Increase In Serum IgM Research Articles

Antibody and Cytokine Responses to the Cilium-Associated Respiratory Bacillus in BALB/c and C57BL/6 Mice

The cilium-associated respiratory (CAR) bacillus is a gram-negative, gliding bacterium that causes persistent respiratory tract infections in rodents despite histologic and serologic evidence of a marked immune response. To assess humoral immunity and cytokine responses in CAR bacillus disease, 6-week-old female BALB/c and C57BL/6 mice were inoculated intratracheally with 10(5) CAR bacillus organisms. CAR bacillus-specific serum immunoglobulins (immunoglobulin M [IgM], IgG1, IgG2a, IgG2b, IgG3, and IgA) and local pulmonary cytokines (tumor necrosis factor alpha [TNF-alpha], gamma interferon [IFN-gamma], and interleukin-4 [IL-4]) were evaluated by enzyme-linked immunosorbent assay every 7 days for 49 days. BALB/c mice developed CAR bacillus-induced lesions early in the course of disease that became more severe with time. Correlating with increasing disease severity, BALB/c mice had elevations in all antibody isotypes tested, and elevations in pulmonary TNF-alpha, IFN-gamma, and IL-4. C57BL/6 mice developed mild lesions with mild increases in serum IgM, IgG1, IgG2b, and IgG3 levels and minimally detectable IgG2a and IgA. Cytokine perturbations were not detected in C57BL/6 mice. The persistence of infection in BALB/c mice with vigorous serum antibody responses and increased IFN-gamma and IL-4 responses suggests that humoral immunity and T-cell responses are ineffective at preventing CAR bacillus disease. Furthermore, the lackluster antibody responses and undetectable cytokine responses in C57BL/6 mice suggest that humoral immunity and T-cell responses are not critical in resistance to CAR bacillus-induced disease.

Long-term immunologic effects of thymectomy in patients with myasthenia gravis

Background: Thymectomy (Tx) is a common therapeutic option to treat myasthenia gravis (MG), but its effects on the immune system are still obscure in humans. Objective: We sought to evaluate long-term immunologic effects of therapeutic Tx in patients with MG. Methods: T- and B-cell subsets and T-cell repertoire were analyzed in 35 patients with MG, 16 with previous Tx (at least 8 years before), 6 with recent (<1 year) Tx, and 13 without Tx, as well as in 32 healthy subjects used as normal control subjects. Serum immunoglobulins and a variety of autoantibodies were also measured. A subsequent 3-year clinical follow-up was performed to verify the possible appearance of systemic autoimmune diseases. Results: The long-term thymectomized (Txd) patients had mild T-cell lymphopenia and an expansion of some Vβ families among circulating CD4+ and CD8+ T cells. They displayed a normal number of total B and CD5+ B-circulating lymphocytes, but they also displayed a polyclonal increase in serum IgM and IgG associated with the presence of high levels of a variety of organ- and nonorgan-specific autoantibodies, including anti-dsDNA and anticardiolipin, without clinical evidence of autoimmune disease. These serologic abnormalities were not detectable in both non-Txd and recently Txd patients. After 3 years, 2 long-term Txd patients had systemic lupus erythematosus and an undifferentiated connective tissue disease. Conclusions: The association between MG and laboratory findings of systemic autoimmune disease may be in part related to Tx rather than to MG. Tx may represent a risk for the development of systemic autoimmune disorders over years in patients with MG. (J Allergy Clin Immunol 1999;103:865-72.)

Waldenström's macroglobulinemia in young African-American adults.

We have identified five African-American patients with Waldenström's macroglobulinemia (WM) diagnosed at a young age (ages 35, 38, 38, 40, 51; 4 males, 1 female). All had a history of intravenous heroin abuse and four also used cocaine. Their manner of presentation and clinical course were typical. Three of three patients tested for the hepatitis C virus (HCV) were positive and three of three patients tested were HIV negative. The potential relationship between intravenous drug abuse and/or HCV to development of WM in this group of young patients is provocative, especially since a polyclonal increase in serum IgM is commonly seen in chronic intravenous heroin addicts. More recently, the contribution of HCV is being evaluated in lymphoproliferative disorders. Although WM is typically a disease of older people, it should also be considered in the differential in a young patient with a suggestive clinical picture.

HYPER - IgM SYNDROME WITH LYMPHOID HYPERPLASIA 77

Immunodeficiency with Hyper-IgM (HIM) is a rare primary or secondary disorder characterized by very low serum IgG and IgA but either a normal or, more frequently, markedly elevated concentration of IgM. The most common clinical manifestatious include recurrent bacterial infections, lymphoid hyperplasia and autoimmune disorders the most frequent of which is reccurent neutropenia. We describe the case of a boy, age 6,5 years old who came at age 3 because of neutropenia and cervical adenitis, when the investigation revealed low levels of serum IgG and IgA and elevated IgM. With the diagnosis of hyper-IgM syndrome treatment with regular infusion of intravenous gamma globulin and granulocyte colony-stimulating factor (G-CSF) was started. Three years after initial diagnosis the boy was admitted because of rapid worsening of lymphadenopathy, severe hepatosplenomegaly prolonged fever and significant increase in serum IgM. The lymph node's liver's and spleen's biopsy as well as immunologic and immunohistochemical investigation are compatible with polyclonal B-Lymphoid hyperplasia a complication seen usualy during the second decade of life. Treatment with Interferon-A showed a good response.

Isochromosome i(3q) and premature chromosome condensation are recurrent findings in chronic B-cell lymphocytosis with binucleated lymphocytes.

Chronic B lymphocytosis with binucleated lymphocytes (LWBL) is a recently described entity. The lymphocytosis is stable over years and atypical binucleated lymphocytes are detected on peripheral blood smears. Further investigation has shown a predominance in females, a polyclonal increase in serum IgM and HLA-DR7 expression in most cases. In almost all cases cytogenetic studies with classical culture conditions have not shown any abnormality. We describe 7 patients with LWBL associated with an abnormal karyotype. An additional i(3q) was found in 6 cases. Premature chromosome condensation (PCC) was detected in all 7 cases. As both abnormalities are rarely present in other benign or malignant proliferations, we suggest a strong correlation between LWBL and i(3q) and/or PCC.

Chronic B-cell lymphocytosis with binucleated lymphocytes (LWBL): a review of 38 cases.

LWBL is characterized by persistent and stable lymphocytosis, seen in but not exclusively female patients, with binucleated lymphocytes evident on peripheral blood smears. There is a polyclonal increase of serum IgM and in all cases immunophenotyping revealed a polyclonal expansion of B-lymphocytes. Whether this syndrome represents a premalignant disease process or a true polyclonal lymphocytosis remains unsettled. The occasional reports of clonal Ig rearrangements in this disorder suggest that in a minority of cases the polyclonal expansion may be followed by the emergence of one predominant clone. The demonstration of a clinically, benign, clonal lymphoid population is well recognised in several T cell disorders such as in the syndrome of large granular lymphocytes expansion. The benign clinical course and the lack of biological evolution in the majority of cases suggest that the importance of recognition of this disorder lies in avoiding aggressive therapy in these cases. A careful follow-up of these patients is mandatory and prospective immunological and genetic studies performed at different stages of the disease may well clarify this issue, particularly since most patients were HLA-DR7 positive.

Intestinal immune function is unaffected by parenteral nutrition in man.

Animal studies have demonstrated intestinal immunoglobulin production is decreased when luminal nutrition is withheld and nutrition is provided solely on the basis of total parenteral nutrition (TPN). Eight normal volunteers were hospitalized in the Clinical Research Center for three weeks. The subjects received TPN as an exclusive means of nutritional support for 14 days followed by 5 days of enteral feeding with either standard or a glutamine- and arginine-supplemented formula in which the protein source was primarily free amino acids and peptides. Endoscopic jejunal biopsies obtained before and after TPN and following enteral refeeding were evaluated by immunofluorescence for the number of IgA, IgM and IgG-producing cells; T and B cells as well as intraepithelial and lamina propria lymphocytes were also counted. Serum immunoglobulins and the molecular forms of serum IgA were determined at the same intervals. The number of intestinal IgA-, IgM- and IgG-producing cells was unaffected by TPN (676 +/- 58 vs. 643 +/- 38, 101 +/- 14 vs. 98 +/- 18, 10 +/- 1 vs. 11 +/- 2 per low power field). The total number of intestinal lymphocytes, and CD3+ lymphocytes in the intraepithelial area was unaffected by TPN (10.4 +/- 0.4 vs. 10.2 +/- 1.3, 7.3 +/- 0.8 vs. 8.6 +/- 1.6 per 100 epithelial cells). Similarly, the total number of lymphocytes and CD3+ lymphocytes in the intestinal lamina propria was unaffected by TPN (4.4 +/- 0.2 vs. 6.2 +/- 0.8, 3.3 +/- 0.7 vs. 4.5 +/- 0.8). A small, but statistically significant increase in serum IgA and IgM was seen with TPN 314 +/- 11 vs. 342 +/- 16 mg/dL and 154 +/- 25 vs. 226 +/- 47 mg/dL, although IgG remained unchanged (1262 +/- 69 vs. 1207 +/- 57 mg/dL). The proportion of polymeric and monomeric serum IgA remained unchanged after TPN (19.2 vs. 22.1% polymeric). The use of TPN is not associated with intestinal immune dysfunction in man. A small, but statistically significant increase in serum IgM, and a borderline statistically significant increase in serum IgM were associated with TPN. The etiology and clinical significance of these observations is unclear.

Immunoglobulin Production in Kawasaki Disease

The production of immunoglobulins that may include specific antibodies to an unknown agent was investigated in Kawasaki disease. That is, serum immunoglobulin concentrations and the numbers of immunoglobulin-secreting cells in peripheral blood mononuclear cells (PBMCs) without culture in vitro were enumerated in the course of the disease, to assess immunoglobulin production at a certain point in vivo. Results showed that the numbers of IgM-, IgG-, or IgA-secreting cells increased in the acute stage prior to increases in serum IgM, IgG, or IgA concentrations, respectively. Moreover, in 2 patients who had a relapse of the illness, the numbers of immunoglobulin-secreting cells were high at the relapse compared with those within 1 week after the initial onset. These results suggest that measurement of immunoglobulin-secreting cells in PBMCs is useful for assessment of the immunoglobulin production ability at a certain point in vivo. Thus, immunoglobulins abnormally produced may include specific antibodies to the epitopes of a certain agent.

Dysregulation of the humoral immune response in old mice.

The increase in autoantibodies with age of both experimental animals and humans has been thought to reflect a shift in the antibody repertoire from foreign to self antigens. In mice, before immunization, the age-associated increase in antibodies reactive with a prototypic autoantigen, bromelain-treated autologous erythrocytes (BrMRBC), reflected a 3-fold increase in serum IgM and the number of IgM-secreting spleen cells in old compared with young mice. However, the percentage of the IgM-secreting spleen cell repertoire reactive with BrMRBC in old mice was actually approximately 50% that in young mice. In contrast, after immunization with sheep erythrocytes (SRBC), old mice showed a 5-fold increase in the percentage of IgM-secreting cells reactive with BrMRBC while young mice showed no significant increase. The converse is true for the percentage of IgM-secreting spleen cells in old mice specific for SBRC, which is 10% the number generated by young mice. The increased autoantibody response of old mice is not, however, linked to their poor response to the nominal antigen. Thus, immunization with phosphorylcholine (PC) conjugated keyhole limpet hemocyanin, an antigen that induces a comparable anti-PC response in old and young mice, also induced more autoantibody forming cells in old than young mice. The increased autoantibody response of old mice after immunization can be accounted for by both an increased number of Ig-secreting spleen cells as well as an increased percentage of the expressed repertoire of IgM-secreting spleen cells that react with autoantigens.(ABSTRACT TRUNCATED AT 250 WORDS)

Persistent polyclonal lymphocytosis with binucleated B lymphocytes: a genetic predisposition

Persistent lymphocytosis is usually associated with a malignant lymphoproliferative disease (MLPD). We report six female patients presenting a chronic, moderate lymphocytosis of 2-16 years duration with atypical binucleated lymphocytes on peripheral blood smears. Further investigation showed a polyclonal increase in serum IgM and HLA-DR7 phenotype in all patients. The B cells were polyclonal because Southern hybridization of DNA and polymerase chain reaction failed to demonstrate a clonal rearrangement of immunoglobulin heavy chain genes. Peripheral blood examination showed binucleated lymphocytes in a family member of two of the cases; taken together with the association with HLA-DR7 these data suggest a genetic predisposition. The identification of this benign syndrome is important in order to prevent its misdiagnosis as a MLPD.

The effect of colostral immunoglobulin supplement on the passive immunity, growth and health of neonatal calves

Neonatal dairy calves were randomly allotted to three colostrum feeding regimens with increasing intakes of immunoglobulins (Ig) on the first day of life. The control group was fed one litre of pooled colostrum (Ig intake 19.5 g). In two experimental groups, the pooled colostrum was supplemented with 0.5 or 1.5 litres of commercial Ig-concentrate, giving a total Ig intake of 52.7 and 119.0 g, respectively. Serum IgG, IgM and IgA levels increased linearly (p &lt; 0.001) on day 2 post partum with the increasing Ig intake. The calculated mean Ig-absorption rate was 61% and decreased linearly for IgM (p = 0.051) and IgG (p = 0.078) with increasing Ig intake. At the highest Ig intake, serum IgG remained above 10 g/l during 30 days post partum. In the experimental groups, serum IgM and IgA decreased sharply during the first week of life and were relatively constant thereafter. In the control group, however, there was an increase in serum IgM after one week post partum, perhaps due to the in situ production of Ig. With the increasing Ig intake there was a small and non-significant tendency for better live weight gain (p = 0.286) and a lower incidence of diarrhoea (p = 0.421) during the first four weeks of life. It is concluded that the Ig-product tested is well absorbed during 24 hours post partum and it can be used either as a supplement to maternal colostrum when its quality is poor, or as a substitute when colostrum is not available.

Characterization and measurement of CD5+ B cells in normal and Trypanosoma congolense-infected cattle.

CD5+ B cells in cattle are present in peripheral blood and spleen, but not in lymph nodes, tonsils or Peyer's patches. Compared to classical B cells, they express similar levels of B cell surface markers, but have higher levels of surface IgM. We failed to find evidence for IgD on bovine B lymphocytes. The CD5+ B cells expressed CD11b (Mac-1). Another small subpopulation of B cells carried CD11b but not CD5. In cattle infected with Trypanosoma congolense, a dramatic increase in the percentage of CD5+ B cells in blood and spleen was observed. This increase occurred 7-10 days after parasites were first detected in the blood and correlated with the increase in serum IgM and the increase in the absolute number of B cells that is typical to trypanosome-infected animals. The increase in B cells was found to be due mainly to the expansion of the CD5+ B cell subpopulation. The cause of the amplification of the CD5+ B cells and their possible involvement in the production of autoantibodies and non-parasite-specific antibodies which have been described in trypanosome-infected animals are discussed.

Effective therapy of the LP-BM5 murine retrovirus-induced lymphoproliferative immunodeficiency disease with diethyldithiocarbamate.

The effects of therapy with the immunomodulator diethyldithiocarbamate (DTC) on the manifestation and natural history of LP-BM5 murine retrovirus infection in adult C57 Black 6 mice was investigated. DTC itself, had limited effects on the spleen weight, serum IgM, or mitogen responses of the non-virus-infected control mice when evaluated over a 9-week period. The virus inoculum administered was such that there was approximately a twofold increase in serum IgM and a halving of phytohemagglutinin (PHA) and lipopolysaccharide (LPS) responses in about two weeks and death of all animals by about 26 weeks postinfection. Doses of DTC of 20 and 200 mg/kg weekly or 5 days per week (intraperitoneally) in mice with LP-BM5 infection did not alter the manifestations or course of the disease. Doses of 400 or 600 mg/kg given 5 days per week, starting either 2 weeks before or the day of virus inoculation significantly reduced hypergammaglobulinemia, spleen weight, lymphadenopathy, and also prolonged survival. A dose of 400 mg/kg started 2 weeks after virus inoculation resulted in partial prevention of hypergammaglobulinemia, splenomegaly, and lymphadenopathy as well as 100% survival compared with 12.5% in non-drug-treated controls at 23 weeks after virus inoculation. The 9 surviving animals in the treated group were then allocated to continue treatment or stop treatment. In the animals without further treatment, lymphadenopathy and mortality occurred starting within 6 weeks after cessation of therapy while the animals with continued treatment remained in good condition for 40 weeks. There was only a very limited and transient effect of DTC therapy on the decline of the proliferative responses to phytohemagglutinin or lipopolysaccharide in any of the treated groups in the above described experiments.(ABSTRACT TRUNCATED AT 250 WORDS)

Establishment of dose-response relationships in BALB/c mice, using Brucella cell surface protein and lipopolysaccharide

SUMMARY A study was conducted to determine the immune (increased antibody) and protective (reduced colony-forming units) responses induced in mice by a: (i) single vaccinal inoculation, using various concentrations of Brucella cell surface protein (bcsp) or lipopolysaccharide (lps); (ii) primary inoculation, using various concentrations of bcsp, followed by a secondary inoculation, using a standard concentration of bcsp; and (iii) primary inoculation, using 1 concentration of bcsp or lps, followed by a secondary inoculation, using various concentrations of bcsp or lps. Four weeks after the primary inoculation, mice were challenge exposed with approximately 1 × 104 colony-forming units of Brucella abortus strain 2308 and all mice were euthanatized at 6 weeks. Reduced splenic weights and reduced colony-forming units in the spleens of vaccinated mice, compared with nonvaccinated mice, were the criteria of protection. Increase in serum IgM and IgG was defined as immunity. Both bcsp and lps induced protective and immune responses that were proportional to the dose given up to an optimal limit. However, concentrations higher than optimal decreased the protective and immune responses. This was true for mice given either 1 or 2 vaccinal inoculations. Enhanced secondary protective responses were seen only when suboptimal doses were used in the primary inoculation. Excessive or optimal doses in the secondary inoculations prevented or obscured the protectiveness and immunity by primary inoculations. The protective effects appeared to be additive when suboptimal doses were used in the primary and secondary inoculations. Inoculation of subimmunogenic doses induced a relative reduction in the antibody concentration after challenge exposure, compared with nonvaccinated mice. The overall results indicated that the protective responses induced by bcsp were probably attributable to lps. The results also indicated a linear increase in protection and immune response corresponding to increasing doses up to an optimal dose, and this stoichiometric optimum may be achieved by the use of 1 or more vaccinal inoculations. However, once this optimum was obtained, additional amounts of bcsp or lps cause perturbation of both the protective and serologic responses.

Silent Thyroiditis in an Eleven-Year-Old Girl, Associated with Transient Increase in Serum IgM and Thyroid Hormone.

An 11-year-old-girl with silent thyroiditis associated with a transient increase in serum IgM and thyroid hormone is described. The levels of serum IgM decreased from 4.38 g/L to 3.35 g/L after 1.5 months at the same time as thyroid hormones returned to normal. An unidentified antecedent infection or exposure to antigen causing the increase in serum IgM might have triggered the occurrence of silent thyroiditis in this patient, although a search for viral antibodies revealed no significant titer changes during the course of the disease.

Chronic in vivo depletion of CD4 T cells increases both serum IgM levels and the expressed frequency of anti-ssDNA precursors in both NZB and [formula omitted] mice

Chronic depletion of CD4 T cells has been employed as therapy in a number of models of autoimmune disease, including spontaneously autoimmune NZB W mice. In the present study, we evaluated the influence of CD4 depletion on the production of IgM and IgM anti-ssDNA. Beginning at 8 weeks of age, NZB and DBA 2 mice received 12 weekly injections of monoclonal antibody GK1.5 (anti-CD4) or normal rat IgG. In both strains, CD4 T cell depletion resulted in an increase in serum IgM. Anti-ssDNA precursors, which are increased in NZB mice, were further increased by depletion of CD4 T cells. The DBA 2 mouse expresses anti-ssDNA precursors relatively infrequently; however, CD4 T cell depletion resulted in a significant increase in the expression of these autoantibody precursors as well as an increase in the RNA content of splenic B cells. These results indicate that although CD4 T cell depletion ameliorates clinical manifestations of autoimmunity in some situations, this treatment may also increase serum IgM levels and the production of anti-ssDNA autoantibodies.

Effects of recombinant human interleukin-3 in patients with myelodysplastic syndromes

In a phase I-II study, nine patients with myelodysplastic syndromes and concomitant severe transfusion-dependent cytopenias were treated with recombinant human interleukin-3 (rhIL-3) to improve hematopoietic function. Doses of rhIL-3 ranged from 250 micrograms/m2 to 500 micrograms/m2 and were given as daily subcutaneous bolus injections for 15 days. Blood leucocyte counts increased 1.3- to 3.6-fold in all nine patients, including neutrophils, eosinophils, lymphocytes, basophils, and monocytes. The mean absolute neutrophil counts increased from 1,350/microL (range, 150 to 2,420) to 2,660/microL (range, 300 to 9,380) (P less than .05) immediately after the end of rhIL-3 therapy and to a maximum count of 4,096/microL (range, 350 to 10,820) (P less than .01). Platelet responses were seen in two of four profoundly thrombocytopenic patients, resulting in discontinuation of platelet transfusion. The requirements for red blood cell transfusion temporarily improved in one patient. Stimulation of plasma cells was evident by a significant increase in serum IgM and IgA levels. Mild side effects (fever, headache, local erythema, and bone pain) were observed in some patients, while transient thrombocytopenia developed in two patients. Disease progression with an increase in blast cells was seen in one patient. These results suggest that rhIL-3 is effective in stimulating hematopoiesis of all lineages in patients with myelodysplastic syndromes and may produce at least short-term hematologic improvement.

Effects of Recombinant Human Interleukin-3 in Patients With Myelodysplastic Syndromes

In a phase I-II study, nine patients with myelodysplastic syndromes and concomitant severe transfusion-dependent cytopenias were treated with recombinant human interleukin-3 (rhIL-3) to improve hematopoietic function. Doses of rhIL-3 ranged from 250 micrograms/m2 to 500 micrograms/m2 and were given as daily subcutaneous bolus injections for 15 days. Blood leucocyte counts increased 1.3- to 3.6-fold in all nine patients, including neutrophils, eosinophils, lymphocytes, basophils, and monocytes. The mean absolute neutrophil counts increased from 1,350/microL (range, 150 to 2,420) to 2,660/microL (range, 300 to 9,380) (P less than .05) immediately after the end of rhIL-3 therapy and to a maximum count of 4,096/microL (range, 350 to 10,820) (P less than .01). Platelet responses were seen in two of four profoundly thrombocytopenic patients, resulting in discontinuation of platelet transfusion. The requirements for red blood cell transfusion temporarily improved in one patient. Stimulation of plasma cells was evident by a significant increase in serum IgM and IgA levels. Mild side effects (fever, headache, local erythema, and bone pain) were observed in some patients, while transient thrombocytopenia developed in two patients. Disease progression with an increase in blast cells was seen in one patient. These results suggest that rhIL-3 is effective in stimulating hematopoiesis of all lineages in patients with myelodysplastic syndromes and may produce at least short-term hematologic improvement.

Chlorpromazine-Induced Immunopathy: Progressive Increase in Serum IgM

Long-term chlorpromazine therapy has been associated with the asymptomatic development of a high incidence of antinuclear antibodies, coagulation inhibitors, and increased serum levels of IgM. The purpose of this study has been to characterize the natural history of this chlorpromazine-induced (CPZ) immunopathy. To this end we carried out a prospective study of schizophrenic patients with the immunopathy to compare the effect of continuing CPZ versus switching to haloperidol therapy. Although no marked differences were noted between the 2 groups at the end of 5 years, 6 of 29 patients who continued to receive CPZ, as compared to none of 14 patients on haloperidol, had progressive elevations of serum IgM. In spite of a high incidence of antinuclear antibodies, none of the patients developed a lupus-like syndrome. One patient, however, who had been maintained on CPZ for more than 15 years, developed Waldenström macroglobulinemia, as characterized by an IgM monoclonal gammopathy and a lymphocyte immunoglobulin heavy and kappa light chain gene rearrangement. Another CPZ-treated patient developed immune thrombocytopenia. Based on the potential serious sequelae of prolonged stimulation of the immune system by CPZ, we recommend that patients who develop an increase in serum IgM while on CPZ be switched to other types of anti-psychotic medications.

Chlorpromazine-Induced Immunopathy: Progressive Increase in Serum IgM

Chlorpromazine-Induced Immunopathy: Progressive Increase in Serum IgM