IgA Values Research Articles

Verläufe des sekretorischen Immunglobulins A des Darms und Befindlichkeit von Patienten unter naturheilkundlicher Therapie und Heilfasten

Change of the Secretory Immunoglobulin A and the Condition of the Patients during Naturopathic Therapy and Heal-Fasting Therapy Background: In clinical observations it was noticed that patients who have been treated with naturopathic methods – especially with the treatment of heal fasting – experience a stabilization of their immune system. The immune system stands in close relation to the intestinal flora and influences the condition of the patient. Question: For this reason the influence of a 3-week in-hospital naturopathic therapy – among others a heal-fasting therapy –, a corresponding follow-up on the intestine-associated immune system as well as the condition of the patients have been examined. Patients and Methods: Classical naturopathic treatments based on standardized therapy concepts were applied. The patients (n = 55) showed different kinds of basic diseases, whereof in 56% of the cases the patients suffered of diseases of the skeleton, the muscles, and the connective tissue. The patients got a 3-week standardized high-quality nutrition or they took part in a juice-modified fasting therapy. The state of the local endogenous defense system within the intestine was measured by the concentration of the secretory immunoglobulin A (sIgA) in the feces of the patients. A positive criterion was a sIgA concentration in the stool of under 0.5 mg/g. Additionally the judgement of the patients concerning their own condition (‘quality of life’) was determined by the condition scale. Results: It was shown that the content of the sIgA within the stool was increased during the course of the in-hospital stay, in the complete population of patients as well as in the different subgroups ‘with heal-fasting’ and ‘without heal-fasting’. Even in the follow-up analysis it could be observed that 3 months after the treatment the content of secretory IgA in the stool of all groups was between 0.78 and 0.89 mg/g. This value was significantly higher than the starting values. The most intensive effects concerning the change of sIgA were measured within the group of the patients who performed heal fasting (Ε > 1.0). Aside from the increase of the secretory IgA, a mediocre improvement of the condition of the patients within the pre-post comparison could be noticed, but no correlation between the secretory IgA values and the values concerning the condition was found. Conclusion: A 3-week in-hospital therapy with classical naturopathic treatments (but especially the application of the heal-fasting therapy) leads to a significant improvement of the immune condition of the intestine and consequently of the whole organism. The improving effect lasts beyond the stay in hospital.

Bacterial translocation and immunohistochemical measurement of gut immune function

Aims—The local immune response in the small bowel mucosa might play a role in bacterial translocation (BT). The aim of this study was to quantify immune cells and secretory antibodies...

Modulation of human humoral immune response through orally administered bovine colostrum

Eighteen healthy volunteers were randomized into two treatment groups and consumed liquid prepackaged bovine colostrum whey and placebo for 7 days. On days 1, 3 and 5, an attenuated Salmonella typhi Ty21a oral vaccine was given to all subjects to mimic an enteropathogenic infection. The circulating antibody secreting cells and the expression of phagocytosis receptors of the subjects before and after oral immunization were measured with the ELISPOT assay and flow cytometry. All subjects responded well to the vaccine. No significant differences were observed in ELISPOT values for IgA, IgG, IgM, Fcγ and CR receptor expression on neutrophils and monocytes between the two groups. There was a trend towards greater increase in specific IgA among the subjects receiving their vaccine with bovine colostrum. These results suggest that bovine colostrum may possess some potential to enhance human special immune responses.

Increased frequency of monoclonal gammopathy of undetermined significance in patients with nonimmune chronic idiopathic neutropenia syndrome.

This study describes the frequency of monoclonal gammopathy of undetermined significance (MGUS) and the changes in some inflammation-related serum proteins in 157 patients with nonimmune chronic idiopathic neutropenia syndrome (NI-CINS). Of these patients, 42 had pronounced neutropenia with neutrophil counts < 1500/microL, and 115 had mild neutropenia with neutrophil counts ranging from 1500 to 2499/microL. Sixty-six volunteers served as healthy control subjects and 157 age- and sex-matched patients hospitalized for nonmalignant diseases served as patient control subjects. We found that 28.6% of patients with pronounced neutropenia and 14.8% of patients with mild neutropenia had increased serum gamma globulins (above the 95% confidence limit of values of the control subjects). In the group of patients with pronounced neutropenia, 30.9% had increased immunoglobulin (Ig)G values and 23.8% had increased IgA values. In the group of patients with mild neutropenia, 17.4% had increased IgG values and 21.7% had increased IgA values. IgG and IgA values strongly correlated with the neutrophil count. No changes in serum IgM were found. Three of 42 patients with pronounced neutropenia (7.14%) and 3 of 115 patients with mild neutropenia (2.61%) had serum immunofixation tests which showed a small monoclonal spike--4 were IgG-kappa type, 1 was IgG-lambda type, and 1 was IgA-kappa type. None of the healthy or patient control subjects had any evidence of MGUS. No significant changes in the amount of monoclonal spikes were documented during an 18- to 143-month follow-up (median, 58 months). Except for significantly increased alpha1-antitrypsin levels, there were no significant differences in the levels of acute-phase proteins studied between the study patients and the control subjects. These findings are consistent with our previous report suggesting the possible existence of an unrecognized low-grade chronic inflammation in patients with NI-CINS, which may be involved in the pathogenesis of neutropenia in the affected subjects.

Reference value of immunoglobulins in healthy school children of Bangladesh.

The reference value of immunoglobulins (Igs) should be known for a population concerned because it is influenced by many clinical and local conditions. As yet the reference value of the Igs have not been determined in Bangladeshi children. This study determined the reference value of Igs in apparently healthy 261 rural Bangladeshi primary school children (aged 5 to 14 years, mean 9.3 years). IgG, IgM and IgA were determined by an auto-analyzer. The mean (standard deviation) value of IgG was 1728 (344) mg/dl. The corresponding values for IgM and IgA were 200 (88) and 163 (63) mg/dl, respectively. The 95% reference value calculation in all subjects showed that the range for IgG was 1103 to 2524, IgM was 92 to 390, and IgA was 72 to 325 mg/dl. These values could be used to evaluate Ig status in children with a variety of clinical conditions.

Digestive haemorrhage in patients with anti-Anisakis antibodies.

Anisakis simplex parasite causes anisakidosis, a disease that often mimics other gastrointestinal diseases such as peritonitis, appendicitis, Crohn's disease, ulcer, etc. Patients with digestive haemorrhage caused by ulcers, varices or Mallory syndrome were analysed for antibodies to the worm A. simplex. Antibody detection was carried out by enzyme-linked immunosorbent assay (ELISA) and immunoblot using crude extracts of antigen and excretory/secretory products. Total immunoglobulin (Ig), IgG, IgM, IgA and IgE were studied. Eighty-seven patients were studied. The following prevalence rates were found with crude antigen: total Ig 30% (95% confidence interval 21-40), with values for IgG, IgM, IgA and IgE of 22 (CI 14-31), 17 (CI 10-26), 37 (CI 27-47) and 12% (CI 6-20), respectively. Twenty-four positive sera for total Ig response and crude products were selected for determination of specific antibodies with excretory/secretory antigens. We obtained 8, 13, 3 and 16 positive cases for total Ig, IgG, IgM and IgA respectively. The percentages of positivity within the varices and Mallory groups of patients were higher although differences were not significant (35 and 50% respectively). In a healthy population, the prevalence for total Ig is much lower (6%). Twenty-five positive sera for total Ig response were tested by means of immunoblot analysis against crude larval antigen. Concerning total Ig antibody response, 12 of the sera showed an immuno-recognition pattern concordant with the human anisakidosis reference serum (E17). Specific IgG bands were visualized in 30 sera; specific IgM and IgA in 6 and 12, respectively. Different clinical variables of these patients were studied: leucocytes, eosinophils, haemoglobin, prothrombin activity, thromboplastin time, fibrinogen, platelets and erythrocyte sedimentation rate. There were a few significant differences: for total Ig in prothrombin activity and platelets, and for IgM in eosinophils. The prevalence of detectable antibodies against A. simplex is higher in patients with digestive haemorrhage than in the healthy population.

Low induction of varicella-zoster virus-specific secretory IgA antibody after vaccination

Breakthrough after varicella vaccination occurs in approximately 2. 6% approximately 18.6% of immunocompetent children, but the reason has not been demonstrated clearly. As a first defense, specific secretory IgA antibody on the mucosa plays an important role in preventing invasion of microorganisms. To examine induction of varicella-zoster virus (VZV) specific secretory IgA after natural infection and vaccination and its booster mechanisms, 143 salivary samples were tested by ELISA. The VZV-secretory IgA values were significantly higher in the matched children after natural chickenpox than in those after vaccination, although the total secretory IgA did not differ between them. Two (7%) of the vaccinees lacked the sIgA antibody. In the elderly and in immunocompromised children, the VZV-secretory IgA values were no lower than those in healthy children, and they did not lack VZV-secretory IgA. The doctors and nurses taking care of patients with chickenpox had higher values than the other groups as did individuals who had had herpes zoster recently. VZV-secretory IgA was thought to be stimulated by exogenous and reactivated endogenous VZV to neutralize VZV with weak activity. These results suggest that low or no induction of VZV-secretory IgA antibody after vaccination may be one of the possible explanations for a breakthrough.

Squamous cell carcinoma antigen, circulating immune complexes, and immunoglobulins in monitoring squamous cell carcinoma of head and neck: a study of the hellenic co-operative oncology group (HeCOG).

This study investigates the clinical utility of squamous cell carcinoma antigen (SCC-Ag), circulating immune complexes (CIC), and immunoglobulins (IgA, IgG, IgM) in the diagnosis, monitoring, and prognosis of 117 squamous cell carcinoma of the head and neck (SCC-HN) patients having local and/or systemic treatment. Serum marker levels were measured in a prospective study. SCC-Ag was positive in 28.2% of patients, the CIC in 63.2%, the IgA in 11.1%, the IgG in 15.4%, and the IgM in 9.44%. Statistically significant correlation was found between the initial SCC-Ag levels and tumor localization, whereas the CIC levels were increasing significantly with progressing disease stages. It was also found that the significant decrease of SCC-Ag, IgA, and CIC levels at the end of treatment was correlated with an increased incidence of disease-free status. The initial values of IgG and the disease stage were significantly correlated with a favorable treatment outcome. The pretreatment elevated SCC-Ag and IgM serum values showed a significant trend to predict a disease progression. Using a Cox proportional hazards model the IgG serum values, the primary site, and the disease stage were significant predictors for time to progression. The significant decrease of SCC-Ag, IgA, and CIC values at the completion of treatment was correlated with an increased incidence of disease-free status. This study indicates that only the estimation of SCC-Ag and in some degree the IgM and/or IgG is a potential tool for monitoring the efficacy of treatment or disease recurrence in SCC-HN.

Estandarización de la ELISA IgM e IgA para el inmunodiagnóstico de la triquinosis humana

An ELISA test for trichinosis using as antigen a larvae soluble fraction from Trichinella spiralis was carried out for the detection of IgM and IgA specific antibodies in 45 serum samples from patients confirmed or suspected to have trichinosis by strong clinical and epidemiological evidences. All the patients had positive serology detected by precipitin test, bentonite floculation test, indirect hemagglutination test and ELISA IgG test. The cut-off value was determined using two criteria. Criterion A was determined in each plate, using three positive controls and two negative ones; the average of the negative controls and the weakest positive control, multiplied by a 1.2 factor was, considered the cut-off value. Criterion B was determined using the average plus three standard deviations from 64 apparently healthy persons serum samples. In both cases, three serum dilutions (1:10, 1:100 and 1:500) were used. The sensitivity of ELISA IgM was 100.0, 93.3 and 82.2% using serum dilutions of 1:10, 1:100 and 1:500 respectively (criterion A) and 100.0, 97.8 and 95.6% for the same dilutions (criterion B), whereas the values for ELISA IgA were: 100.0, 91.1 and 86.7% (criterion A) and 100.0, 100.0 and 91.1% (criterion B). In order to find out the specificity of ELISA IgM and ELISA IgA, additional 118 serum samples from individuals with other parasitoses, such as cysticercosis (18) hydatidosis (39), fascioliasis (12), toxocariasis (30), Chagas' disease (12) and individuals with non-specific eosinophilia (7), were also tested. ELISA IgM presented a specificity of 92.3, 93.4 and 97.3% (criterion A) and 96.2, 97.8 and 97.8% (criterion B) whereas the results for ELISA IgA were 97.8, 98.9 and 99.4% (criterion A) and 98.4% for the 1:10 and 1:100 dilutions and 100.0% for the 1:500 dilution (criterion B). The positive predictive values of ELISA IgM were 76.3, 77.8 and 88.1% (criterion A) and 86.5, 91.7 and 91.5% (criterion B) whereas the negative ones were 100.0, 98.3 and 95.7% (criterion A) and 100.0, 99.4 and 98.9% (criterion B). The positive predictive values of ELISA IgA were 91.8, 95.3 and 97.5% (criterion A) and 93.8, 93.8 and 100.0% (criterion B) whereas the negatives ones were: 100.0, 97.8 and 96.8% (criterion A) and 100.0, 100.0 and 97.8% (criterion B). The use of ELISA IgM and ELISA IgA in the immunodiagnosis of trichinosis is discussed.

EFFECT OF SPRINT TRAINING ON THE CELLULAR AND HUMORAL IMMUNE RESPONSE IN MALE ADOLESCENTS

128 The purpose of this study was to determine the immunologic response to a brief bout of intense exercise in adolescents and to determine the effects of sprint training(ST) on this response. Counts of leukocytes and their subsets, counts of lymphocytes and their subsets, natural killer(NK) cell number, immunoglobulins(IgA, IgG, and IgM), and complements (C3 and C4) were determined before and after(3 min and 60 min) a wingate test at pre- and post-ST in 12 adolescents (17 years of age). The subjects were divided into two group, control and experimental group. The training period comprised three parts and lasted, in total, 12 weeks. The Turkey's studentized range test and analysis of variance were used to determine statistical significance, with values expressed as mean ± SD. Three minutes after the wingate test before sprint training, all subjects increased significantly in WBC and NK cell(p<.05). But the rest of parameters showed no significant differences. And one hour after wingate test before sprint training all of the immune parameters except NK cell returned to the pre-wingate test level. After 12 weeks' sprint training WBC, T cell, helper T cell and TH/TS ratio increased significantly in the experimental group(p<.05). On the contrary after 12 weeks' sprint training suppressor T cell and NK cell decreased in the experimental group. Humoral immune parameters, values of IgA and C4 of experimental group were significantly higher than those of the control group after 12 weeks sprint training(p<.05). From the discussion of above results, it could be concluded that a brief bout of intense exercise induced a transient immune response to adolescents and long term sprint training brought about the positive changes in immune response both of cellular and humoral immune systems. Increase of WBC, T cell, Helper T cell and H/S ratio and decrease of suppressor T cell indicated that immune function about diseases and viruses have improved.

The relationship between anti-endomysium antibodies and villous atrophy in coeliac disease using both monkey and human substrate.

Circulating antibodies offer a noninvasive diagnostic screening test in patients with coeliac disease with severe histopathological abnormalities. This study assesses for the first time the sensitivity and reliability of anti-endomysium in screening for coeliac disease in patients with milder forms of villous atrophy using human umbilical cord and monkey ileum. Serum from 124 adults and children > 2 years old including 33 patients with coeliac disease on a gluten-free diet and 91 patients referred to the laboratory for screening was studied. The presence of IgA-anti-gliadin (AGA) (ELISA) and IgA-anti-endomysium (EMA) was detected in the serum using monkey ileum and human umbilical cord (HUC) substrates. Patients with abnormal serology results or severe clinical complaints were invited to attend for a small-bowel biopsy. The prevalence of EMA detected on monkey ileum and HUC was compared with the histopathological features of coeliac disease at presentation. Fifty-three of the 91 patients screened for coeliac disease underwent a small intestinal biopsy. Twenty-three of the 91 patients suspected of having coeliac disease had coeliac disease. The EMA test was positive in 18 of 23 using both monkey ileum and HUC (sensitivity 78%). Partial villous atrophy (PVA) was seen in four of the five EMA-negative patients, and subtotal/total villous atrophy (SVA/TVA) was demonstrated in 18 of the 23 cases with positive EMA. Both substrates detected identical positive cases. There was an excellent concordance between EMA sensitivity evaluated on HUC and those on monkey ileum. One patient was EMA-negative on monkey ileum but positive on HUC and one patient who was EMA-positive on monkey ileum was EMA-negative on HUC. Only one of 33 coeliac disease patients on gluten-free diet for more than one year with persisting TVA had positive EMA. The rest of the cases had a negative EMA on both HUC and monkey ileum. A negative result for EMA in coeliac disease patients with a normal IgA value does not exclude the diagnosis of coeliac disease. A positive EMA is seen mostly in those coeliac disease patients with severe tissue damage (SVA/TVA). EMA has a low sensitivity in coeliac disease patients with PVA in spite of use of different substrates.

Characterization of immunoglobulins and cytokines in human cervical mucus: influence of exogenous and endogenous hormones

Mucosal immunity in the female reproductive tract is influenced by immunoglobulins (Igs), cytokines, and reproductive hormones. Previous studies of reproductive-aged women demonstrated that IgA and IgG increases in cervical mucus corresponded to elevated levels of IL-1 β which occurred 1 day before the peak of endogenous estradiol production prior to ovulation. We sought to determine the effect of exogenous hormones on reproductive tract immunity in women on oral contraceptive pills (OCPs) and to compare the results with respect to naturally cycling women. Twelve women of reproductive age who had negative cervical cultures, a normal pap smear, and agreed to abstain from sexual intercourse during the study initiated OCPs. Cervical mucus and vaginal washes were collected at six intervals (2–3 days apart) throughout the treatment cycle. Fifteen naturally cycling women had similar samples collected prior to, during, and subsequent to ovulation. Cervical mucus samples were assayed for IgA, IgG, IL-1 β, IL-6, and IL-10 by enzyme-linked immunosorbent assay (ELISA). IgA, IgG and IL-1 β levels in women on OCPs paralleled increasing levels of norethindrone. Mean values of IgA increased from a low of 14.4±3.1 to 41.1±9.4 mg/dl and decreased significantly after the cessation of the pills ( P<0.001). In naturally cycling women, the largest quantities of Igs were detected prior to ovulation. By comparison, mean values of IgA in the cervical mucus of women on OCPs (24.4 mg/dl) exceeded peak levels of IgA in the cervical mucus of naturally cycling women (14.6 mg/dl). IgA was the predominant Ig detected in cervical mucus of women on OCPs. Both immunoglobulins in each group exhibited changes relative to their hormonal status. The increased levels of IgA in the cervical mucus of women on OCPs may explain the clinical observation of a lower incidence of sexually transmitted diseases.

Serum Immunoglobulins and IgG Subclasses in SS Patients with Saudi Arabia/India Haplotype

Objectives: This study investigates serum immunoglobulin fractions (IgG, IgA and IgM) and IgG subclasses (IgGScs; IgG1–4) in SS patients with the Saudi Arabia/India (SAI) haplotype. The influence of gender, Hb F levels, spleen function and coexistent α-thal trait were studied. Methods: Immunoglobulins and IgGScs were assayed using nephelometry. β^s-globin gene cluster haplotyping and α-globin genotyping were done using a combination of PCR and allele-specific oligonucleotide hybridization techniques. Results: Twenty-nine steady-state (i.e. not acutely ill) SS patients (23 SAI homozygotes and 6 SAI/Benin compound heterozygotes) and 34 healthy age- and sex-matched Hb AA and AS controls were studied. Mean serum IgG and IgA values were significantly higher in the patient group, while there were no significant differences in the mean IgGScs. The patient group was further subdivided depending on whether the spleen was normally visualized (group 1), partially visualized (group 2) or not visualized (group 3) on ^99mTc-labeled tin colloid scintigraphy. There was a significant sequential increase in mean IgG values from group 1 to group 3 but the reverse was true for IgM, while IgA showed no consistent trend. The mean levels of IgG1 and IgG3 were significantly higher in group 3 (p < 0.01). Hb F level did not influence immunoglobulins or IgGScs, but SS patients with coexistent α-thal trait tended to have lower IgG and IgG1 levels. Conclusions: Increased serum IgG is associated with poor splenic function and recurrent infections among SAI patients, while increased IgM is seen mainly in those with relatively normal splenic function.

Allotype‐Associated Differences in Concentrations of Human IgA2

Concentrations of immunoglobulin (Ig)A2 were determined in 176 Finnish blood donor sera. Their IgA, IgM, IgE, IgG1, IgG2, IgG3 and IgG4 concentrations and Gm allotypes had been determined earlier. The mean concentration of IgA2 was higher in individuals carrying the Gm(ax) allele (0.15 g/l) than in those negative for Gm(x) (0.103 g/l). The difference was statistically significant (P = 0.006). As > or = 70% of IgA was usually IgA1, its concentration could be calculated fairly reliably by subtracting the IgA2 value from the IgA value. The mean IgA1 concentration (2.03 g/l) seemed to be independent of the Gm allotypes.

Dermal and Bronchial Responsiveness of Aluminium Smelter Workers

Dermal and Bronchial Responsiveness of Aluminium Smelter Workers: Evgenije HoSovski, et al. Health Center, Department of Occupational Medicine Uzice—Tests on derma! and bronchial responsiveness were carried out in aluminium smelter workers (exposed group, n = 127), and in office workers (control group, n=49). All the participants were male, apparently healthy, and tobacco non‐smokers. The studied groups were comparable for all parameters used, but not for occupational environment conditions (i. e. aluminium and other toxic noxae exposure). Patch and prick cutaneous test revealed hypersensitive reaction to pure aluminium, aluminium smelter dust, and histamine in a significant number of exposed workers. Bronchial hyperresponsiveness to acetylcholine (but not to aluminium aerosol) was found in 38.5% of exposed workers, versus 2.0% of the control group. The research showed that mean values for IgA and IgG (but not IgE and IgM), were considerably higher in the serum of exposed workers. In respect to genetic markers, no important difference between the groups studied in alpha‐ 1 ‐anti‐trypsin values in serum was noted. The changes noted lead to the conclusion that there is an immunological disturbance in workers exposed for a long time to toxic compounds (mainly aluminium) in an aluminum smelter. Present knowledge cannot explain these findings by the adverse effects of aluminium alone.

Longitudinal characterization of CD4, CD8 T-cell subsets and of haematological parameters in healthy newborns of cynomolgus monkeys

A longitudinal characterization of immune cell subpopulations (lymphocytes, CD4 + and CD8 + cells), of routine haematological parameters and of immunoglobulin serum levels was carried out in newborn Macaca fascicularis starting from 1 week up to 1 year of life. In neonates, the percentage of CD4 + lymphocytes is almost double, while the percentage of CD8 + cells is lower than that found in adult monkeys (> 5-years old). An inverted trend in the percentage of the two T-lymphocyte subpopulations was observed during the weeks following birth, with a progressive increase of circulating CD8 +, paralleled by a decrease of CD4 + cell number. Consequently, the CD4 CD8 ratio slowly decreases, even if, at 12 months of life, it is still higher than that found in adult animals. Several differences were also noted between young and adult monkeys with regard to the total number of circulating CD4 + and CD8 + cells. Haematological parameters did not show consistent differences with respect to adult values. The plasma IgG level is high at birth, then decreases until 6 months of life, while the IgM and IgA values are very low during the first weeks of life but increase in the following period. Our data showed that variations of immunological (CD4 +, CD8 + cells) patterns and of some haematological parameters in M. fascicularis are dependent on age. These variations should be therefore considered whenever young animals are used in experimental protocols.

Saliva and marathon running.

The aim of this study was to follow changes in saliva and serum after strenous prolonged exercise. Twenty individuals, three women and 17 men, 24-62 years old, well-trained but not at elite level, participating in the Stockholm Marathon, were selected for the study. Two of the subjects broke the race after 20 km. Three samples of saliva were collected, i.e. (i) just before the race, (ii) directly after the race, and (iii) 1 h after the race. Paraffin-stimulated whole saliva, resting non-stimulated whole saliva and citric acid-stimulated parotid saliva were investigated. In all three types of saliva, there was a decrease in secretion rate and only 14 of the 18 participants could produce resting non-stimulated whole saliva directly after the race. The salivary concentration of chloride, phosphate, potassium, amylase, hexosamine, sialic acid and salivary peroxidase were significantly higher after than before the race. There were no significant changes in salivary pH and buffer capacity. The total protein concentration was increased in all types of saliva after the race. To conclude, there were several changes in the saliva composition just after the marathon, but most of the values were back to baseline after 1 h of rest. However, the values for sodium, calcium, phosphate, salivary peroxidase, amylase and salivary IgA were still elevated 1 h after the race.

The effect of methotrexate and azathioprine on the serum levels of IgA-alpha 1-antitrypsin complex in juvenile chronic arthritis.

In the present study we investigated the influence of methotrexate (MTX) and azathioprine (AZA) on the serum levels of the IgA-alpha 1-antitrypsin (IgA-AT) complex in patients with the systemic form of juvenile chronic arthritis (JCA). Fifty-six JCA patients (22 treated with MTX, 18 treated with AZA, and 16 not treated with any immunosuppressive agent) were enrolled in the study. MTX dosage ranged from 0.3 to 0.5 mg/kg-1 week-1, while AZA was given daily at an average dose of 1 mg/kg. MTX was given for 13 months (SD = 7 months) whereas AZA for 11 months (SD = 6 months). The average value of the complex was higher in JCA patients than in both control groups (0.74 +/- 0.73 U vs 0.37 +/- 0.13 U (control children), P < 0.001 and vs 0.23 +/- 0.12 U (control adults), P < 0.001). Values exceeding the normal range were found in twenty-two JCA patients (39.4%). Serum IgA-AT level was lowest in the MTX group compared to AZA and non-treated patients (0.56 +/- 0.24 U, 0.76 = 0.43 U, 0.95 +/- 0.52 U, respectively, P < 0.05). IgA values exceeding normal levels for age were found in 14% of the patients. A correlation between the levels of the IgA-AT complex and C-reactive protein (r = 0.43, P < 0.01), alpha 1-acid-glycoprotein (r = 0.45, P < 0.01), alpha 1-antichymotrypsin (r = 0.52, P < 0.01), alpha 1-antitrypsin (r = 0.40, P < 0.01) and IgA (r = 0.56, P < 0.01) was established.

IMMUNOGLOBULIN (IG) LEVELS AND IMMUNE RESPONSE TO HEPATITIS B VACCINE IN CHILDREN WITH CANCER 130

The aim of this study was to correlate the seroconversion rate following hepatitis B vaccination in children with malignant diseases, to serum IG levels, the latter being an indirect method for determining B-cell function and humoral immunity status. One hundred and eight (108) patients (60 boys, 48 girls), 2-20 years old, with negative HBV, HCV and HIV markers, on or off chemotherapy, were studied. Of the 108 patients, 87 suffered from acute leukaemia, 11 from lymphoma, 7 from solid tumors and 3 had systematic Langerhan's cell histiocytosis. All patients were divided into 2 groups according to therapy status: group A comprised 70 patients under chemotherapy and group B 38 patients who had been off chemotherapy and in complete remission for 3 months to 10 years. Prior to the first vaccine dose, levels of IgG, IgA, IgM as well as IgG subclasses (G1, G2, G3, G4) were measured. Recombinant hepatitis B vaccine (20 mcg/dose) was administered at 0, 1, 2, and 6 months and the level of anti-HBs was determined one month after each dose. Protective titres were considered to be ≥ 10 mlU/ml. In group A the percentage of patients with normal values of IgG, IgA and IgM was 54%, 76% and 27% respectively, with a total seroconversion rate of 36%, whereas the corresponding percentage in group B were 97%, 100% and 71% with a total seroconversion rate of 82%. There was no significant correlation of immune response, either low or satisfactory, to any of the IgG subclasses. Our results support the hypothesis that the immunodeficiency status of patients under chemotherapy is responsible for the limited seroconversion rate to HBV vaccination. After the completion of therapy and the reconstitution of humoral immunity, a very good response to this vaccine is achieved.

Immunoglobulins, Immunoglobulin G Subclasses and Complement in Adult Omanis

Immunoglobulins and complement were quantitated in 100 healthy adult Omanis in order to establish a reference range based on local data. Mean values were IgA 2.38 g/L, IgM 1.14 g/L, IgE 241 kiu/L, C3 7.44 micro mol/L and C4 1.57 micro mol/L, values similar to those found in the West. However, the mean level of IgG was almost 50% higher than that found in North America and Europe, that is, 14.63 g/L compared with 10-11 g/L. The values for IgG, IgA, IgM and IgE are similar to those reported for Iraq, but IgG levels were much lower than those found in Iran (25.52 g/L), although IgA, IgM and IgE were comparable. Comparison of Omani data with that for Saudi Arabia showed significantly more IgG in Oman (14.63 versus 11.68 g/L) and significantly less IgM (1.14 versus 1.66 g/L). IgA and IgE levels were similar. As reported elsewhere, females had significantly more IgM than males (1.32 versus 0.97 g/L). The levels of IgG subclasses in Oman are 9.44, 4.01, 1.06 and 0.62 g/L for IgG1-4 respectively. The percentage of the various subclasses are very similar to those reported elsewhere, that is, 62%, 27%, 7% and 4% for IgG1-4. However, in Iraq, a higher percentage (and level) of IgG3 (16%) and the lower IgG2 (18%) compared to Oman may reflect differing immune responses resulting from exposure to different microorganisms. It is essential to use local reference data when evaluating patients.