Trace elements and protein-calorie malnutrition in the Fès area (Morocco)

Copper and selenium are essential micronutrients for development and growth as well as being necessary for the immune system and as an antioxidant defense. These trace elements present a variable distribution according to geographic regions. Several studies have shown reduced serum copper and selenium levels, as well as the activity of erythrocyte copper-zinc superoxide dismutase (SOD) and selenium-glutathione peroxidase (GPX) in protein-calorie malnutrition (PCM). The aim of this study was to evaluate the erythrocyte enzymatic activity depending on copper or selenium and the levels of these elements in serum. Fifty-six Moroccan children between the age of 6 to 60 months were selected, then divided into 20 control group children and 36 patients suffering from PCM (15 mildly malnourished and 21 severely malnourished). The malnourished group showed a significant decrease of selenium and copper levels that was related to the severity of malnutrition. Serum selenium decreased more than serum copper. No differences were noted between the groups in erythrocyte GPX activity, whereas SOD activity showed more discrepancy than in the copper levels in malnutrition. Serum copper or ceruloplasmin levels could be used as indicators of the severity of malnutrition, whereas the selenium levels could be used as indicators of the nutritional status.     

The sickness impact profile: validation of a health status measure

Postmortem concentration of the three immunoglobulins IgA, IgG and IgM has been studied by single radial immunodiffusion in 81 cases of sudden unexpected death in infancy and in 6 deaths between 2 and 11 years of age. The examinations of serum were repeated after several days after the sera had been kept at different temperatures. For comparison the serum immunoglobulin levels of IgA, IgG and IgM were determined in 11 corpses of adults directly after death and again 1 or 2 days later. Results: With the radial immunodiffusion method postmortem serum immunglobulins are determinable. A critical estimation of postmortem IgA-, IgG- and IgM serum levels has to consider postmortem protein modifications and keeping sera at higher temperatures (+44 degrees C., + 20 degrees C.) For determinations at a later date sera must be kept at -35 degrees C. The measured postmortem serum levels of IgA and IgG in cases of sudden unexpected death in infancy correspond with the normal variation of value in healthy children of the same age. The lowest concentrations of IgG were found about the 5th. month in infancy. Many of the IgM levels were higher than the normal mean value in healthy children of the same age. This is not caused by postmortem influences. The higher IgM concentration in sera suggest an active immunological reaction before death.     

A generalized consideration of myocardial preservation with cold crystalloid versus warm blood cardioplegia in heart valve replacement

The spontaneous as well as mitogen-induced in vitro production of interleukin-6 (IL-6) was studied in cultures of peripheral blood mononuclear cells (PBMC) from 14 children with marginal protein-energy malnutrition, 43 children with definite protein-energy malnutrition and 38 eutrophic controls of similar age, sex, race and socioeconomical condition. PBMC were cultured without added mitogen or stimulated with either lipopolysaccharide (LPS) or phytohemagglutinin (PHA). After 48 h incubation, cell-free culture supernatants were collected and stored at -70 degrees C. The amount of IL-6 in the supernatants was determined by a specific bioassay based on the proliferation of B9 hybridoma cells using human rIL-6 as standard. The mean level of IL-6 was significantly increased in supernatants from nonstimulated PBMC cultures from definitely malnourished children as compared with that observed in those of the controls. Stimulation with either LPS or PHA induced a rise in cytokine bioactivity in the supernatants of PBMC cultures from the different nutritional groups tested. Interestingly, IL-6 was significantly increased in the supernatants of PHA-stimulated cultures from malnourished children as compared with those of the controls.     

Defective leucocyte inhibitory factor (LIF) production by lymphocytes in children with kwashiorkor

Production of the lymphokine leucocyte inhibitory factor (LIF) by phytohaemagglutinin (PHA)-stimulated lymphocytes was assessed in 25 children with kwashiorkor. Although the lymphocytes of 12 of these patients produced adequate amounts of LIF, the rest of the group failed to produce lymphokine after PHA activation. There was no correlation between the ability to produce LIF and the age, severity of malnutrition or any other clinical parameters assessed in these patients. This finding confirms the presence of defective cell-mediated immunity observed in a substantial proportion of kwashiorkor children.     

Sarcomas in syrian hamster, induced by an oncorna virus and cellfree transmissible (author''s transl)]

A previous study had shown that in children with third degree protein-energy malnutrition, ultrafilterable or diffusible serum calcium concentrations remain normal, while the protein-bound fraction is low in those with hypoalbuminemia, accounting for over-all hypocalcemia. In order to retest those findings, a new series consisting of 20 small marasmic infants and 16 children with kwashiorkor was studied, using a membrane ultrafiltration procedure. Fifteen eutrophic children served as controls. At time of their admission into hospital, both groups of patients showed hypocalcemia, more so the cases of kwashiorkor. Diffusible calcium was normal, while the protein-bound moiety was significantly decreased in children with kwashiorkor. Upon recovery, protein-bound as well as total calcium concentrations returned to normal values.     

Effect of early postnatal under- and overnutrition on the development of IgA plasma cells in mouse gut

Development of gut IgA plasma cells was studied in early postnatal under- and overnutrition. Female mice were allowed to suckle in litters of 4, 9 or 20 pups to produce a state of obesity (litter of 4) or protein-energy malnutrition (litters of 20). Litters of nine were considered as control groups. Overfeeding during the suckling period did not change the development and the number of IgA plasma cells of the small intestine. By contrast, the weanling protein-energy malnourished mice had shorter intestines, reduced weight of gut mucosal, muscular and serosal layers and reduced length of villi. However, protein-energy malnutrition, when limited to the suckling period, had no marked effect on the development of IgA plasma cells. A diminished number of these cells was observed only when a more severe and prolonged state of malnutrition was induced.     

Evidence for differential effects of sulphasalazine on systemic and mucosal immunity in rheumatoid arthritis

OBJECTIVE: To study the effects of sulphasalazine (SASP) on the systemic and mucosal humoral immune systems in patients with rheumatoid arthritis (RA). METHODS: Serum concentrations of interleukin 6 (IL-6), class and subclass specific IgG, IgA and IgM, IgA and IgG antigliadin antibodies and rheumatoid factors (RF) of IgG, IgA (including IgA1 and IgA2 subclasses) and IgM isotypes were measured before and 16 weeks after sulphasalazine (SASP) therapy in 15 female and three male patients with RA. Amounts of immunoglobulins in saliva and jejunal fluid were measured as estimates of mucosal humoral immunity. RESULTS: Serum concentrations of IgA and IgG decreased significantly during SASP therapy and correlated with reduced concentrations of IL-6. In addition, levels of circulating IgA RF, IgA anti-gliadin antibodies and IgM RF decreased significantly after the treatment. In contrast, immunoglobulin levels in saliva and jejunal fluid were unaltered. CONCLUSION: SASP exerts powerful but selective inhibitory effects on systemic immunoglobulin production, whereas no effects on mucosal immunoglobulin production were observed. The decreased systemic B cell activity may be mediated by downregulation of the production of IL-6, a cytokine with Ig switching properties.     

Development of humoral immunity system of the small bowel

The study was performed in 24 children aged 2 months to 6 years, without intestinal or immunological diseases. Intestinal biopsies were obtained by a Crosby's capsule, pediatric size. The number of immunoglobulin forming cells of lamina propria was measured by planimetry. Under 12 months of age there are increased levels of IgM forming cells and a low IgA forming cells/IgM forming cells quotient, but over 1 year the difference disappears. This suggests that the maturity process is very rapid. There are no correlation between serum IgA, IgM, and IgG levels and its respective forming cells number of lamina propria. It seems to support that the participation of intestinal lymphoid tissue in serum pool of immunoglobulin is very poor and that systemic and intestinal immunity maturation are completely independent.     

Lipids and lipoproteins of malnourished children during early renutrition: apolipoprotein A-IV as a potential index of recovery

Twenty-six children with marasmus and 27 with kwashiorkor were compared with 23 control children of matching ages. Kwashiorkor was characterized by increased phospholipids (NS), low (P < 0.01) apolipoprotein (apo) B-rich LDL, and near normal apo A-I and HDL-C. In children with marasmus apo B (P < 0.02) LDL-C (NS), apo A-I (P < 0.01), and HDL-C (P < 0.001) decreased. Fifteen children in each group were followed for 2 wk. Control values were progressively reached after 2 wk. In the younger children final apo B was higher than in control subjects (P < 0.03) but apo A-I was identical. Apo A-IV, assayed because it correlates with the functional state of intestine, was near normal in children with kwashiorkor and decreased with treatment. In children with marasmus apo A-IV decreased by 50%, increased with treatment in older children, but further diminished in younger children. After 2 wk apo A-IV was significantly lower in all patients than in control subjects. Apo A-IV, by remaining depressed after other variables normalized, seems a good index of nutritional status.     

Malta and the British Navy: the medical connection during the nineteenth century. Part III. Medical and other problems

In this report we present data that help to define the impact of malnutrition during the suckling period on the gut associated lymphoid tissues (GALT). Fifty-day old rats malnourished during lactation presented a diminished percentage of s alpha +B cells and IgA level in the intestinal fluid. Also, a decrease in the CD4+ and CD8+ T cell subsets was found. At 120 days of age the percentage of s alpha +B cells and IgA level in the intestinal fluid was similar to the control. However, the percentage of T cells remained altered. When three doses of chorea toxin were administered orally since day 28, the IgA anti CT antibodies were diminished in the intestinal fluid, while the immunization schedule started after seven days of refeeding (28 days of age). This impairment of the immune response remained even after a CT booster was given to animals 113 days old. This diminishing in the CD4+ T cells may be the major cause of the nonresponsiveness described herewith.     

Atrophy of the corpus callosum associated with cognitive impairment and widespread cortical hypometabolism in carotid artery occlusive disease

BACKGROUND: The independent influences of small-intestinal bacterial overgrowth and old age on mucosal immunoglobulin production and secretion have not been assessed. This is an important issue, since luminal IgA deficiency may exacerbate small-intestinal bacterial overgrowth, the prevalence of which is high in selected elderly populations. METHODS: Proximal small-intestinal aspirates were obtained from 33 subjects for bacteriologic analysis and measurement of total IgA, IgM, total IgG. IgG subclass, and IgD concentrations. IgA subclasses were measured in 24 unselected subjects. Serum immunoglobulin and salivary IgA concentrations were measured in all subjects. RESULTS: IgA2 and IgG3 were predominant IgA and IgG subclasses in proximal small-intestinal luminal secretions. Luminal concentrations of IgA2 and IgM, but not IgG3 or any other IgG subclass, were significantly increased in small-intestinal bacterial overgrowth, which was present in 19 of 33 (57.6%) subjects. Old age did not influence these levels. Luminal immunoglobulin concentrations did not correlate significantly with either serum or salivary values. IgD was not measureable in proximal small-intestinal secretions. CONCLUSIONS: Increased luminal concentrations of the secretory immunoglobulins, IgA2 and IgM, occur in small-intestinal bacterial overgrowth. Local investigation is mandatory when assessing the mucosal immunopathology of this disorder. Luminal IgG3 is unlikely to be predominantly derived from serum. Old age does not independently influence luminal immunity.     

Immunoglobulin class and subclass distribution of antibodies reactive with the immunodominant antigen of Actinobacillus actinomycetemcomitans serotype b

The aims of this study were to determine the immunodominant antigens of Actinobacillus actinomycetemcomitans serotype b (Aab) for the different immunoglobulin (Ig) classes and subclasses and to determine the relative levels of these different Igs in serum. Seropositive early-onset periodontitis patients were sampled, and the Ig classes IgG, IgA, and IgM and subclasses IgG1, IgG2, IgG3, IgG4, IgA1, and IgA2 were studied. Reactivity with Aab antigens was assessed by using the Western blot (immunoblot) in limiting dilution analysis and radioimmunoassay with sera from 13 early-onset periodontitis subjects. A smeared antigen in the upper portion of the immunoblots, typical of high-molecular-weight LPS, was immunodominant for IgG, IgA, IgM, IgG1, IgG2, IgG3, IgA1, and IgA2. This smeared antigen was present in every patient for all of these Igs at the endpoint. A few additional antigens were also present at the endpoint in some patients, but none were present in more than half of the subjects. The distribution of antibody titers by Ig classes reactive with the Aab immunodominant antigen was IgG > IgA > IgM. The distribution of antibody titers by IgG subclass was IgG2 > IgG1 approximately IgG3. Further quantitation by radioimmunoassay revealed that the mean concentration of IgG2 (65.7 micrograms/ml) was significantly greater than that of IgG1 (8.8 micrograms/ml). The IgA subclass distribution was IgA1 > IgA2, with IgA1 apparently being second only to IgG2. Therefore, the Aab antigen eliciting the highest antibody level in virtually all Ig classes and subclasses appeared to be lipopolysaccharide, and IgG2 was markedly elevated over all other serum Ig classes or subclasses reactive with Aab.     

Experimental mucosal disease in cattle: changes in the number of lymphocytes and plasma cells in the mucosa of the small and large intestine

Changes in the number of lymphocyte and plasma cell subtypes were investigated in the lamina propria and in the epithelium of the small and large intestine of cattle with mucosal disease. Mucosal disease had been induced experimentally in seven out of 13 animals persistently viremic with non cytopathogenic BVD-virus by inoculation with a matching cytopathogenic BVD-virus. For comparison, six clinically healthy, persistently viremic cattle were used. IgA+, IgM+ and IgG1+ plasma cells, BoCD4+, BoCD8+ and gamma delta + T-lymphocytes, and the antigen of the cytopathogenic BVD-virus were demonstrated in tissue sections by immunohistochemistry. Distribution of cellular subtypes in the controls was consistent with data reported from non infected cattle. In cattle with mucosal disease, a decrease in the number of plasma cells which was significant for IgA+ and IgM+, but not for IgG1+ plasma cells was found in the lamina propria. The number of BoCD4+ T-lymphocytes was reduced in the small intestine, whereas their number per mm2 of mucosa was increased in the large intestine. Numbers of intraepithelial BoCD8+ and gamma delta + T-lymphocytes were severely decreased. Antigen of the cytopathogenic BVD-virus was detected predominantly in epithelial cells of the crypts. Overall there is a severe loss of effector cells which are essential components of the humoral and cell mediated immune protection of the mucosal barrier. The decrease of immunoregulatory cells in the lamina propria and epithelium may contribute to the transformation of mucosal architecture in mucosal disease.     

Fractionation of Crotalus durissus cumanensis venom by gel filtration

Serum lipid levels were determined in 30 children with kwashiorkor and in 30 healthy children of comparable age. The serum concentrations of unesterified and esterified cholesterol, albumin and the cholesterol esterifying activity (CEA) were also measured in children with kwashiorkor before treatment and after recovery. All serum lipid fractions were significantly lower in kwashiorkor than in the normal children. After treatment and recovery, serum lipid levels were comparable to those observed in normal children. There was also a significant increase in serum cholesterol esterifying activity (CEA) following recovery from kwashiorkor.     

Characteristics and responses of EBV immortalized B cells from periodontal disease patients

OBJECTIVE: This study was designed to examine human B cell responses to Actinobacillus actinomycetemcomitans (Aa). The general hypothesis to be tested was that Epstein-Barr virus (EBV) immortalized B cells could be used to investigate variations in B cell responsiveness of periodontitis patients to periodontal pathogens, and that B cells derived from the peripheral blood of periodontal disease patients infected with Aa demonstrate differences in in vitro activities compared to periodontally healthy subjects. DESIGN: EBV-transformed B cell lines were used to analyze immunoglobulin and Aa-specific antibody responses, as well as to determine the frequencies of cells producing immunoglobulin (Ig) of a specific isotype and detect clones secreting antibodies specific for Aa. Lymphoblastoid cells lines (LCL) were derived by clonal transformation of peripheral blood lymphocytes from 10 Aa-infected patients with adult periodontitis (Aa-AP) and seven normal subjects. METHODS: The B cells were incubated in Aa-coated polystyrene plates to separate adherent and non-adherent cells, and stimulate the cells with the whole bacteria. In addition, the B cells were stimulated with Aa LPS, E. coli LPS, or the polyclonal B cell activators (PBAs), pokeweed mitogen (PWM) and Staphylococcus aureus protein A (SpA). Both adherent and non-adherent cell populations were cultured for up to 15 days. MAIN OUTCOME MEASURE: Total immunoglobulins (Igs) and antibody (IgG, IgA, IgM) levels to Aa in the culture supernatants were assessed using an ELISA. The distribution of IgG, IgA, IgM and Aa-specific antibody producing cells was analyzed by a double immunoenzymatic staining technique. RESULTS: IgM levels produced by the LCLs were significantly increased vs IgG and IgA (P < 0.001). Three days after Aa stimulation, a marked increase in the level of total Igs and Aa-specific antibody was observed in adherent cells from Aa-AP (P < 0.05-0.03). Aa-specific antibody levels were significantly higher in the supernatants from Aa-AP vs normals throughout the culture interval (P < 0.03). There was also a significant increase in Aa-specific antibody levels after stimulation with Aa LPS or E. coli LPS (P < 0.05), whereas PWM and SpA had no significant effect on antibody to Aa. There was a predominance of IgM cells compared to IgG and IgA isotypes (P < 0.04) in LCLs from Aa-infected patients. After stimulation with Aa, a significant increase in the number of IgA (111%) and IgG (48%) secreting cells was observed, concomitant with a 74% decrease in the Ig-negative cell population. Total Aa+ cells increased significantly after stimulation (P < 0.001), predominated by Aa-specific IgG and IgM antibody producing cells. CONCLUSIONS: These results showed that LCLs from Aa-infected patients were polyclonal with respect to isotype distribution. Further stimulation with Aa revealed a shift to cytoplasmic IgG and IgA expression, as well as increases in the Aa-specific B cell population. In contrast, the PBAs stimulated the LCLs to synthesize primarily IgM. Additionally, the findings indicated that: (1) without T cells, polyclonal activation of B cells may lead to elevated Aa-specific B cell populations; and (2) the presence of previously sensitized B cells is required to exert an antigen specific antibody response in the LCL. We conclude that secondary activation of primed B cells by oral bacteria or their products in advanced periodontal lesions may contribute to the local accumulation of significant numbers of Ig-producing cells. This report also suggested that EBV-mediated transformation can be used to probe B cell-bacterial interactions in studies of periodontitis.     

Complications after BCG vaccination in the urban section of Lod? in the years 1994-5

The purpose of this paper was to evaluate the incidence of complications after BCG vaccination in children from urban area of Lód? in 1994-1995 and to give their pathological and prognostic interpretation on the basis of immunological and Gro?r allergometric examinations. The obtained data demonstrate that postvaccinal complications occurred in 46 children, that is 0.7/1000 of vaccinated population. They were observed mainly in newborns (45.7%), whereas they were particularly rare in revaccinated six-year-old children (13%) and schoolchildren (8.7%). In half of the cases there was an evidence of ulceration and suppuration in the site of vaccination, in another half--suppuration of local lymph nodes with or without fistula. Immunological and allergometric examinations were carried out in 21 children with post-vaccinal complications and 21 children with normal post-vaccinal period. In both groups the following were the subjects of evaluation: values of B and T lymphocytes and their CD4 and CD8 subpopulations, lymphocytes proliferative response to mitogenic PHA doses and tuberculin, as well as IgG, IgA and IgM levels. Immunological and allergometric examinations indicated that immunosuppression was neither the cause nor the effect of BCG complications.     

Comparison of cardiac findings at necropsy in octogenarians, nonagenarians, and centenarians

The Toxoplasma gondii rhoptry protein Rop2 was expressed in Escherichia coli as a fusion protein containing 44 kDa of the 55-kDa mature Rop2, supplied with six histidyl residues at the N-terminal end (Rop2196-561). Humoral response during Toxoplasma infection of humans was analyzed by immunoglobulin G (IgG), IgA, and IgM enzyme-linked immunosorbent assay with Rop2196-561 as the antigen substrate. The analyzed sera were divided according to T. gondii-specific serological tests (IgG, IgA, or IgM indirect immunofluorescence and IgA or IgM immunosorbent agglutination assay) as group A (IgG+ IgA- IgM-; n = 35), group B (IgG+ IgA+ IgM+; n = 21), group C (IgG+ IgA+ IgM-; n = 5), and group D (IgG+ IgA- IgM+; n = 16). Twenty-six T. gondii-seronegative sera from individuals with other infections were also included (group E). Anti-Rop2 IgG antibodies were detected in 82.8% of group A sera and in 97.6% of the sera with acute-phase marker immunoglobulins (groups B, C, and D). The percentage of IgA antibody reactivity against Rop2196-561 was 17.1% in group A, 50% in group D, and 80.8% in groups B and C. The percentage of IgM antibody reactivity was 0% in groups A and C and 62% in groups B and D. Sera from group E failed to show IgA, IgM, or IgG antibody reactivity. Since T. gondii Rop2 elicits a strong humoral response from an early stage of infection, it is suggested that recombinant Rop2196-561 would be suitable for use in diagnostic systems, in combination with other T. gondii antigens, to detect specific IgG, IgA, and IgM antibodies.     

Of sick turkeys, kwashiorkor, malaria, perinatal mortality, heroin addicts and food poisoning: research on the influence of aflatoxins on child health in the tropics

Similarities between the geographical and climatic prevalences of kwashiorkor and of exposure to dietary aflatoxins, and between the biochemical, metabolic and immunological derangements in kwashiorkor and those in animals exposed to aflatoxins, prompted investigation of the associations between kwashiorkor and aflatoxins. Studies in Africa in the 1980s indicated a role for these toxins in the pathogenesis of the disease. Paediatric cases of kwashiorkor are less prone to severe Plasmodium falciparum malaria than normal children. In mice infected with P. berghei, aflatoxin exposure inhibits parasite growth and ameliorates morbidity. Aflatoxins occur in < or = 40% of samples of breast milk from tropical Africa, usually as low concentrations of the relatively non-toxic derivatives of aflatoxin B1 (AFB1) but sometimes as high concentrations of the very toxic AFB1. This could explain kwashiorkor in breast-fed babies. Aflatoxin exposure occurs in > or = 30% of pregnancies in tropical Africa and the toxins are often in cord blood, sometimes at extremely high concentrations. Aflatoxins are now incriminated in neonatal jaundice and there is circumstantial evidence that they cause perinatal death and reduced birthweight. Aflatoxin-induced immunosuppresion may explain the aggressive behaviour of HIV infection in Africa. There are similarities between observations on HIV cases in Africa and those on heroin addicts in Europe, where 'street' heroin is frequently contaminated with aflatoxin. Aflatoxins were found in 20% of random urine samples from heroin addicts in the U.K. and the Netherlands. Aflatoxins have also been incriminated in episodes of food poisoning which have been associated with serious morbidity and mortality, particularly among young children.     

Ambiguous and obscure problems of liver resection

Earlier work has suggested that up to 25% of children undergoing tonsillectomy because of recurrent sore throats are relatively deficient in IgA immunoglobulin and that they do less well after the operation than 'normal' children. Measurements of serum immunoglobulin levels were carried out in 96 children undergoing tonsillectomy for recurrent sore throats. Levels of IgA, IgM and IgG were found to be similar to those in healthy children, 7-29% of those studied had 'low' IgA serum levels. There was a significant relationship between serum IgA levels and the age of the child. No relationship could be established between IgA levels and pre- or postoperative clinicaal state of the children. Low IgA serum levels are probably the result of delayed immunological maturation rather than a true immunodeficient state. IgA estimations, therefore, have no bearing on selection for operation or the prognosis after operation.