Transfer of experimental autoimmune thyroiditis by serum from thyroidectomized donors.

When rabbits were injected with 10.0 mg rabbit thyroglobulin in complete Freund's adjuvant, the earliest thyroid lesions were seen on day 5 and uniformly severe thyroid lesions were seen by day 14; these observations were not significantly different from the thyroid lesions observed at 1 and 2 months post-immunization. Pooled sera were obtained from immunized, thyroidectomized, and nonthyroidectomized donors on various days and transferred to normal recipient rabbits in different experiments. Successful transfer of thyroid lesions was seen when serum containing early antithyroglobulin antibody obtained from thyroidectomized donor animals at various times after immunization was injected into normal recipients in a sequential manner. Immunofluorescent studies of recipient thyroid glands showed focal fixation of rabbit gamma-globulin and beta(1C) complement in thyroid follicles. When purified antibody to rabbit thyroglobulin obtained from thyroidectomized donor sera was transferred sequentially as above, significant thyroid lesions were seen in recipient rabbits. In contrast, no thyroid lesions were seen in recipient animals injected with rabbit sera containing late antithyroglobulin antibody from thyroidectomized donors or hyperimmune sera from guinea pigs. No thyroid lesions were seen in recipient animals injected either with sera from donors given complete adjuvant without thyroglobulin or with globulin fraction of pooled sera containing early antithyroglobulin antibody obtained on various days from nonthyroidectomized donors. Similarly, rabbits rendered unresponsive to guinea pig gammaG-globulin and periodically injected with guinea pig anti-rabbit thyroglobulin showed no thyroid lesions.

The role of mycobacteria and the effect of proteolytic degradation of thyroglobulin on the production of autoimmune thyroiditis.

Data are presented which suggest that the initial event involved in experimental autoimmune thyroiditis following injection of rabbits with homologous thyroglobulin in complete Freund's adjuvant is alteration of the thyroglobulin. Alteration of the thyroglobulin does not occur during incorporation into the adjuvant or in vitro storage in the adjuvant, and the mycobacteria in the adjuvant have no direct effect on the thyroglobulin. Most likely, the alteration results from an increase in hydrogen ion concentration within cells or local areas in the granuloma and the subsequent action of proteolytic enzymes. These conditions are probably established in the granuloma as the result of neutrophilic response to the mycobacteria in the adjuvant. Rabbits injected with aqueous preparations of homologous thyroglobulin partially degraded in vitro with pepsin at acid pH produced antibody to native thyroglobulin and developed thyroiditis. Most of these rabbits responded to a subsequent injection of native thyroglobulin given 1 month later.

Metabolism of autologous and homologous IgG in rheumatoid arthritis.

The metabolism of radioiodinated IgG was studied in 20 patients with rheumatoid arthritis and 11 normal controls using autologous IgG and homologous IgG pooled from normal donors. Fractional catabolic rates in the controls were 4.44% of the autologous- and 4.29% of the homologous-labeled protein per day. The corresponding rates in the rheumatoid patients were 9.67% of the autologous- and 8.64% of the homologous-labeled protein per day. Extravascular catabolism occurred only in the rheumatoid group and accounted essentially for the entire increased catabolism of IgG observed in these patients. 10 patients were especially hypercatabolic, with fractional catabolic rates for autologous IgG greater than 10%. Moreover, they catabolized their autologous IgG significantly faster than the homologous IgG (12.6 vs. 9.9%). The increment of catabolism of autologous over homologous IgG also occurred in the extravascular compartment. These highly hypercatabolic patients had a significantly increased number of manifestations of extra-articular disease. The hypercatabolism of IgG could not be correlated with age, weight, sex, duration of disease, joint erosions, corticosteroid therapy, erythrocyte sedimentation rate, rheumatoid factor titer, serum IgG concentration, or circulating immune complexes as measured by the Raji cell radioimmunoassay. Conceivable sites of extravascular catabolism and possible causes of faster catabolism of autologous (rheumatoid) than of homologous (normal) IgG are discussed.

Delayed-type hypersensitivity to a recombinant mycobacterial antigen, MPB64, in guinea pigs sensitized to Mycobacterium tuberculosis or Mycobacterium bovis BCG.

Recombinant MPB64 (rMPB64), a mycobacterial antigen, was obtained from an Escherichia coli clone transformed with a recombinant expression vector, pMAL64c. The rMPB64 was examined for the activity to elicit delayed-type hypersensitivity (DTH) in guinea pigs injected with liver Mycobacterium tuberculosis H37Rv or live M. bovis BCG Tokyo. It was found that rMPB64 has the same reactivity as native MPB64 (nMPB64) or MPT64 (nMPT64) and the potency to elicit DTH was 13.4 times higher than that of PPD. Because MPB64 is secreted only by living M. tuberculosis and some strains of BCG, it is possible to use this antigen for the diagnosis of tuberculosis.

Roles of estradiol and progesterone in eiliciting the midcycle luteinizing hormone and follicle-stimulating hormone surges.

The positive feedback effects of estradiol (E2) and progesterone (P) on LH and FSH release were studied under novel experimental conditions in three women of reproductive age who had undergone oophorectomy and received uninterupted E2 replacement by subdermal implants. Basal serum E2 levels were in the midfollicular phase range, while LH and FSH levels were normal or slightly elevated. Each volunteer underwent seven experiments at 2- to 4-week intervals, receiving im injections of increasing amounts of estradiol benzoate (E2B) alone and in combination with P. The time and dose of P (administered via P-impregnated polysiloxane intravaginal rings) were varied. In two of the seven experiments, P was given without E2B injections. In all three subjects, increasing serum E2 levels mimicking the preovulatory E2 peak were followed by a surge of LH but not of FSH. However, when serum P levels rose after an increase in serum E2 concentrations had occurred, the LH surge occurred earlier and was accompanied by an FSH peak. When serum P levels rose before serum E2 concentrations had risen or when P levels increased without a rise in serum E2, neither a serum LH nor FSH peak was observed. When administered concomitantly, E2B and P suppressed FSH but not LH levels, while P alone did not affect serum LH or FSH concentrations. These data indicate that an acute rise in serum E2 is a necessary condition for the midcycle LH and FSH surges, that P facilitates or blocks the positive feedback response of gonadotropin release in a time-dependent manner, and that P is required for the preovulatory FSH peak.

Classification of secondary amenorrhea based on distinct hormonal patterns.

Patients with secondary amenorrhea have been classified into 4 clincal groups. In order to further investigate these 4 groups, LH, FSH, and estradiol (E2) were measured at 15 min intervals for 4 h in 21 patients with secondary amenorrhea. Patients within each group had similar hormonal patterns, but there was a distinct variation among the groups. Three patients in group 1 (polycystic ovaries [PCO]) had elevated basal levels of only LH with marked irregular fluctuations. Seven patients in group II (hypothalamic-pituitary dysfunction) had normal basal levels of LH, FSH, and E2. Only LH showed oscillations of varying mahnitude and frequency. Eight patients in group III (hypothalamic-pituitary failure) had low or low-normal levels of LH, FSH, and low E2 with minimal or absent fluctuations. Three patients in group IV (ovarian failure) had high basal levels of FSH and LH and irregular fluctuations. This study confirmed the rationality of separating patients with secondary amenorrhea into 4 different groups. In addition, it was found that in group III patients, the total amount of LH secreted in a 4-hour period of time appears to be insufficient to stimulate E2 production from the ovary even when a single sample was found to be in the normal range.

PIP: Patients with secondary amenorrhea were classified into 4 groups based on clinical evidence. The patients were classified according to the presence of polycystic ovaries (Group 1), hypothalamic-pituitary dysfunction (Group 2), hypothalamic-pituitary failure (Group 3), and ovarian failure (group 4). These groups were further characterized by measurement of luteinizing hormone (LH), follicle stimulating hormone (FSH), and estradiol (E2) every 15 minutes for 4 hours. 3 patients in Group 1 showed elevated basal levels of LH with inconsistent fluctuations. Normal basal levels of LH, FSH, and E2 were observed in 7 patients in Group 2, though there were oscillations in LH levels of varying magnitude and frequency. Low or low-normal levels of LH, FSH and E2, with minimal or no fluctuations, were found in 8 patients in Group 3. In this group, the total amount of LH secreted over the 4-hour period was insufficient to stimulate E2 production from the ovary. 3 patient in Group 4 showed high basal levels of FSH and LH, with irregular fluctuations. The results support the approach of classifying patients with secondary amenorrhea in 4 groups.

Changes in physiologically free circulating estradiol and testosterone during exposure to levonorgestrel.

PIP: The biological activity of circulating sex steroids is dependent upon the relative binding to (SHBG) sex hormone-binding globulin. Only that fraction which is not specifically bound to the high affinity binding protein is available to the receptors or for metabolism. (D-Ng) Levonorgestrel, a synthetic gestagen used for contraception decreases the hepatic production of SHBG. Volunteers wearing contraceptive vaginal rings containing (E2) estradiol and d-Ng were studied to determine the changes in sex steroid binding which occur when d-Ng is administered in a sustained release fashion. The % of steroids not specifically bound to SHBG was measured by fractionating the serum proteins with ammonium sulfate precipitation. A binding capacity assay was used to quantitate SHBG. During the normal menstrual cycle in control subjects, the unbound fractions of both E2 and (T) testosterone remained constant at about 25% of total E2 and 10% of total T. During treatment with d-Ng, however, the % of unbound E2 increased to about 80% of the total, and that of T increased to about 55% of the total, significantly greater than that in the control cycles (p 0.01). SHBG was constant during the normal menstrual cycle, averaging 85.9 + or - 1.92 nM but was suppressed during the administration of d-Ng to 10.0 + or - 2.6 nM. When SHBG concentration was greater than 50 nM, the % binding of both E2 and T were independent of the concentration of this binding protein. When SHBG was suppressed below 50 nM, the % binding of E2 and T was directly related to the concentration of the binding protein. The affinity of SHBG for d-Ng allows competition with E2 and T for SHBG-binding sites at concentrations of SHBG below 50 nM. The increase in physiologically free E2 and T, therefore, may be a result of both the suppression of SHBG concentration by d-Ng as well as the competition between d-Ng and endogenous sex steroids for the decreased number of available binding sites on SHBG.^ieng

Insulin resistance in nonobese patients with polycystic ovarian disease.

To determine whether insulin resistance occurs in polycystic ovarian disease (PCO) in the absence of obesity and acanthosis nigricans, circulating levels of insulin in response to oral glucose administration were measured in 10 nonobese PCO patients without acanthosis nigricans and in 10 normal women matched for weight and height. Mean serum testosterone (T), androstenedione (A), dehydroepiandrosterone (D), D sulfate, and LH levels were significantly elevated in the PCO patients compared to those in control subjects. In PCO patients, the mean +/- SE basal insulin level (18.7 +/- 2.9 microU/ml) and the sum of the insulin levels in response to glucose (674 +/- 119 microU/ml) were significantly greater than those in the control group (11.0 +/- 0.8 microU/ml and 248 +/- 29 microU/ml, respectively). In all subjects, serum levels of T and A, but not D and D sulfate, were significantly correlated to basal insulin levels and insulin sums. Serum cortisol, GH, and PRL levels were similar in both groups. These results indicate that in PCO, a significant degree of insulin resistance exists, which clearly is not related to obesity. The positive correlation of serum T and A levels to circulating insulin levels in this study suggests that the insulin resistance in PCO may be, in part, a consequence of hyperandrogenism.

Measurement of serum LH, FSH, progesterone, 17-hydroxy-progesterone and estradiol-17beta levels at 4-hour intervals during the periovulatory phase of the menstrual cycle.

PIP: Measurement of serum luteinizing hormone (LH), follicle stimulating hormone (FSH), progesterone, 17-hydroxyprogesterone, and estradiol-17beta in 4 women every 4 hours during the midcycle LH peaks preceded by estradiol peaks and followed by ovulatory levels of serum progesterone (greater than 3 ng/ml). 48 hours was the average length of the LH peak, and 36-62 hours later progesterone rose to ovulatory levels. 17-hydroxyprogesterone rose after the initial onset of the midcycle LH surge in 2 subjects and concomitant with the onset in the other two. The estradiol peak occurred prior to the midcycle rise in 17-hydroxyprogesterone in all subjects. It was postulated that the incr ease in 17-hydroxyprogesterone secretion occurs as a result of the LH surge. In 2 subjects estradiol levels were declining prior to the initiation of the LH surge and in 2 they were not; therefore, it was suggested that estradiol may not be the mechanism for the midcycle release of LH.^ieng

Correlation of human follicular fluid inhibin activity with spontaneous and induced follicle maturation.

We sought to correlate the inhibin activity of individual ovarian follicles (greater than 16 mm in diameter) from untreated (7 patients; 7 follicles), clomiphene-stimulated (150 mg/day; menstrual cycle days 5-9; 9 patients, 14 follicles), and human menopausal gonadotropin (hMG)-stimulated (150 IU/day; menstrual cycle days 3-11; 8 patients; 23 follicles) ovarian cycles and to correlate these results with the follicular fluid (FF) steroid concentration. Follicular aspirates were obtained via laparoscopy from 24 regularly menstruating patients when the diameter of the largest follicle reached 20 mm, as determined by serial ultrasonography. FF concentrations of estradiol, progesterone, testosterone, 17-hydroxyprogesterone, and androstenedione were determined by RIA. Inhibin activity was determined using the inhibition of basal 24-h FSH secretion by dispersed rat anterior pituitary cells. Inhibin values were highest among the follicles aspirated from those patients who received hMG [277 +/- 31 (+/- SE) U/ml] compared to untreated subjects (51 +/- 13 U/ml) or those who received clomiphene (96 +/- 14 U/ml). Estradiol was highest in FF from untreated patients (2295 +/- 1155 ng/ml) compared to levels in patients who received hMG (368 +/- 1.76 micrograms/ml) or clomiphene (1049 +/- 174 ng/ml). FF progesterone values were highest in untreated patients (9.4 +/- 2.59 micrograms/ml) compared to those in hMG-treated (5.04 +/- 1.76 micrograms/ml) and clomiphene-treated patients (7.82 +/- 1.24 ng/ml). FF 17-hydroxyprogesterone values (7.82 +/- 1.24 ng/ml). FF 17-hydroxyprogesterone values were similarly higher in the untreated (1.55 +/- 0.21 micrograms/ml) and clomiphene-treated (2.54 +/- 0.27 micrograms/ml) patients than in the hMG-treated group (0.73 +/- 0.09 micrograms/ml). FF androstenedione (untreated, 50.7 +/- 30 ng/ml; clomiphene-treated, 73.4 +/- 23.4 ng/ml; hMG-treated, 60.2 +/- 19.8 ng/ml) and testosterone (6.66 +/- 2.45, 5.98 +/- 1.46, and 6.39 +/- 2.16 ng/ml, respectively) concentrations in all three patient groups were similar. In untreated patients, there was a highly significant positive correlation between intrafollicular inhibin activity and FF estradiol, testosterone, and androstenedione concentrations and a statistically significant negative correlation between intrafollicular inhibin activity and FF progesterone concentrations. Patients receiving clomiphene therapy demonstrated at least two different response patterns, one with a positive and one a negative correlation between intrafollicular inhibin activity and FF steroid concentrations. The patients receiving hMG therapy had no statistically significant correlation between intrafollicular inhibin

Visualization of anti-I-J antibody binding sites on bone marrow-derived macrophages.

I-J antigens on BMDM were visualized by immunofluorescence. Nonspecific binding of IgG antibody to Fc receptors was eliminated by the pretreatment of the antibody with anti-mouse IgG Fc portion antibody.

Cell-cell interaction responsible for the induction of first order suppressor T cells in hapten-specific contact sensitivity reactions.

C3H/He mice were found to be low responders in the contact sensitivity response to ABA. Intravenous injection of ABA-coupled syngeneic spleen cells induced hapten-specific Ts in C3H/He mice. These cells were Ts1 because they acted on the inductive phase of the contact sensitivity. They could suppress the contact sensitivity in H-2-compatible CBA mice which were known to be high responders to ABA. Using in vivo and in vitro systems for the induction of Ts, it was shown that I-A-I-J+Thy-1- adherent cells were necessary as APC for the induction of Ts1.

I-J-positive cloned macrophages as accessory cells for the induction of suppressor T cells in vitro.

I-A+/I-J+ cloned macrophages, SL-1, played the role of APC in the in vitro induction of Ts against DTH to BCG. By treating SL-1 cells with various antibodies, it was shown that I-J antigens on SL-1 cells are essential for Ts induction, but not for the effector cell induction for DTH. Ia-negative cloned macrophages, SL-4, did not show any APC activity either in suppressor or effector cell induction. The precursors of the Ts were also I-J-positive, and I-J restriction resided between T cells and macrophages in the Ts induction. Thus, it is suggested that the pre-Ts recognizes the antigenic determinants of BCG presented on the APC in association with the I-J antigen and differentiates into the Ts. This pathway seems analogous to that of helper or effector T induction, where the antigenic determinant is recognized by a T cell in association with the I-A antigen on APC.

Localization of follicle regulatory protein in the porcine ovary.

The granulosa cell secretes a protein (follicle regulatory protein: FRP) that affects the responsiveness of other follicles to gonadotropin stimulation. This protein was purified, partially characterized, and rabbit antisera as well as monoclonal antibodies were prepared against FRP. Fixed sections of porcine ovaries were prepared on slides and then incubated with the monoclonal antibody or polyclonal antisera and then incubated with either biotinylated mouse IgM or rabbit IgG antisera, respectively. These sections were then incubated with avidin conjugated to horseradish peroxidase, followed by substrate. Staining with both the monoclonal antibody and the antisera was present in the cytoplasm of granulosa cells of small- or medium-sized antral follicles. Staining distribution was localized preferentially to cells near the basal lamina; the antral granulosa cells of viable follicles did not stain. Neither primordial follicles nor pre-antral follicles (less than 300 microns in diameter) showed any positive staining. Thecal cells were not stained in follicles less than 5 mm in diameter, whereas some large follicles (greater than 5 mm) contained staining in the theca. In the latter, specific granulosa staining was only weakly positive with the polyclonal antibody and negative with the monoclonal antibody. Atretic follicles contained significant staining of all epithelial cells adjacent to the basal lamina by both the monoclonal and polyclonal antibody preparations. Staining of the luteal ovary by the monoclonal antibody was limited to the large luteal cells. These findings suggest that FRP is produced by the granulosa cells of porcine follicles at the stage of maturation corresponding to 0.5 mm in diameter. As the viable follicle increases in size, production of FRP in the granulosa is reduced below the detectable level when the follicle exceeds 5 mm in diameter. The main source of FRP during the luteal phase is the large cell of the corpus luteum.

In vitro induction of suppressor T-cells in delayed-type hypersensitivity to BCG and an essential role of I-J positive accessory cells.

Antigen-specific suppressor T-cells in delayed-type hypersensitivity (DTH) to BCG were induced in vitro. Normal spleen cells of C3H/He mice were incubated with 50 micrograms of PPD per ml for 4 days at 37 degrees C, and the non-adherent cells in the culture were transferred intravenously into cyclophosphamide (CY)-treated syngeneic recipients. The recipients were immunized to BCG immediately after the cell transfer, and DTH was measured by the footpad reaction to PPD two weeks later. Footpad reaction to PPD was positive in CY-treated C3H/He mice immunized to BCG, while it was suppressed by the transfer of the in vitro induced suppressor cells. When the suppressor cells were treated with anti-thy-1.2 antiserum and complement before transfer, the suppression was abrogated. Next, the spleen cells were separated into plastic adherent and non-adherent fractions. After treatment with anti-thy-1.2 and complement, the adherent cells were treated with either anti-I-Jk or anti-I-Ak antiserum and complement. Then, they were reconstituted with the non-adherent cells and cultured with PPD. Treatment of the adherent cells with anti-I-Jk antiserum and complement abrogated the suppressor cell induction, while the treatment with anti-I-Ak had no effect. These facts indicate that I-J positive non-T-adherent cells play an essential role in the induction of suppressor cells in DTH.

Autoantibodies to nonhistone nuclear antigens and their clinical significance.

Identification of the immunologic specificity of antinuclear antibodies (ANAs) in the various systemic rheumatic diseases has become increasingly important. The standard immunofluorescence technique may enable detection of antibodies to nuclear antigens present in abundance in the nucleus, such as DNA, histones, Sm, nuclear ribonucleoprotein (nRNP), and SS-B/La. The nuclear antigens present in low concentrations, such as SS-A, proliferating cell nuclear antigen (PCNA), rheumatoid arthritis nuclear antigen (RANA), and Ku antigens, are unique to cell types, and their detection requires special substrates or reagent systems. Anti-Sm, anti-Scl-70, anticentromere, and anti-PM-1 are characteristic serologic markers for systemic lupus erythematosus, scleroderma, the CREST syndrome of scleroderma, and polymyositis, respectively. Distinct profiles of ANA characterize different rheumatic diseases. A number of ANAs are found in SLE, whereas other diseases are characterized by the presence or absence of a certain ANA or by differences in mean ANA titers. Specific ANAs have been used to isolate and characterize nuclear antigens at molecular and functional levels.

Recent progress in the study of autoantibodies to nuclear antigens.

Autoantibodies to nuclear antigens can now be classified according to their immunologic specificities. They include antibodies that react with DNA, deoxyribonucleoprotein, nuclear histones, and nuclear acidic protein antigens. It has been established that there are several antinuclear antibodies that react with nuclear acidic proteins, and these include antibodies to Sm antigen, nuclear ribonucleoprotein, and SS-A and SS-B antigens. It has also been established that certain systemic rheumatic diseases, such as systemic lupus erythematosus, Sjögren's syndrome, and scleroderma, are characterized by antibodies of some specificities and not of others. Thus, distinct profiles of antibodies to nuclear antigens may be present, and these may be used as diagnostic aids. Further characterization of these specific nuclear antigen-antibody systems may help in unraveling the etiology and pathogenetic mechanims of these diseases.

Hospitalization experience of Navajo subjects with type II diabetes and matched controls: an historical cohort study.

Using an historical cohort study design with a 12 year follow-up, we found that 77 Navajo adults with type II diabetes mellitus were hospitalized at a rate of 335 hospitalizations per 1000 patient years compared to a rate of 167 hospitalizations per 1000 patient years for 77 age, sex, and residence matched non-diabetic controls, yielding a risk ratio of 2.0. Using matched pairs analysis (sign test), the observed difference in number of hospital admissions is statistically significant (z = 2.30, p less than 0.05). The average duration of hospitalization, however, was not statistically different in matched pairs analysis (z = 0.95, p greater than 0.05). The 136 excess hospitalizations of the diabetic subjects included 45 admissions for poor metabolic control of diabetes, 50 excess admissions for infectious disease, and 26 excess admissions for conditions of the heart, eye, kidney, or non-traumatic amputation. In multivariate analyses, variables found to be associated with greater hospitalization experience among the 77 diabetic subjects in the 12 years follow-up period included older age at entry to the study, poorer metabolic control early in the study period, and presence of diabetic complications.

Improved estrogen receptor assay in human mammary cancer. Technics for handling small tissue samples.

Studies of various technics that aid in performing estrogen receptor assays on small tissue samples from primary cancers of the breast are reported. It is shown how sufficient protein can be obtained from less than 100 mg of small primary tumor without ultracentrifugation to assay estrogen receptor by a simplified two-point Scatchard plot method. The resulting Kd and maximum binding site values with 36 tumor tissue samples approximated the values obtained with the more laborious, larger tissue sample-demanding six-point Scatchard plot. Target and nontarget tissue controls are easily included in an assay run of four to eight samples. For interpretive purposes the derivation of the characterizing value of the Kd for estrogen receptor is given and compared with nonspecific associating binders.

Microhemagglutination test for detection of antibodies to nuclear Sm and ribonucleoprotein antigens in systemic lupus erythematosus and related diseases.

A reproducible hemagglutination procedure to detect antibodies to Sm and ribonucleoprotein nuclear antigens is described. The application and interpretation is discussed. The hemagglutination test was found to be more sensitive than the immunodiffusion test; however, the hemagglutination test may not detect the presence of low titers of anti-ribonucleoprotein in the presence of a high level of anti-Sm antibody. Anti-ribonucleoprotein antibodies in the presence of high titers of anti-Sm antibodies are best identified by gel precipitation methods where precipitin lines can be characterized by their interaction with precipitin lines produced by known prototype antisera.