Reassessment of the association between Guillain-Barré syndrome and receipt of swine influenza vaccine in 1976-1977: results of a two-state study. Expert Neurology Group.

Although the original Centers for Disease Control study of the relation between A/New Jersey/8/76 (swine flu) vaccine and Guillain-Barré syndrome (polyradiculoneuritis) demonstrated a statistical association and suggested a causal relation between the two events, controversy has persisted. To reassess this association, the authors obtained medical records of all previously reported adult patients with Guillain-Barré syndrome in Michigan and Minnesota from October 1, 1976 through January 31, 1977. To identify previously unreported hospitalized cases with onset of symptoms during this period, the authors surveyed medical care facilities. A group of expert neurologists formulated diagnostic criteria for Guillain-Barré syndrome and then reviewed the clinical records in a blinded fashion. Of the 98 adult patients from the original Centers for Disease Control study eligible for consideration, three were found to have been misclassified by date of onset and were excluded. Of the remaining 95, the 28 (29%) who did not meet the diagnostic criteria were equally distributed between the vaccinated group (18 of 60, 30%) and the unvaccinated group (10 of 35, 29%). In addition to the 67 remaining cases who met the diagnostic criteria, six previously unreported cases (three of whom had been vaccinated) were found and included in this analysis. The relative risk of developing Guillain-Barré syndrome in the vaccinated population of these two states during the 6 weeks following vaccination was 7.10, comparable to the relative risk of 7.60 found in the original study. These findings suggest that there was an increased risk of developing Guillain-Barré syndrome during the 6 weeks following vaccination in adults. The excess cases of Guillain-Barré syndrome during the first 6 weeks attributed to the vaccine was 8.6 per million vaccinees in Michigan and 9.7 per million vaccinees in Minnesota. No increase in relative risk for Guillain-Barré syndrome was noted beyond 6 weeks after vaccination.

Guillain-Barré syndrome and its relationship to swine influenza vaccination in Michigan, 1976-1977.

Active surveillance to detect all patients with Guillain-Barré syndrome who had had onset of illness from July 1, 1976 through April 30, 1977 was undertaken in Michigan after indications that the syndrome might be associated with the National Influenza Immunization Program of 1976-1977. Hospital record room librarians, neurologists, and neurosurgeons reported the greatest number of cases; coded hospital discharge records were the best means of ascertaining case occurrence. This differed from national surveillance, which relied essentially on reports that neurologists and other clinicians sent to state epidemiologists and then to the Centers for Disease Control; hospital discharge lists were not systemically reviewed nationally. A total of 79 of the Michigan cases were in persons who had not received swine influenza vaccine, while 46 cases were in persons who had received it. For unvaccinated adults, the incidence of Guillain-Barré syndrome during the 10-month surveillance period was 0.36 cases per 10(6) person-weeks; for adults with onset within six weeks of vaccination, it was 2.31 cases per 10(6) person-weeks. After six weeks post-vaccination, the rate decreased to 0.17 cases per 10(6) person-weeks. The attributable risk for acquiring Guillain-Barré syndrome within six weeks after receiving swine influenza vaccine was 11.70 cases per 10(6) persons vaccinated.

Isolation of oval cells by centrifugal elutriation and comparison with other cell types purified from normal and preneoplastic livers.

Oval cells and biliary epithelial cells were isolated from livers of rats fed a choline-deficient diet containing 0.1% ethionine and from normal rat livers, respectively. Nonparenchymal cell suspensions prepared from these livers by collagenase perfusion followed by digestion of undissociated tissue with 0.1% collagenase, 0.1% Pronase, and 0.004% DNase I were separated into six fractions by centrifugal elutriation. Cells in each fraction were characterized histochemically for gamma-glutamyl transpeptidase, peroxidase, alkaline phosphatase, and glucose-6-phosphatase activities, and for albumin and alpha-fetoprotein by immunocytochemical methods. Cells from Fraction 5 of the elutriation procedure had various features predicted for oval cells and were selected for further studies. The cell yield in this fraction, from each preneoplastic liver, was 5.7 X 10(7) cells, 93 +/- 2% of which were gamma-glutamyl transpeptidase positive, 6 +/- 1% peroxidase positive, 61% albumin positive, and 29% alpha-fetoprotein positive. Cells in this fraction have a median diameter of 13.1 micron and are diploid and cycling. The majority of these cells has morphological features characteristic of biliary epithelial cells, although some cells display features intermediate between duct cells and hepatocytes. Nucleic acid hybridization using specific probes revealed that these cells contain albumin and alpha-fetoprotein messenger RNAs, while hepatocytes from normal and preneoplastic liver contain only albumin messenger RNA. Biliary cells obtained from normal livers do not contain albumin messenger RNA. The large-scale purification and characterization of cell populations from preneoplastic livers is an important step in elucidating the cellular derivation of liver tumors.

Isozyme profiles of oval cells, parenchymal cells, and biliary cells isolated by centrifugal elutriation from normal and preneoplastic livers.

The fetal liver isozymes aldolase A and pyruvate kinase K increase in livers of adult rats fed a choline deficient-diet containing 0.1% ethionine. Oval cells isolated by centrifugal elutriation from preneoplastic livers of animals receiving the carcinogenic diet contained these fetal forms as well as fetal-adult isozyme hybrids. In contrast, parenchymal cells isolated from the livers of these animals had only aldolase B and pyruvate kinase L, the same isozymes present in parenchymal cells of normal adult rats. Liver homogenates from rats receiving the carcinogenic diet contain lactate dehydrogenase (LDH) 1, LDH 2, and LDH 3 in addition to LDH 4 and LDH 5, which are the forms detected in normal liver homogenates. LDH 1, LDH 2, and LDH 3 are present in oval cells of preneoplastic livers and in biliary epithelial cells of normal livers, but not in parenchymal cells isolated from normal and preneoplastic livers. Cells of biliary epithelium from normal livers also contain aldolase A and pyruvate kinase K, but not the fetal-adult isozymes present in oval cell populations. The results indicate that, in animals receiving this carcinogenic diet, isozyme alterations associated with neoplasia result from the proliferation of a new cell population which contains these enzymes and not from "dedifferentiation" of mature hepatocytes. Furthermore, the data suggest that this new cell population may include a liver stem cell compartment containing cells in transitional states of differentiation.

Phenolsulfonphthalein (phenol red) metabolism in primary monolayer cultures of adult rat hepatocytes.

The sulfonic acid dye, phenolsulfonphthalein (PSP or phenol red), has been incorporated as a pH indicator in many tissue culture media formulations since the emergence of tissue culture methodologies. The present study was designed to examine the pathway, time course, and degree of metabolism of this anionic dye in monolayer cultures of adult rat hepatocytes. Thin layer chromatographic studies coupled with beta-glucuronidase studies show that glucuronidation is the major metabolic pathway for PSP in vitro. About 20% of the dye is metabolized in the first 24 h, but this functional activity is decreased by approximately half at 48 h, and even further at 72 h of culture. This metabolic activity was not affected by continuous exposure to the dye. The effect of PSP concentration on its rate of metabolism by the adult rat hepatocyte in culture seemed to be biphasic, and at concentrations of less than 100 microM there was indication of a saturable process. Although PSP seemed not to be toxic to hepatocyte cultures, it is partially metabolized by these cells (as opposed to no observed metabolism in human fibroblasts or HeLa cells). Therefore, its incorporation into tissue culture media formulations for use in hepatocyte cultures should be avoided, especially when studying the mechanism(s) of glucuronidation or metabolic pathways thought to be affected by this anionic dye.

Trypan blue dye uptake and lactate dehydrogenase in adult rat hepatocytes--freshly isolated cells, cell suspensions, and primary monolayer cultures.

Leakage of lactate dehydrogenase and staining by the vital dye trypan blue were investigated in adult rat hepatocytes at the time of isolation, in suspensions up to 3 h and in primary monolayer cultures up to 3 d. These two parameters of plasma membrane integrity were found to correlate closely in hepatocyte suspensions, but to a lesser degree in monolayer cultures. Functional activity was demonstrated in culture by glucose consumption and lactic acid production. There was a balance of total lactate dehydrogenase (LDH) activity over time for both hepatocyte suspensions and cultures. Loss of LDH activity in the cell fraction was accompanied by a corresponding increase in enzyme activity in the media fraction. Lactate dehydrogenase activity per dye-excluding hepatocyte was calculated to be 9.2 +/- 1.5 X 10(-6) IU assayed at 37 degrees C for 25 preparations of isolated hepatocytes. The results suggest that leakage of cytoplasmic enzyme and vital dye staining are of comparable sensitivity in evaluating hepatocyte preparations. Measurement of LDH leakage offers a less subjective alternative to cell counting procedures and is applicable to both attached and suspended cells.

Liver function abnormalities in the course of a type A (H1N1) influenza outbreak: relation to Reye's syndrome.

In the course of the A/Brazil (H1N1) outbreak of 1978-1979, two cases of Reye's syndrome occurred in Grayling, Michigan, an area with a county-wide population of 2056 school age children. School absenteeism peaked at levels between 16-28 per cent. Clinical histories and paired blood specimens were collected from 860 school children; the initial blood was obtained shortly after the peak of the outbreak. Serologic results confirmed that type A H1N1 virus was the cause of the outbreak. Serum alanine aminotransferase (SGPT) and creatine phosphokinase (CPK) values were determined on all initial blood specimens and a sample of the second specimens. CPK results did not correlate with infection, illness or SGPT values. SGPT values of 60 IU/l or greater were found in 1.5 per cent of those tested. The elevated values were not associated with illness but were associated with influenza infection. Based on the excess number with elevated results in those with recent infection, it is estimated that at least 2.7 per cent of individuals infected by type A (H1N1) influenza had associated elevated SGPT.

Questionable relation of aryl hydrocarbon hydroxylase to lung-cancer risk.

To test whether the genetically determined trait, aryl hydrocarbon hydroxylase inducibility, affects susceptibility to lung cancer, we measured this trait in cultured lymphocytes from a normal population, patients with lung cancer and progeny of such patients. We found very low aryl hydrocarbon hydroxylase activity (19 per cent of normal) in about half the patients with lung cancer. Only part of this activity can be accounted for by reduced cell growth and by reduced protein synthesis. In an indirect assessment of inducibility, both 57 progeny and 27 matched controls had a mean inducibility of 2.95 and a similar distribution into low, intermediate and high groups (chi-square = 0.3 P = 0.9). No differences in basal or induced activity were observed. Thus, if patients with lung cancer possess altered aryl hydrocarbon hydroxylase inducibility or activity these characteristics are not transmitted to their progeny.

Distribution of aryl hydrocarbon hydroxylase inducibility in cultured human lymphocytes.

We measured aryl hydrocarbon hydroxylase (AHH) in cultured human lymphocytes. A striking seasonal variation in AHH activity was observed with induced AHH activity levels from January through May measuring approximately 20% of the values during the remainder of the year. AHH inducibility was determined by comparing lymphocytes from the same person cultured with and without the inducer 3-methylcholanthrene. If measurements are limited to the summer and fall seasons when AHH activity is high, AHH inducibility is reproducible for most persons with repeat determinations on the same person averaging 11% from the mean. The values of AHH inducibility in 53 persons ranged from 0.9 to 5.0, but the distribution of values did not fall into three distinct, nonoverlapping classes as reported by others. We were not able to determine the distribution of AHH inducibility in lung cancer patients since lymphocytes from less than half of the patients tested could be successfully cultured.