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Antiviral immunity involves NK cells, which circulate rhythmically every 24 hours. We have investigated circadian and 12-hour rhythms in the peripheral count of circulating NK cells in 15 men infected with human immunodeficiency virus (HIV) and 13 healthy controls. We analyzed three phenotypes using double-labeling with monoclonal antibodies and flow cytometry assessment: CD3- CD16+, CD3-CD57+, and CD2+CD3-. A statistical validation of time-dependent differences was achieved if significance (p < 0.05) was validated both with analysis of variance and cosinor. The circadian rhythm had a similar asymmetric waveform for the three phenotypes and is homogeneous on an individual basis. The circulating NK cell count peaked in the early morning and was low at night. A circadian rhythm and a circahemidian harmonic characterized all phenotypes in healthy subjects. We considered two groups of HIV-infected men: those who were asymptomatic (eight) and those with acquired immune deficiency syndrome (AIDS) (seven). Circadian changes in NK cell count were similar in both subgroups and in healthy controls. The circadian pattern was also consistent among individual patients. Asymptomatic HIV-infected men (early-stage disease) exhibited more pronounced 12-hour rhythmicity than did patients with AIDS or controls. The circulation of NK cells does not appear to share the same synchronizer(s) as other circulating T- or B-lymphocyte subsets. Thus, HIV infection gradually abolished circadian rhythmicity in circulating T and B cells, whereas it did not disturb that in NK cells.

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To assess the place of passive immunotherapy in the treatment of AIDS, a randomized study was conducted that evaluated the safety and short-term efficacy of serial transfusions of human immunodeficiency virus type 1 (HIV-1) seropositive plasma in 18 patients. Heat-inactivated anti-HIV antibody-rich plasma was compared with seronegative fresh-frozen seronegative plasma given in addition to zidovudine and other conventional prophylactic treatments. Seven transfusions every 2 weeks of immune plasma significantly reduced (2 vs. 8, P = .016) the number of opportunistic infections. Antigenemia became undetectable. When transfusions were stopped, positive p24 antigenemia returned at a level higher than before treatment and was correlated with a severe clinical deterioration, suggesting a rebound effect. This trial suggests that passive immunotherapy is promising in AIDS treatment. It confirms also that plasma donation does not affect donors' CD4 cell count over a 1-year period. In patients with severe immunodeficiency, special attention should be paid to withdrawal of an effective therapy as virologic relapse may be explosive and poorly tolerated.

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In order to highlight the underlying mechanism(s) of the CD8 lymphocyte expansion in the HIV infection, two distinct CD8 subsets were analysed: T CD8bright+ CD3+ with MHC-restricted activity, and non-T CD8dim+ CD3-, which performs natural killer (NK) activity. It consists of a cross-sectional study including 168 HIV-infected patients (74 CDC stage II, 48 CDC stage III and 46 CDC stage IV) compared among them and to 60 healthy individuals. We observed an expansion of CD8+ CD3+ cells which masks a depletion of CD8+ CD3-. The comparative study showed that the expansion of the CD8+ CD3+ is relatively higher than that of total CD8+ lymphocytes and that the depletion of the CD8+ CD3- subset is severe, begins early and remains constant through the HIV progression. The comparison of CD4/CD8 and CD4/CD8+ CD3+ ratios showed that the latter could possibly be a better indicator in the HIV infection. The mechanism of inverted CD4/CD8 ratio in healthy individuals was also clarified. The CD8+ CD3+, CD8+ CD3- and CD4/CD8+ CD3+ parameters would be more specific markers than total CD8 and CD4/CD8 ratio especially in therapy trials.

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A sensitive enzyme immunoassay (EIA) micromethod is described which can measure levels of a 14 kDa human brain lectin (HBL) in the cerebrospinal fluid (CSF) of patients submitted to CSF examination. The assay is based on the use of a polyclonal antibody to HBL and the simultaneous application of biotinylated and unlabeled HBL. Biotin was then reacted with a streptavidin-peroxidase (Strep-HRP) conjugate and the bound enzyme quantified with the substrate orthophenylenediamine (OPD). The assay requires only 50 microliters of CSF and is very sensitive: as little as 6 ng/ml of HBL 14 can be detected. In a blind-test screening, the mean (+/- SEM) concentration of the HBL immunoreactive material (HIM) in CSF was determined to be 72.4 +/- 6.6 ng/ml. Our results indicate that EIA measurement of HIM levels in the CSF may find useful applications in elucidating the involvement of HBL in the physiopathology of human nervous system (NS).

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The present study is a therapeutic trial of phase I, based on the principle of passive immunotherapy in acquired immunodeficiency syndrome (AIDS). Eighteen patients with full blown AIDS (stage IV C2 of CDC) were subdivided into two groups: nine receiving every two weeks 300 ml of plasma collected from HIV-1 seropositive symptomless (stage II or III of CDC) individuals, and nine (control group) receiving 300 ml of seronegative plasma at the same rythm and for the same period. Each patient received seven transfusions. Clinical and biological results during the transfusional and post-transfusional periods are reported.

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The exact frequency of HIV-associated thrombocytopenia (TCP), defined as platelet count less than 150 x 10(9)/1, was studied in 435 symptom-free HIV-seropositive individuals. At the baseline control, 23 (5.5%) had TCP. TCP individuals had a significantly lower mean CD4 lymphocyte count than the non-TCP individuals. During a mean follow-up of 30 months, 79 out of the 435 individuals (18%) had TCP at least once. During the study period, only 1% of our patients had a platelet count less than 50 x 10(9)/l. TCP was more frequent in intravenous drug users than in other risk groups. A spontaneous normalization of platelet count was observed in more than 50% of TCP individuals.

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Natural killer (NK) cell-related phenotypes were analyzed in human immunodeficiency virus (HIV) infection. Our study involved 168 HIV-infected patients (72 CDC Stage II, 48 Stage III, and 46 Stage IV) and 60 healthy individuals. Analyses were conducted using flow cytometry and monoclonal antibodies. In comparison to the control group, all patient groups showed a significant decrease (p less than 0.001) of the CD16+ and CD16+CD3- phenotypes; furthermore, the comparison among patient groups showed no significant difference. It seems, therefore, that the decrease begins in the asymptomatic stage (CDC II) and remains constant during the infection. CD16+ NK cells were further divided into two subsets: CD16+CD8+ and CD16+CD8-. This subdivision shows a severe selective depletion of the CD16+CD8+ subset, but not in the CD16+CD8- subset. The depletion of the CD16+CD8+ subset also appears in the CDC asymptomatic stage and remains constant in CDC stages III and IV. Elsewhere, we observed that CD16+CD8+ lymphocytes are CD3-; complementary analysis of CD3-CD8+ cells showed a depletion comparable to that of the CD16+CD8+ phenotype. Depletion of the CD3-CD8+ subset, which belongs to the NK cell compartment, was observed although the total CD8 population showed a statistically significant increase. We conclude that, in HIV infection, there is a quantitative decrease of the NK CD16+ cell population, which appears to be due to a selective depletion of the CD16+CD8+CD3- compartment. This severe depletion appears to begin early in the infection.

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Alterations in the circadian time structure of the secretion of several hormones were investigated in 13 male patients infected with human immunodeficiency virus (HIV). Seven were asymptomatic (classified CDC II, according to the criteria of the Atlanta Centers for Disease Control), and 6 had acquired immunodeficiency syndrome (CDC IV). Ten healthy males volunteered as controls. Plasma levels of dehydroepiandrosterone (DHEA) and its sulfate (DHEA-S), cortisol, testosterone, ACTH, and beta-endorphin were determined by RIA in blood samples obtained every 4 h from 0830-0830 h the next morning. Data were analyzed both by two-way analysis of variance and the cosinor method. Circadian rhythms were statistically validated for each of the six hormones in each of the three groups of subjects. Compared with the control subjects, mesors (24-h adjusted means) were significantly higher for cortisol and lower for DHEA, DHEA-S, and ACTH (P less than 0.001 for all four hormones) in all HIV-infected patients. Plasma testosterone mesors were similar in controls and CDC II patients, but decreased significantly in the CDC IV patient group (P less than 0.05). Analysis of the circadian rhythms of plasma hormone levels clearly indicated an altered adrenal hormonal state in HIV-infected male patients, even during the asymptomatic period of the infection. For instance, plasma cortisol at 0430 h was more than twice as high in HIV-infected patients as it was in time-qualified controls. Although patients already had elevated plasma cortisol and lowered adrenal androgen levels at this stage, hypogonadism was not observed, as gauged by plasma testosterone concentrations. We speculate that the primary hormonal defect in HIV-infected patients is increased cortisol secretion resulting from circadian-varying stimulation of the adrenal cortex by a factor other than pituitary ACTH. This factor might be a stimulating substance secreted primarily by infected immune cells. Excess cortisol would lower adrenal androgen secretion by shifting adrenal steroid biosynthesis toward glucocorticoids and decreasing pituitary ACTH secretion via a negative feedback mechanism.

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A technique is described for lymphocyte preparation which permits analyses by two-color immunofluorescence and flow cytometry. It consists, briefly, of the lysis of red blood cells and washing of white blood cells prior to labeling. We tested this technique with a large panel of monoclonal antibodies in mono- and dual immunofluorescence. By comparing these results to those obtained after density gradient separation, we found the following statistically significant differences: the count of the phenotype B1+ was higher after whole blood lysis preparation than after density gradient separation; whereas, the corresponding counts of OKT4+ and Leu-4-Leu-7+ phenotypes were lower. No difference was detected with OKT8+, Leu-4+, OKT8+Leu-4+, OKT8+Leu-4-, OKT8-Leu-4+, OKT8+Leu-7+, Leu-4+Leu-7+, Leu-4-Leu-11c+, OKT8+Leu-11c+ and OKT8+Leu-15+ phenotypes. We have studied the reproducibility of both methods and the correlation between them. The disparity of the lymphocyte subset count between these two methods, though statistically significant, was relatively weak and seems to be due to the density gradient separation. Since the preparation of lymphocytes using the density gradient method is time consuming, we propose whole blood lysis as an alternative lymphocyte separation method when assessing immune status in human disease by flow cytometry. It offers the following advantages: (i) it does not require additional steps, (ii) it permits two-color immunofluorescence through the labeling of white blood cells after washing, (iii) it is reliable, (iv) it is reproducible, and (v) it is helpful in studies of lymphopenia since it offers the possibility of lymphocyte enrichment.

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Among the HIV-1 seropositive subjects detected through blood donation in Paris area who every six months voluntarily went through a thorough clinical and biological follow-up in the Institut National de Transfusion Sanguine, a cohort of 77 subjects had completed at least four biannual controls by september 1988. Upon inclusion in the study, all subjects were CDC stage II or III, none had received any treatment. Biological parameters in entrance in the study were assessed in a attempt to forecast the CD4 lymphocyte count decrease during the 18 months follow-up time. Multivariate forward stepwise analysis indicated that only p24 ag level, IgA level, and partially neopterin or Beta-2-Microglobulin levels were independently predictive of CD4 count at the end of the follow-up and of the CD4 loss at the same time. The prediction by these biological parameters is a rather poor one, 39% of the variation of CD4 lymphocyte count or 30% of the variation of CD4 loss after 18 months of the cohort follow-up being explained. In conclusion, HIV-infection seems to possess an intrinsic evolution which escapes our surveillance by biological parameters.

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Many laboratories do not have access to a flow cytometer allowing three-color immunofluorescence analysis through the use of multiple light sources. In view of the usefulness of such analyses in the dissection of cell parameters, we describe an approach permitting the study of three labels by using one light source and the two-color immunofluorescence assay. It is useful for the enumeration of cell subpopulations positive for one label and negative for two or more others as well as for qualitative analysis concerning the expression of these labels. This approach is simple and rapid; it does not require additional material and technical steps other than that used in the two-color immunofluorescence assay. Briefly, it consists of the use of a label coupled to a dye (PE or FITC or instance) and two different labels coupled to the other dye. An argon ion laser, operating at 488 nm and 60 mW, excites both fluorescein and phycoerythrin conjugated antibodies. We provided a general example, using three hypothetical labels (X, Y, and Z), and four practical applications: CD3+CD4CD8- and CD8+CD16-CD3- peripheral blood lymphocytes, CD2+CD16-CD3- and CD56+CD16-CD3- peripheral blood, and decidual infiltrating lymphocytes.

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No difference in HLA-A, B or DR gene frequencies could be observed between 172 control subjects and 180 HIV-1-seropositive subjects of European ancestry diagnosed through the systematic screening of blood donations. In contrast, progression to acquired immune deficiency syndrome (AIDS; 21 patients) or CD4 lymphocyte loss equal or more than 20% over a 6-month period (37 subjects) was found to be associated with the B8DR3 haplotype (relative risk = 10.64, p less than 0.003, and 2.23, p less than 0.092, respectively). Other independently significant associations assessed through the multivariate Cox proportional-hazards model were B16, BW21 and B35 alleles as factors of bad prognosis. Conversely, A11 and DR4 alleles were factors favouring longer survival.

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Flow cytometry, supported by monoclonal antibodies, has widely contributed in the cellular identification, notably in the clinical and haematological fields. This technique has found several applications since the qualitative phenotyping and the quantitative analysis of the immune system's cell populations are helpful in the diagnosis and the therapy. Besides, these indications require an appropriate knowledge of several methodological aspects including factors related to the sample donor: age and sex; sampling: time and quantity; and the sample preparation conditions. References values, needed for the results interpretation, have a meaning only if they are defined within these validity limits. Previous trials have been done in order to define a biological value representative of the immunological status, such as the CD4/CD8 ratio. Unfortunately this ratio is not justified in the scope of new knowledge concerning the cellular interactions and the functional heterogeneity of cells involved in the immune system.

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Sixty-eight asymptomatic HIV-seropositive people with a CD4 lymphocyte count above 400/mm3 at the first examination were followed up every year over a 3-year period, by monitoring the biological markers of AIDS (CD4 lymphocyte decrease, loss of anti-p24 or anti-p17 antibodies, positive p24 antigenemia, increase of erythrocyte sedimentation rate, and of serum levels of immunoglobulin G. immunoglobulin A, neopterin and beta 2-microglobulin). The percentages of subjects positive for at least one marker at the first, second, third and fourth examinations were 66, 88, 94 and 97%, respectively. The increase in the number of markers with time was significant (chi-square test; P less than 0.001). This increase suggests a progression to AIDS in the majority of asymptomatic seropositive subjects, even those without a decreased CD4 lymphocyte count.

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A beta-galactoside-binding hemagglutinin was detected in soluble extracts of human brain. This soluble lectin was purified to homogeneity by affinity column chromatography on lactose coupled to divinylsulfone-activated agarose. The purified lectin had an isoelectric point of 3.9 and its subunit molecular mass estimated by polyacrylamide gel electrophoresis in sodium dodecyl sulfate was 14,500. Human brain lectin was not a glycoprotein and its amino acid composition was characterized by a high content of serine, glutamic acid, and glycine, and a low content of methionine and cysteine. The most potent saccharide inhibitors tested were thiodigalactoside, lactose, and p-nitrophenyl-beta-D-galactoside. An antibody was raised to the pure lectin. Immunological relationships were found between the brain lectin and several other soluble lectins of various vertebrate origins.

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Circadian rhythms in circulating B and T (CD3, CD4, CD8) lymphocyte subsets and in plasma cortisol were studied in 13 HIV-infected men and 14 healthy male controls. The circadian maximum (acrophase) of plasma cortisol was similar in both groups, approximately 8.00 A.M., however, a statistically significant increase was found in the 24 hour-mean value (mesor) of infected patients as compared to healthy controls. Circadian rhythms were statistically validated in all lymphocyte subsets of healthy controls, whereas, large alterations were found in patients with acquired immunodeficiency syndrome (AIDS), already in asymptomatic infected individuals. The alterations concern the mesor and the amplitude for B and CD4 lymphocytes and all cycle parameters for CD3 and CD8 lymphocytes.

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Biological markers of HIV infection were studied in 17 asymptomatic HIV seropositive subjects in the 12 months preceding the onset of the disease. No single marker of HIV infection preceded the development of AIDS. Therefore, the clinical care of asymptomatic seropositive subjects should include a number of tests to evaluate HIV activity and immune suppression.

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