Similar localization of conformational IgE epitopes on the house dust mite allergens Der p 5 and Der p 21 despite limited IgE cross-reactivity.

BACKGROUND: Due to high IgE recognition frequency and high allergenic activity, Der p 5 and Der p 21 are clinically important house dust mite (HDM) allergens. The objective of this study was to characterize the immunodominant IgE epitopes of Der p 5 and Der p 21 responsible for their high allergenic activity. METHODS: A panel of 12 overlapping peptides spanning the Der p 5 and Der p 21 sequence were synthesized to search for sequential IgE epitopes by direct testing for allergic patients' IgE reactivity. Peptide-specific antibodies raised in rabbits were used in inhibition studies for localizing conformational IgE epitopes which were visualized on the surfaces of the allergen structures by molecular modelling. IgE cross-reactivity between the allergens was investigated by IgE inhibition studies. RESULTS: Immunodominant IgE epitopes defined by allergic patients' IgE on Der p 5 and Der p 21 were primarily of the conformational, discontinuous type including N- and C-terminal portions of the protein. They could be located on each allergen on one area with similar localization, but despite similar structure of the allergens, no relevant IgE cross-reactivity could be detected. CONCLUSION: Our study shows that Der p 5 and Der p 21 contain a major conformational IgE epitope-containing area located on similar portions of their structure, but they lack relevant IgE cross-reactivity. These data are important for the development of modern allergy vaccines based on defined molecules for allergen-specific immunotherapy of HDM allergy.

Isolation of a high-affinity Bet v 1-specific IgG-derived ScFv from a subject vaccinated with hypoallergenic Bet v 1 fragments.

BACKGROUND: Recombinant hypoallergenic allergen derivatives have been used in clinical immunotherapy studies, and clinical efficacy seems to be related to the induction of blocking IgG antibodies recognizing the wild-type allergens. However, so far no treatment-induced IgG antibodies have been characterized. OBJECTIVE: To clone, express, and characterize IgG antibodies induced by vaccination with two hypoallergenic recombinant fragments of the major birch pollen allergen, Bet v 1 in a nonallergic subject. METHODS: A phage-displayed combinatorial single-chain fragment (ScFv) library was constructed from blood of the immunized subject and screened for Bet v 1-reactive antibody fragments. ScFvs were tested for specificity and cross-reactivity to native Bet v 1 and related pollen and food allergens, and epitope mapping was performed. Germline ancestor genes of the antibody were analyzed with the ImMunoGeneTics (IMGT) database. The affinity to Bet v 1 and cross-reactive allergens was determined by surface plasmon resonance measurements. The ability to inhibit patients' IgE binding to ELISA plate-bound allergens and allergen-induced basophil activation was assessed. RESULTS: A combinatorial ScFv library was obtained from the vaccinated donor after three injections with the Bet v 1 fragments. Despite being almost in germline configuration, ScFv (clone H3-1) reacted with high affinity to native Bet v 1 and homologous allergens, inhibited allergic patients' polyclonal IgE binding to Bet v 1, and partially suppressed allergen-induced basophil activation. CONCLUSION: Immunization with unfolded hypoallergenic allergen derivatives induces high-affinity antibodies even in nonallergic subjects which recognize the folded wild-type allergens and inhibit polyclonal IgE binding of allergic patients.

Fusion proteins consisting of Bet v 1 and Phl p 5 form IgE-reactive aggregates with reduced allergenic activity.

The cross-linking of effector cell-bound IgE antibodies by allergens induces the release of inflammatory mediators which are responsible for the symptoms of allergy. We demonstrate that a recombinant hybrid molecule consisting of the major birch (Bet v 1) and grass (Phl p 5) pollen allergen exhibited reduced allergenic activity as compared to equimolar mixes of the isolated allergens in basophil activation experiments. The reduced allergenic activity of the hybrid was not due to reduced IgE reactivity as demonstrated by IgE binding experiments using sera from allergic patients. Physicochemical characterization of the hybrid by size exclusion chromatography, dynamic light scattering, negative-stain electron microscopy and circular dichroism showed that the hybrid occurred as folded aggregate whereas the isolated allergens were folded monomeric proteins. IgG antibodies raised in rabbits against epitopes of Bet v 1 and Phl p 5 showed reduced reactivity with the hybrid compared to the monomeric allergens. Our results thus demonstrate that aggregation can induce changes in the conformation of allergens and lead to the reduction of allergenic activity. This is a new mechanism for reducing the allergenic activity of allergens which may be important for modifying allergens to exhibit reduced side effects when used for allergen-specific immunotherapy.

Priming of the fluid pump by osmotic gradients across rabbit corneal endothelium.

The present study shows that the inclusion of 5% Dextran (average mol. wt. 40 000) in solutions to preserve in vitro rabbit corneal endothelium induces a sizable osmotic flow across the preparation which is superimposed on the existing fluid transport. Furthermore, even after fluid transport ceases due to in vitro deterioration, the Dextran-induced flow remains for some addition time. The osmotic permeability was 162 +/- 17 micrometer/s in the presence of glucose and 451 +/- 84 micrometer/s in its absence. The latter, comparatively high value suggests that such osmotic flow traverses the intracellular junctions. In addition, temporary (10--15 min) imposition of an osmotic gradient has a separate stimulatory 'priming' effect on the rate of fluid transport. Thus, the rate of fluid pumping increased by about 40% after challenge with Dextran. It was further noted that, after addition of Dextran, preparations in the absence of glucose escape gross deterioration for a time longer than those in the presence of glucose. On the other hand, mere addition of Dextran to a glucose-containing solution does not appear to prolong the estimated 'survival time' of the pumping mechanism. The sizable osmotic flows and the priming effect described here may provide a physiological context with which previously described Dextran effects on cornea preservation can now be compared.

Essential role of the beta subunit in modulation of C-class L-type Ca2+ channels by intracellular pH.

Elevation of intracellular pH (pHi) enhances the activity of native L-type Ca2+ channels in cardiac and smooth muscle. We studied the modulation by pHi of expressed L-type Ca2+ channels comprised of either the alpha1c subunits alone or of alpha1c plus beta2a subunits. Ca2+ channels were expressed in human embryonic kidney cells (HEK 293) and pHi was increased from a basal level of 7.3 to 8.3 by exposure of cells to NH4Cl (20 mM) or by elevation of extracellular pH to 8.5. Elevation of pHi enhanced the activity of Ca2+ channels derived by coexpression of alpah1c and beta2a subunits. This alkalosis-induced stimulation of channel activity was mainly due to an increase in channel availability. Channels derived by expression of alpha1c alone were not affected by intracellular alkalosis. Our results demonstrate that the pHi sensitivity of L-type Ca2+ channels is conferred by the beta subunit of the channel complex.

Whole-body PET imaging with [18F]fluorodeoxyglucose in management of recurrent colorectal cancer.

HYPOTHESIS: Metabolic imaging by positron emission tomography (PET) using [18F]fluorodeoxyglucose will be more accurate than anatomic imaging by computed tomography (CT) for detection of recurrent colorectal cancer. More accurate staging of recurrent tumor by PET will lead to more appropriate management decisions. DESIGN: Prospective blinded study comparing PET with CT, using histologic diagnosis, serial CT imaging, and clinical follow-up as criterion standards, with a fully blinded, retrospective reinterpretation of PET studies. Changes in diagnosis resulting from PET findings were correlated with subsequent treatment and surgical findings. Potential cost savings resulting from use of PET for preoperative staging were calculated. SETTING: Private practice in an outpatient tertiary referral center. PATIENTS: A group of 155 consecutive patients with imaging for diagnosis or staging of recurrent colorectal cancer. Twenty-one patient (14%) were excluded due to lack of a criterion standard. Computed tomographic scans were available for comparison for 115 patients. RESULTS: Positron emission tomographic scan sensitivity and specificity were 93% and 98%, respectively, compared with 69% and 96% for CT. Ninety-five percent confidence intervals for the differences between the modalities were 16% to 32% for sensitivity and 1% to 5% for specificity. The sensitivity of both modalities varied with anatomic site of recurrence. Positron emission tomographic scans were true positive in 12 (67%) of 18 patients with elevated serum carcinoembryonic antigen levels and negative CT findings. In 23 (29%) of 78 preoperative studies in which CT showed a single site of recurrence, PET showed tumor at additional sites. At surgery, nonresectable, PET-negative tumor was found in 7 (17%) of 42 patients who had PET evidence of localized recurrence only. Potential savings resulting from demonstration of nonresectable tumor by PET were calculated at $3003 per preoperative study. CONCLUSIONS: Positron emission tomography was more sensitive and specific than CT for detection of recurrent colorectal cancer. Preoperative detection of nonresectable tumor by PET may avoid unnecessary surgery, and thereby reduce the cost of patient treatment.

Staging non-small cell lung cancer by whole-body positron emission tomographic imaging.

BACKGROUND: A need exists for an accurate, noninvasive means of staging non-small cell lung cancer. METHODS: A prospective evaluation of regional and whole-body positron emission tomography (PET) imaging for staging lung cancer was carried out in 99 patients. Mediastinal PET and computed tomography findings were compared with results of surgical staging in 76 patients. Those PET and computed tomography findings that indicated possible distant metastasis were compared with biopsy results and the results of clinical and imaging follow-up. RESULTS: Sensitivity and specificity for the diagnosis of N2 disease were 83% and 94% for PET and 63% and 73% for computed tomography, respectively. Positron emission tomography showed previously unsuspected distant metastasis in 11 patients (11%), with no demonstrated false-positive results. Normal PET findings were obtained at distant sites of computed tomography abnormality in 19 patients (19%). Clinical and imaging follow-up in 14 of these patients showed no evidence of metastasis. In 1 case, the PET result proved to be falsely negative. CONCLUSIONS: Imaging with PET was more accurate than computed tomography for diagnosis of mediastinal and distant metastasis. Detection of unsuspected metastatic disease by PET may permit reduction in the number of thoracotomies performed for nonresectable disease.

Oxidation of fluorescent glycero- and sphingophospholipids in human plasma lipoproteins: alkenylacyl subclasses are preferred targets.

OBJECTIVES: Oxidation of polyunsaturated fatty acids in lipoproteins is supposed to play a crucial role at the early stages of atherogenesis. The polyunsaturated lipids (PUFAs) become oxidized and, thus, the degree and rate of lipid oxidation depend on their concentration and, probably, on the lipid moiety to which they are attached. DESIGN AND METHODS: To determine the relative oxidation susceptibilities of sphingo- and glycerolipid-bound fatty acyl chains, we used fluorescent analogs of the respective compounds, in which one natural fatty acyl chain was replaced by fluorescent diphenylhexatriene propionic acid. RESULTS: Oxidation susceptibilities of the fluorescent acyl chains in the presence of Cu2+ or AAPH depended, in general, on the phospholipid to which they were bound and the lipoprotein. Phospholipids were oxidized faster in HDL than in LDL or Lp(a). Plasmalogens were more susceptible to oxidation than phosphatidylcholine and sphingomyelin. CONCLUSION: Thus, HDL and plasmalogens may be considered as preferred targets of lipid oxidation before the bulk of polyunsaturated phospholipids (mainly phosphatidylcholine) in LDL is subject to free radical attack.

A new fluorescence method for the continuous determination of surface lipid oxidation in lipoproteins and plasma.

We report on a new method for the determination of lipid oxidation in lipoproteins and plasma. The biological lipid system is preloaded with a fluorescent analog of phosphatidylcholine containing diphenylhexatriene (DPH) propionic acid covalently linked to the sn-2 position. When externally added, the respective phospholipid label (DPHPC) localizes to the surface monolayer of a lipoprotein. Under oxidative conditions (e.g. in the presence of Cu2+ ions) the fluorophore undergoes decomposition, resulting in a continuous decrease of fluorescence intensity which reflects the oxidation of a chemically defined phospholipid molecule with well defined localization. When incorporated into LDL particles, the kinetics of the decrease in DPHPC fluorescence intensity upon exposure to Cu2+ us very similar to that of conjugated diene accumulation. Furthermore, our assay can be applied to follow the oxidation of lipids in diluted serum and may also be developed into a suitable test system for clinical studies of susceptibility of plasma lipids to oxidation.

[Egr-1 transcription factor regulates the growth of glomerular mesangium cells]. / Der Transkriptionsfaktor Egr-1 reguliert das Wachstum glomerulärer Mesangiumzellen.

BACKGROUND: The transcriptional regulator Early growth response gene-1 (Egr-1) is rapidly and transiently induced by various mitogens in cultured rat mesangial cells (MCs). METHOD AND RESULTS: Here we show Egr-1 induction in an in vivo model of mesangioproliferative glomerulonephritis (GN). A 14.9-fold increase in Egr-1 mRNA was observed 6 days after disease induction. A concomitant increase in Egr-1 protein was demonstrated by immunocytochemistry. Egr-1 was mainly localized to the nuclei of cells in mesangial localization. To test whether Egr-1 directly regulated MC proliferation, we preincubated cultured MCs with antisense oligonucleotides directed against Egr-1. The platelet-derived growth factor (PDGF)-induced increase in Egr-1 mRNA and protein levels was inhibited by 75% and 74%, respectively. At the same time Egr-1 antisense oligonucleotides dose-dependently inhibited MC-proliferation as determined by thymidine-uptake by up to 75%. Control oligonucleotides were without effects on Egr-1 mRNA, protein or MC growth. CONCLUSION: We conclude that Egr-1 induction is a necessary step in the mitogenic signaling cascade in glomerular MCs.

[Importance of helicopter rescue]. / Stellenwert der Hubschrauberrettung.

Helicopter emergency medical service (HEMS) have become a main part of prehospital emergency medical services over the last 40 years. Recently, an ongoing discussion about financial shortage and personal shortcomings question the role of cost-intensive air rescue. Thus, the value of HEMS must be examined and discussed appropriately. Since the number of physician-staffed ground ambulances may decrease due to the limited availability of qualified physicians, HEMS may fill the gap. In addition patient transfer to specialized hospitals will require an increasing number of air transports in order to minimize prehospital time. The higher risk ratio for HEMS missions when compared with ground rescue requires a rigorous quality management system. When it comes to missions in remote and exposed areas, the scope of medical treatment must be adjusted to the individual situation. Medical competence is key in order to balance guideline compliant or maximal care versus optimal care characterized as a mission-specific, individualized emergency care concept. Although, medical decision making and treatment is typically based on the best scientific evidence, personal skills, competence, and the mission scenario will determine the scope of interventions suitable to improve outcome. Thus, the profile of requirements for the HEMS medical crew is high.

Neuropeptide Y modulates steroid production of human adrenal H295R cells through Y1 receptors.

Neuropeptide Y (NPY) is abundantly expressed in the nervous system and acts on target cells through NPY receptors. The human adrenal cortex and adrenal tumors express NPY receptor subtype Y1, but its function is unknown. We studied Y1-mediated signaling, steroidogenesis and cell proliferation in human adrenal NCI-H295R cells. Radioactive ligand binding studies showed that H295R cells express Y1 receptor specifically. NPY treatment of H295R cells stimulated the MEK/ERK1/2 pathway, confirming that H295R cells express functional Y1 receptors. Studies of the effect of NPY and related peptide PYY on adrenal steroidogenesis revealed a decrease in 11-deoxycortisol production. RIA measurements of cortisol from cell culture medium confirmed this finding. Co-treatment with the Y1 antagonist BIBP2336 reversed the inhibitory effect of NPY on cortisol production proving specificity of this effect. At mRNA level, NPY decreased HSD3B2 and CYP21A2 expression. However NPY revealed no effect on cell proliferation. Our data show that NPY can directly regulate human adrenal cortisol production.

Radioimmunoassay for immunoreactive non-collagenous domain of type IV collagen (NC1) in serum: normal pregnancy and preeclampsia.

The use of a magnetic separation agent in a modified radioimmunoassay for the non-collagenous cross-linked region (NC1) of basement membrane collagen is described. The rabbit anti-NC1 serum employed in the assay revealed a binding behaviour similar to that reported recently (Mark et al. (1985) Eur. J. Biochem. 146, 555-562; Schuppan et al. (1986) J. Clin. Invest. 78, 241-248) with respect to the integrity of NC1-disulphide bridges, affinity to NC1 subunits and lack of reactivity with other determinants of type IV collagen. Immunoreactive serum NC1, which increased towards the end of gestation, showed a broad peak during the second trimester of pregnancy. In preeclampsia, immunoreactive serum-NC1 was slightly elevated.

CT signs of duodenal perforation secondary to blunt abdominal trauma.

Two cases of duodenal perforation secondary to blunt abdominal trauma demonstrate CT findings of focal bowel wall thickening, interruption of progress of bowel contrast medium, and extraluminal gas and fluid.

[Is there greater danger of sports injury or osteoporosis caused by inactivity in patients with hip prosthesis? Sequelae for long-term stability of prosthesis anchorage]. / Ist die Gefahr der Sportverletzung oder die Gefahr der Inaktivitätsosteoporose beim Hüftprothesenträger grösser? Folgerungen auf die Dauerhaftigkeit von Prothesenverankerungen.

We found a lower rate of loosening of total hip replacement in patients exercising sports, than in inactive people. Accidents of sport have never been the cause of fractures in our patients.