Biochemical properties and study of antigenic cross-reactivity between Africanized honey bee and wasp venom.

Africanized honey bees and the wasp Polistes versicolor are common insects in Brazil; their venoms are composed of a complex mixture of components which present several biological activities. Stinging accidents are very frequent and are generally followed by important clinical reactions, and even deaths are not uncommon. In the present study, venom was extracted from Africanized honey bees and P. versicolor, and it was biochemically characterized and the antigenic cross-reactivity was investigated by Western blot analysis and specific IgE determination by ELISA in the sera of subjects allergic to each venom. The honey bee venom presented higher phospholipase A2 and hyaluronidase activities than P. versicolor venom, which in turn presented higher lipase, acid phosphatase and esterase activities. A high incidence of false-negatives was also observed during determinations of specific IgE for P. versicolor venom when the kits with venoms from wasps of temperate climates were used, suggesting that the diagnosis of allergy to neotropical wasp venom must take into consideration the clinical history and skin tests.

Anticardiolipin antibodies in patients with infectious diseases.

IgG or IgM anticardiolipin antibodies were present in the sera of 67% of 33 patients with Hansen's disease, in 53% of 30 patients with tuberculosis and in 50% of 16 patients with endocarditis. Despite the high frequency of these antibodies, no patient had a history of thrombosis or abortion. Anti-denatured DNA antibodies were tested in patients with tuberculosis and patients with Hansen's disease. Only in the latter group did we observe a statistically significant association between anticardiolipin and anti-denatured DNA antibodies. Anticardiolipin binding activity, however, could not be inhibited by preincubation of sera with a variable concentration of denatured DNA. These data suggest that: a) Anticardiolipin antibodies in infectious diseases do not necessarily participate in the pathogenesis of thrombotic or obstetric complications; b) Anti-denatured DNA and anticardiolipin antibodies in the population studied do not have a cross-reaction.

Stenosing ureteritis in a child with necrotizing vasculitis.

Although vasculitidis may involve several organs and tissues, ureteral involvement is rare. The present report describes a case of a female child with ureteral stenosis in whom a diagnosis of necrotizing vasculitis was made.

Neuropsychiatric manifestations of systemic lupus erythematosus: the value of anticardiolipin, antigangliosides and antigalactocerebrosides antibodies.

In an attempt to find a serological marker for neuropsychiatric manifestations (NPM) of SLE, sera from 66 patients (classified in three groups, according to their NPM-defined, probable and without NPM) were analysed by ELISA for IgG and IgM anticardiolipin, antigangliosides and antigalactocerebrosides antibodies. A strong correlation was found between IgM antigangliosides and antigalactocerebrosides antibodies and NPM, but not with IgG class. IgM and IgG antibodies anticardiolipin were not correlated with NPM in this study. Both IgM antigangliosides and antigalactocerebrosides antibodies disappeared in seven patients with definite but clinically inactive NPM. The analysis of these autoantibodies showed an important role predictive for NPM in SLE; the negative test decreases the chance of the NPM.

Anticardiolipin antibodies in Behçet's syndrome: a predictor of a more severe disease.

A high incidence of anticardiolipin antibodies were detected in 7 of 20 patients (35%) with Behçet's Syndrome. Three patients had IgG-ab, three had IgM-ab and one had both IgG and IgM antibodies. IgG-ACA was detected mainly in patients with ocular disease (30%) and one of them also has cerebral vascular disease. A lower incidence of ACA was found in the patients taking steroids compared with the ones taking other drugs. This work draws attention to the more severe disease present in patients with ACA and also the possibility of such tests become negative in patients taking immunosuppressive drugs.

Anticardiolipin antibodies in patients with rheumatoid arthritis.

Anticardiolipin antibodies (ACA) were assayed by ELISA in 73 patients with rheumatoid arthritis. Twelve (16.48%) patients showed levels of ACA three standard deviations above the value of the control group and were considered positive; these patients were compared to the group with ACA within the normal levels regarding the following clinical and laboratorial characteristics: spontaneous abortions, central nervous system involvement, systematization and activity of disease, alterations in platelet counts, presence of antinuclear antibodies and rheumatoid factor. Significant statistical association could be demonstrated between systematization and presence of antinuclear antibodies (ANA) and positiveness to ACA (IgG, IgM or both). These findings might indicate that ACA in patients with RA could have relevance to morbidity of disease or perhaps to its pathogenesis.

Pericardial tamponade in juvenile dermatomyositis.

Cardiac involvement in dermatomyositis has been well described; myocarditis and cardiac arrhythmias are the most frequent manifestations. An 8-year-old girl is presented, who developed pericardial tamponade in the course of the disease. It is the first time this association has been reported.

Comparison of five methods for the detection of antiribosomal P protein antibody.

1. We have compared the sensitivity and specificity of immunofluorescence, counterimmunoelectrophoresis, immunodiffusion, Western blotting and ELISA for the detection of antiribosomal P protein antibodies using 153 lupus sera. 2. Western blotting and ELISA were the 2 most sensitive and specific techniques for the detection of these antibodies. In contrast, cytoplasmic immunofluorescence was observed in only one third of the anti-P-positive patients. Immunodiffusion and counterimmunoelectrophoresis, although highly specific, detecting 14% and 29% of all anti-P-positive sera by Western blotting, were the least sensitive tests. 3. The frequency of anti-P in lupus patients, as detected by Western blotting analysis was 18%. The most frequently observed antibody in anti-P sera was anti-Ro/SSA (39%). Anti-P antibodies were also detected in the sera of 3 patients with negative nuclear immunofluorescence. 4. Anti-P is an additional serological marker for systemic lupus erythematosus and Western blotting is the method of choice for detecting this antibody due to the limited availability of the fusion protein in Brazil.

The low hydroxyproline content of prematurely ruptured human fetal membranes.

Since collagen is one of the main factors responsible for the mechanical properties of soft tissue, we have determined the hydroxyproline content of the placental amnion, the free amnion and the chorion of 32 unruptured and 25 prematurely ruptured human fetal membranes. The hydroxyproline content of prematurely ruptured membranes was approximately 50% lower than in unruptured membranes. Hydroxyproline (microgram/mg lyophilized tissue), reported as mean +/- SD, was: 19.46 +/- 3.60 vs 37.53 +/- 8.93 for placental amnion; 16.97 +/- 3.93 vs 33.00 +/- 8.25 for free amnion, and 7.74 +/- 3.00 vs 13.23 +/- 3.95 for the chorion. This finding and the known decrease of hydroxyproline content of the amnion towards the end of gestation in normally evolving pregnancies suggest that an abnormally low collagen content may be the general cause of prematurely ruptured human fetal membranes.

Antibodies to new cytoplasmic autoantigens: anti-JA, a potential marker for disease activity in systemic lupus erythematosus.

1. We describe new autoantibodies which recognize two cytoplasmic proteins of 30 and 26 kDa. They were detected by Western blot analysis in the sera of 6 of 79 randomly selected systemic lupus erythematosus (SLE) patients and are denoted anti-JA antibodies. This antibody specificity is different from the previously described lupus autoantibodies, anti-P and anti-S10. 2. The targeted autoantigens are trypsin sensitive, and resistant to RNase and DNase treatment. The binding to the antigens was not modified when reticulocyte ribosomes were prepared with protease inhibitors indicating that these are primary antigens and not degradation products. Several lines of evidence suggest that these proteins are almost certainly part of the ribosome. 3. Anti-JA reactivity was not observed in the sera from 60 patients with other autoimmune diseases or from normal individuals. In contrast, 55% of lupus sera selected for a high titer of anti-dsDNA (double stranded DNA) and LE cells were also anti-JA positive. 4. Anti-JA antibodies may be useful as a specific serological marker for disease activity in SLE. The strong association with anti-dsDNA antibodies and LE cell in the sera of SLE patients requires further study.

Antiphospholipid antibodies in syphilis.

1. An enzyme-linked immunosorbent assay was used to determine the phospholipid specificity of antibodies present in sera from 35 syphilis patients. 2. Based on the cross-reaction obtained against a mixture of cardiolipin, phosphatidylcholine and cholesterol that is standard for flocculation tests according to the Venereal Disease Research Laboratory (CECON, São Paulo, Brazil), all 35 patients tested positive for antibodies of the IgG class whereas 13 (37%) also had IgM antibodies for the same mixture of lipids. IgG antibodies to cardiolipin were demonstrated in 2 patients (6%) and IgM antibodies in 5 (15%). Significant levels of IgG anti-phosphatidylcholine were detected in 3 patients (9%) and IgM antibodies in 4 (11%). IgG anti-phosphatidylethanolamine antibodies were found in 1 patient (3%) and IgM antibodies in 3 (9%). Antibody binding to cardiolipin plus cholesterol or cardiolipin plus phosphatidylcholine was as effective as when the standard mixture of all 3 lipids was used. 3. A comparison with serum from systemic lupus erythematosus patients and inhibition studies using liposomes of cardiolipin or the mixture of 3 lipids suggests that there are at least 3 groups of anticardiolipin antibodies.

Mycobacterial subcutaneous arteritis.

The authors report three patients with subcutaneous erythematous nodules in different phases of development, unspecific systemic symptoms, positive PPD test, and normal chest X-rays. The histopathological study of the older nodules showed a granulomatous arteritis with a few acid-fast bacilli in the vascular wall. The nodules at an early phase showed an unspecific panniculitis with some acid-fast bacilli in apparently normal cutaneous vessels. These findings suggest that the mycobacterium has a vascular tropism and may cause a primary granulomatous arteritis.

[Myasthenia gravis induced by D-penicillamine in a patient with progressive systemic sclerosis]. / Miastenia grave induzida por D-penicilamina em paciente com esclerose sistêmica progressiva.

The development of autoimmune diseases in some patients treated with D-penicillamine (DPA) suggests that the reported occurrence of a conduction disorder at the neuromuscular junction and the development of a reversible myasthenia gravis in rheumatoid disease, progressive systemic sclerosis or Wilson's disease after the use of DPA are part of a general predisposition for autoimmune disease related to DPA therapy. The case reported is an example. The DPA- induced myasthenia gravis (MG) is similar to the spontaneous MG clinically and electrophysiologically, though ocular signs prevail in the former. Antibodies to acetylcholine receptor have been demonstrated and thymic hyperplasia also has been formed. Regarding the onset of myasthenic manifestations the duration of the treatment with DPA varies from 6 to 10 months. The action of DPA on the neuromuscular junction is different from that occurring in spontaneous MG. The pathogenesis of the DPA induced MG is still obscure. The chemical properties of DPA permit it to react with many proteins and some alteration of proteins may appear, with structural changes in the composition and antigenicity of the collagen fibers. In vitro DPA causes disorder of acetylcholine receptor bridges to alpha, beta, gamma sub-units with reduction of the S-S bridges in the gamma-subunit. This decreases the linkage of high affinity and abolishes its positive cooperative system, reducing the S-S connection in the alpha-unit near the acetylcholine linkage. The interaction between DPA and receptor may induce antigenic alteration in this latter, starting the autoimmune phenomena. The other possibility is the stimulation of prostaglandin E-1 synthesis by DPA may fill the allosteric place of ACh receptor, interfering on the neuromuscular junction.

[Dermatopolymyositis: evaluation of 63 patients]. / Dermatopolimiosite: avaliação de 63 pacientes.

Sixty-three patients with dermatopolymyositis were evaluated from the clinical, laboratory and therapeutical aspects during a period of 15 years: 39 are women and 24 men. The mean age was 36.8 +/- 15.6 years. No correlation was observed between clinical and isolated therapeutics employed; when corticosteroids and cytolytic drugs were used simultaneously, the clinical response was satisfactory. No special fact was seen that can predict the therapeutical response.

Possible mechanisms of chronic leprosy-related arthritis.

Microbial agents induce arthritis through mechanisms such as direct infiltration of tissue and by inducing autoimmune phenomena. The mechanisms involved in this last type of arthritis have been investigated. In experimental models of adjuvant and reactive arthritis, the involvement of T cells in some cases mycobacteria in the development of arthritis have been confirmed. Cross-reactivity between the 65 kD mycobacterial protein and cartilage proteoglycans has been postulated as a possible mechanism. In this study, chronic peripheral arthritis was observed in patients with Hansen's disease, in patients with resolved Hansen's and in those with paucibacillary forms. This arthritis was not related to reactional states (erythema nodosum leprosum and reversal reaction), in contrast to several reports in the literature. The mechanisms by which microbes could induce chronic arthritis are discussed herein.

Humoral immunity in Hansen's disease.

For many years immune response in leprosy has been studied. Since 1960 several reports dealing with humoral immunity have been described in the literature. Different autoantibody rates occur in leprosy. There is an increase in the prevalence of autoantibodies in elderly patients with long standing disease, in lepromatous leprosy and in those with reactional states. The differences in rates among various studies are attributed to different methods and variations among patient samples concerning age, gender, polar forms, therapy and other elements. The prevalence of numerous antibodies, immune complexes, cryoglobulins and complement levels have been studied by many authors. This also highlights the importance of the more recent reviews of anti-Mycobacterium leprae glycolipid antibodies such as the anti-phenolic glycolipid-I antibodies in which titers are variable and depend on genetic factors.

Action of the 4-nitro-2-phenoximethanesulphonanilide (nimesulide) on neutrophil chemotaxis and superoxide production.

4-nitro-2-phenoximethanesulphonanilide (nimesulide) is a nonsteroidal anti-inflammatory agent that has been employed in the treatment of inflammatory diseases because of its specific actions on the inflammatory response mechanisms caused by injury. The objectives of this paper were to determine the action of this agent on two notable neutrophil functions, chemotaxis and production of the superoxide anion. These two functions were studied after the neutrophils were pre-incubated with three different concentrations of 4-nitro-2-phenoximethanesulphonanilide (0.1; 0.3 and 0.5 mN). The results obtained herein demonstrated that 4-nitro-2-phenoximethanesulphonanilide-exposed peripheral blood neutrophils from healthy subjects produced significantly less superoxide when challenged by phorbolmirystate acetate (PMA at 50 ng/ml) or formy-methionil-leucyl-phenilalanine (FMLP 10-7 M) and opsonizided zymozan (1 mg/ml). Additionally, the agent was equally effective in reducing the PMN chemotoaxis when challenged by C5a factor (2% zimozan activated solution), FMLP 10-9 M and leukotrien (3.10-7 M). The results obtained suggest that in addition to its interference in the metabolism of the aracdonic acid, the 4-nitro-2-phenoximethanesulphonanilide may interfere in a more direct fashion with the neutrophil function. This specific action may contribute to its anti-inflammatory activity.

Chronic active hepatitis associated with anti-liver-kidney microsome antibody type 1.

A 3 years old girl presented with clinical feature of an acute hepatitis-like illness, with jaundice, hepatosplenomegaly, high alanine aminotransferase activity (ALT) and high gamma-globulin values. We were able to demonstrate high titre of anti-liver-kidney microsome antibodies type 1 (LKMA1) in the serum of this patient using immunofluorescence, ELISA (Enzyme-linked immunoabsorbent assay) and Western blot (WB) analysis. This observation together with the liver morphology and after excluding other possible causes of hepatitis established the diagnosis of chronic active hepatitis associated with anti-LKM1 antibody. Immunosuppressive therapy was therefore started immediately.

[Quantification of serum interference in immune complex phagocytosis in seronegative spondylarthropaties, systemic lupus erythematosus, and rheumatoid disease]. / Quantificação da interferência do soro na fagocitose de imunocomplexos nas espondiloartropatias soronegativas, lúpus eritematoso sistêmico e doença reumatóide.

Pathological samples (55) of serum selected from patients with Seronegative Spondylarthropathies, Systemic Lupus Erythematosus and Rheumatoid Disease were studied. The serum of all these patients showed negative rheumatoid factor by latex fixation reaction. The determination of the interference on the phagocytosis of gamma globulin aggregated by guinea pig's macrophages was obtained by one formula. The serum characterization was determined by selecting the ones that presented the most expressive results in the phagocytosis interference, by facilitation or inhibition. The results, in absolute and percentage values, showed the predominance of the interference phenomenon in phagocytosis, with significant statistical values (p < 0.05), when compared with normal serum. The comparative analysis among the diseases studied in the quantification of the serum interference in the phagocytosis of the immunocomplexes has not showed any significant difference. The phagocytosis inhibition occurred with more preponderance in the serum of patients with Reiter's Syndrome and Psoriatic Arthritis; in serum patients with Reiter's Syndrome there was a statistically significant difference in the inhibition of the phagocytosis (p = 0.0247). The serum characterization did not show that the serum fraction was responsible for the phagocytosis interference. In this stage it has been verified that there has not been an uniformity in the graphic curve of dilutions studied. The possibility of the existence of more than one element with interference in the phagocytosis of the studied immunocomplexes was mentioned.

[Primary erythromelalgia]. / Eritromelalgia primária.

Erythromelalgia is a rare disease characterized by intense erythema, burning pain and increased temperature in the distal of the extremities. Primary forms and secondary forms have been described, most commonly with essential thrombocythemia and policythemia vera. The authors describe a fifteen year old patient with primary erythromelalgia and discuss the pathogenic, clinical and therapeutic features of this disease.