Psychiatric kibitzing.

Foreword from Dr. Sharfstein: In this era of managed care, utilization review, and concerns about costs, a clinician-reviewer who knows little about a case may make a decision that profoundly affects the course of a patient's treatment. Although Dr. Houghton's timely essay does not involve a managed care or utilization reviewer, it serves to remind us about the dangers inherent in criticizing the work and the judgment of other clinicians.

Parenterally transmitted non-A, non-B hepatitis: virus-specific antibody response patterns in hepatitis C virus-infected chimpanzees.

An established chimpanzee model of parenterally-transmitted non-A, non-B hepatitis was used to define virus-specific immune response patterns in acutely and persistently infected animals. Serial bleedings were obtained from 23 chimpanzees that had been experimentally infected with an isolate of hepatitis C virus, originally recovered from contaminated lots of factor VIII (antihemophilic) materials. Sera were assayed for the presence of antihepatitis C virus by a newly developed radioimmunoassay procedure that incorporated recombinant DNA-expressed viral antigen as a reagent. Twenty-one of 23 hepatitis C virus infected animals were shown to acquire antihepatitis C virus, most within 2-8 weeks after the major peak of alanine aminotransferase activity. All chimpanzees with biochemical, electron microscopic, and histological evidence of chronic disease clearly acquired antibody; 14 of 16 animals observed through the acute phase of disease were also shown to acquire antibody. A booster effect or anamnestic response was noted in two chimpanzees (one of which was negative for antihepatitis C virus following the acute phase of disease) after challenge with hepatitis C virus. Antihepatitis C virus was not neutralizing, because some animals with high levels of antibody were also shown to have high titers of circulating hepatitis C virus. The development and maintenance of anti-hepatitis C virus appears to reflect concomitant virus replication and high potential for infectivity.

Allospecific T cell recognition of HLA-A2 antigens: evidence for group-specific and subgroup-specific epitopes.

Interleukin 2-dependent alloreactive cytotoxic T cell lines, with activity predominantly directed against the HLA-A2 antigen, have been generated in vitro by stimulating blood mononuclear cells from donors nonimmune to the Epstein-Barr (EB) virus with appropriate numbers of EB virus-transformed B cells from A2-homozygous individuals. Such effector cells were tested against a panel of EB virus-transformed target cell lines all expressing the serologically defined A2 antigen but typed into "common A2" and "variant A2" subgroups on the basis of their recognition by A2-restricted EB virus-specific cytotoxic T cells. "Variant A2" responder cells cocultivated with "common A2"-bearing stimulators gave rise to effector T cell lines which recognized only the "common A2"-bearing subgroup of targets. By contrast, responder cells from A2-negative donors stimulated with "common A2"-bearing cells produced effector T cell lines in which the strong lysis of "common A2"-bearing targets was accompanied by a lower, but still significant, lysis directed against all targets within the "variant A2" subgroup. In both cases, lysis of the target cells was blocked equally well by the anti-A2-specific monoclonal antibody MA2.1 as by the monoclonal antibody W6/32 specific for HLA-A, -B, and -C determinants. This suggests that HLA-A2 molecules possess at least two distinct sets of epitopes capable of inducing alloreactive T cell cytotoxicity: first, epitopes probably associated with T cell-restricting sites, which generate subgroup-specific responses, and second, epitopes shared by all A2 molecules, and perhaps associated with serologically defined sites, which generate "pan A2" group-specific responses.