Complement components and terminal complement complex in oesophageal smooth muscle of patients with achalasia.

This study investigates whether patients with achalasia exhibit autoimmune reactions with subsequent complement activation within oesophageal smooth muscle, vessels and neurones. Oesophageal muscular biopsies from 8 patients undergoing surgery for achalasia and from 6 patients operated for oesophageal cancer were investigated by immunofluorescence for the presence of the complement components C1q, C4, C3c, C3d, C9 and the C9 neoantigen of the terminal C5b-C9 complement complex. Tissues were also investigated for the expression of immunoglobulins (G,A,M) and of the antigens of rubella and varicella zoster viruses. In addition, sera of both patient groups were tested for the presence of autoantibodies against Auerbach's plexus. The terminal complement complex C5b-C9 was found within muscle cells from all patients with achalasia but in only one specimen from a patient with cancer. Two patients with achalasia also exhibited the terminal complement complex as well as IgM within ganglion cells. Muscle cells stained positive for the complement component C9 in all five patients with achalasia in whom this test was performed but in none of the control tissues. In addition, sera from four patients with achalasia contained antibodies against Auerbach's plexus. Studies for the complement components C1q, C4, C3c and for antigens of rubella and varicella zoster viruses revealed negative results in all patients and controls. The results of this study suggest that a complement activation is involved in the autoimmune pathogenesis of achalasia. However, the triggering mechanism of this phenomenon remains to be determined.

The diagnostic value of anti-mitochondrial antibodies, especially in primary biliary cirrhosis.

Anti-mitochondrial antibodies (AMA) are present in sera of approximately 90-95% of patients with primary biliary cirrhosis (PBC) and, thus, constitute one of the most important diagnostic criteria for this disease. The major mitochondrial autoantigens have been identified, cloned, and sequenced and the immunological features of AMA, including their antigen specificities and epitopes, have been well characterized. In clinical laboratories, indirect immunofluorescence (IIF) microscopy is routinely employed for the detection of AMA mainly because of technical simplicity and cost effectiveness. However, IIF lacks both specificity and sensitivity, and in up to 10% of patients diagnosed with PBC based on standard diagnostic criteria, AMA cannot be detected by IIF. In some of these patients, AMA aredetectable by more sensitive techniques, such as enzyme-linked immunosorbent assays (ELISAs) or SDS-PAGE followed by immunoblotting. Nonetheless, there are patients whose sea are negative for AMA by any of these methods despite clinical, biochemical, and histological findings that are diagnostic for PBC. Some have argued that AMA-positive and AMA-negative PBC represent two distinct entities, but recent evidence supports the view that they are clinically and biochemically quite similar. The situation is further complicated by the fact that AMA, even those recognizing the major PBC autoantigens, are also present in a variety of other liver diseases. In addition, patients exhibiting the clinical, histological, and biochemical features of both PBC and autoimmune hepatitis, the so-called 'overlap syndrome,' are not uncommon. In conclusion, AMA status, though invaluable in establishing and confirming the diagnosis of PBC in > or =90% of PBC patients, is not sufficient by itself to allow the differential diagnosis of liver diseases. The choice of therapeutic regimen should, therefore, be based on a combination of serological, biochemical and histological findings, rather than AMA status alone.

A new autoantibody in celiac disease.

A 74-year-old female patient with therapy-resistant sprue (celiac disease) and a new IgA autoantibody is presented. This autoantibody was demonstrated by immunofluorescence and differs from the conventional antibody against type 3 connective tissue (so-called endomysium antibody). It reacts predominantly with the muscularis and less strongly with the muscularis mucosae of the monkey esophagus. The reaction is not retiform but punctiform; the typical reaction sites of the antibody against type 3 connective tissue are negative. Especially on esophageal sections the antibody can be mistaken for the characteristic antibody directed against tissue transglutaminase, in particular at low magnification. The antigen of the new antibody is as yet unknown.

Effects of abciximab and tirofiban on vitronectin receptors in human endothelial and smooth muscle cells.

human umbilical venous endothelial cells. 7E3 binding correlated with alphavbeta3-expression in all cell types. Integrin-mediated cell functions were analysed with adhesion and spreading assays on vitronectin. In human umbilical venous endothelial cells, these functions were mediated by alphavbeta3 and in human iliac arterial smooth muscle cells by alphavbeta5. In human umbilical venous smooth muscle cells, both vitronectin receptors were involved. Abciximab potently inhibited alphavbeta3-mediated cell adhesion and spreading. With tirofiban, no significant inhibition of vascular cell functions was observed. The present data demonstrate that vitronectin-cell interactions in vascular cells are mediated via two distinct integrin-receptors, alphavbeta3 and alphavbeta5. Abciximab, which solely inhibits alphavbeta3-mediated cell functions, may be particularly effective in human endothelium and in beta3-integrin expressing vascular smooth muscle cells.

Angiotensin II and PDGF-BB stimulate beta(1)-integrin-mediated adhesion and spreading in human VSMCs.

beta(1)-Integrins play an important role for adhesion and spreading of human smooth muscle cells. In the present study we examined the influence of angiotensin II and platelet-derived growth factor (PDGF)-BB on beta(1)-integrin-dependent functions of human smooth muscle cells obtained from iliac arteries. Treatment of these cells with PDGF-BB (20 ng/mL) and Angiotensin II (1 micromol/L) did not change beta(1)-integrin expression up to 48 hours as analyzed by flow cytometry and reverse transcription polymerase chain reaction. beta(1)-integrins predominantly mediated adhesion of human smooth muscle cells to collagen I (79.7+/-4.4%, P<0.01) and fibronectin (66. 6+/-2.4%, P<0.01). Treatment of smooth muscle cells with Angiotensin II (1 micromol/L) and PDGF-BB (20 ng/mL) significantly increased the adhesion to collagen I by 56.5% and 44.3%, respectively, and to fibronectin by 49.6% and 36.4%, respectively (all P<0.05). Angiotensin II-induced effects were mediated by the AT(1) receptor. The PDGF-BB mediated increase of adhesion was inhibited in the presence of genestein, a tyrosine-kinase inhibitor and by protein kinase C downregulation with phorbol 12-myristate 13-acetate. Spreading of smooth muscle cells also was beta(1)-integrin dependent on collagen I and alpha(5)beta(1)-integrin dependent on fibronectin. Angiotensin II and PDGF-BB increased cell spreading on fibronectin up to 276% and 318%, respectively, and on collagen I up to 133% and 138% (all P<0.05). These increases were significantly inhibited by blocking antibodies against beta(1)-integrin, alpha(5)-integrin on fibronectin, the AT(1) receptor blocker irbesartan, and genestein. The present data demonstrate that angiotensin II and as well PDGF-BB enhance beta(1)-integrin-dependent adhesion and spreading of human vascular smooth muscle cells. Furthermore, the experiments with PDGF suggest an involvement of protein kinase C activation leading to these enhanced effects.

Exon 9 of the CFTR gene: splice site haplotypes and cystic fibrosis mutations.

The alternatively spliced exon 9 of the cystic fibrosis transmembrane conductance regulator (CFTR) gene codes for the initial part of the amino-terminal nucleotide-binding fold of CFTR. A unique feature of the acceptor splice site preceding this exon is a variable length polymorphism within the polypyrimidine tract influencing the extent of exon 9 skipping in CFTR mRNA. We investigated this repeat for its relationship to CFTR mutations and intragenic markers on 200 chromosomes from German patients with cystic fibrosis (CF). Four frequent length variations were strongly associated with the four predominant haplotypes previously defined by intragenic marker dimorphisms. One of these alleles displayed absolute linkage disequilibrium to the major CF mutation delta F508. Other frequent CFTR mutations were linked to one particular splice site haplotype indicating that differential exon 9 skipping contributes little to the clinical heterogeneity among CF patients with an identical mutation. We also identified a novel missense mutation (V456F) and a novel nonsense mutation (Q414X) within the coding region of exon 9. The missense mutation V456F adjacent to Walker motif A was present in a pancreas-sufficient CF patient. In contrast, the pancreas-insufficient Q414X/delta F508 compound heterozygote suffered from a severe form of the disease, indicating that alternative splicing of exon 9 does not overcome the deleterious effect of a stop codon with this exon.

Cystic fibrosis: the impact of analytical technology for genotype-phenotype studies.

The generalized exocrinopathy cystic fibrosis (CF) is the most common severe genetic disease in Caucasian populations. A panel of more than 700 chromosomes from German and Turkish CF patients was screened for disease-causing mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene by chemical cleavage of mismatch, single strand conformation polymorphism, restriction analysis and direct sequencing of genomic DNA amplified by polymerase chain reaction. Besides the major 3-bp deletion, delta F508 that was found on 73% of German CF chromosomes, more than 50 other missense, nonsense, frame-shift, and splice-site mutations have already been identified. In general, a CFTR mutation is linked with a single 10-marker haplotype which indicates that in most cases a particular mutation spread from a common ancestor. The comparison of mutation genotypes with the disease phenotype emphasized the causative role of the type and localization of the CFTR mutation for clinical course and prognosis. Pancreatic status and the risk of colonization of airways with opportunistic pathogens are genetically determined. Most patients who are harbouring mutations in the nucleotide binding folds were suffering from severe CF disease. Mild or even aberrant forms of CF were observed for many missense mutations located in the putative transmembrane domains or for mutations that are expected to result in a truncated protein of half of wild-type CFTR.

Genetic determinants of airways' colonisation with Pseudomonas aeruginosa in cystic fibrosis.

Exocrine pancreatic insufficiency and lung infection with Pseudomonas aeruginosa are major features of cystic fibrosis (CF). This monogenic disease is caused by mutations in the CF transmembrane conductance regulator (CFTR) gene. 267 children and adolescents with CF who were regularly seen at the same centre were assessed for an association of the CFTR mutation genotype with exocrine pancreatic function and the age of onset of chronic colonisation with P aeruginosa. The major mutation delta F508 accounted for 74% of CF alleles; 33 further CFTR mutations had been detected on the CF chromosomes of the study population by June, 1992. With the exception of delta F508/R347P compound heterozygotes, patients of the same mutation genotype were either pancreas insufficient (PI) or pancreas sufficient (PS). The age-specific colonisation rates with P aeruginosa were significantly lower in PS than in PI patients. The missense and splice site mutations that are "mild" CF alleles with respect to exocrine pancreatic function were also "low risk" alleles for the acquisition of P aeruginosa. On the other hand, the proportion of P aeruginosa-positive patients increased most rapidly in the PI delta F508 compound heterozygotes who were carrying a termination mutation in the nucleotide binding fold-encoding exons. Pancreatic status and the risk of chronic airways' colonisation with P aeruginosa are predisposed by the CFTR mutation genotype and can be differentiated by the type and location of the mutations in the CFTR gene.

Intra- and extragenic marker haplotypes of CFTR mutations in cystic fibrosis families.

In order to facilitate the screening for the less common mutations in the cystic fibrosis (CF) gene viz., the CF transmembrane conductance regulator gene (CFTR), marker haplotypes were determined for German non-CF (N) and CF chromosomes by polymerase chain reaction analysis of four polymorphisms upstream of the CF gene (XV-2c, KM.19, MP6-D9, J44) and six intragenic polymorphisms (GATT, TUB9, M470V, T854T, TUB18, TUB20) that span the CFTR gene from exon 6 through exon 21. Novel informative sequence variants of CFTR were detected in front of exons 10 (1525-61 A or G), 19 (3601-65 C or A), and 21 (4006-200 A or G). The CF locus exhibits strong long-range marker-marker linkage disequilibrium with breakpoints of recombination between XV-2c and KM.19, and between exons 10 and 19 of CFTR. Marker alleles of GATT-TUB9 and TUB18-TUB20 were found to be in absolute linkage disequilibrium. Four major haplotypes encompass more than 90% of German N and CF chromosomes. Fifteen CFTR mutations detected on 421 out of 500 CF chromosomes were each identified on one of these four predominant 7-marker haplotypes. Whereas all analysed delta F508 chromosomes carried the same KM.19-D9-J44-GATT-TUB9-M470V-T854T haplotype, another frequent mutation in Germany, R553X, was identified on two different major haplotypes. Hence, a priori haplotyping cannot exclude a particular CF mutation, but in combination with population genetic data, enables mutations to be ranked by decreasing probability.

Cystic fibrosis with three mutations in the cystic fibrosis transmembrane conductance regulator gene.

Three mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene were discovered in a pancreas-insufficient patient with cystic fibrosis (CF) who displayed an uncommon combination of almost normal chloride concentration in sweat tests and typical symptoms of gastrointestinal and pulmonary disease. The R553Q mutation was found on the maternal delta F508-CFTR gene. Codon 553 is located within a consensus motif of the ATP-binding cassette transport proteins at a less conserved position. Other members of this protein superfamily contain a glutamine instead of arginine at the homologous position, suggesting a modulating rather than disease-causing role of the R553Q mutation in CFTR. The amplification refractory mutation system did not detect the R553Q mutation in a further 65 normal, 113 delta F508, and 91 non-delta F508 CF chromosomes. The index case carried the R553X nonsense mutation on the paternal chromosome. The R553X mutation was present on a further 9 out of 86 German non-delta F508 CF chromosomes linked with the XV2c-KM19-Mp6d9-J44-GATT haplotypes 2-2-2-1-1 and 1-1-2-1-2. The location of R553X on separate haplotypes including both alleles of the intragenic GATT repeat suggests an ancient and/or multiple origins of the R553X mutations. The association of the genotype of the CFTR mutation and the clinical phenotype was assessed for the patients carrying the related genotypes delta F508/delta F508 (n = 80), delta F508/R553X (n = 9) and delta F508-R553Q/R553X (n = 1). In compound heterozygotes, the median chloride concentration in pilocarpine iontophoresis sweat tests was significantly lower than in the delta F508 homozygotes (P less than 0.01). The patient groups were significantly different with respect to the distributions of the centiles for height (P less than 0.001) and weight (P less than 0.01) as the most sensitive predictors of the course and prognosis in CF. Growth retardation was more pronounced in the compound heterozygotes.

Compatibility of enalaprilat with dobutamine, dopamine, heparin, nitroglycerin, potassium chloride and nitroprusside.

The physical and chemical compatibility of enalaprilat in admixtures of dobutamine, dopamine, heparin, nitroglycerin, potassium chloride, or sodium nitroprusside, in 5% dextrose, were studied at room temperature over a 24-h period. Enalaprilat was found to be physically compatible and chemically stable in all admixture solutions tested.

Frequency of the F508 deletion in the CFTR gene in Turkish cystic fibrosis patients.

The F508 deletion in the cystic fibrosis transmembrane conductance regulator (CFTR) gene was found in 8 out of 30 Turkish cystic fibrosis (CF) chromosomes (27%). Five Turkish delta F508 CF chromosomes were associated with the risk haplotype B in KM19 (2 allele)/XV2c (1 allele). In the Turkish population, cystic fibrosis is predominantly caused by mutations other than the F508 deletion.

Comparative bioavailability characteristics of commercial quinidine polygalacturonate and sulfate tablets.

This study compared the relative bioavailability characteristics of quinidine polygalacturonate (QP) and quinidine sulfate (QS) after oral administration of commercial tablets and a liquid form prepared from crushed tablets in 13 healthy adult male volunteers. Each subject received the following four single-dose treatments in a randomized, crossover manner with a one-week washout period between treatments: 400 mg QS liquid, two 200-mg QS tablets, 550 mg QP liquid, and two 275-mg QP tablets. All four treatments were equivalent in terms of the dose of quinidine base. Multiple serum samples and two 24-hour urine specimens were collected over 24 and 48 hours, respectively, and assayed for quinidine with a specific HPLC assay method. For the absorption and disposition parameters measured (maximum serum concentration, time to reach maximum concentration, area under the concentration-time curve [0-48 hours], absorption and elimination rate constants, absorption and elimination half-lives, apparent total body clearance, apparent volume of distribution, and dose fraction excreted in the urine) no significant differences were observed for any of the parameters among the four treatments (p greater than 0.05). The results of the present investigation demonstrated that QP and QS produced identical serum quinidine concentration-time curves when given in the form of a tablet or liquid. The clinical implications of these observations with respect to the dosing of QP are discussed.

Stability of esmolol hydrochloride in the presence of aminophylline, bretylium tosylate, heparin sodium, and procainamide hydrochloride.

The visual and chemical compatibility of esmolol hydrochloride mixed with aminophylline, heparin sodium, bretylium tosylate, or procainamide hydrochloride in 5% dextrose injection was studied. Esmolol hydrochloride 600 mg was injected into polyvinyl chloride bags containing 100 mL of 5% dextrose injection with aminophylline 100 mg, heparin sodium 5000 units, bretylium tosylate 100 mg, or procainamide hydrochloride 400 mg. All admixtures were prepared in triplicate and stored at room temperature under fluorescent light. Esmolol concentrations were measured with high-performance liquid chromatography at 0, 2, 4, 8, and 24 hours. Samples were also examined for precipitate formation and pH and color changes by using visual, microscopic, and spectrophotometric methods. No detectable changes in color or pH and no particulate formation were observed in any of the sample bags. Esmolol concentrations varied by less than 5% throughout the 24-hour study period. Esmolol hydrochloride was visually compatible and chemically stable for at least 24 hours when mixed with aminophylline, heparin sodium, bretylium tosylate, or procainamide hydrochloride in polyvinyl chloride bags containing 5% dextrose injection.

Changes of immunological parameters in immunocompromised patients under selective decontamination of the digestive tract. Second Part: Investigations on the influence of drugs on zymosan-induced and luminol-enhanced chemiluminescence of peripheral leucocytes.

The influence of drugs used for selective decontamination, given in therapeutically effective concentrations, was examined in healthy controls and immunocompromised patients with hematologic systemic diseases by measuring the zymosan-induced and luminol-enhanced chemiluminescence of peripheral leucocytes. Drug-induced repression of phagocytic activity could usually be found both in healthy controls and in patients with hematologic systemic diseases. The combination of trimethoprim and sulfamerazine had a pronounced repressive effect. Such indications should be taken as a basis for further investigations in order to avoid additional iatrogenic restriction of defence. If possible, drugs with effects leading to repression of phagocytosis should not be used for selective decontamination.

[Chemoluminescence study of the influence of phagocytosis of peripheral blood leukocytes using a perfluorocarbon-containing blood substitute]. / Chemolumineszenzuntersuchungen zur Beeinflussung der Phagozytose der Leukozyten des periphern Blutes durch perfluorcarbonhaltige Blutersatzmittel.

In an animal experimental model (rats) the influence of which model substances for blood substitution of GDR origin may have on the phagocytosis behaviour of leukocytes of the peripheral blood was investigated by means of luminol-amplified chemoluminescence. After applying the model substance in an amount corresponding to 10% of the circulating blood volume a reversible increase of luminol-amplified chemoluminescence could be observed. The values referred to the portion of neutrophilic granulocytes, however, showed no significant differences compared to the control groups. The opsonizing capacity of the serum towards cymosan revealed a temporary deficit after applying blood substitution substances of GDR origin. The conclusion is drawn that the functions of leukocytes of the peripheral blood recorded by the applied method are not depressed by the model substances used.

Changes of plasma fibronectin concentration and phagocytic activity in immunosuppressed patients during selective decontamination.

Plasma fibronectin and phagocytic activity play important roles in combating infections. The question is discussed, whether both defense systems are also of importance in immunosuppressed patients. Further, the behaviour of plasma fibronectin determined by laser nephelometry, and phagocytic activity determined by chemiluminescence is demonstrated in patients with leukaemia under the conditions of selective decontamination of the intestinal tract. The following results are shown: Plasma fibronectin concentration decreases 10 to 14 days before onset of the first clinical signs of an infection. Plasma fibronectin level changes appear earlier than that of C-reactive protein (Crp). Therefore, it is suitable as a parameter for assessment of the course of an infection. Decreased plasma fibronectin levels occurring over longer periods have to be regarded as unfavourable prognostic criterion. The phagocytic activity of immunosuppressed patients selectively decontaminated is significantly below that of healthy adults. A clear assignment of phagocytic activity to the clinical picture, the number of granulocytes and plasma fibronectin level is not possible at present. Additional studies are necessary. Both plasma fibronectin level and phagocytic activity do not appear to be influenced by selective decontamination of the intestinal tract.