E.J. Holborow

Linear IgA disease in adults

A multi‐centre study is described in which thirty‐five adult patients with papillary IgA dermatitis herpetiformis (DH) were compared with forty‐two patients with linear IgA deposits, of whom thirty‐four had homogeneous‐linear (HL) and eight had granular‐linear (GL) IgA deposits.

SUBPOPULATIONS OF HUMAN PERIPHERAL BLOOD LYMPHOCYTES DISTINGUISHED BY COMBINED ROSETTE FORMATION AND MEMBRANE IMMUNOFLUORESCENCE

Abstract A combined test has been used to identify among human blood lymphocytes cells bearing surface Ig, and cells forming rosettes with sheep erythrocytes. In 7 normal subjects, 20-30% of the blood lymphocytes stained for surface Ig heavy-chain determinants, and 29% (mean) gave rosettes. There was no overlap between the two populations. In 2 cases of chronic lymphatic leukaemia, and in 5 of sarcoidosis, the percentage of staining cells was increased and the percentage of rosette-forming cells was reduced, compared with normal.

TISSUE ANTIBODIES IN DERMATITIS HERPETIFORMIS AND ADULT CŒLIAC DISEASE

Abstract A new antibody of IgG class reacting with connective tissue in rat and human organs was found in 17% of 29 patients with dermatitis herpetiformis and in 36% of 31 patients with adult coeliac disease. The antibody appeared to be directed against reticulin rather than basement membrane. In 34% of the dermatitis-herpetiformis patients antinuclear factors of IgG or IgM class were present.

ANTI-RETICULIN ANTIBODIES IN CHILDHOOD CŒLIAC DISEASE

Abstract 19 patients with childhood cœliac disease and 28 controls have been investigated for the presence of anti-reticulin antibody. The antibody was found in 14 of the 19 patients with cœliac disease. 10 of these 19 were on a normal diet, and in 9 of these the antibody was found; whereas in the 9 patients on a gluten-free diet, it was found in 5. The antibody was also found in 1 of 28 control subjects. The anti-reticulin antibody is apparently specific for cœliac disease and may be of help in the diagnosis of the disease.

Antireticulin antibody: Incidence and diagnostic significance

Sera from 101 patients with adult coeliac disease, 46 patients with childhood coeliac disease, 50 patients with dermatitis herpetiformis, and 479 patients with various other diseases, including skin, gastrointestinal, haematological, and immunological disorders, have been tested for the presence of the antireticulin antibody. Positive sera were retested at higher dilutions. Antireticulin antibody was only found in a significant proportion of patients with three diseases, ie, coeliac disease, dermatitis herpetiformis, and Crohns disease. Antireticulin antibody was present in 38 out of 101 patients (38%) with adult coeliac disease, 27 out of 46 patients (59%) with childhood coeliac disease, 11 out of 50 patients (22%) with dermatitis herpetiformis, and nine out of 38 patients (24%) with Crohns disease. In the 434 other patients with various disorders the antireticulin antibody was present in only six 1·4%) (two patients were pregnant, one had vitiligo, one had tropical sprue, one had reticulum cell sarcoma, and one had pernicious anaemia). In patients with gluten-sensitive enteropathy, ie, coeliac disease and dermatitis herpetiformis, there was a significantly higher incidence in patients taking a normal diet compared with those on a gluten-free diet. The presence of antireticulin antibody would appear to be particularly helpful in diagnosing childhood coeliac disease as it was found in 22 out of 26 patients (85%) taking a normal diet.

POSITIVE DIRECT COOMBS TESTS AND ANTINUCLEAR FACTOR IN PATIENTS TREATED WITH METHYLDOPA

Abstract Treatment with α-methyldopa was changed to other antihypertensive drugs in 30 hypertensive patients who had a positive direct Coombs test (D.C.T.). The D.C.T. became negative in 19 of 23 patients who had been off the drug for 6 months and the length of time for the D.C.T. to become negative depended on the initial titre. Reintroduction of methyldopa in 3 patients who had previously had a positive D.C.T., but whose D.C.T. had subsequently become negative, gave a positive D.C.T. again in 1 patient after 4 months, but the D.C.T. was still negative after 6 months in the other 2 patients. Of 38 patients who started methyldopa for the first time, 10 (24%) developed a positive D.C.T. at varying intervals from 3 to 6 months. Antinuclear factor (A.N.F.) was looked for in the serum of 240 hypertensive patients, 158 of whom were on methyldopa. In 23 (14.6%) patients on methyldopa the A.N.F. was positive at titres varying from 1/10 to 1/1250. In 82 hypertensive patients, on other drugs, the A.N.F. was positive in 3.

PRECIPITATING ANTIBODY TO D.N.A. DETECTED BY TWO-STAGE ELECTROIMMUNODIFFUSION: STUDY IN S.L.E. AND IN RHEUMATOID ARTHRITIS

Abstract A method for the detection in human sera of precipitating antibody specific for D.N.A. by two-stage electroimmunodiffusion is described. The results obtained in a pilot study on 351 sera indicate that the significance of this antibody may be different from that attributed to D.N.A. antibodies detected by other procedures, since development of nephropathy in cases of systemic lupus erythematosus was associated with absence of the antibody, while its presence correlated with the occurrence of cutaneous vasculitic lesions.

Anti-gliadin antibodies and small intestinal mucosal damage in dermatitis herpetiformis

Sera from forty‐six patients with dermatitis herpetiformis (DH) were examined for anti‐gliadin antibodies (AGA) by the enzyme linked immunosorbent assay (ELISA) test and by a simple new immunofluorescent (IF) test. AGA were present in fifteen out of thirty‐two patients taking a normal diet, but in none of the fourteen taking a gluten‐free diet (GFD). The presence of circulating AGA was related to the severity of the enteropathy. AGA were present in all ten patients with a flat mucosa and in four of six with a convoluted mucosa, but in only one out of thirty patients with normal morphology of the small intestine. However, in those patients taking a normal diet and with a normal morphology of the intestine there was evidence of gluten sensitivity compared to those taking a GFD, as the intraepithelial lymphocyte count (IELC) was significantly raised in the peri‐nuclear and supra‐nuclear positions. The study shows that the presence of AGA in the serum is a good indication of the degree of gluten sensitivity as expressed by severe mucosal damage in patients with DH.

Lymphocyte: Erythrocyte (L.E.) rosettes as indicators of the heterogeneity of lymphocytes in a variety of mammalian species

Lymphocytes and red cells from various mammalian species have been mixed in vitro in conditions which favor their aggregation in the form of rosettes. The frequencies of rosette formation taken in conjunction with observations on surface bound immunoglobulin on the lymphocytes favor the interpretation that, in many species of animal, rosette formation can be used as an indicator of the thymic (T) or bursal equivalent (B) origin of lymphocytes.