Evidence for a new segregant series of B cell antigens that are encoded in the HLA-D region and that stimulate secondary allogenic proliferative and cytotoxic responses.

Five new histocompatibility antigens, designated secondary B cell or (SB) antigens, have been identified by secondary allogeneic proliferative and cytotoxic responses. The reagents used to define the SB antigents are lymphocytes primed between donors matched for all known HLA antigens. The SB antigens stimulate weak primary allogeneic proliferative responses (a mean relative response of 8%) but strong secondary proliferative responses. Strong secondary cell-mediated cytotoxicity is generated against target antigens that are distinguishable from the SB antigens defined by proliferation. Studies by direct lysis and by cold-target inhibition indicate that these target antigens are preferentially expressed on B cells relative to T cells. The SB antigens segregate with HLA, and the gene(s) encoding the SB1, 3, and 4 antigens maps centromeric to HLA-B. The SB antigens are major histocompatibility antigens not only because they are encoded by major histocompatibility complex (MHC) genes, but also by the functional criteria that the proliferative and cytotoxic responses to SB antigens are not restricted by HLA-DR or HLA-A,-B. Parallel studies of the SB antigens and the DR antigens with respect to: (a) their preferential expression on B cells, (b) their function in secondary allogeneic proliferative and cytotoxic respones, and (c) the location of their structural gene within the MHC. However, the SB antigens and the DR antigens are clearly distinct antigens, because population studies indicate that they can occur independently, and family studies indicate that specific SB antigens segregate with HLA haplotypes having different D and DR specificities. Our data are consistent with the hypotheses that the SB antigens are a new segregant series of B cell alloantigens, and that the SB gene and the DR gene derive from a duplicated ancestral gene.

Recombination within the HLA-D region. Correlation of molecular genotyping with functional data.

Molecular genotyping of the HLA-D/DR region in a family correlated with serologic and cellular typing data. It was further possible to predict a subtle difference in SB region-related functions from such molecular studies. A family that included an individual who inherited an HLA haplotype with a paternal recombination between HLA-B and the HLA-D/DR region was identified by classic HLA typing techniques. Segregation of HLA-D/DR region genes in this family was studied by Southern blot analysis using cDNA probes for DR alpha, DR beta, DC alpha, DC beta, and SB beta. Restriction enzyme fragment polymorphisms observed for every gene tested were in concordance with assigned HLA haplotypes (including the individual known to have inherited a paternal recombinant haplotype) with one exception: two HLA identical siblings were observed to have different SB beta restriction fragment patterns. Further testing revealed that one individual inherited a maternal HLA haplotype recombinant between the HLA-D/DR region and SB beta. Although both maternal SB alleles typed as SB4, allelic differences could be detected cellularly by primed lymphocytes and by the differential expression of a class II cell surface antigen using monoclonal antibody. Therefore, predicted and nonpredicted recombinant haplotypes were detected in a family by molecular genotyping.

Gender Disparities in Financial Relationships Between Industry and Orthopaedic Surgeons.

BACKGROUND: Recent studies in a number of surgical subspecialties have demonstrated that financial relationships with industry differ between men and women. This study aimed to determine if gender disparities exist in industry relationships with orthopaedic surgeons. METHODS: This retrospective study utilized publicly available data from the Centers for Medicare & Medicaid Services (CMS) at OpenPayments.cms.gov. Data were extracted for payments made to orthopaedic surgeons from industry for royalties, licensing, or consulting fees from 2016 to 2017. A physician's profile was used to determine name, gender, practice location, and subspecialty. Years of experience were recorded from publicly available websites. Total number of payments and amounts were compared among men and women, subspecialties, and locations. Multivariable linear regression models were used to determine predictors of total payments and number of payments. RESULTS: Royalties and consulting fees were paid to 3,418 individual physicians (11% of 29,996 physicians in the American Academy of Orthopaedic Surgeons [AAOS] census) and accounted for 88% of total payments. The majority of the total payment amount (99.6%) was made to men, while only 0.4% went to women. Male gender was a predictor of total number of payments (ß = 5.17, p < 0.001), as were years of experience (ß = 0.15 [95% confidence interval (CI): 0.10 to 0.20], p < 0.001), Mountain region (ß = 2.77 [95% CI: 0.37 to 5.17], p = 0.02), and adult reconstructive subspecialty (ß = 4.07 [95% CI: 1.89 to 6.25], p < 0.001). Years of experience (ß = 0.046 [95% CI: 0.039 to 0.052], p < 0.001), male gender (ß = 1.09 [95% CI: 0.67 to 1.51], p < 0.001), Mountain region (ß = 0.35 [95% CI: 0.020 to 0.68], p = 0.04), and adult reconstructive subspecialty (ß = 0.33 [95% CI: 0.030 to 0.63], p = 0.03) were associated with higher payments. CONCLUSIONS: Male gender, years of experience, Mountain region, and adult reconstructive subspecialty are independent predictors of a higher number of industry payments and payment amount. These disparities in industry payments may contribute to continued inequities in scholarship, academic rank, and leadership opportunities.

Evidence of acidification of headwater streams in the new jersey pinelands.

Seventeen years of stream pH data indicate a trend of acidification in two small streams in the New Jersey Pine Barrens which drain relatively undisturbed areas. The decline in pH has amounted to approximately 0.4 unit, with an estimated increase in H(+) concentration of about 50 microequivalents per liter. The data collected to date are consistent with the postulation of an atmospheric source for the increased H(+).

B lymphocyte antigens in sicca syndrome.

All individuals tested in this study with sicca syndrome, a human autoimmune disease, bear two immunologically distinct and genetically unrelated B lymphocyte antigens that appear similar to the immune response associated (Ia) antigens of the mouse. The genes coding for these two antigens are present in only 37 and 24 percent of normal controls. In animal models Ia antigen genes are closely linked to immune response genes. Our findings suggest that two such genes may be required for the development of sicca syndrome.

In vitro lymphocyte proliferation response to therapeutic insulin components. Evidence for genetic control by the human major histocompatibility complex.

Genes in the major histocompatibility complex of mice and guinea pigs control immunologic responsiveness to insulins from other animal species. In order to determine if similar genetic control exists in man, we have examined lymphocyte proliferation responses to components of therapeutic insulins by employing lymphocytes from diabetic patients that receive insulin. Distinct groups of individuals demonstrated positive lymphocyte proliferative responses to beef insulin, beef and pork insulin, beef proinsulin, pork proinsulin, and protamine. Lymphocytes from the patient population were typed for the HLA-A, B, C, and DR antigens. An increased frequency of certain HLA antigens was found in those individuals that responded to the following therapeutic insulin components: beef, HLA-DR4; beef and pork, HLA-DR3; beef proinsulin, HLA-BW4, CW2, CW5, DR2, and DR5; protamine, HLA-CW3, CW5, and DR7. The results demonstrate that the human immune system recognized the structural differences between human and beef and/or pork insulin. These differences are two amino acids in the A chain, alpha loop, of beef insulin and the single terminal amino acid, alanine, which is common to pork and beef insulins. Positive responses to both beef proinsulin and pork proinsulin demonstrated the capability of restricted recognition of more complex proteins represented by the C-peptide in these insulin preparations. Lymphocyte proliferative responses to protamine were also restricted, which suggests a genetic control to this antigen. The association of these responses with HLA alloantigens strongly suggests that genes within the human major histocompatibility complex control recognition and lymphocyte response to therapeutic insulin components.

Blastogenic suppression and alloantibody activity of sera from renal allograft recipients.

To evaluate whether immunological enhancement plays a role in adaptation to renal allografts, we studied sera from transplant recipients to determine whether those which suppressed mixed leukocyte culture (MLC) responses in vitro contained alloantibodies reactive with donor cells. Sera from five of nine renal transplant recipients consistently and specifically suppressed autologous autologous MLC responses to donor cells without impairing the blastogenic responses to third-party leukocytes, soluble antigens, or nonspecific mitogenic agents. In three of the five cases the suppressive activity of the serum was striking; in two cases the effect was less marked but still readily demonstrable in studies designed to evaluate the dose of serum which provided optimal suppression of MLC responses. Serum from one of the recipients nonspecifically suppressed blastogenic activity both to donor cells and other stimuli. No alloantibody reactive with donor leukocytes was found in any of the sera which exhibited suppressive activity in MLC, whereas in one patient, serum which contained antibody reactive with donor cells did not suppress MLC response to that donor. These findings suggest that, if the serum factors which suppress MLC responses in vitro are enhancing antibodies, they are not detectable even with very sensitive techniques either because they are present in very low concentrations, belong to immunoglobulin classes other than IgA, IgG, or IgM, or are complexed with donor antigen in such a way that their ability to react with fresh donor cells in vitro is blocked.

Randomised trial of high frequency oscillatory ventilation or conventional ventilation in babies of gestational age 28 weeks or less: respiratory and neurological outcomes at 2 years.

BACKGROUND: The long term outcome of children entered into neonatal trials of high frequency oscillatory ventilation (HFOV) or conventional ventilation (CV) has been rarely studied. OBJECTIVE: To evaluate respiratory and neurodevelopmental outcomes for children entered into the United Kingdom Oscillation Study, which was designed to evaluate these outcomes. METHODS: Surviving infants were followed until 2 years of age corrected for prematurity. Study forms were completed by local paediatricians at routine assessments, and parents were asked to complete a validated neurodevelopmental questionnaire. RESULTS: Paediatricians' forms were returned for 73% of the 585 surviving infants. Respiratory symptoms were common in all infants, and 41% had received inhaled medication. Mode of ventilation had no effect on frequency of any symptoms. At 24 months of age, severe neurodevelopmental disability was present in 9% and other disabilities in 38% of children, but the prevalence of disability was similar in children who received HFOV or CV (relative risk 0.93; 95% confidence interval 0.74 to 1.16). The prevalence of disability did not vary by gestational age, but boys were more likely to have overall disability. Developmental scores were unaffected by mode of ventilation (relative risk 1.13; 95% confidence interval 0.78 to 1.63) and were lower in infants born before 26 weeks gestation compared with babies born at 26-28 weeks. CONCLUSIONS: Initial mode of ventilation in very preterm infants has no impact on respiratory or neurodevelopmental morbidity at 2 years. HFOV and CV appear equally effective for the early treatment of respiratory distress syndrome.

Cholesterol metabolism in alloxan-induced diabetic rabbits.

The effect of diabetes control on the activities of hydroxymethylglutaryl-CoA reductase (HMG-CoA reductase), cholesterol acyltransferase (ACAT), and phenol 2-monooxygenase, the major enzymes regulating cholesterol metabolism, was determined in alloxan-induced diabetic rabbits, and the results obtained were correlated with lipid and lipoprotein levels. Although intestinal HMG-CoA reductase activity was significantly increased (P less than 0.001) in poorly controlled compared with moderately controlled diabetic rabbits, there was a significant reduction in the activities of intestinal ACAT (P less than 0.01), hepatic HMG-CoA reductase (P less than 0.05) and ACAT (P less than 0.001), and phenol 2-monooxygenase (P less than 0.01). The poorly controlled animals were hypercholesterolemic (P less than 0.01), and this was reflected in the very-low-density and high-density lipoprotein fractions. Serum cholesterol levels in the nondiabetic and moderately controlled diabetic groups were similar. This increase in intestinal HMG-CoA reductase activity in the poorly controlled diabetic animals occurred in the absence of hyperphagia. Although abnormalities in cellular cholesterol metabolism could be partly responsible for the alterations in serum cholesterol levels in diabetes, the precise mechanisms underlying these enzymatic changes have yet to be elucidated.

Increased esterification of cholesterol and transfer of cholesteryl ester to apo B-containing lipoproteins in Type 2 diabetes: relationship to serum lipoproteins A-I and A-II.

This study examines the activity of two key enzymes of reverse cholesterol transport, cholesterol ester transfer protein (CETP) and lecithin:cholesterol acyl transferase (LCAT) in 21 patients with non-insulin dependent diabetes mellitus (NIDDM) and 21 control subjects. Serum CETP was assessed by measuring plasma-mediated cholesteryl ester transfer between pooled exogenous lipoprotein with endogenous LCAT inhibited--an estimate of CETP mass. CETP activity was determined as cholesteryl ester transfer in the presence of the patients' lipoproteins and LCAT (endogenous assay). LCAT activity was determined in the same assay. There was no significant difference in CETP mass between the diabetic and non-diabetic subjects and there was no correlation between CETP mass and LCAT activity. Using the endogenous lipoprotein assay, CETP was elevated in serum from diabetic patients compared to control subjects (10.05 +/- 1.89 vs. 5.50 +/- 0.53 nmol/ml/h P < 0.05). LCAT was also increased in the diabetic patients (53.63 +/- 4.70 vs. 41.22 +/- 3.40 nmol/ml/h P < 0.05). Serum free cholesterol from diabetic and control subjects correlated with CETP activity measured using endogenous lipoprotein assay (r = 0.77, P < 0.001 and r = 0.82, P < 0.001), and also with LCAT activity (r = 0.76, P < 0.01 and r = 0.79, P < 0.01). There was a negative correlation between CETP activity with the endogenous lipoprotein assay and serum high density lipoprotein (HDL) cholesterol in the diabetic patients (r = -0.38, P < 0.01), but not in control subjects. In a subgroup of 10 control subjects, there was a positive correlation between LCAT activity and apolipoprotein (apo) A-I (r = 0.49, P < 0.05) and apo A-II (r = 0.51, P < 0.05) and also between CETP activity (endogenous assay) and apo A-I (r = 0.87, P = 0.001) and apo A-II (r = 0.63, P < 0.05). No relationship was observed between CETP activity and apo A-I or apo A-II in the diabetic subjects. Thus, serum CETP mass was normal in Type 2 diabetes but CETP activity (endogenous assay) was increased and was related to free cholesterol levels and LCAT activity in both diabetic and non-diabetic subjects.

The detection of HLA-DR, MB and MT determinants on purified class II molecules by inhibition of microcytotoxicity.

An assay has been developed which makes it possible to determine the HLA allospecificities carried by molecules in purified fractions of detergent lysates from EBV-transformed human lymphocytes. It is based on inhibition of the standard microlymphocytotoxic test used for identifying HLA class I and II antigens with alloantisera. Soluble cell membrane products from EBV-transformed cell lines homozygous for the HLA region gave specific inhibition of standard typing antisera. The test requires preincubation of microliter volumes of soluble antigen preparations maintained in 0.05% NP-40 with selected antisera prior to adding EBV-transformed cells as target cells. It was possible using this assay to follow isolation of the structurally related human class II molecules bearing the MB and DR specificities. Detergent lysates of cells were fractionated on affinity columns prepared from monoclonal antibodies directed against distinct class II antigens. Eluates from these columns contained the expected DR and MB specificities. The assay is easy to perform, highly reproducible and allows multiple determinations.

Strong mixed lymphocyte reaction associated with the LA or first locus HL-A.

Bidirectional strong stimulation in one-way mixed lymphocyte cultures (MLC) is reported between an HL-A recombinant and sibling, apparently differing only at the LA or first locus HL-A. The strong MLC reaction may represent a second strong MLR-S locus associated with the LA or first locus HL-A. Alternative explanations are discussed. A second example of a recombinant HL-A haplotype transmitted to progeny is also reported.

Cellular crossreactivity. Implications for solid organ transplantation matching.

This study evaluates the cellular crossreactivity among DR11, DR13, and DR8 molecules using TLC reagents generated in reciprocal priming combinations where the responder and stimulator cells express different microvariants of DR11. The large majority of T lymphocyte clones (TLC) derived from such stimulation detect not only the product of the specific DR11 allele expressed by the stimulator but also detect subsets of DR molecules that span serologic specificities. Thus, TLC generated in response to DR(alpha,beta1*1102) detect DR(alpha,beta1*1103) and products of specific DR13, DR8, DR2 and DR4 alleles. Whereas, TLC generated in response to DR(alpha,beta1*1104) detect DR(alpha,beta1*1101), DR(alpha,beta1*1103), and products encoded by specific DR8 and DR2 but not DR13 or DR4 alleles. Since DR11 microvariants cannot be identified serologically, this type of mismatch certainly occurs frequently between DR11 serologically matched donors and recipients. Particularly affected are populations, such as the African American population, that exhibit extensive HLA diversity and exhibit different frequencies of HLA alleles compared with those of the majority of serologically matched cadaveric donors. Rapid methods of DNA-based HLA typing now makes it feasible to utilize this methodology for allele level identificaiton of recipient and donor alleles. Based on the strength of the alloproliferative responses and on the recognition patterns of the TLC reported here, we suggest that retransplant patients might benefit by excluding subsequent donors expressing DR molecules that in vitro demonstrate strong cellular crossreactivity with DR molecules expressed by the previous donor(s) as well as those DR molecules shared with the previous donor(s). Since such a matching schema has the potential to improve retransplant allograft survival, particularly in patients from minority population groups, it should be evaluated clinically.

Measles virus-specific human T cell clones: studies of alloreactivity and antigenic cross-reactivity.

Cross-reactivity between altered self and foreign major histocompatibility complex (MHC) may be of etiologic importance in autoimmune disease. We have studied 29 measles virus-specific cloned and uncloned T cell lines from a patient with multiple sclerosis (MS) and from a normal subject. Two of the T cell clones derived from the normal subject reacted with foreign MHC determinants. No cross-reactivity between measles virus and either myelin basic protein (BP) or galactocerebroside (GC) was detected. T cell clones which are specific for nominal antigen and which also recognize alloantigen were detected with much smaller frequency than that reported in murine systems. Our data do not support a role for alloreactive measles-specific T cells, nor for cross-reactivity between measles virus and either BP or GC, in the pathogenesis of MS.

Alterations in cellular cholesterol metabolism following administration of 6-hydroxydopamine to rabbits.

1. The role of adrenergic mechanisms in the regulation of cholesterol metabolism was investigated by studying the effects of 6-hydroxydopamine (6-OHDA) on serum cholesterol levels and on the activities of 3-hydroxy-3-methylglutaryl coenzyme A (HMGCoA) reductase, acyl coenzyme A: cholesterol-O-acyl-transferase (ACAT) in the livers and intestines, and cholesterol 7 alpha-hydroxylase in the livers of male New Zealand White rabbits. 2. Total serum cholesterol levels were significantly reduced (P less than 0.01) in 6-OHDA-treated animals. This was reflected in the very low density lipoprotein, low density lipoprotein and high density lipoprotein fractions. The reduction in lipoprotein cholesterol levels reflected reduced cholesterol proportions in the lipoprotein fractions. 3. The 6-OHDA-treated animals also had significantly lower activities of intestinal (P less than 0.001) and hepatic (P less than 0.01) HMGCoA reductase. The specific activities of intestinal ACAT, hepatic ACAT and cholesterol 7 alpha-hydroxylase were comparable in both groups. 4. In contrast to the results observed in vivo, 6-OHDA did not have any in vitro effect on cholesterol biosynthesis in cultured human leucocytes. 5. This latter finding suggests that the effects of 6-OHDA on cellular cholesterol biosynthesis in vivo are indirect, possibly resulting from the known toxic effect of this drug in sympathetic nerve terminals, and imply a potential role for the sympathetic nervous system in the regulation of cellular cholesterol biosynthesis in vivo.

Monoclonal antibodies specific for human polymorphic cell surface antigens. I. Evaluation of methodologies. Report on a workshop.

Five techniques, the direct and the antiglobulin enhanced cytotoxicity assays, indirect immunofluorescence, the enzyme-linked immunosorbent assay, and the radioimmunoassay, were evaluated in a workshop to determine their utility in studies of the interactions of monoclonal antibodies with HLA antigens expressed on lymphocytes. Several well-defined antibodies, both cytotoxic and noncytotoxic, were tested against well-characterized human lymphoid cells. All the methods suffer from some deficiency. The enhanced cytotoxicity assay, however, is most useful as a routine screening tool because of its ease and simplicity; whereas, the enzyme-linked immunosorbent assay is most useful when dissection of antigenic structure is sought because it yields information on the quantities of the antigenic determinants expressed on the cell surface without requiring radioactive reagents.

Clonal analysis of HLA-DPw1 (SB1) associated allodeterminants: recognition of novel epitopes and evidence for quantitative variation in class II antigen expression.

Alloreactive human T-lymphocyte clones were derived from the SB1 HLA-DPw1)-specific, primed lymphocyte typing cell line SB1A used in the Ninth International Histocompatibility Workshop. The clones from two separate subclonings were analyzed for their proliferative patterns in panel experiments with cells from unrelated individuals and in family segregation analyses. While only one clone gave a perfect correlation with the DPw1 specificity, the maturity of clones recognized multiple specificities apparently associated with but not identical to HLA-DPw1. Most clones defined "splits" or subsets of DPw1 and some also displayed "extra" reactions with DPw1-negative stimulator cells. Further evidence was also found that, of the molecules bearing epitopic subsets associated with DPw1, some may be selectively expressed on the cell surface whereas the surface density of other DPw1-associated antigens may be varied. Thus, the HLA-DP region appears to encode a complex array of alloantigens and is in this regard similar to the HLA-DR region.

Segregation of three recently identified HLA specificities in an American Black family.

Three recently identified HLA specificities have been detected in a ten-member American Black family using 8th International Histocompatibility Testing Workshop and local antisera. Independent segregation of the two principal components of 8w59 (Bu and SV) was demonstrated. An Aw19-related specificity also segregated in the family.

Molecular characterization of HLA-B71 from an African American individual.

We have sequenced a cDNA clone encoding an HLA-B71 (B70) allele from an African American individual. Serologic definition of B70 allelic products is very difficult due to extensive cross-reactivity of the alloantisera with B35, B15, and B5 antigens. The new sequence most closely resembles the sequence of B*1503, differing only by three amino acids at positions 63, 67, and 116. The B71 sequence differs from alleles of the B15 antigenic group (serologically defined as B62) by 7-8 amino acids and from members of the B35 family by 10 to 12 amino acids. B71 may represent an evolutionary intermediate, sharing elements common to both B35 and B15 allelic groups.

The impact of naturally occurring DR3 microvariants, DRw17 and DRw18, on T-cell allorecognition.

The limited amino acid sequence differences between the DR3 microvariants, DRw17 and DRw18, are found in the second variable region of the DR beta chain (residues 26 and 28) as well as in framework residues 47 and 86. Using selected responder/stimulator combinations, alloproliferative T-lymphocyte clones (TLC) were generated which recognize either a supertypic DR3-related determinant(s) or only those T-cell recognition determinants created by the four amino acids which differ between DRw17 and DRw18. Results indicate that the microvariation creates potent T-cell recognition determinants while leaving the DR3-related determinant(s) unaffected. Several TLC were generated which recognize the DRw18 molecule strongly and the DRw52c molecule weakly reflecting the sequence similarity between these molecules. In addition, one TLC was generated which recognizes DRw18 and DRw14,Dw9 but not DRw14,Dw16 molecules, a result not predicted by linear amino acid sequence comparisons. The intricate and sometimes unpredictable allorecognition patterns observed demonstrate that the molecular context of a specific amino acid sequence is as important as the actual sequence in forming a T-cell recognition site and, thus, in shaping the immune response profile of a given allele.