[Dilated cardiomyopathy as clinical syndrome: experience with nosological diagnostics with biopsy and treatment approaches].

AIM: To study possibility of nosological diagnosis in patients with dilated cardiomyopathy (DCMP) with use of myocardial biopsy. MATERIAL AND METHODS: The trial enrolled 62 patients (23 females) with DCMP syndrome (end diastolic left ventricular size > 5.5 cm, ejection fraction < 55%). Mean age of the patients was 46.0 +/- 12.8 years. The examination included diagnosis of viral infections (Herpes virus, parvovirus B19), measurement of anticardial antibodies titer, 99Tc-MIBI single photon emission computed tomography of the myocardium, multislice computed tomography, MRT of the heart, coronarography, morphological study of the myocardium (n=20) with application of polymerase chain reaction (PCR) for H.simplex viruses of types 1, 2 and 6, herpes zoster, Epstein-Barr, cytomegalovirus, parvovirus B-19, adenoviruses. The control group (20 operated patients with valvular heart disease and coronary heart disease) was examined for viral genome in the blood and myocardium. RESULTS: Complex examination of DCMP patients showed the following distribution by nosological entuities: myocarditis (n=41, 66.1%) including virus-positive (n=14), primary DCMP (n=16, 25.9%) including with non-compact myocarditis (NCM) in 3, with debute at delivery of the child--in 3. Arrhythmogenic right ventricular dysplasia combined with viral myocarditis (n=2), genetic myopathy (n=1) and Takayasu disease (n=1) combined with NCM, isolated NCM (n=1) were diagnosed in the rest cases. Morphological investigation of the myocardium was made in 20 patients: diagnosis of myocarditis and primary DCMP were made in 70% (including in 2 patients with CHD) and 20%. Detection of viral genome was 20 and 15% in the study and control group, respectively, in the myocardium--in 57.9 (test for parvovirus B19 was not made in 26%) and 65.0% (complete diagnosis). All the virus-positive patients with DCMP were diagnosed to have signs of active/borderline myocarditis. Diagnostic criteria and poor prognosis factors were defined. CONCLUSION: The nosological diagnosis of DCMP was made in all the examinees basing on the complex of clinical, case history and device evidence. The diagnosis was morphologically verified in 33.9% patients. Treatment approaches are developed.

[A method of detecting soluble immune complexes in tissue biopsies]. / Sposob vyiavleniia rastvorimykh immunnykh kompleksov v bioptatakh tkanei.

Pretreatment of cryostat slices of tissue biopsy specimens with 30-50% water ethanol mixture increases the rate of detection of immune complexes in the intercellular substance of the epidermis to 100% in patients with acantholytic pemphigus. This method permitted the detection of immune complexes in all the examined cases with benign familial Hailey-Hailey pemphigus, which has never been reported heretofore. The authors believe that 30-50% water-ethanol mixture is capable of soft denaturation of proteins, stabilizes the slightly affine antibody-antigen relations, and aggregates soluble immune complexes into larger protein formations, this preventing their washing out from tissues.

[Cardiomyocyte cytoskeleton in dilated cardiomyopathy and ischemic heart disease]. / Ul'trastruktura mezhmitokhondrial'nykh kontaktov kardiomiotsitov cheloveka pri alkogol'noi kardiomiopatii i ischemicheskoi bolezni serdtsa.

Summary. Vinculin, the protein of cardiomyocyte cytoskeleton in the myocardium of patients with a dilated cardiomyopathy and ischemic heart disease, was revealed by means of monoclonal antibodies and by a method of indirect immunofluorescence. Cytoskeleton of patients with dilated cardiomyopathy is disorganized, hypertrophic and contains greater amounts of vinculin than cytoskeleton of normal cardiomyocytes. This most likely negatively influences cell contractile capacity. The vinculin content was also higher in cardiomyocyte cytoskeleton of patients with ischemic heart disease but at a less degree than in patients with dilated cardiomyopathy.

[Humoral immunopathologic changes in the myocardium after clinical allotransplantation of the heart]. / Gumoral'nye immunopatologicheskie izmeneniia v miokarde pri allotransplantatsii serdtsa v klinike.

Endomyocardial diagnostic biopsies, recipient heart removed at operation, endomyocardial biopsies of allotransplants and postmortem material were studied using immunofluorescence to specify immunopathological process and to detect humoral rejection. Altogether 306 samples from 55 patients were studied. In the early postoperative period (one year) 8 out of 18 patients with heart transplants repeatedly showed immunopathologic picture of acute humoral (vascular) rejection which was characterized by a widespread immunoglobulin G and complement fixation in the capillary walls accompanied by enhanced capillary permeability and fibrin deposition in intestitial tissue. Such patients often had graft dysfunction. 1 to 5 years after transplantation in 24 out of 37 patients discrete focal immunoglobulin and complement fixation was observed as one of chronic rejection component.

[An immunomorphological study of the effect of ionizing radiation on the nonlymphoid structures of the mouse thymus using monoclonal antibodies]. / Immunomorfologicheskoe izuchenie vliianiia ioniziruiushchei radiatsii na nelimfoidnye struktury timusa myshei s pomoshch'iu monoklonal'nykh antitel.

Expression of cytoskeleton components revealed with monoclonal antibodies was increased in epithelial cells of mouse thymus one day after total gamma-irradiation with doses of 0.5-4.0 Gy, while after the doses of 10 and 15 Gy it was decreased. The antigen expression was reversed to initial level 14 days after the dose of 4 Gy; thymocyte depletion was progressed and continuous massifs of epithelial cells was formed. The oval cysts and immunoglobulin deposits were appeared in thymus two months after irradiation with the dose of 4 Gy.

[Determination of autoantibodies to antigens of thymic epithelial cells of clean up team workers and patients who survived acute radiation sickness at distant periods after irradiation]. / Opredelenie autoantitel k antigenam épitelial'nykh kletok timusa u likvidatorov i bol'nykh, perenesshikh ostruiu luchevuiu bolezn', v otdalennyi period posle oblucheniia.

A group of patients, suffering from sequelae of acute radiation sickness (ARS), and liquidators was studied 5 years after exposure to a complex of factors resulting from the Chernobyl A.P.S. disaster. Studied were: the antibody titres to antigens of the cytoplasm of thymus epithelial reticulum cells and to Hassall's corpuscles the levels of serum immunoglobulins M, G, A; and the content of serum alpha 1-thymosin. Patients with ARS sequelae and liquidators showed a high level and incidence of autoantibodies to antigens of cytoplasm of thymus epithelial reticulum cells and to Hassall's corpuscles. There were no significant differences between the antibody levels in the blood of patients with ARS sequelae and liquidators. The antibodies were found to belong to IgM class; there was a correlation between the serum IgM titres and the rate of the indirect immunofluorescence reaction with autoantibodies to antigens of the cytoplasm of the thymus epithelial reticulum cells. To identify autoantibodies cryostat sections of human and mouse, (CBA x C57BL/6) F1, thymus as well as the epithelial and stromal cell culture of mouse thymus can equally be used.

[Immunopathologic study of the myocardium in dilated cardiomyopathy]. / Immunopatologicheskoe issledovanie miokarda pri diliatatsionnoi kardiomiopatii.

Myocardial tissues of patients with dilated cardiomyopathy were studied by immunofluorescence. While immunoglobulin A fixation was observed in myocardial capillary wall and cardiomyocyte sarcolemma in the majority of patients (11 of 12), immunoglobulin G and C3 complement component were a rare finding. In the vessel wall of heart allografts immunoglobulin A fixation occurred 3-6 days after transplantation. As a result of the intensive immunosuppressive therapy which was used after the operation immunoglobulin A disappeared from heart allografts within 4-5 weeks. Immunoglobulin A fixation in the heart of patients with dilated cardiomyopathy is attributed to the anti-tissue or antivirus antibodies and probably is involved in the development of this disease.

[Characteristics of cytoplasmic antigens of cells from differentiated epidermal layers in human thymic epithelium]. / Osobennosti lokalizatsii antigenov tsitoplazmy kletok differentsirovannykh sloev épidermisa v épitelii timusa cheloveka.

It was found that donor's serum and serum of patients with rheumatic fever, erysipelas and myasthenia gravis contained autoantibodies to the cytoplasmic antigens and to the antigen of perinuclear zone of differentiated layers cells of human epidermis. Using the serum with different level of autoantibodies to these epidermal antigens it's localization in the human thymus epithelium was determined. It was shown that perinuclear antigen of differentiated epidermis cells is localized in the cytoplasm of cortical and medullar thymus epithelial cells and in the perinuclear zone of some cells in Hassall's corpuscles. The cytoplasmic antigen of differentiated epidermal cells is detected only in the cytoplasm of the Hassall's corpuscle cells. The ability of many tissues (possibly all of them) and in the first turn of epidermis to produce lymphokine along with immunomodulating properties of thymus hetero-organic antigens enables to consider these thymus antigens as a complex of immunomodulating factor proper for other tissues. These factors may provide the competence of certain T-cell subpopulations to different organ's tissues necessary for proceedings them the immunological survey both in normal and pathological conditions.

[Group A streptococcal polysaccharide--stimulator of nonspecific cytotoxic reaction in autologous system of spleen cells]. / Polisakharid streptokokka gruppy A--stimuliator nespetsificheskikh tsitotoksicheskikh reaktsii v autologicheskoi sisteme kletok selezenki.

p4 was shown the ability of group A streptococcal polysaccharide (A-PS) to stimulate nonspecific cytotoxic effect of spleen cells on autologous adherent cells (macrophages). The stimulating effect can be observed in vivo under the treatment of spleen cells with A-PS and any antigen (BSA, PPD, M-protein of group A streptococci). In the presence of antigen A-PS can induce nonspecific cytotoxic effect of normal spleen cells (mice CBA, BaLB/c) and of the mice with DHT and therefore these two immunologic phenomena do not depend on each other. Because A-PS has cross-reactive (CR) determinant with thymus epithelial antigen (factor), it can be assumed that via the CR determinant A-PS links with T-cells receptor for this thymus factor and thus realized the stimulating effect as it's functional analogue.

[A case of seronegative systemic lupus erythematosus (an immunopathological study)]. / Sluchai seronegativnoi sistemnoi krasnoi volchanki (immunopatologicheskoe issledovanie).

A case of systemic lupus erythematosus (SLE) in a 37-year-old female is described which was primarily diagnosed as epilepsy. Immunopathologically, an immunoglobulin in the nuclei of the majority of cells in the skin biopsy and blood cells was found against the background of the lack of SLE manifestations (antinuclear factor in the circulating blood, skin lesions, etc.). Antibodies against the antigen of vascular intima are revealed in the blood by means of the indirect immunofluorescence. The epilepsy diagnosis was established due to the prevalence of the brain vessels affection (frequent loss of consciousness). The progression of the disease with the involvement of joints, heart, lungs and other organs, high indexes of the rheumatoid factor made it necessary to differentiate between rheumatoid arthritis and SLE. The immunopathological examination confirmed the SLE diagnosis. Hemosorption combined with a standard therapy was followed by the decrease of the immunopathological manifestations.

[The effect of splenic factors on the course of the autoimmune process in New Zealand mice]. / Vliianie selezenochnykh faktorov na techenie autoimmunnogo protsessa u novozelandskikh myshei.

To exert an effect on the autoimmune process in 54 New Zealand mice aged 6 and 10 months, 0.2 ml of a solution obtained in perfusion of isolated pig's spleen (perfusate) was injected intravenously at intervals of 2--3 days (a total of 8 injections). The control group (43 mice) received injections of an isotonic buffer solution in the same regimen. After the end of perfusate administration the number of antibodies to DNA and the level of circulating immune complexes (IC) reduced markedly in the blood of the experimental mice as compared to these values in the control group. Kidney immunofluorescence demonstrated reduced number of IC deposits in the glomeruli of 6- and 10-month old mice of the experimental group. The perfusate contributes, probably, to intensified excretion of IC from the blood flow and kidneys of the experimental mice.

[The immunopathological mechanisms of the skin lesion in erysipelas patients]. / Immunopatologicheskie mekhanizmy porazheniia kozhi u bol'nykh rozhei.

The localization of bound IgG, IgA, IgM and component C3 of the complement in the focus of skin lesion in patients with different forms of erysipelas has been studied by the method of direct immunofluorescence. The presence of fixed immune complexes and component C3 in the affected areas of the skin at the acute period of the disease and their absence in the healthy areas of the skin have been established, which seems to be indicative of the presence of the local immunocomplex process in erysipelas. This process is one of the mechanisms of erysipelatous inflammation.

[Leukocytic thermostable alpha-glycoprotein and lactoferrin from granulocyte cytoplasm (immunocytochemical study)]. / Leikotsitarynyi termostabil'nyi alpha-glikoproteid i laktoferrin tsitoplazmy granulotsitov (immunotsitokhimicheskoe issledovanie).

The immunofluorescence techniques with monospecific antibodies to lactoferrin (LF) and leukocytic thermostable alpha-glycoprotein (LT alpha-G) has demonstrated that both the proteins are specific components of the peripheral blood granulocytes of normal subjects. LF and LT alpha-G are detectable in the cytoplasmic granules of polynuclear leukocytes but not on the external surface of these cells' membranes. Differences between the direct and indirect immunofluorescence techniques, used for the detection of the granulocytic LF and LT alpha-G are discussed. Examinations of the blood smears from patients, operated on under artificial circulation, have shown that the emergence of granulocytic protein aggregates between the cells and LF and LT alpha-G sorption on the red cell surface indicate a disease.

[Disordered keratinocyte differentiation in epidermal tumors and mycosis fungoides]. / Narushenie differentsirovki keratinotsitov pri épidermal'nykh opukholiakh i gribovidnom mikoze.

The immunocytochemical method with monoclonal antibodies to human and murine epidermis basal-cell antigen (BCAg) has been used in studies on the disorders in keratinocyte differentiation in epidermal tumors and mycosis fungoides. The fluorescence intensity augmented and BCAg distribution in the cytoplasm grew more diffuse as the degree of the tumor cell differentiation lowered. In mycosis fungoides the BCAg reaction has been positive first in the suprabasal layers; as the disease progressed, the fluorescence has involved the entire epidermis. The BCAg test is a sensitive tool for estimating the epidermal cell maturity in processes associated with impaired differentiation of keratinocytes.

[Ultraimmunocytochemical diagnosis of squamous cell cancer of the digestive tract]. / Ul'traimmunotsitokhimicheskaia diagnostika ploskokletochnogo raka pishchevaritel'nogo trakta.

Procedure using fluorescent and peroxidase labeling and monoclonal antibodies to basal-cell antigen of multilayer epithelium showed the antigen to occur in squamous cell cancer irrespective of site and degree of cell differentiation; this, however, was not the case with tumors of other origins. Ultraimmunocytochemical method was used to identify localization of the antigen at cellular and subcellular levels, namely, in tonofilaments and desmosomes. Said situation is considered to suggest squamous cell carcinoma.

[Monoclonal autoantibodies to different epithelial structures of the thymus gland obtained by the immunization with streptococcal group A antigens]. / Monoklonal'nye autoantitela k razlichnym épitelial'nym strukturam timusa, poluchennye pri immunizatsii antigenami streptokokka gruppy A.

By the indirect immunofluorescence method it was shown to which epithelial thymus structures monoclonal antibodies (mAT) reacting with the different epidermal structures are directed. These mAT related to the autoantibodies were obtained earlier, as a result of lymphoid cells polyclonal activation, by the immunization of BALB/c mice with streptococcal group A nonspecific protein antigens of the cell wall. It was shown that mAT A6/1, reacting with the basal layer of the skin epithelium are directed to the epithelium of the cortical and medullar thymus zones, which is regarded as the so called endocrinal epithelium. These mAT, by the study with immunoblotting method, react with the protein of mV SOkD, B5/1 mAT to the skin epithelium, on the thymus sections react with the single cells around the Hassel bodies.

[Characteristics of the development of interphase death of hematopoietic tissue in dogs in response to gamma irradiation]. / Osobennosti proiavleniia interfaznoi gibeli krovetvornoi tkani u sobak v otvet na gamma-obluchenie.

In experiments with 2-3 week dogs it was shown that whole-body gamma-irradiation with a dose of 3 Gy causes an insignificant absolute rise in the amount of degrading chromatin of the haemopoietic organs during the first 24 h following irradiation. After 48 h, this cell death parameter is normalized. A considerably lower radiosensitivity of lymphoid cells of dogs compared to small laboratory animals is indicated by a stable DNA content per 1 g of thymus, intactness of its structure after irradiation, and the absence of an increase in thymidine content of blood of young and adult dogs under the effect of 3-3.7 Gy radiation.