Kinetics of IgM and IgA antibody response to 23-valent pneumococcal polysaccharide vaccination in healthy subjects.

PURPOSE: A poor antibody response of IgM and IgA antibodies upon vaccination with pneumococcal polysaccharides (PnPS) is discussed as independent risk factors for bronchiectasis in patients with antibody deficiency syndrome (ADS) receiving immunoglobulin replacement therapy. However, the kinetics of the specific IgM and IgA response to vaccination with multivalent pneumococcal polysaccharides requires a more detailed knowledge. In this study we aimed i) to develop a standardised multivalent PnPS-IgM and IgA-ELISA, and ii) to compare the sensitivity of the multivalent to the serotype specific antibody response, and iii) to determine the kinetics of the anti-PnPS IgM and IgA antibodies in healthy subjects. METHODS: We immunised n=20 healthy adults with a 23-valent PnPS vaccine (Pneumovax®). The kinetics of the 23-valent antibody response was assessed for 1 year with newly developed ELISAs for IgM and IgA isotypes, along with serotype specific responses. RESULTS: The IgA and IgM antibody response peaked at 2 and 3 weeks, respectively. IgM antibody levels remained at a plateau (above 80 % of peak response) for 3 months. After one year, specific antibody levels were still at about 30 % of the peak response. The 23-valent antibody response yielded significantly higher responder rates than assessment of single serotypes. CONCLUSION: Testing the IgM and IgA immune response to polysaccharide vaccination with a multivalent PnPS ELISA may be a feasible tool for assessment of the immune function in patient groups who receive IgG replacement therapy.

Paraneoplastic neurological antibodies: a laboratory experience.

Antineuronal antibodies are associated with rare paraneoplastic neurological syndromes, and their identification alerts clinicians to examine for the presence of a tumor. Presented here is laboratory experience (prevalence, difficulties, and procedures) and several interesting but inconclusive results. A total of 1045 samples were screened over a 2-year period; 91 showed a degree of binding of antibodies to the cerebellum, and 22 of these 91 were confirmed, by Western blot, to have specific antineuronal antibodies. Thirteen of 22 were Hu-positive, and 6 of these also had antinuclear antibodies. Six were Yo-positive, 2 had anti-Ma antibodies, and 1 was Tr-positive. An additional 27 of 91 patients had cerebellar antibodies giving recognized staining patterns (Hu, Yo, and Ma). However, Western blot did not confirm these specificities, and hence they were reported as atypical. Six of 27 of these patients had neoplasms; 3 of the 6 gave nucleolar patterns (not Ma). Two appeared similar to Yo, and 1 similar to Hu. Antineuronal antibodies are rare, and in the absence of a specific etiology patients should be examined further for the possible presence of an underlying tumor. Methodical classification of the antibodies must be conducted to avoid incorrect reporting. Further criteria on the typing/reporting of atypical results may aid diagnosis of paraneoplastic neurological syndromes.

Vocal cord medialization by transcutaneous injection of calcium hydroxylapatite.

Transcutaneous vocal cord augmentation has increasingly become the method of choice when treating causes of vocal cord insufficiency. Many substances have accompanied this technique, but they all have problems. One newer substance is calcium hydroxylapatite (CaHA). CaHA may produce fewer problems and offer a longer-lasting treatment. Twenty-one patients were treated in the Pacific Voice Clinic with trancutaneous injection of CaHA for vocal cord paralysis (n = 19) and vocal scarring (n = 2). Maximum phonation time (MPT) was the measure of vocal performance. An improvement was seen in 20 patients with the MPT, who improved from 4.6 seconds before treatment to 10.8 seconds at posttreatment of 3 months (n = 15). This improvement was maintained at 6 months (MPT = 12 seconds, n = 12). Follow-up was incomplete because of the terminal nature of some diagnoses and the large geographical area covered by the clinic. Three subjects had submucosal injection of CaHA (two resolving spontaneously). Two other patients had extrusion of the material. With short-term and medial-term follow-up on a small group of patients, encouraging results were seen with transcutaneous injection of CaHA for vocal cord augmentation.

Significant, quantifiable differences exist between IgG subclass standards WHO67/97 and ERM-DA470k and can result in different interpretation of results.

OBJECTIVES: Accurate measurement of IgG subclass (IgGSc) levels are essential to aid in the diagnosis of disease states such as primary immunodeficiencies. However, there is no single standardisation of nephelometric and turbidimetric assays for these analytes and two reference materials have been utilised. We expand on previous reports and present data from a multi-site analysis that both identifies and quantitatively defines the differences in calibration resulting from the use of different reference materials. DESIGN AND METHODS: IgGSc antibodies in the serum specimens and reference materials were measured according to the manufacturers' instructions using commercially available IgGSc assays or components. RESULTS: Data from four independent sites showed that in spite of the different commercial suppliers of IgGSc assays calibrating to different reference materials, ERM-DA470k and WHO67 /97, the resulting calibrations were comparable for IgG1 and IgG2. However, for IgG3 and IgG4 the calibrations were significantly different. The use of assay specific normal ranges should compensate for these calibration differences, however, the two manufacturers' assays can give differing clinical classifications. The agreement between the different manufacturers' IgGSc assays was between 85.1% and 95.8% for all IgGSc assays, the discordance of sample classification for IgG1 and IgG2 assays was approximately 12% and 15% respectively, whilst that for IgG3 and IgG4 was 4% and 13% respectively. CONCLUSION: We discuss the similarities and differences between assays that utilise the different reference materials.