Age and origin of major Smith-Lemli-Opitz syndrome (SLOS) mutations in European populations.

BACKGROUND: Smith-Lemli-Opitz syndrome (SLOS) (MIM 270 400) is an autosomal recessive multiple congenital anomalies/mental retardation syndrome caused by mutations in the Delta7-sterol reductase (DHCR7, E.C.1.3.1.21) gene. The prevalence of SLOS has been estimated to range between 1:15000 and 1:60000 in populations of European origin. METHODS AND RESULTS: We have analysed the frequency, origin, and age of DHCR7 mutations in European populations. In 263 SLOS patients 10 common alleles (c.964-1G>C, p.Trp151X, p.Thr93Met, p.Val326Leu, p.Arg352Trp, p.Arg404Cys, p.Phe302Leu, p.Leu157Pro, p.Gly410Ser, p.Arg445Gln) were found to constitute approximately 80% of disease-causing mutations. As reported before, the mutational spectra differed significantly between populations, and frequency peaks of common mutations were observed in North-West (c.964-1G>C), North-East (p.Trp151X, p.Val326Leu) and Southern Europe (p.Thr93Met). SLOS was virtually absent from Finland. The analysis of nearly 8000 alleles from 10 different European populations confirmed a geographical distribution of DHCR7 mutations as reported in previous studies. The common Null mutations in Northern Europe (combined ca. 1:70) occurred at a much higher frequency than expected from the reported prevalence of SLOS. In contrast the most common mutation in Mediterranean SLOS patients (p.Thr93Met) had a low population frequency. Haplotypes were constructed for SLOS chromosomes, and for wild-type chromosomes of African and European origins using eight cSNPs in the DHCR7 gene. The DHCR7 orthologue was sequenced in eight chimpanzees (Pan troglodytes) and three microsatellites were analysed in 50 of the SLOS families in order to estimate the age of the three major SLOS-causing mutations. CONCLUSIONS: The results indicate a time of first appearance of c.964-1G>C and p.Trp151X some 3000 years ago in North-West and North-East Europe, respectively. The p.Thr93Met mutations on the J haplotype has probably first arisen approximately 6000 years ago in the Eastern Mediterranean. Together, it appears that a combination of founder effects, recurrent mutations, and drift have shaped the present frequency distribution of DHCR7 mutations in Europe.

Salt sensitivity in humans is linked to enhanced sympathetic responsiveness and to enhanced proximal tubular reabsorption.

If high sodium intake is involved in the pathogenesis of essential hypertension, the effects of changing the sodium intake should be demonstrable in the susceptible part of the normotensive population. Therefore, we have investigated the effects of moderate salt restriction in 52 young normotensive subjects with and without a family history of hypertension; 22 (42%) responded to moderate salt restriction (200 to 50 mmol/day) over 2 weeks, with a significant fall in blood pressure shown by continuous automatic blood pressure recordings. Accordingly, these subjects were classified as salt-sensitive, and the remainder as salt-resistant. Compared to salt-resistant subjects, salt-sensitive subjects showed a 2.5-fold higher incidence of a positive family history of hypertension (p less than 0.01), and a significantly higher blood pressure and lower salivary sodium concentration during the usual high sodium diet. Although there were no differences in Na,K-ATPase activity and in Na-K cotransport of erythrocytes, the pressor response to infused norepinephrine in salt-sensitive subjects was double that of salt-resistant subjects independent of the diet and this was linked to indirect evidence for enhanced proximal tubular sodium reabsorption. On the usual high sodium diet, 40% of the normal population may be salt-sensitive and prone to develop hypertension. Hypersensitivity to catecholamines (genetically determined?) may be the cause of salt sensitivity. A low sodium concentration in saliva deserves further study as a simple screening test to identify salt-sensitive subjects.

Endemic Tyrolean infantile cirrhosis is not an allelic variant of Wilson's disease.

Recently, 138 cases of infantile cirrhosis originating in several families in the Austrian province of the Tyrol were reported. This endemic Tyrolean infantile cirrhosis (ETIC) is indistinguishable from Indian childhood cirrhosis (ICC), idiopathic copper toxicosis (ICT), and resembles the early forms of Wilson's disease (WND). It has been argued that ETIC might represent an allelic variant of the WND gene, which is a copper transporting P-type ATPase (ATP7B). Assuming that ETIC results from a founder effect, a possible role for ATP7B in ETIC was investigated by association studies and haplotype sharing. Because of its lethality, the mapping of ETIC was focused on obligate gene carriers, i.e. the patients' parents. Our data indicate that ETIC is a separate genetic entity, distinct from WND.

Estimation of reference intervals from a SENIEUR protocol compatible aged population for immunogerontological studies.

Because many laboratory values change with age, the study of healthy aging as well as diagnosis of disease in geriatric patients requires specific age-corrected reference intervals. We have established such reference intervals for a healthy population aged 65-74 years by selection of a sample group applying the clinical criteria of the SENIEUR protocol and we have compared them with those of a young control group (20-33 years) fulfilling the same criteria. Significant or minor elevations were seen, e.g. for plasma concentrations of fasting glucose, urea, total and LDL-cholesterol, triglycerides, gamma-glutamyl-transferase, alkaline phosphatase, erythrocyte sedimentation rate and serum neopterin levels. These reference intervals can be used for selecting a SENIEUR compatible population aged between 65 and 74 years. Additionally, plasma lipid parameters (cholesterol, triglycerides) are proposed to be included in the SENIEUR protocol.

Serum glycoprotein hormones and their free alpha-subunit in a healthy elderly population selected according to the SENIEUR protocol. Analyses with ultrasensitive time resolved fluoroimmunoassays.

The SENIEUR protocol was elaborated by a working party of European Community's Concerted Action Programme on Aging (EURAGE) to define strict admission criteria for 'healthy' elderly subjects and young controls for immunogerontological studies. This protocol, which is based on case history, laboratory values and drug consumption, intends to limit the influence of underlying disease and/or medication in order to allow analyses of the aging process per se. In a group of 38 male and 37 female individuals we determined the impact of age and classification according to the SENIEUR protocol on luteinizing hormone (LH), follicle stimulating hormone (FSH), human chorionic gonadotropin (hCG) and free glycoprotein hormone alpha-subunit serum values. Analyses were performed by a set of ultrasensitive time-resolved immunofluorometric assays (IFMA) using our own panel of monoclonal antibodies (MCA). HLH and hFSH, but also hCG and free alpha serum levels increased highly significantly with age in the female population (P < 0.001). In males hFSH, hLH hCG and the free alpha-subunit increased with age. However, only the rise of hFSH and of Free alpha was statistically significant (P < 0.01). The influence of the SENIEUR status on the respective hormone serum levels was determined using two factor analysis of variance, which revealed no statistically significant difference (P > 0.01) between SENIEUR and NON-SENIEUR individuals for all four analytes in both sexes. We conclude that the age related increase of hLH, hFSH, hCG and free alpha is an intrinsic age-dependent phenomen and is not modified by or due to underlying disease or medication as demonstrated by analyses of SENIEUR individuals. Since SENIEUR and NON-SENIEUR individuals had comparable hormone values, a randomly chosen, 'apparently healthy' population seems to be sufficient for physiological studies on serum GPH levels. Lastly, these age related hormonal changes in an extremely well defined healthy population underline the need for age adjusted 'normal' hormone values as elaborated in this communication.

Approach to define "normal aging" in man. Immune function, serum lipids, lipoproteins and neopterin levels.

In 53 healthy women with mean age 25.1 years (age range 21-34 years) and in 51 healthy women with mean age 82.1 years (age range 75-91 years), a panel of immunological and biochemical tests was performed. These tests, comprising lymphocyte mitogen responsiveness, phenotyping of lymphocytes, uptake of low density lipoprotein by T cells, serum levels of neopterin, lipids and lipoproteins, as well as routine blood chemistry, were investigated for a possible effect of age and of the classification according to the SENIEUR Protocol of admission criteria by the European Economic Community's Concerted Action Program on Aging (EURAGE). A highly significant effect of age on serum levels of neopterin, lipids and lipoproteins was found. No clear effects, however, of SENIEUR status on these variables was detected. As expected, age had a significant impact on mitogen responsiveness of T cells. Proportional numbers of helper/inducer and cytotoxic/suppressor T cells (as well as antigen density on these cells) were not influenced by age. SENIEUR classification did not affect these immunologic variables. Thus, most of the tested variables that are not included in the SENIEUR admission criteria appear to present information not yet covered by the SENIEUR variables. Various ways for a possible revision or extension of the SENIEUR Protocol are discussed.

Analysis of fluorescent low density lipoprotein uptake by lymphocytes. Paradoxical increase in the elderly.

Uptake of dioctadecylindocarbocyanine (DiI)-labelled low density lipoproteins (LDL) by peripheral blood lymphocytes (PBL) from young healthy donors has been characterized by flow cytometric analysis. The receptor positive cells were primarily (greater than 70%) T cells. Saturation and competition studies were performed with freshly isolated PBL as well as after a 2-3-day incubation in cholesterol-free medium. In both cases uptake was specific for LDL and not high density lipoprotein. It was also abrogated by chemical modification of apo B, and was not shown by PBL from a patient with familial hypercholesterolemia. DiI-LDL-uptake by cells from elderly donors was compared with that of PBL from young donors. There was a clear increase in uptake by freshly isolated PBL from aged donors which was shown not to stem from underlying "sickness". In contrast, uptake by pre-incubated cells was very variable, in terms of percentage receptor-positive cells and the level of uptake by those cells. However, LDL rescued mevinolin-suppressed mitogen responses from both old and young donors indicating that there is no impairment of uptake or degradation of LDL by PBL from the elderly.

Age-related changes in lymphocyte subset proportions, surface differentiation antigen density and plasma membrane fluidity: application of the eurage senieur protocol admission criteria.

Peripheral blood lymphocytes from 260 "apparently healthy" males and females, aged 20-97, have been investigated for age-related changes in a number of immunological parameters (percent and number of lymphocytes, OKT 4+ and OKT 8+ cells; OKT 4/8 ratio; intensity of fluorescence of OKT 4 and OKT 8 stained cells; membrane fluidity). Data were then reassessed after exclusion of people who did not conform to the SENIEUR PROTOCOL admission criteria of EURAGE (European Economic Community's Concerted Action Program on Aging) in order to investigate whether the differences observed were attributable to underlying disease. A slight decrease in the number and percentage of lymphocytes, OKT 4+ and especially OKT 8+ cells was found. Intensity of fluorescence of OKT 4 and OKT 8 stained cells from the elderly was reduced and may explain the lower percentages. Membrane fluidity was decreased in old persons (over the age of 75); the free cholesterol/phospholipid molar ratio in the serum increased up to the age of 75 and then declined, and it did not correlate with decreased membrane fluidity. Exclusion of the 20-60% of the study groups who were not eligible for admission according to the SENIEUR PROTOCOL criteria did not affect these results. The feasability and applicability of the PROTOCOL is discussed.

Properties of low density lipoproteins relevant to oxidative modifications change paradoxically during aging.

Atherosclerosis is a common problem among the elderly. Because lipid peroxidation is considered a contributor to the development of atherosclerosis, we compared oxidative properties of lipoproteins in an otherwise healthy (SENIEUR-classified) aged population (65-74 years) with young controls (18-30 years). Relative amounts of oxidatively altered low density lipoprotein (LDL), estimated by means of an antibody against LDL modified by 4-hydroxynonenal, a product of lipid peroxidation, were increased marginally in serum from the elderly (9.8 vs. 7.4%, P = 0.07). In contrast, isolated LDL from the elderly revealed a decreased susceptibility to in vitro oxidation: the lag time was increased (2.34 vs. 2.10 h, P < 0.01), and the maximal rate of LDL oxidation decreased (0.88 vs. 1.01 O.D./h, P = 0.001). However, there were no age-related changes in lipid composition of native LDL and consumption of fatty acids during in vitro oxidation. The serum concentrations of ascorbic acid and most lipophilic anti-oxidants (the latter expressed per g serum lipids) were significantly decreased in the elderly except tocopherols which tended to be higher. In conclusion, our data reveal paradox age-related alterations of LDL as to its behaviour in oxidation in vivo vs. in vitro.

Studies of the mechanism of tolerance induced by short-term immunosuppression with cyclosporine in high-risk corneal allograft recipients. I. Analysis of CTL precursor frequencies.

Transplantation of unmatched allogeneic corneas into highly vascularized recipient eyes under the cover of short-term immunosuppression with cyclosporine enables permanent engraftment. The aim of this study was to further elucidate the mechanism(s) underlying this tolerant state. In eight "high-risk" cornea recipients the clone sizes of donor-specific and third-party reactive cytotoxic T cell precursors were assessed by limiting dilution analyses before and at three and six months after transplantation. Acquired allograft tolerance in these patients was not accompanied by clonal reduction of donor-specific CTL-p, whereas in the case of an irreversible rejection the donor-specific CTL pool size was significantly enlarged. This donor-specific CTL-p increase could already be seen two months before clinical manifestation. These patterns differed from that of tolerant renal transplant patients, in whom marked and donor-specific reduction of CTL-p was observed. During rejection identical patterns with increasing donor-specific CTL-p frequencies were seen in both groups of patients. We conclude that induction of tolerance by short-term CsA to unmatched cornea grafts is not caused by clonal reduction of the effector precursor cell pool.

Neopterin excretion after liver transplantation and its value in differential diagnosis of complications.

The aim of this study was to investigate patterns and clinical utility of a neopterin marker in liver allograft recipients. Urinary neopterin levels were studied in 59 transplant patients daily until discharge. During the early postoperative period (days +1 to +20) neopterin excretion exhibited a liver-specific pattern that clearly differed from that seen in renal and bone marrow transplant recipients. Neopterin concentrations increased and reached peak values on day +7. The height of this early peak varied in context with complications such as infection or rejection, and was correlated with an unfavorable prognosis. In contrast to the early phase, no liver-specific pattern was observed after day 20. As seen in all other transplant patient populations, values normalized in patients with an uncomplicated course but again increased during infection or rejection episodes. Neopterin levels were particularly high during CMV infection, and their increments were directly related to the severity of CMV disease. The neopterin marker, although not specific, enables discrimination between patients with a complicated and uncomplicated clinical course. High neopterin values early after transplantation are associated with unfavorable prognosis and correlate with an increased risk of developing CMV disease.

Neopterin release in human mixed lymphocyte culture: requirement of HLA-DR disparity.

Recent evidence suggests that immune responses in vivo as well as in vitro are accompanied by release of neopterin [C. H. Huber, et al. (1983) J. Immunol. 130, 1047]. This investigation aimed to elucidate the genetic control of in vitro neopterin release in family mixed lymphocyte culture (MLC) studies. Neopterin levels and responder cell proliferation were assessed in a total of 92 MLCs established from different intrafamilial combinations. Results indicated a strong association between the magnitude of responder cell proliferation and the neopterin levels induced by stimulation with allogeneic cells. This conclusion was based on three findings: first, almost no neopterin release and proliferation was seen in MLCs established between HLA genotypically identical siblings; secondly, very low proliferation and neopterin levels were observed in MLCs between HLA-DR phenotypically identical family members; and thirdly, high neopterin release and strong cellular proliferation were a feature of MLCs established between individuals differing for at least one HLA-DR antigen. We thus conclude that T cell activation subsequent to recognition of HLA-DR disparity represents an essential prerequisite for induction of neopterin release in human MLC.

Antibodies in human sera recognizing a recombinant outer membrane protein encoded by the envelope gene of the human endogenous retrovirus K.

Human endogenous retrovirus (HERV) K is present in about 50 copies in the human genome and transcription of HERV-K has previously been detected in several tumor cell lines as well as in peripheral blood lymphocytes from healthy donors. By means of immunoblotting we investigated the presence of antibodies recognizing recombinant HERV-K-envelope outer membrane constructs in different serum collectives. A total of 12.6% of sera obtained from normal blood donors was found positive. In serum collectives from breast carcinoma patients, HIV-1-positive individuals, and persons with cytomegalovirus infections no significant difference from the normal blood donor serum collective could be observed. Only a group of persons with a repeatedly raised serum neopterin concentration (> 10 nmol/liter) of unknown cause (HIV and hepatitis B and C virus infections were excluded) showed a significant higher percentage of HERV-K-outer membrane envelope-positive sera (21%). Furthermore we could observe a parallel HIV-1/HERV-K seroconversion, which probably is not due to an HIV-1/HERV-K-outer membrane envelope cross-reactivity. Possible implications of these findings are discussed.

Neutralization of HIV type 1 by alloimmune sera derived from polytransfused patients.

Antibodies (Abs) against HLA and other cell surface molecules, which HIV-1 acquires during the budding process at the host cell surface, neutralize HIV-1 in vitro. Macaques were protected against infection by SIV grown in human cells after xenoimmunization with human MHC molecules. Besides the immune responses arising against xenogeneic antigens, the highly polymorphic character of the HLA antigens enables the induction of alloresponses after exposure to allogeneic HLA molecules. Since polytransfused (PT) patients develop alloresponses, including humoral anti-HLA responses, we assumed that sera derived from PT patients may neutralize HIV-1. In a model system two PT sera out of a panel of 12 PT and 6 normal control sera neutralized HIV IIIB in vitro. Neutralizing activity of the PT sera was comparable to the efficacy of anti-HIV sera. The neutralizing capacity coincided with strong IgG reactivity against (HIV-infected) cell lines, which were used for virus production, and recognition of cell-free viral particles. Active human complement enhanced HIV neutralization mediated by the sera. Our results suggest an IgG-mediated neutralization based on recognition of allogeneic HLA molecules expressed on the viral surface. A vaccination strategy based on alloimmunization appears conceivable and requires further investigation.

Dendritic cell responsiveness to stimulation with influenza vaccine is unimpaired in old age.

We have previously demonstrated that whole virus influenza vaccine can activate dendritic cells (DC). In the present study we analyzed whether DC activation was affected by the aging process. For this reason the expression of immunoregulatory molecules and the production of cytokines were compared in blood-derived DC from old and young healthy individuals following stimulation with inactivated influenza virus. Unstimulated DC from young and old individuals had a similar surface expression of MHC class II and CD54 and secreted moderate amounts of IL-12 and TNF-alpha. Stimulation with influenza vaccine led to a marked increase in the production of surface molecules and cytokines. These changes were equally pronounced in cells from young and old individuals. Our results demonstrate that DC responsiveness to stimulation with a viral vaccine is unimpaired in old age. DC may, therefore, represent a potent tool for immunotherapy and may increase the efficacy of vaccines in the elderly.

Environmental influence on age-related changes of human lymphocyte membrane viscosity using severe combined immunodeficiency mice as an in vivo model.

Peripheral blood lymphocytes (PBL) of healthy elderly people show increased plasma membrane viscosity compared to young subjects, that inversely correlates with lymphocyte proliferation after mitogen stimulation in vitro. Maintenance of a constant membrane viscosity, which is necessary for proper cell function, is crucially dependent on the membrane lipid composition. The cellular lipid metabolism, and thus lymphocyte function, may be subject to modulation by diet or drugs. To study the susceptibility of membrane viscosity to environmental conditions, we established an in vivo model using severe combined immunodeficiency (SCID) mice: human peripheral blood lymphocytes from healthy young and old subjects were engrafted for three days intraperitoneally into SCID mice to offer identical environmental conditions. First, we demonstrate that human lymphocytes can take up and utilize murine lipoproteins: engrafted human PBL can participate in the mouse lipid metabolism, and an exchange of membrane lipids in vivo is, therefore, possible. Second, plasma membrane viscosity was determined before and after engraftment: before engraftment, PBL from the elderly showed a significantly higher membrane viscosity than that from young controls, but this difference vanished during engraftment into SCID mice, wherein cells from both age groups exhibited nearly identical values. It was, therefore, concluded that lymphocyte membrane viscosity is influenced by environmental factors, and that the age-related increase is, in principle, reversible.

Interferons (IFNs) and tumor necrosis factors (TNFs) in T cell-mediated immune responses against alloantigens. I. Influence on the activation of resting and antigen-primed T cells.

The aim of this study was to investigate the influence that endogenous IFNs released in response to antigenic or viral stimuli has on recognition of alloantigens in MLC. Results indicated that both the magnitude and the kinetics of response can be modified by IFNs. Neutralizing antibodies with specificity for IFN-gamma inhibit early and enhance late proliferative responses in MLC. Addition of physiological concentrations of IFN-gamma enhanced both early and peak proliferation, whereas IFN-alpha markedly inhibited alloantigen-induced lymphocyte proliferation. Further experiments revealed that IFN effects in MLC are not caused by direct interaction with responder cells: pretreatment with IFNs neither failed to alter their subsequent proliferative reactivity, nor did it influence production of IL 2 in MLC. IFN-gamma mainly affected MLC responses by direct interaction with stimulator cells. These influences on hemopoietic and non-hemopoietic stimulator cells were complex and could not simply be explained on the basis of an altered expression of class II MHC antigens. When induced by IFN-gamma to maximally express class II antigens, pbmnc, LCL or homogeneous populations of macrophages showed a marked deficiency to induce primary or secondary proliferative T cell responses. Resting unsensitized or sensitized T cells were not stimulated by class II MHC antigens constitutively expressed or induced by IFN-gamma on cell types other than dendritic cells or LCL. Class II antigens on the former cells were, however, readily recognized by T helper blasts, and this process involved the T4 epitope of the T cell receptor. IFN-gamma treatment also influenced the intrinsic suppressive capacity of macrophages or keratinocytes without involving prostaglandin synthesis or inducing expression of IL 2 receptors on non T cells.

Influence of local radiotherapy of breast cancer patients on the frequency of cytotoxic T lymphocyte precursor cells.

Alloantigen-specific cytotoxic T lymphocyte precursor (CTL-p) frequencies were analyzed in ten patients with histologically proven breast cancer receiving prophylactic RT. The frequency of CTL-p was assessed by limiting dilution (LD) analyses before, immediately after discontinuation of treatment and at various times following RT. The number of pbmnc, adherent cells and T cells was determined in parallel. Local RT led to a minor and transient reduction of CTL-p frequencies lasting approximately three months: on average a 25% decrease of CTL-p numbers was seen immediately after RT. Three months following treatment, a 20% reduction was still evident. Values subsequently returned to pretreatment levels. Moreover, these changes in the frequency of antigen-specific CTL were accompanied by a 25% to 39% decrease in the blood T cell counts lasting for more than 12 months. The reductions following local RT were less pronounced than those induced by immunosuppressive drugs in allograft recipients.

Exogenous IL2 partially reverts CML non-reactivity acquired during prophylactic immunosuppression with cyclosporin A of human allograft recipients.

Proliferative and cytolytic lymphocyte responses and the influence of exogenous interleukin 2 (IL2) on cell-mediated lympholysis (CML) reactivity were evaluated in 12 allograft recipients. Responses were induced by mitogenic lectins or by donor and third-party cells. Patients were tested immediately before transplantation (Tx) and one and three months after grafting. Prophylactic immunosuppression consisted of Cyclosporin A (CyA) and low-dose prednisone (P). Analysis of post transplant cells revealed a reduced overall proliferative T cell responsiveness induced by both alloantigens and mitogenic lectins. No evidence for donor-specific reduction of MLC responses was seen. Overall CML reactivity of post-Tx lymphocytes was also impaired. This was accompanied by donor-specific CML non-reactivity in six of seven patients with quiescent grafts. In these patients, the cytolytic potential against donor cells could be restored when maximal T cell help via exogenous IL2 was provided.

Peripheral blood stem cell (PBSC) collection in extremely low-weight infants.

While PBSC collection has become a safe procedure for adults, only a few reports exist about its efficacy, safety and feasibility in paediatric patients, especially extremely low-weight infants. We describe successful PBSC collection in three infants of less than 10 kg body weight (BW; range: 6.92-9.4 kg) suffering from stage IV neuroblastoma. Harvest of PBSC started after mobilisation with high-dose chemotherapy and G-CSF, as soon as 1.0% CD34+ cells were detected. Collections were performed using a Baxter CS-3000 Plus separator primed with a mixture of irradiated, white cell-depleted and CMV-negative packed red cells resuspended in 5% human albumin and diluted with saline to match the patient's haematocrit. Performing a median of four, (4-7, median, range) procedures we collected at least 4 x 10(8)/kg BW nucleated cells (NC) from all three patients. The infants were not sedated and showed no serious side-effects. All three children were successfully transplanted with myeloid engraftment in 8 (7-9) days, independence from red cell support was achieved in 15 (10-20) days and from platelet transfusions in 25 (14-29) days after PBSC infusion. We conclude that PBSC harvesting using continuous flow cell separators is safe, even in low-weight infants of less than 7 kg BW.