Expression of the hyaluronan-binding glycoprotein hyaluronectin in leukemias.

Hyaluronectin (HN), a hyaluronan (hyaluronic acid, HA)-binding glycoprotein is normally expressed in the nervous system, found in the desmoplasia of tumours, and is also produced in vitro by peripheral blood mononuclear cells. We have therefore investigated the expression and the production of HN by leukemic cells, with the hypothesis that HN would be expressed in leukemias of the myeloid lineage. Fresh and frozen leukemic cells were studied from 70 patients of whom 53 had acute myeloblastic leukemia (AML). HN was strongly expressed (> 80% blood cells) in two out of 13 M4 AMLs and four out of four M5B AMLs. One further M4 AML displayed 25% positive cells and two 20% cell positivity cases were seen, in one case of M4 AML and in one case of chronic myelomonocytic leukemia (CMML). The rest of the cases of AML as well as all cases of acute lymphoblastic leukemia (ALL) showed almost no positivity (< 1%). The residual positive cells appeared to be normal blood promonocytes. Taken together > or = 20% positive cells was seen in eight out of 56 (14%) examined myeloid leukemias. The HN production was significantly higher (p < 0.0001) in cell culture media of M4 and M5 AML cells than in other AML or ALL cell culture media. A significant correlation was found (p < 0.0001) between the number of HN-positive leukemic cells and the number of cells with a monocytic morphology, suggesting that HN is a marker for the promonocyte.

An idiotype D23-bearing polyspecific, murine anti-DNA monoclonal antibody forms glomerular immune deposits. Pathogenic role of natural autoantibodies?

Identification of the immunochemical and structural properties of pathogenic anti-DNA antibodies is a major goal for understanding their origins and the mechanisms whereby they induce tissue lesions. Herein, we report on the production of an IgG2a,k anti-DNA monoclonal antibody (4B1), derived from a 12-month-old (NZB x NZW)F1 lupus mouse, able to form glomerular immune deposits. mAb 4B1 is a polyspecific antibody able to bind to ssDNA, actin, tubulin, cardiolipin and to laminin as shown by solid phase ELISAs. Indirect immunofluorescence labeling of HEp-2 cells gave a cytoplasmic staining pattern similar to that obtained with anti-cytoskeleton antibodies. Western blot analysis demonstrated that mAb 4B1 bore idiotype D23, previously shown to be characteristic of natural antibodies derived from normal mice. After injecting the 4B1-secreting hybridoma intraperitoneally into normal (NZW x BALB/c)F1 mice, glomerular immune deposits were observed along the capillary wall. These deposits contained mainly IgM, IgG2a and mAb 4B1, as demonstrated by direct immunofluorescence using a biotinylated-rat anti-4B1 idiotype mAb and kidney eluate analysis. Nucleotide sequence analysis of the VH and VL genes showed that mAb 4B1 is encoded by VH Q52, DSP2.9 and JH2 genes with minimal mutations and by VK8 very similar to the canonic D23 light chain, and JK1 germline genes. No arginine residues were observed in the VH CDR and both chains lacked N-segment addition. Thus, no structural characteristics deduced from the primary structure of mAb 4B1 could explain its pathogenic potential. However, the immunochemical and structural properties suggest that autoantibodies closely related to natural autoantibodies may be pathogenic.

Immunofluorescence and immunoelectron microscopy analyses of a human monoclonal anti-epithelial cell surface antibody that recognizes a 185-kD polypeptide: a component of the paraneoplastic pemphigus antigen complex?

We recently reported the production of a human monoclonal antibody (MoAb) derived from a patient with pemphigus vulgaris (PV) that binds to the keratinocyte membrane and reacts with a 185-kD polypeptide by immunoblot analysis. We have since examined the tissue specificity of that MoAb, F12. By indirect immunofluorescence (IIF), F12 stained both the cell membrane and the basement membrane zone of stratified squamous epithelia. Moreover, MoAb F12 stained other epithelial tissues, such as urinary bladder, small bowel, thymus, and liver, and non-epithelial tissues, such as myocardium. Indirect immunoelectron microscopy (IIEM) analysis showed that MoAb F12 bound to a component common to desmosomal and hemidesmosomal plaques and to zona adherens-type junctions between hepatocytes and bile duct cells. Inhibition experiments were then performed with sera from patients with pemphigus vulgaris, pemphigus foliaceus, paraneoplastic pemphigus, or bullous pemphigoid. Three sera blocked F12 reactivity; two were from paraneoplastic pemphigus patients and the other was from the pemphigus vulgaris patient whose peripheral blood lymphocytes were used to make F12. All these sera recognized a 185-kD band that co-migrated with the polypeptide labeled by MoAb F12 on immunoblots. In addition, the IIF and IIEM staining patterns of MoAb F12 were similar to those observed with sera from two patients with paraneoplastic pemphigus. These observations suggest a relationship between MoAb F12 and the autoimmune response characterizing paraneoplastic pemphigus patients' sera.

Identification of a new antibody population directed against a desmosomal plaque antigen in pemphigus vulgaris and pemphigus foliaceus.

Pemphigus vulgaris and pemphigus foliaceus are characterized by autoantibodies directed against transmembrane glycoproteins of desmosomes. F12, a human monoclonal autoantibody that binds to the desmosomal plaque, recognizes a 180-190-kDa doublet when immunoblotted against bovine tongue epithelium. Because F12 was derived from the peripheral blood lymphocytes of a patient with pemphigus vulgaris, we looked for the presence of anti-180-190-kDa antibodies in pemphigus vulgaris and pemphigus foliaceus serum. By immunoblot analysis, a third of the pemphigus serum contained anti-180-190-kDa antibodies that belonged to IgG subclass 1 or 3, unlike those that recognized desmogleins 1 and 3 (IgG4). By immunoelectron microscopy analysis on human oral mucosa and human skin with mAb to human IgG3, pemphigus serum containing anti-180-190 kDa antibodies recognized desmosomal plaques. The presence of antibodies with F12 properties in pemphigus serum was further demonstrated by a rabbit anti-F12 idiotype antiserum that allowed detection of F12 idiotype in serum with anti-180-190-kDa antibodies. These results indicate that some pemphigus vulgaris and pemphigus foliaceus serums contain antibodies that react with both intra- and extracellular structures of desmosomes and further demonstrate the heterogeneity of the autoimmune response in both types of pemphigus.

Overlapping distribution of autoantibody specificities in paraneoplastic pemphigus and pemphigus vulgaris.

Paraneoplastic pemphigus is an autoimmune bullous skin disease in which autoantibodies immunoprecipitate a characteristic antigenic complex. The objective of this study was to analyze by immunoblotting and immunoelectron microscopy the autoimmune response in five patients with clinical and immunohistologic features typical of paraneoplastic pemphigus. In a first series of experiments, immunoblotting and immunoelectron microscopy were performed using anti-human whole Ig. Although immunoblotting results were consistent with the autoantibody specificities previously described in paraneoplastic pemphigus sera, immunoelectron microscopy demonstrated the presence of Ig deposits on desmosomal plaques, on hemidesmosomes and, surprisingly, on both the extracellular part of desmosomes and the keratinocyte plasma membrane. In a second series of experiments, immunoblotting and immunoelectron microscopy were carried out using antihuman IgG subclasses. The major observation was that two sera contained, in addition to the anti-desmoplakins I-II, anti-185-kD and anti-230-kD autoantibodies, autoantibodies that stained the desmoglea by indirect immunoelectron microscopy and bound to a 130-kD polypeptide by immunoblotting. One serum was particularly demonstrative: IgG1 bound to the 250- and 220-kD bands corresponding to desmoplakins I and II on immunoblots and to the desmosomal plaques of keratinocytes in immunoelectron microscopic preparations; IgG3 recognized a 185-kD immunoblotting band and hemidesmosomes and desmosomal plaques by immunoelectron microscopy; IgG4 bound to the 130-kD immunoblotting band of pemphigus vulgaris and labeled the desmoglea and the keratinocyte plasma membrane by immunoelectron microscopy. These results demonstrate that the paraneoplastic-pemphigus autoimmune response involves both intracellular and extracellular desmosomal antigens and suggest an overlapping distribution of autoantibody specificities among autoimmune bullous skin diseases.

Brain glycoprotein in tumours of the nervous system.

We studied various tumours of the nervous system by the immunofluorescence technique using an anti-brain specific alpha 2 glycoprotein antiserum (anti-NSA3 antiserum). We found the antigen in 24/27 astrocytomas and 4/4 oligodendrogliomas but in none of the 8 meningiomas tested. There was an identity between the astrocytoma/oligodendroglioma antigen and that of normal brain as shown by the immunoprecipitation technique. By the immunofluorescence technique using inhibition of the antiserum we demonstrated that the tumour antigen is devoid of some specific nervous system determinants present in normal brain.

Localization and solubilization of hyaluronan and of the hyaluronan-binding protein hyaluronectin in human normal and arteriosclerotic arterial walls.

Hyaluronectin (HN), a hyaluronan (hyaluronic acid, HA)-binding glycoprotein isolated from human brain, was studied in normal and atherosclerotic human arteries. It can be detected and assayed in tissue samples by immunohistochemistry. In addition, its high and specific affinity for HA makes it possible to develop specific histological localization of HA using HN as a probe. We tested the presence of HN and HA in human carotid artery samples from adults and newborns. In atheroma-free arterial samples HN was found in the intima, between smooth muscle cells and in the adventitial extracellular matrix. In atherosclerotic lesions, HN was strongly expressed in the diffuse thickened intima and surrounding extracellular microcrystalline calcium deposits, and very little in the lipid core. HA was found in the same locations. The similar localizations of HN and HA shown by immunohistology and demonstration of HN-HA complexes by high pressure liquid chromatography (HPLC) suggest that they are associated in vivo.

Characterization of hyaluronic acid on tissue sections with hyaluronectin.

An affinity immunological procedure for hyaluronic acid detection on tissue sections is described. This new, sensitive, and specific technique is based on the high affinity of hyaluronectin for hyaluronic acid, utilizing anti-hyaluronectin-hyaluronectin immune complexes. Elimination of binding when the reagent was supplemented with hyaluronic acid or when Streptomyces hyaluronidase-digested tissue sections were used emphasizes the specificity of the assay. This technique made possible accurate HA localization in embryonic mesenchyme, in neural tissue, in kidney medulla, and in tumors.

Localization of hyaluronectin in the nervous system.

The localization of hyaluronectin was determined by immunofluorescence and immunoperoxidase methods, in the rat, the sheep and the human. The study of the peripheral nervous system revealed the localization of this protein at the node of Ranvier. It was also present at this site in the central nervous system where the appearance was less characteristic than in the peripheral nervous system. The protein was also observed around about 10% of neurones in all of the regions studied. The subcellular structures labelled could not be precisely defined with the optical microscope.

Relationship between the in vivo localization and the immunoblotting pattern of anti-basement membrane zone antibodies in patients with bullous pemphigoid.

OBJECTIVE: To compare the localization of anti-basement membrane zone (BMZ) antibodies bound in vivo with the antigenic specificities of circulating anti-BMZ antibodies in patients with bullous pemphigoid (BP). DESIGN: Comparison of the results of an examination of the skin specimens of the patients using direct immunoelectron microscopy and direct immunofluorescence on 1-mol/L sodium chloride-split skin with the results of an analysis of the corresponding serum samples using the immunoblot technique. SETTING: Immunodermatology department in a teaching hospital. PATIENTS: Thirty-six patients with typical BP and circulating anti-BMZ antibodies. RESULTS: Serum samples from 22 patients with BP indicated only BP antigen 1 in the results of immunoblot analysis. Using direct immunofluorescence, an analysis of the peribullous skin samples obtained from these 22 patients showed deposits of IgG exclusively located along the epidermal side of sodium chloride-split skin; the results of direct immunoelectron microscopic examination showed deposits of IgG located on the intracellular portion of hemidesmosomes in 18 (82%) of these 22 specimens, whereas 4 biopsy specimens had linear IgG deposits located both intracellularly and extracellularly along the keratinocyte plasma membrane. The results of immunoblot analysis of the serum samples from 5 patients with BP indicated BP antigen 2 alone; the results of direct immunoelectron microscopic examination of peribullous skin samples from these 5 patients showed linear intracellular and extracellular deposits along the keratinocyte membrane, corresponding to an epidermal fluorescence labeling pattern of peribullous sodium chloride-split skin in 2 patients and a combined (dermal and epidermal) pattern in 3 patients. CONCLUSION: The 2 different patterns of reactivity of anti-BMZ antibody deposits bound in vivo closely corresponded to the antigenic specificities indicated in the corresponding serum samples of the patients. These results are in accordance with those previously obtained in vitro and argue for identical binding profiles of circulating antibodies that are bound in vivo in BP.

[Thyroid pathology and lymphoproliferative diseases]. / Pathologie thyroïdienne et maladies lymphoprolifératives.

Four cases are reported, of an association between a thyroidal illness (1 hypothyroidism, 3 hyperthyroidism) on one hand, and a lymphocytic proliferation and/or monoclonal gammapathy on the other. The following findings: HLA B8 or DrW3 in 3, antithyroid antibodies at a very high level in 2, and thyroid stimulating immunoglobulin in 2 support the conclusion of thyroidal diseases of auto-immune nature. Simultaneous appearance of both thyroidal and hematologic illness favors the hypothesis of a non coincidental association. A direct thyroidal activity of the monoclonal paraprotein has been found only once among the 4 published and our 2 cases in which it has been studied. A more likely link would be a common physiopathology: a functional deficiency of T suppressor lymphocytes allowing the proliferation of a cellular clone producing an abnormal immunoglobulin, would also allow the development of a thyroidal illness when favored by a genetic predisposition.

[Latent and postpartum thyroiditis. Prospective study]. / Thyroïdite latente et post-partum. Etude prospective.

Thyroid evaluation was performed in 85 women at childbirth, then between 2 and 7 months, and 14 months later. Transient subclinical hypothyroidism was found in one woman; antithyroid antibodies were found in 10 and were persistent in 6, suggesting a late thyroiditis. For these 6 cases, 5 HLA typing showed 3 Locus DR4. The proportion of antithyroid antibody was the same in a reference population. This finding would be in agreement with the hypothesis of a latent thyroiditis, revealed by pregnancy. Relative iodine deficiency in France could explain the low frequency of post partum thyroiditis in the present study.

[Light and heavy chain deposition disease with cutaneous and renal manifestations]. / Maladie des dépôts de chaînes lourdes et légères avec manifestations cutanées et rénales.

INTRODUCTION: Monoclonal light and heavy chain deposition disease is a rare syndrome distinct from light chain amyloid, which is defined by the presence of monoclonal deposits of immunoglobulins in various tissues. CASE-REPORT: A 65-year-old man presented with renal symptoms due to membranoproliferative glomerulonephritis, associated with urticarial papules located on the arms and back. Histological examination of a skin biopsy specimen showed lymphocytic vasculitis. Direct immunofluorescence examination of kidney and skin lesions using anti-gamma 2 and anti-Kappa monoclonal antibodies, showed a similar staining on the basement membrane zone and vessel walls. COMMENTS: As far as we know, this is the first documentation of monoclonal light and heavy chain deposition disease associated with a lymphocytic skin vasculitis and renal involvement caused by similar monoclonal deposits of immunoglobulins in the kidney and skin.

[Nervous system tumour proteins. G.F.A. and hyaluronectin (author's transl)]. / Les proteéines des tumeurs du système nerveux. G.F.A. et hyaluronectine.

G.F.A. (gliofibrillary acid protein) and hyaluronectin studied here are two antigens defined by the heteroantibodies which appear in the serum of the immunised animal. G.F.A. is associated with gliofilaments and is considered as an astrocyte marker, either normal or tumoral. Hyaluronectin, is found in the Ranvier nodes and at the periphery of neurones. It is not specific to the nervous system. It is found in all tissues and tumors, and in particular marks the intercellular spaces of gliomas, where it is associated with hyaluronic acid for which it has a great affinity. Serum estimation of these Proteins is being undertaken with the view to a clinical application.

[Immunocytochemical localization of gliofibrillary proteins (GDAP) in human cerebral tumors. Histological and in vitro studies]. / Localisation de la protéine gliofibrillaire (GFAP) par immunocytochimie dans les tumeurs cérébrales humaines. Etude histologique et en culture in vitro.

On the basis of studies utilizing antibody to GFAP (glial fibrillary acidic protein) in the indirect immunofluorescent and immunoperoxydase methods we report the presence of GFAP in 5 astrocytomas, 1 ependymoma and 1 medulloblastoma. The GFAP was evidenced on cryostat sections of frozen material and in short-term tissue culture. Five others tumors including 1 oligodendrocytoma, 1 choroid-plexus papilloma, 1 meningioma and 2 secondary sarcomas were negative. Possible applications of antibodies to GFAP for localization and therapy of brains tumors were considered.

[Waste management as part of self-care: an in-hospital training?]. / La gestion des déchets d'autosoins: vers une éducation hospitalière?

As a health care professional, I feel concerned by the gap existing between urban and hospital practice concerning the management of waste, even when it is the same objects which are disposed. In the daily practice of the hospital care givers, the patients' education is mainly focused on the prevention measures or the care techniques to be adopted. The waste dumping modes are very seldom taken in consideration, despite the fact that everybody is afraid at the discovery of care material abandoned in a public place. That is why the following hypothesis was formulated: "The better the patient is educated, the better he will manage his self-care waste." The methods used for this diploma work are the documentary research and the investigation interviews with all the actors in and out of the hospital concerned by the patients' education and/or the management of care waste. The pilot study was conducted by means of enquiry questionnaires. It was focused on the hospital care givers and on the insulin-dependent diabetic patients who practice their self-care, through the enquiry technique "before-after" The aims of this research were to assess the quality of the education given by the hospital care giving staff on the management of self-care waste and the impact of this training on the patients. The drawing up of a system of reference (at the end of this research investigation work) should enable the improvement of the present situation. The small size of the sample used for the pilot study did not enable us to invalidate or confirm our working hypotheses. But the results obtained during out pilot study showed the bad quality of the training given by the hospital care givers and the inadequacy of the patients' procedure. That is why our professional project is based on an updating of the knowledge of the hospital care givers for the management of the self-care material in order to improve the quality of the care given by a hospital team and its adequation to the needs of the population at which it is aimed.

[Immunocytochemical demonstrating of a neurofibrillary component of the peripheral nervous system manifested by a human natural antibody]. / Mise en évidence immunocytochimique d'un composant neurofibrillaire du système nerveux périphérique révélé par un anticorps naturel humain.

Human serum SH2172, obtained from a girl suffering from bullous dermatosis, showed a natural immunoreactivity against the peripheral nervous system (PNS) of rat, mouse and hamster. Immunocytochemical staining and examination by light and electron microscopy demonstrated an intracellular neurofibrillary network localized in neurites and neuronal pericaryons. Comparative testing clearly showed that SH2172 immunoreactivity is different from that of the antibodies against the triplet of proteins NFP70, 160 and 200 kD. This unique serum should be a useful probe to study PNS neurocytoskeleton.

Expression of hyaluronic acid-binding glycoprotein, hyaluronectin, in the developing rat embryo.

Immunological and histological methods have been applied to the developing rat embryo to study the distribution of hyaluronectin (HN, a glycoprotein with hyaluronic acid-binding properties) previously shown to be present in the nervous system and in desmoplasias. HN was absent in the morula and the blastula and was first detected in the mesenchyme bordering the neural tube and somites on Day 10, i.e., at a time when hyaluronic acid is already widely dispersed in the mesenchyme. At this stage HN appeared to be closely associated with the basement membrane around the epithelial structures (somites, notochord, ectoderm) whereas the intercellular areas of mesenchyme were less strongly strained. The delineation of basement membranes decreased progressively, while the accumulation of HN increased in the cell-free areas of mesenchyme, giving a continuous, diffuse pattern. Differentiation of mesenchyme into vertebral cartilage and gut smooth muscle was accompanied by a progressive disappearance of HN. Even after streptomyces hyaluronidase or chondroitinase digestion the antigen was not unmasked in these tissues. The results are in agreement with the few observations made in the human. They suggest that HN could play a role, in association with fibronectin and glycosaminoglycans (hyaluronic acid), in the physiology of the embryonic extracellular matrix. HN appeared at a later stage in the embryonic nervous tissue; its distribution was extracellular in areas where both cell migration and proliferation occur.