- Email: [email protected]
Occurrence of lymphocytotoxic lymphocytes and antibodies after corneal transplantation
418
SurvOphthalmol 22 (6) May-June 1978
CURRLNT OPHTHALMOLOGY
3. The time of onset in life may be different. 4. The disease may appear with degeneration of the peripheral retina, with atrophy of the optic nerve, with color blindness and with mental deterioration. (Abstract by A. Neetens)
Comment A patient with Doyne macular dystrophy and slightly elevated serum IgM levels is described. The authors examine the patient’s six siblings, the blood of his parents, two of his nine children, and eight of his 25 nieces and nephews. Since IgM levels in the range of 175 mg/ml are present along with Doyne’s choroiditis, the authors propose a relationship between the two. Unfortunately, the study suffers from some shortcomings in methodology. Control values for the IgM levels are missing; it would have been helpful to include IgM levels for a group of individuals from the same environment or even the IgM levels of those families without the syndrome. Also, the authors state that they have measured IgM by immunoelectrophoresis; however, immunoelectrophoresis does not yield quantitative data such as that presented in the paper. IgM and hyperviscosity are erroneously used interchangeably, and no measurement of serum hyperviscosity is mentioned. Nevertheless, the authors have studied an interesting, large, three-generation family in which Doyne macular dystrophy has occurred along with a modest elevation of IgM in the serum. MATHEA ALLANSMITH
Occurrence of Lymphocytotoxic Lymphocytes and Antibodies After Cornea1 Transplantation, by N. Grennet, T. Kristensen, F. Kissmeyer-Nielsen and N. Ehlers. Acta Ophthalmol54:167-173, 1976 Twenty-five recipients of penetrating cornea1 grafts were investigated for the presence in the peripheral blood of cytotoxic lymphocytes by the direct cell mediated lympholysis (direct CML) test as well as for lymphocytotoxic antibodies. In the direct CML test lymphocytes from the patients were mixed with Crsl labelled PHA lymphoblasts from four selected normal individuals. These cells possessed 14 different HLA-A and B antigens. Release of radioactivity from target cells to supernatant indicated cell damage. Lymphocytotoxic antibodies were studied in the patients’ serum by use of the trypanblue-exclusion test. Eight patients presented a positive direct CML. Six of these patients have shown clinical signs of graft rejection, while two patients had clinically uncomplicated courses. Only one of the 25 patients had lymphocytotoxic antibodies. This patient showed a negative direct CML and a clinically uncomplicated course. The findings seem to imply that recipients of cornea1 grafts can be immunized by their grafts and that cytotoxic lymphocytes in the peripheral blood appear frequently in those patients showing graft rejection. It may be stressed that the material is selected, being composed of patients under care during the months September-December 1975. The number of HLA-A and B incompatibilities did not influence the distribution of patients reacting positive or negative in direct CML. Further, only two of the observed eight positive scorings in direct CML could be explained by the HLA-A and B antigens mismatched in the transplantation and present on the target lymphoblasts. It may be that the number of patients studied was too small and that the target cells did not possess all the known HLA-A and B antigens, but alternatively it may suggest that other histocompatibility loci are important (Abstract by N. Ehlers)
Comment The authors, who are an excellent group of workers, have omitted a critical aspect of the patient group from their abstract. The abstract leads one to believe that people who reject their cornea1 transplants are more likely to have lymphocytes in their serum that can successfully attack and kill the mix of test lymphocytes that all together contain an enormous number of HL-A antigens. The previous sentence is true and well supported by the authors’ statistics. The crucial factor, however, may not be that patients who make lymphocytes that can kill cells bearing foreign HL-A antigens also lose their grafts. Five of the six patients who rejected their grafts had vascularized corneas. Therefore, it is not yet possible to say which is the crucial element: a) cells that can kill other cells with foreign HL-A markers; b) a vascularized cornea; or c) (there always is a c in HL-A and transplantation work) a combination of a and b or other factors. MATHEA R. ALLANSMITH
SurvOphthalmol 22 (6) May-June 1978
CURRLNT OPHTHALMOLOGY
3. The time of onset in life may be different. 4. The disease may appear with degeneration of the peripheral retina, with atrophy of the optic nerve, with color blindness and with mental deterioration. (Abstract by A. Neetens)
Comment A patient with Doyne macular dystrophy and slightly elevated serum IgM levels is described. The authors examine the patient’s six siblings, the blood of his parents, two of his nine children, and eight of his 25 nieces and nephews. Since IgM levels in the range of 175 mg/ml are present along with Doyne’s choroiditis, the authors propose a relationship between the two. Unfortunately, the study suffers from some shortcomings in methodology. Control values for the IgM levels are missing; it would have been helpful to include IgM levels for a group of individuals from the same environment or even the IgM levels of those families without the syndrome. Also, the authors state that they have measured IgM by immunoelectrophoresis; however, immunoelectrophoresis does not yield quantitative data such as that presented in the paper. IgM and hyperviscosity are erroneously used interchangeably, and no measurement of serum hyperviscosity is mentioned. Nevertheless, the authors have studied an interesting, large, three-generation family in which Doyne macular dystrophy has occurred along with a modest elevation of IgM in the serum. MATHEA ALLANSMITH
Occurrence of Lymphocytotoxic Lymphocytes and Antibodies After Cornea1 Transplantation, by N. Grennet, T. Kristensen, F. Kissmeyer-Nielsen and N. Ehlers. Acta Ophthalmol54:167-173, 1976 Twenty-five recipients of penetrating cornea1 grafts were investigated for the presence in the peripheral blood of cytotoxic lymphocytes by the direct cell mediated lympholysis (direct CML) test as well as for lymphocytotoxic antibodies. In the direct CML test lymphocytes from the patients were mixed with Crsl labelled PHA lymphoblasts from four selected normal individuals. These cells possessed 14 different HLA-A and B antigens. Release of radioactivity from target cells to supernatant indicated cell damage. Lymphocytotoxic antibodies were studied in the patients’ serum by use of the trypanblue-exclusion test. Eight patients presented a positive direct CML. Six of these patients have shown clinical signs of graft rejection, while two patients had clinically uncomplicated courses. Only one of the 25 patients had lymphocytotoxic antibodies. This patient showed a negative direct CML and a clinically uncomplicated course. The findings seem to imply that recipients of cornea1 grafts can be immunized by their grafts and that cytotoxic lymphocytes in the peripheral blood appear frequently in those patients showing graft rejection. It may be stressed that the material is selected, being composed of patients under care during the months September-December 1975. The number of HLA-A and B incompatibilities did not influence the distribution of patients reacting positive or negative in direct CML. Further, only two of the observed eight positive scorings in direct CML could be explained by the HLA-A and B antigens mismatched in the transplantation and present on the target lymphoblasts. It may be that the number of patients studied was too small and that the target cells did not possess all the known HLA-A and B antigens, but alternatively it may suggest that other histocompatibility loci are important (Abstract by N. Ehlers)
Comment The authors, who are an excellent group of workers, have omitted a critical aspect of the patient group from their abstract. The abstract leads one to believe that people who reject their cornea1 transplants are more likely to have lymphocytes in their serum that can successfully attack and kill the mix of test lymphocytes that all together contain an enormous number of HL-A antigens. The previous sentence is true and well supported by the authors’ statistics. The crucial factor, however, may not be that patients who make lymphocytes that can kill cells bearing foreign HL-A antigens also lose their grafts. Five of the six patients who rejected their grafts had vascularized corneas. Therefore, it is not yet possible to say which is the crucial element: a) cells that can kill other cells with foreign HL-A markers; b) a vascularized cornea; or c) (there always is a c in HL-A and transplantation work) a combination of a and b or other factors. MATHEA R. ALLANSMITH