Association of complement factor B allotypes and serum biomarkers in rheumatoid arthritis patients and their relatives.

The aim of the study was to investigate the allotypic variability of complement factor B (BF) in patients and relatives with rheumatoid arthritis (RA) and its association with serological biomarkers and clinical features of the disease. BF allotypes were determined by high-voltage agarose gel electrophoresis in serum samples of 180 patients with RA, 198 relatives and 98 controls from Southern Brazil. Anticyclic citrullinated peptide (anti-CCP), antimutated citrullinated vimentin (anti-MCV) and IgA-rheumatoid factor (RF) were determined by ELISA and IgM-RF by latex agglutination in all samples. No significant differences were found in the allotypic variants of BF between patients with RA, relatives and controls, nor associations with gender and age of RA onset. BF*S07 allotype was significantly associated with extra-articular manifestations (EAMs; Secondary Sjögren Syndrome, pneumonitis, rheumatoid nodules) in patients with RA (P = 0.02; OR = 6.62). Patients with phenotype BF F had lower positivity for anti-MCV biomarker (P = 0.02; OR = 0.22) and those with allotype BF*S had higher prevalence of this autoantibody (P = 0.02; OR = 3.77). An increased frequency of RF-IgA was detected in relatives of patients with RA with BF FS07 phenotype (P = 0.02; OR = 7.78). Complement BF variability did not influence the development of RA in the studied patients, but BF variants may act as markers of disease prognosis, such as development of EAMs, corroborating with the role of the alternative pathway in the pathogenesis of RA.

Avian IgY antibodies: characteristics and applications in immunodiagnostic / Anticorpos IgY aviário: características e aplicações em imunodiagnóstico

Immunoglobulin Y (IgY) is the major antibody isotype in birds, reptiles, amphibia, and lungfish, playing a similar biological role as mammal IgG. Due to its phylogenetic distance, immune diversification and presence in the egg yolk, IgY provide a number of advantages in immunodiagnostic compared to IgG from mammals. Moreover, IgY production is in agreement with international efforts to reduce, refine and if possible, to replace animals in experimentation, contributing substantially in favor of animal welfare. This article presents an overview about structural and functional features, production and applications of IgY in immunodiagnostic, as well as the advantages of chicken antibodies use.(AU)

A imunoglobulina Y (IgY) é a classe de anticorpos de maior importância em aves, répteis, anfíbios e peixes pulmonados, desempenhando um papel semelhante a IgG de mamíferos. Devido a sua distância filogenética, mecanismos de diversificação imune e presença na gema do ovo, IgY proporciona uma série de vantagens em imunodiagnóstico, quando comparada a IgG de mamíferos. Além disso, esse método alternativo de produção de anticorpo está de acordo com os esforços internacionais para reduzir, refinar e, se possível, substituir animais em experimentação, contribuindo substancialmente a favor do bem-estar animal. Este artigo apresenta uma revisão sobre as características estruturais e funcionais da IgY, bem como os métodos de produção, vantagens e aplicações em imunodiagnóstico, além das vantagens da sua utilização.(AU)

Clinical applications of immunoglobulin: update: [review]

Human immunoglobulin is the most used blood product in the clinical practice. Immunoglobulin applications have increased quickly since the elucidation of its immunomodulatory and antiinflammatory properties which turned this blood product into a precious tool in the treatment of numerous diseases that present with humoral immune deficiency or that cause immune system dysfunction. Currently, the approved indications for Ig are: primary immunodeficiencies, secondary immunodeficiencies (multiple myeloma or chronic lymphoid leukemia), Kawasaki syndrome, immune thrombocytopenic purpura, Guillain Barré syndrome, graft-versus-host disease following bone marrow transplantation and repeat infections in HIV children. On the other hand, there are numerous "off-label" indications of immunoglobulin, which represent 20-60 percent of all clinical applications of this drug. It is important to study all these indications and, above all, the scientific evidence for its use, in order to provide patients with a new therapeutic option without burdening the health system. This review results from a wide selection of papers identified in the Pubmed and Lilacs scientific electronic databases. A group of descriptors were used from human immunoglobulin to the names of each disease that immunoglobulin is clinically applied. Our main objective is to list the numerous indications of immunoglobulin, both authorized and "off-label" and to analyze these indications in the light of the most recent scientific evidence.

Deficiência de anticorpos anti-polissacarídicos: relato de casos / Impaired polysaccharide responsiveness: cases report

Introdução: A deficiência de anticorpos antipolissacaride ou deficiência parcial de anticorpos é considerada uma dasquatro imunodeficiências mais comuns da infância e sua principal manifestação são as infecções bacterianas repetitivas das vias aéreas.Descrição: São relatados casos de três pacientes com historta de infecções de repetição de diferentes evoluções cujaavaliação imunológica demonstrou uma produção alterada de anticorpos ao Streptococcus pneumoniae após imunização para os sorotipos testados, embora apresentasse níveis normais deimunoglobulinas, cuja instalação de um tratamento adequado promoveu a redução nas infecções bem como da qualidade de vida desses pacientes.Comentários: A grande maioria dos pacientes com deficiência de anticorpos antipolissacaride necessita de tratamento antibiótico agressivo nas infecções, cursos de antibióticos profiláticos, e em alguns casos, de terapia de reposição de imuneglobulinas.Alguns pacientes podem se beneficiar da vacinação heptavalente conjugada para o S.pneumoniae. É necessárioampliar a informação médica com relação ao diagnóstico apresentadonessa série, bem como, melhorar a rede laboratorial de propedêutica diagnóstica para permitir a identificação dessa patologia.

Introduction: Impaired polysaccharide responsiveness or partial antibodies defect is considered one of the four mostcommon immunodeficiencies in pediatric patients and is characterized by recurrent bacterial respiratory infectlons.Description: Three cases are related with a recurrent infections history with different evaluations, which immunological evaluations showed impaired antibodies response againstStreptococcus pneumoniae after immunization for tested serotypes,although presented normal leveis of immunoglobulin. The adequate treatment reduced the number and severity of infections and improved the patient's quality of life.Comments: The majority of patients with impaired polysaccharide responsiveness require aggressive antibiotic treatmentduring infections, serres of prophylactic antibiotics, and, rarely, IgG replacement. Some patients may clinicai benefit from írnmunization with the conjugate vaccine to S.pneumoniae. It'simportant to improve the medical information about the presenteddiagnosis, in addition to amplify the number of practiced laboratories to better identification of this disease.

Genetic interactions of KIR and G1M immunoglobulin allotypes differ in obese from non-obese individuals with type 2 diabetes.

We analyzed the natural killer cell immunoglobulin-like receptor (KIR) genes and immunoglobulin allotypes in the development of type 2 diabetes (T2D) based on body mass index (BMI) measurements (obese vs. non-obese) in Puerto Rican Americans. Genetic interactions between the KIR haplotype A homozygotes (HAH) and its fraction containing two inhibitory receptors 2DL3 and 2DL1 and the activating receptor 2DS4 with immunoglobulin allotypes were studied. We found a significant association between the HAH and T2D (p=0.002; OR=7.97) and its interaction with the immunoglobulin allotype z: GM f/f (-) (p=<0.0001; OR, not determined) only in non-obese individuals. This association were due to the interactions between the 2DL3/2DL3, 2DL1/2DL1, and 2DS4 fragment with GM f/f (-) in T2D patients (p=0.0017; OR=3.45). Analysis based on BMI demonstrated associations in both obese (p=0.037; OR=2.43; 95% CI=0.97-6.31) and non-obese individuals (p=<0.0001; OR=8.38; 95% CI=2.49-29.31). By contrast, the interaction of the GM allotype f/f (-) with the HAH fragment was associated with T2D only in non-obese individuals (p=<0.0001; OR=18.2; 95% CI=3.71-113.4). As expected, interaction of both HAH and its fragment with HLA-C group's ligands were significant. We used informative short tandem repeats (STRs) that distinguish major populations to determine genetic admixture and found that there was no genetic stratification in our cohort. Our findings are consistent with the possibility of an autoimmune and/or innateimmune component in the pathogenesis of T2D: NK receptors with chronic inflammation in obese and genetic interactions with G1M allotype in T2D non-obese possibly mediating autoimmunity.

Immunogenicity of autologous immunoglobulins: principles and practices.

The immunogenicity of immunoglobulin idiotypes in syngeneic systems is a rather rare phenomenon. Very few studies have attempted to determine the mechanisms underlying the anti-idiotypic response that certain autologous idiotypes can elicit. Furthermore, the studies addressing a possible physiological role for such behaviors are even less. In the present article, the results of the characterization of a highly immunogenic idiotype are reviewed and compared with some related works on the subject. We finally propose a possible immunoregulatory role for idiotypic immunogenicity.

Porque usamos imunoglobulina anti-D em excesso no abortamento precoce? / Why do we waste anti-D immunoglobulin in early miscarriage?

OBJETIVO: avaliação da hemorragia feto-materna (HFM) nas pacientes que receberiam profilaxia da aloimunização Rh com emprego de imunoglobulina anti-D (300 mig), pós-aborto precoce. MÉTODO: foram admitidas no estudo pacientes do grupo sanguíneo Rh negativo, com parceiro Rh positivo ou ignorado, com quadro de aborto até 12 semanas de gestação internadas para curetagem uterina. Uma amostra de 5 ml de sangue venoso destas pacientes foi obtida após o procedimento, na qual realizamos o teste qualitativo de roseta para detectar quais casos necessitariam determinação quantitativa do volume de sangue fetal transferido para circulação materna, que foi então apurado pelo teste de Kleihauer-Betke (K-B). RESULTADOS: das 26 pacientes avaliadas, em uma o teste de roseta foi positivo, e o teste de K-B apontou HFM de 1,5 ml. CONCLUSÕES: a dose de imunoglobulina anti-D nos casos de abortamento até a 12ª semana de gestação deveria ser substancialmente reduzida, parecendo-nos oportuna a disponibilização no mercado nacional de apresentação com 50 mig, que representaria além da economia, maior racionalidade.

Complement C3 F and BF S allotypes are risk factors for Chagas disease cardiomyopathy.

The heterogeneity in the clinical expression of Chagas disease gives strong evidences for the involvement of genetic factors on its pathogenesis. Several studies have indicated different markers of genetic susceptibility to Chagas cardiomyopathy. In the present study, we present evidence of association between complement C3 and BF allotypes, and the susceptibility to Chagas disease and the development of cardiomyopathy. C3, BF, C4A, C4B and C2 polymorphism were determined in 100 seropositive Chagasic patients [cardiomyopathic (CARD), n = 57; asymptomatic indetermined (IND), n = 43] and in 100 non-related seronegative healthy controls. Patients and controls were matched according to their ethnic and geographical origin. A significantly increased frequency of C3F was observed in patients with the CARD form (8/57 14.03%), when compared with those presenting the IND form (0/43, 0%; RR 7.0) and with the healthy controls (5/100, 5%; RR 3.1). A negative association of the BF S allotype was observed in the CARD patients (19/57 33.33%) and in the Chagas total (38/100 38.0%), when compared with the controls (55/100, 55.0%; RR 0.4). All other C3, BF, C4A, C4B and C2 alleles showed no significant differences. These results suggest the allele C3F as a susceptible marker for the progression of the CARD form. On the other hand, BF S may represent a protective role against severe CARD disease. These results corroborate the importance of the alternative pathway in Trypanosoma cruzi infection and indicate possible genetic markers of Chagas cardiomyopathy.

Is the prevalence of celiac disease increased among epileptic patients?

OBJECTIVE: To assess the prevalence of celiac disease (CD) among a group of epileptic patients attending the Epilepsy Clinics of two general hospitals in the city of Brasilia (DF), Brazil. METHOD: Serum samples were collected from 255 epileptic patients (119 children, 136 adults) originating from Epilepsy Clinics, and from a control group composed by 4405 individuals (2034 children, 2371 adults) attending the Laboratory of Clinical Analysis, for routine blood testing. The diagnosis of CD was determined by the antiendomysium antibody (IgA-EMA) test and by small intestine biopsy. RESULTS: two of the 255 epileptic patients (1:127) and fifteen subjects from the control group (1:293) tested positive for the IgA-EMA assay. CONCLUSION: the prevalence of CD was 2.3 times higher in epileptic patients than in controls (7.84 per 1000 versus 3.41 per 1000). Although still not statistically significant, this result is highly suggestive of an increased prevalence of CD among epileptic patients

GM, KM immunoglobulin allotypes and other serum genetic markers (HP, GC, PI, and TF) among South American populations living at different altitudes (Jujuy Province, Argentina): admixture estimates.

A total of 154 individuals belonging to three populations located at different altitude levels in northwest Argentina (San Salvador de Jujuy, 1,200 m; Tilcara, 2,500 m; Abra Pampa, 3,500 m) were studied for the GM, KM, HP, GC, PI and TF genetic systems. Individuals were selected on the basis of ethnocultural affiliation. Gene frequency values were found to be comparable to those reported for other South American populations. The populations studied showed a close genetic identity and an absence of interpopulation heterogeneity. Distribution of the GM phenotypes and haplotypes corresponds to historical data on human settlements in Jujuy Province. The presence of some alleles and the anthropological significance of the allele distribution are discussed, as are the effects of the admixture with Africans and Spaniards. The genetic pattern appears to be the result of a varying admixture due to the genetic isolation in populations located at various altitude levels.

Hyperimmunoglobulinemia E in the absence of atopy and filarial infection: the Huaorani of Ecuador.

Hyperimmunoglobulinemia E (HIGE) is associated with various conditions such as atopy, dermatitis, hypersensitivity reactions, and certain parasitic infections. In the course of vaccination initiatives in the province of Napo, eastern Ecuador, blood samples were collected from one of the two remaining rural subgroups of Huaorani Indians who in 1979 were reported to have the world's highest concentrations of IgE. One subgroup of Huaorani, the Dicaron, lives in a protected Amazonian region which has reportedly suffered from extensive pollution after petroleum industry exploration. Plasma was collected from 31 members of the Dicaron (age range 15-75 years), eight non-Dicaron Huaorani, and 16 Quichua Indians from the same province, and tested for IgE, IgG, IgM, IgA, and immunoglobulin allotypes. Subjects were examined for evidence of filariasis, a group of parasitic diseases associated with HIGE. Mean IgE concentration in the Dicaron was measured by CAP ELISA at 11,850 IU/mL (range 5000-33,000) while IgA and IgM concentrations were within normal limits compared to North American controls. IgG levels were slightly elevated and there was no evidence of filariasis. Compared to the Quichua and non-Dicaron Huaorani, two other Amerindian tribes in the Ecuadorian Amazon, the highest concentrations of IgE were recorded from the Dicaron who live within the allegedly polluted section of the Amazon. We conclude that an unexplained HIGE syndrome exists among only one subgroup of Huaorani, the Dicaron. Other eastern Ecuadorian Amerindians, such as the Quichua and resettled Huaorani, have IgE concentrations expected in a population with intestinal helminthiasis. Environmental factors cannot be excluded as the cause of HIGE in the Dicaron.

[Gm and Km allotypes in a Chilean urban population sample]. / Alotipos Gm y Km en una muestra de población urbana chilena.

BACKGROUND: The knowledge of the genic structure of a population is of great importance for evolutive studies. AIM: To estimate in a Chilean population sample from the low-middle and low socioeconomic strata of Santiago, haplotypes and allele frequencies for Gm and Km loci. SUBJECTS AND METHODS: The sample included 460 controls of a case-control study of typhoid fever. RESULTS: The G1m-G2m-G3m most frequent haplotypes were: za;..;g or 1,17;(-);21 = 0.4493;fn;b or 3;23;5,13 = 0.2522; f-,..;b or 3;(-);5,13 = 0.1389; zax;..;g or 1,2,17;(-);21 = 0.0685; za;..;b or 1,17;(-);5,13 = 0.0454; za;n;g or 1,17;23;21 = 0.0207; f;..;g or 3;(-);21 = 0.0129. The frequencies of Km alleles were 0.2391 and 0.7609 for Km1 and Km3 respectively. CONCLUSIONS: These frequencies are within those found in Amerindian and Caucasian populations as expected from the origin of the Chilean population. Gm haplotypes did not differ from Hardy-Weinberg equilibrium, while a significant lack of homozygous Km1/km1 was found in Km.

Gm and Km allotypes and typhoid fever.

Gm and Km allotypes of immunoglobulins were determined in children with typhoid fever (Cases), in children without infectious diseases (Con-1), and in children with fever but no Salmonella in their blood or bone marrow (Con-2). Children were sampled from the urban population of Santiago; and they belonged to the low and low-middle socioeconomic strata. Cases had a higher frequency of [f;(-);b1,b3 or 3;(-);5,13] G1m, G2m, G3m haplotype than Con-1 and Con-2. Con-1 and Con-2 did not differ in their Gm haplotype or Km allele frequencies, but they differed in phenotype distribution. Con-1 deviated from Hardy-Weinberg equilibrium for Km due to a lack of Km 1-1 homozygotes. The relationship among these results, the ethnic origin of Chileans, and the differential susceptibility to typhoid fever are discussed.

Immunoglobulin kappa chain allotypes (KM) in onchocerciasis.

GM and KM allotypes, powerful tools for genetic characterization of human populations, have been shown to play an important role in genetic predisposition to some infectious diseases. Two diverse racial groups--Afro-Ecuadorians and Amerindians--living in a single restricted geographical area of Ecuador, appear to have different risk factors for acquisition and clinical expression of onchocerciasis, a disease caused by the filarial parasite Onchocerca volvulus. In this study, GM and KM allotypes were determined in 25 Afro-Ecuadorians and 24 Amerindians infected with Onchocerca volvulus (INF) and in putative immune individuals (PI). In Afro-Ecuadorians, the frequency of the homozygous KM 3 phenotype was significantly decreased in INF as compared with the PI group (20 vs. 68%; P= 0.0012), while the frequency of the heterozygous KM 1,3 phenotype was increased in INF as compared with the PI subjects (48 vs. 9%; P= 0.0044). These results suggest that in Afro-Ecuadorians KM 3 is associated with a lower relative risk (resistance), whereas KM 1,3 is associated with an increased risk (susceptibility) of onchocerciasis.

Gm and Km allotypes in Wayampi, Wayana and Emerillon Indians from French Guiana.

We have studied 506 Amerindians from three French Guiana groups: 194 Wayampi, living in Trois-Sauts, and 100 in the Camopi area; 47 Emerillon also living in the Camopi area and 165 Wayana on the Litani and Maroni rivers. All samples were tested for G1m(1,2,3,17), G3m(5,6,10,11,13,14,15,16,21,24,28) and Km(1) by the classical method of hemaglutination inhibition. The phenotype and haplotype distributions are presented and have been subjected to factorial correspondence analysis. Two Gm haplotypes are common: Gm1,17;21,28, and Gm1,2,17;21,28, but with an important variation in frequency. A rare haplotype, probably the result of a genetic anomaly: Gm1,17;21R,28, is frequent in the Emerillon (17%). These populations show no evidence of Black or Caucasian admixtures.

Immunoglobulin allotypes (GM and KM) in three Amerindian populations of French Guiana.

We have studied 506 Amerindians from three French Guiana groups: 194 Wayampi, living in Trois-Sauts, and 100 living in the Camopi area; 47 Emerillon also living in the Camopi area and 165 Wayana living on the Litani and Maroni rivers. All samples were tested for G1M (1,2,3,17), G3M (5,6,10,11,13,14,15,16,21,24,28) and KM(1) by the classical method of hemaglutination inhibition. The phenotype and haplotype distributions are presented and have been subjected to factorial analysis of correspondence. Two common GM haplotypes are GM1,17:21,28 and GM1,2,17;21,28 but with an important variation in frequency. A rare haplotype, GM1,17;21R,28, probably the result of a genetic anomaly, is frequent in the Emerillon (17%). These populations show no evidence of Negroid or Caucasian admixtures.