but transient proliferative response by these activated B cells. The rIL-2-induced Tac+ B cells were noted to be relatively large. A fraction of these Tac+ cells, but not the Tac- cells, produced and secreted immunoglobulins. Incubation with rIL-2 enhanced the Ig secretion, and the anti-Tac antibody blocked this enhancement. Time-course analysis revealed that rIL-2 induced transient Tac expression, whereas mature plasma cells in 6-day cultures no longer expressed detectable Tac antigen. In conclusion, these observations suggest that IL-2 transiently upregulates expression of IL-2R, via which it induces the terminal growth and differentiation of activated B cells into plasma cells.

Identification of an early activation antigen (Bac-1) on human B cells.

We have produced a monoclonal antibody, Bac-1, that appears to identify a novel antigen on activated human B cells. The Bac-1 antigen can be detected between 8 to 16 hr, as well as transferrin receptors (T9), after activation of small resting B cells with phorbol myristic acetate, anti-IgM antibody, Staphylococcus aureus Cowan I, or Epstein-Barr virus. The expression of the Bac-1 antigen precedes that of IL 2 receptors (Tac-1). Peak expression of the Bac-1 antigen was observed on day 3 after activation, and decreased thereafter. The Bac-1 antigen was present on a minor subpopulation of relatively large B cells isolated from blood samples, and on "preactivated" B cells of heterogeneous size isolated from spleens and tonsils. It was not detected on bone marrow pre-B cells, blood small B cells, or plasma cells, nor was it expressed by resting or activated T cells or nonlymphoid cells. Certain B cell neoplasms and B lymphoblastoid cell lines were Bac-1+, but neoplastic cells of non-B lineage were Bac-1-. With immunoperoxidase staining, Bac-1+ cells were detected predominantly in the germinal centers of tonsil sections. The Bac-1 antigen on activated B cells was destroyed by protease treatment and was enhanced by neuraminidase treatment, suggesting that the Bac-1 antibody detects a cell surface molecule via an antigenic determinant which is partially obscured by neighboring sialic acid residues. The reactivity pattern of Bac-1 differs from the patterns of cellular reactivity reported for other monoclonal antibodies with specificity for activated human B cells.