Gathering expert consensus to inform a proposed trial in chronic nonbacterial osteomyelitis (CNO).

Chronic nonbacterial osteomyelitis (CNO) is an autoinflammatory bone disease that primarily affects children and adolescents. CNO is associated with pain, bone swelling, deformity, and fractures. Its pathophysiology is characterized by increased inflammasome assembly and imbalanced expression of cytokines. Treatment is currently based on personal experience, case series and resulting expert recommendations. Randomized controlled trials (RCTs) have not been initiated because of the rarity of CNO, expired patent protection of some medications, and the absence of agreed outcome measures. An international group of fourteen CNO experts and two patient/parent representatives was assembled to generate consensus to inform and conduct future RCTs. The exercise delivered consensus inclusion and exclusion criteria, patent protected (excludes TNF inhibitors) treatments of immediate interest (biological DMARDs targeting IL-1 and IL-17), primary (improvement of pain; physician global assessment) and secondary endpoints (improved MRI; improved PedCNO score which includes physician and patient global scores) for future RCTs in CNO.

Successful treatment of retroperitoneal fibrosis with tamoxifen in a child.

We describe our experience with tamoxifen in a prepubertal girl with retroperitoneal fibrosis who had failed treatment with high dose corticosteroid therapy. Her response was excellent.

Cross-reactions of anti-immunoglobulin sera with synthetic T-cell receptor beta peptides: mapping on a 3-dimension model.

The derived amino acid sequences of human T-cell receptor beta chain shows significant homology to lambda light chains of immunoglobulins in its variable, joining, and constant regions. We assessed the cross-reactivity between Tcr beta chains and immunoglobulin light chains by determining the capacity of rabbit antisera to human or murine immunoglobulins to react to a synthesized set of nested, overlapping 16-mer peptides corresponding to the VDJC sequence of the Tcr beta chain YT35. The observed reactivities were consistent with homologies to lambda and kappa light chains, the strongest reactivity being with a peptide that corresponds to the "switch peptide" of light chains, as assessed by ELISA binding and competitive inhibitions assays. Other regions reactive with anti-light chain sera corresponded to CDR1 and Fr3 segments of the variable domain and a segment of the constant region predicted to loop out of the tight globular structure. The peptide immunochemical results, together with the identification of specific regions of sequence correspondence between Tcr beta and the characterized lambda light chain Mcg, allowed us to develop a 3-dimensional model of the beta chain consistent with its role in antigen recognition.

Light and heavy chains specifying a human IgM kappa autoantibody to a T-cell receptor V beta-antigen.

Humans frequently produce serum IgM autoantibodies reactive with T-cell receptor beta chains at a determinant defined by peptides corresponding to the first complementarity determining region. It is likely that this determinant serves as a public idiotype involved in immunoregulation. Following screening of culture supernatants from over 60 Epstein-Barr virus-carrying B-cell lines of normal and neoplastic origin, we identified a line, IARC307, that secretes an IgM kappa protein showing marked specificity for the V beta 8.1 CDR1 sequence CKPISGHNSLFQWYRQT. We cloned and sequenced the complete variable regions of the V kappa and VH chains used by the autoantibody. The light chain has a V kappa III sequence related to the 'a' subgroup and uses J kappa 2. The heavy chain has a VHIII sequence essentially identical to the germ-line sequence DP54 and uses the JH6C minigene. The CDR3 is unique, differing from those of other autoantibodies. The antibody is rigorously specific in its specificity for the V beta 8 peptide and does not show polyspecificity for protein or DNA antigens.

Reactions of anti-immunoglobulin sera with synthetic T cell receptor peptides: implications for the three-dimensional structure and function of the TCR beta chain.

The derived amino acid sequence of the human TCR beta chain shows considerable homology to lg lambda light chains in its variable (V) and constant (C) domains, and in its joining segment (J). We assessed the cross-reactivity between TCR beta chains and lg light chains by synthesizing a set of nested, overlapping 16-mer peptides that duplicated the sequence that corresponds to the continuous VDJC sequence of TCR beta chain and determining the capacity of rabbit antisera to human or murine lgs to react with these peptides. The reactivities we observed were consistent with homologies to lambda and kappa light chains. The strongest reactivity in ELISA binding and competitive inhibition was with a peptide that corresponds to the 'switch peptide' of light chains. The sequence is encoded by the C-terminal region of the J segment (Fr4) and the N-terminus of the C region. Other regions reactive with anti-light chain sera corresponded respectively to CDR1 and Fr3 segments of the V region, and a segment of the constant region predicted to loop out of the tight globular structure. The peptide immunochemical results, coupled with the identification of specific regions of sequence correspondence between TCR beta and the characterized lambda light chain Mcg, allowed us to develop a three-dimensional model of the beta chain consistent with its role in antigen recognition and response to superantigens.

Lack of preferential V beta usage in synovial T cells of rheumatoid arthritis patients.

The T-cell receptor V beta subfamily repertoires of synovial and peripheral T cells of 8 rheumatoid arthritis (RA) patients were determined using the polymerase chain reaction. Three normal controls were included. Some of the rheumatoid synovial samples did not express the complete range of V beta families and lacked as many as 6 gene families. However, these patients showed considerable individual variation in expression. Overall, the data do not support preferential T-cell receptor V beta usage in synovial T cells of RA patients either in comparison to their autochthonous peripheral T cells or to peripheral T cells of normal subjects.

Human autoantibodies reactive with synthetic autoantigens from T-cell receptor beta chain.

We used mapping with synthetic overlapping peptides in combination with molecular modeling to analyze the IgG antibodies that humans naturally produce against human T-cell receptor beta chains and to localize the recognized peptide autoantigens in the three-dimensional structure of the molecule. Healthy individuals produce low levels of antibodies against T-cell receptor peptides, and these can be increased in autoimmune diseases. We characterized the reactivities in detail because IgG molecules reactive with self peptides occur in preparations of intravenous immunoglobulin and can be isolated by immunoaffinity chromatography. Natural IgG antibodies were directed against three major peptides. One corresponds to the first complementarity-determining region of the variable region. A second corresponds to the third framework of the variable region. The third is located in the constant region and is predicted to be a loop that extends out of the beta-barrel structure. This peptide is one that would give a characteristic structural distinction between the beta-chain constant region and the constant regions of immunoglobulin light chains to which beta chains are homologous. The capacity to bind these peptides is found in small fractions of normal polyclonal IgG, which contains both kappa chains and lambda chains. The activity is antibody-like in being confined to the Fab fragment and in its capacity to discriminate among homologous synthetic peptides corresponding to distinct beta-chain variable-region genes. We propose that a recognition and regulatory process naturally occurs that parallels the immune network for the regulation of the production of antibodies.

Antigenic mapping of a human lambda light chain: correlation with three dimensional structure.

Although the amino acid sequence and three-dimensional structure of human immunoglobulin light chains have been known for more than 15 years, the location of antigenic markers characteristic of lambda chains has not been determined. Here, we use a set of synthetic overlapping peptides to completely model the sequence of the lambda chain Mcg and test these for the binding of rabbit and goat antisera specific for lambda chain determinants. We assess peptide contributions to lambda-antigenic reactivity and also to identify a portion of C-region where conformational factors contribute to the antigenicity. Specific determinants occur both in the constant and variable (first and third framework) domains of the molecule. The fourth framework of the variable region, a segment specified by the joining gene, is also recognized and cross-reacts antigenically with the homologous region of T cell receptor beta chains. Major lambda specific determinants are localized in the N- and C-terminal segments, which are linear and devoid of major conformational folding. Other segments that are strongly antigenic, such as the third framework of the V region (residue 78-93) and a segment of the constant region (residues 177-192), show strong conformational dependence in antigenicity.

T-cell receptors of man and mouse studied with antibodies against synthetic peptides.

We used polyclonal rabbit antibodies directed against synthetic peptides predicted from the gene sequence of the human T-cell receptor (TCR) beta-chain YT35 to study the antigen receptor on human helper T-cell leukemia lines and on normal mouse thymocytes. Antibodies were raised to peptides corresponding to joining segment (J beta) and to a conserved stretch of sequence around the first cysteine in the constant region (C beta). These peptides were selected on the basis of homology with corresponding segments of immunoglobulin light chains. The specificity of the antibodies was established using synthetic overlapping peptides that modelled the complete TCR beta-chain. Western blot analysis was performed against detergent lysates of T cells. Both of the antibodies reacted strongly with 2-3 polypeptides in the mass range 40-45 kDa in mouse and human cells. Clearance experiments using monoclonal antibodies against murine TCR alpha- and beta-chains and against human TCR beta-chain and immunoprecipitations with monoclonal antibody to the murine T3 complex established that these components represented the alpha/beta heterodimer. An additional component around 31 kDa was detected by anti-J beta antibodies in murine thymus extracts. The use of the affinity-purified antipeptide antibody in two-dimensional Western blot analyses allows the clear discrimination between the characteristic individual receptors of monoclonal neoplastic T cells and the polydisperse patterns representative of heterogeneous normal populations. Antigenic cross-reactions between T-cell receptor beta-chains of man and mouse observed with monoclonal antibodies and rabbit antisera to peptides are consistent with the homology in gene sequence between the two species.