ACTIVITY OF ANIMAL TRANSFER FACTOR IN MAN

198 assumes. His article therefore exaggerates the proportion of dental work which could be carried out by "filling" auxiliaries. In addition, as the report on ancillary personnel pointed out, it has not been established that the dental auxiliary type of ancillary enables the dental team to work more cost-effectively. There is simply no evidence that a two-tier dental profession could produce the "substantial economies" claimed by Profes-

as he took each young patient in his arms and game out of weighing himself and the child together; simple subtraction gave the child’s weight, and the procedure

soon

apparent

made a

a

immediately established an excellent rapport. The percentage error might be greater than with the device described by Valman et al. but this method needs no modification of existing equipment.

Brown.

sor

Equally, there is no evidence that we cannot afford a onetier profession. The dental services are not an accelerating drain on the country’s resources. They account for a stable portion of national income and a declining share of N.H.S. spending. The B.D.A.’s education report suggested that further expansion of dental schools was unnecessary. With wider use of preventive measures, especially water fluoridation, we could be within sight of solving Britain’s dental problems. I emphasise the need for preventive measures because in this respect Professor’Brown’s proposals are curiously backward-looking. As the ancillary personnel report said, the prime need today is probably for preventive and educational ancillaries rather than auxiliary-type ancillaries. Professor Brown’s proposals would be worth considering if we had no prospect of training adequate numbers of dentists and if caries was still the major dental problem. But this is not the situation in which we find ourselves today. 49

Buckingham Road, Aylesbury, Bucks HP19 3PT

Cardiac

Department, Hospital, Cambridge CB2 2QQ

Addenbrooke’s

HUGH A. FLEMING

ACTIVITY OF ANIMAL TRANSFER FACTOR IN MAN

SIR Investigations of human dialysable transfer factor (T.F.d) in animals have been disappointing.’ In some cases positive skin tests have been produced by "priming" the recipient animals with very small amounts of antigen before T.F.d injection.2 Our approach has followed the reverse reasoning: we tested dialysates from animal lymphocytes for activity when injected into man. T.F. may be present in animals but inactive because animal lymphocytes lack the appropriate enzymatic system which allows T.F. activity in man.3 Adult Wistar rats were immunised by intradermal injections of 05 mg of keyhole limpet hmmocyanin (K.L.H.) (five injections at 10-day intervals) and killed 10 days after the final injection. Dialysates from disrupted spleen cells were obtained by

R. A. FOLLOWELL SKIN-TEST RESULTS OF TWELVE CANCER PATIENTS WITH K.L.H.

"FIBRE" IN THE VOCABULARY OF NUTRITION

SIR,-The terms "edible fibre", "dietary fibre"z and "nonnutritive fibre"3 are improvements on "dietary fibre", in that they include polysaccharides, lignin, and related polymers resistant to hydrolysis by human digestive enzymes. However, these terms incorporate the word "fibre"-a word shared with textile manufacturers, muscle and nerve physiologists, and others, and one we can hardly use with accuracy to describe a group of substances that include gums, mucilages, and pectins. Cereal chemists at a recent scientific meeting were puzzled by the nutritionists’ reference to these non-fibrous compounds as "fibre." Also, in the nutritional literature and in food tables, fibre denotes crude fibre, another source of confusion. My colleagues and I have coined the word "plantix",4 from the Latin planta and matrix, because the plant polymers (cellulose, hemicelluloses, pectins, gums, mucilages, and lignin) not hydrolysed by digestive enzymes form a matrix in the gastrointestinal tract of humans until possible digestion by colonic microflora. Plantix has the advantage of being applicable exclusively to a specific range of substances and would eliminate any confusion as to scope. In the past few months I have used plantix satisfactorily in a number of reviews. Department of Nutritional Sciences, Syntex Research, Palo Alto, California 94304, U.S.A.

GENE A. SPILLER

WEIGHING CHILDREN

SIR,—I was interested to read the description by Valman et al. of their rocking-horse pwdiatric weighing machine. In 1959 when I was visiting the cardiac department of the Boston Children’s Hospital I observed Dr Alexander Nadas weigh himself at the beginning of the clinic. The reason for this was 1. 2. 3. 4.

Godding, E. W. Lancet, 1976, i, 1129. Trowell, H. Am. J. clin. Nutr. 1972, 25, 926. Kritschevsky, D., Tepper, S. A., Story, J. A. J. Food Sci. 1975, 40, 8. Spiller, G. A., Fasset-Cornelius, G., Briggs, G. M. Am. J. clin. Nutr. 1976, 29, 934.

5. Valman, H.B.,

Wright B.M.,

de Courtin

J. Lancet, 1976, 11, 1389.

..=not

done.

E=erythema. I=induration.

preparing human T.F.d. dialysates (T.F.dA.) were then injected into seven patients (T.F.dA. from one rat spleen per patient).

the conventional methods used for These animal cancer

T.F.dA. from non-immunised adult rats was prepared in a similar manner and used for injection of five patients as a specificity control. The number of E rosettes and the total number of lymphocytes was determined in seven and six, patients respectively, before and after they were injected with T.F.dA. either from immunised or non-immunised rats. Furthermore, all patients were skin-tested with K.L.H., 10 days after the T.F.dA. injection (table). ; Since K.L.H. injections are immunogenic it is impossible to skin test the same patient before and after T.F.dA. injections so‘ fifteen cancer patients who had not received T.F.dA. were skin tested to evaluate the spontaneous reactivity to K.L.H. Except for one patient who showed an induration, they were all negative. Lawrence, H. S. Harvey Lect. Ser. 1974, no. 68, p. 239. Welch, T. M., Wilson, G. B., Fudenberg, H. H. in Transfer Factor (edited by M. S. Ascher, A. A. Gottlieb, and L. H. Kirkpatrick); p. 399. New York, 1976. 3. Novelli, G. D. ibid. p. 723.

1. 2.

199 The results show that T.F.dA. is active in

man

and may be

antigen specific. Indeed, T.F.dA. from K.L.H.-immunised rats could transfer the K.L.H. reactivity to the injected patients, as assessed by skin tests; there were no skin-test reactions in patients who received T.F.dA. from non-immunised rats. A nonspecific adjuvant activity, as measured by the increase of the E-rosette forming cells and the number of lymphocytes, is also present in the T.F.dA. preparations, and this non-specific effect was also found with T.F.d of human origin (unpublished). These data favour T.F.dA. antigen specificity and should be taken into account in the long-lasting controversy pertaining to T.F.d speCifiCity.4 We postulate that the two activities are carried by different molecules, and further work aiming at their separation is now in progress. CL. BOUCHEIX J. PHILLIPS G. PIZZA CHANTAL SARTORIO D. VIZA

Laboratoire d’Immunobiologie, Service d’Hématologie, Faculté de Médecine Broussais-Hôtel Dieu, 75006 Paris, France

25-HYDROXYVITAMIN-D DEFICIENCY AND OSTEOMALACIA OF CHRONIC RENAL FAILURE

SIR,-Eastwood et al .6 pointed out the role of 25-hydroxyvitamin D (25-OHD) deficiency in the genesis of osteomalacia in chronic renal failure. They support this view by correlating the plasma-25-OHD levels with bone histology. We agree-indeed our clinical observations confirm the importance of 25-hydroxylation in uraemic osteodystrophy.

Effect of high doses of vitamin D] on plasma calcium and alhaline phosphatase in eight haemodiatysed patients (0). One treatment failure (A) was subsequently treated with vitamin for 6 months and with 25-hydroxycholecalciferol for 3 months.

Eight bxmodialysed patients with

severe

bone disease

D3

were

given high oral doses of ergocalciferol or cholecalciferol (600 000 units a week for 6 months). Radiological, biochemical, histological, and hormonal studies revealed a significant

improvement of renal bone disease in six patients. Two did not was a young boy with progressive hypocalcxmia with evidence of osteomalacia despite treatment with high doses of vitamin D and, subsequently, dihydrotachysterol. respond. The first

The lack of response was ascribed to a simultaneous oral anticonvulsant therapy, recognised to be competitive for the hepatic hydroxylation via cytochrome P450. The second failure (see figure) was at first attributed to the fact that the patient was anephric and could not hydroxylate vitamin D in the 1 position. But the fact that three of those who responded to

4. Zuckerman, A. J. Nature, 1975, 258, 14. 5. Salaman, M. R., Valdimarsson, H. Nature, 1976, 259, 250. 6. Eastwood, J. B., Harris, E., Stamp, T. C B., de Wardener, H. E.

1976, ii, 1209.

Lancet,

vitamin D were also anephric suggested that negative response in this patient was not due to I-OH D deficiency. To evaluate the possible role of 25-OHD deficiency, 400 µg of 25-hydroxycholecalciferol was given daily. After 3 months, he showed a good response with marked hypercaicsemia, lowering of serumalkaline-phosphatase and plasma-hydroxyproline, and radio-

logical improvement. We suggest that the success of vitamin D in ursemic osteoin all cases, mediated by the hepatic hydroxylation of the vitamin. In selected patients in whom 25-hydroxylation is impaired, 25-OHD is the drug of first choice.

dystrophy is,

Nefrologia e Dialisi, Ospedale Policlinico, 20122 Milan, Italy Sezione di

DIEGO BRANCACCIO GIORGIO GRAZIANI CELESTINA GALMOZZI CLAUDIO PONTICELLI

NAEGLERIA AND WATER SPORTS

SIR,-Willaert and Stevens’ isolated pathogenic Ncegleria from thermally polluted lake waters in Florida but did not find the amoeba in lakes not receiving thermal discharges. They suggested that the presence of pathogenic organisms in powerplant cooling waters used for recreation should receive close attention. We would like to emphasise the need for the more extensive sampling in environmental problems if erroneous conclusions are to be avoided. We have been isolating pathogenic Naegleria from thermally polluted and freshwater lakes in Florida since February, 1976. Over one hundred isolates have been obtained. The initial isolate was made in late February from a bottom mud sample obtained from a thermally polluted lake which received cooling waters from a power plant. Temperature of the water was 26 C. The first isolate from the water was obtained from a 600ml sample in March when the water temperature was 32°C. As the ambient temperature rose, with resultant increase in the temperature of the freshwater lakes, numerous isolates were obtained, some from lakes approximately 100 miles (160 km) distant from those having thermal pollution. 58% (15/26) of all lakes tested yielded the agent, either from bottom mud or lake samples. Only 1 of the lakes tested was thermally polluted. 17 of the 26 lakes were sampled only once, and 41% of these were positive. Temperatures of the freshwater lakes yielding isolates ranged from 16°C to 34-5°C. No isolates were obtained from lake waters, including the thermally polluted lake, when the water temperature dropped below 26.5C. However, even when temperatures of the freshwater lakes dropped to 16-18OC in December, isolates from lake bottom mud samples were routinely obtained. At the lakeside, 50 gallon (225 1) water samples were passed through a sand column constructed of polyvinyl-chloride plastic pipe 3.75 cm internal diameter and 60cm long. A screen of 45 !Jom nylon mesh was placed over the bottom and held in place with a hose clamp. The column was filled to within 10 cm of the top with Ottawa sand. The concentrated Ncegleria were freed from the sand after it had been removed from the column and thoroughly washed with 1% beef extract. The suspended amoebae were sedimented by centrifugation and inoculated onto non-nutrient agar seeded with Enterobacter aerogenes and incubated at 430C to discourage saprophytic growth and to encourage pathogenic Ncegleria outgrowth. Lake bottom mud samples were treated in a like manner. Identification of isolates was achieved by flagellation tests, examination of cyst morphology, growth in Chang’s calf serum/ yeast/casein medium,:2 and indirect fluorescent antibody studies. In the latter, antiserum prepared in rabbits against the pathogenic Ncegleria GJ strain, which had been isolated from a fatal human case in Florida in 1973, was used. Fluorescence of all pathogenic Naegleria isolates was equal to that of the homologous system whereas non-pathogenic Ncegleria strains 1. Willaert, E., Stevens, A. Lancet, 1976, ii, 741. 2. Chang, S. L. Cur. Top. Comp. Pathobiol. 1971,

p. 201.