Shaun Ruddy

Successful cyclophosphamide treatment of cryoglobulinemic membranoproliferative glomerulonephritis associated with hepatitis C virus infection

A 54-year-old man with cryoglobulinemia and chronic hepatitis C infection presented with progressive renal insufficiency caused by membranoproliferative glomerulonephritis. Because of a steady decline in renal function, cyclophosphamide therapy was instituted. Within 1 month of starting therapy, his cryoglobulins disappeared, and in 3 months, his creatinine clearance had improved from 56 mL/min to 89 mL/min. At no point in his course was there clinical evidence of liver disease. After 1 year, cyclophosphamide was successfully stopped. Fourteen months later, his creatinine clearance is 105 mL/min. These results suggest that cyclophosphamide may be useful therapy for patients with cryoglobulinemic membranoproliferative glomerulonephritis and hepatitis C virus infection who have progressive renal insufficiency.

ACTIVATION OF THE COMPLEMENT AND PROPERDIN SYSTEMS IN RHEUMATOID ARTHRITIS

The classic (C1, C4, and C2) and properdin factors (D, C3b, and B) of complement generate C3 convertases that are capable of cleaving C3 and subsequently activating C5-C9. Both C1 and factor D are serine esterases, and both convertases undergo decay and regeneration. In seropositive rheumatoid arthritis, where intraarticular activation of the classic early components (C1, C4, and C2) by immunoglobulin complexes appears to predominate, findings of relative depressions in synovial fluid levels of factor B indicate recruitment of the amplification loop (D, C3b, and B), and relative declines in properdin levels suggest activation of the properdin pathway as well. Quantitative analysis of the complement system in disease states requires several different approaches: measurement of function and antigenic concentration to assess the functional integrity of the protein; determination of component metabolism to appreciate the relative contributions of hypercatabolism and hyper- or hyposynthesis to the plasma level; and for compartmentalized disease, measurement of the component in the appropriate biologic fluid and determination of local tissue synthesis.

Monocyte complement stimulator: a T-lymphocyte product which stimulates synthesis of the second complement component (C2).

Abstract Monocyte complement stimulator (MCS), a lymphokine previously shown to increase the rate of synthesis of the second complement component (C2) by human monocytes, is produced by sensitive T lymphocytes when exposed to antigen. MCS production requires cooperation of T lymphocytes with monocytes during the first 24 hr of exposure to antigen; both cell types must be capable of synthesizing protein during this time. MCS was found to differ from MIF in two ways: First, antigen-stimulated B lymphocytes and monocytes produce MIF but not MCS and second, MCS is destroyed by heating to 56 °C for 30 min while MIF retains its activity

Effects of thrombospondin purified by heparin affinity or ion-exchange chromatography on the alternative complement pathway.

Thrombospondin (TSP), a platelet glycoprotein, was purified from platelet supernatants applied sequentially to Sepharose 4B and heparin-agarose affinity columns. This TSP inhibited alternative pathway activity in serum as assessed by lysis of rabbit erythrocytes and contained bound heparin, a substance which is known to inhibit the alternative pathway. TSP purified by anion exchange chromatography did not contain heparin and was not inhibitory. Chromatography of this TSP over a heparin-agarose affinity column resulted in TSP which contained heparin and inhibited the alternative pathway. Purification of TSP by the standard technique of heparin affinity chromatography results in preparations which are contaminated with heparin.

Myelinated dorsal root ganglion cultures activate both the alternative and classical pathways of complement

We used rat myelinated dorsal root ganglion (MDRG) cultures to study antibody and complement-mediated mechanisms of peripheral demyelinating diseases. Heat inactivated serum from a patient (LT) with peripheral neuropathy and a monoclonal IgM reactive with myelin-associated glycoprotein (anti-MAG) and sulfated glucuronosyl glycolipids (anti-SGGL) was used as an antibody source. Incubation of whole human serum (WHS) or WHS and anti-SGGL with MDRGs resulted in reduction of classical and alternative pathway hemolytic activities and the development of abnormal myelin sheaths. Incubation of MDRG cultures with C2-deficient serum showed activation of the alternative complement pathway. Classical pathway hemolytic activity was reduced when Factor B-depleted serum was incubated with MDRG cultures. The rat MDRG culture system provides a good model system of a peripheral nerve and has therefore been used by several investigators to study antibody and complement-mediated demyelination associated with peripheral neuropathies. However, our studies indicate a high degree of complement activation and membrane disruption of cultures incubated with WHS.

Enhancement of IGE-induced mediator release from rat peritoneal mast cells by serum-treated zymosan

Phagocytosis of zymosan (Z) treated with rat serum (ZX) by rat peritoneal mast cells caused only a small amount of [3H]serotonin release, and prior release of mediators from mast cells did not affect phagocytosis of sheep erythrocytes bearing IgG and C3b, indicating the independence of these two phenomena. When, however, mast cells were exposed to ZX, subsequent IgE-mediated release of histamine, [3H]serotonin, and beta-hexosaminidase was greatly enhanced. Prevention of complement activation by the presence of EDTA during the treatment of Z with the serum or prior heating of the serum at 56 degrees C for 30 min only slightly impaired the ability of ZX to augment mediator release, whereas prior absorption of the serum with zymosan at 0 degree C greatly diminished the enhancement. Exposure of fresh Z to variable amounts of either the acid or the high-salt eluate of ZX also generated ZX capable of enhancing [3H]serotonin release in a dose-dependent fashion. IgG, IgM, C3, and albumin were detected in the eluates by immunodiffusion. When IgG was depleted from the high-salt eluate by treating with Sepharose-anti-IgG, the enhancement was significantly reduced, indicating that IgG but not C3 or other immunoglobulins was required for the enhancement.