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GALACTOSE RESIDUES IN CHRONIC INFLAMMATORY DISEASE
418 OBSERVATION OF GCLOS IN 1977 AND 1987 !
1
f
*Not significant.
GCLO before biopsy. GCLOs were determined on paraffin sections from formalin-fixed tissue stained with haematoxylin and eosin. Any. antropyloric ulcer or chronic superficial gastritis according to the Whitehead classifications was also noted. GCLOs were identified in 53 patients (48%) in 1977 and 35 patients (32%) in 1987 (table). GCLOs were found in 33 of 46 (72%) patients with an antropyloric ulcer in 1977 and in 17 of 25 (68%) with the same lesion in 1987. The prevalence of GCLO did not differ significantly in the two groups when compared by the Mantel-Haenszel test adjusted for the presence of gastroduodenal lesions (X2 MH = 1,40, 95% confidence interval 0-61-3-02). Thus, in our population, the prevalence of GCLO was similar ten years ago, which suggests that GCLOs were unknown because pathologists did not look for them in gastric biopsy samples. Anatomy and Pathology Laboratory, and Hepatogastroenterology Service, Hôpital Antoine Béclère, 92141 Clamart, France; and Anatomy and Pathology Laboratory, Hôpital Bicêtre, Le Kremlin Bicetre, France
P. BEDOSSA T. POYNARD
J.-C. CHAPUT E. MARTIN
JL. Spirochaetes in gastric glands of macacus rhesus and humans without definite history of related disease. Proc Soc Exp Biol Med 1938; 38: 536-38. 2. Freedberg AS, Baron LE. The presence of spirochetes in human gastric mucosa. Am J Dig Dis 1940; 7: 443-45. 3. Warren JR. Unidentified curved bacilli on gastnc epithelium in active chronic gastritis. Lancet 1983; i: 1273 4. Marshall B. Unidentified curved bacilli on gastric epithelium in active chronic gastritis. Lancet 1983; i: 1273-75. 5 Whitehead R. Mucosal biopsy of the gastrointestinal tract. Philadelphia: WB Saunders, 1979. 1. Doenges
Our patients with primary SLE had no signs of Sjogren’s syndrome as established by lip biopsy and by reduction in lacrimal and salivary secretions. However, the individual oligosaccharide chains in IgG (on average 2’8/molecule) are bi-antennary and each branch may contain a galactose residue; thus, there are varying proportions of chains with two (G[2]), one (G[l]), or no (G[0]) galactose residues (compare structures shown in Axford et al4). Using analytical methods which provide this information, we consistently fmd that values of G(0) for IgG from active RA patients are unequivocally higher than for age-matched normal controls, whereas the G(0) for IgG from the SLE patients described above are within the normal range for age-matched controls. Parekh et all also reported an increased G(0) in patients with RA. From the above discussion, there need be no direct relationship between G(0) and galactose content.
syndrome, ankylosing spondylitis, psoriatic arthropathy, myositis, scleroderma, leprosy, klebsiella infection, and other disorders. Thus, the data from our laboratories shows that this exciting defect is not a characteristic feature of the chronic inflammatory state in general, but has important disease restriction. Department of Rheumatology Research, J. S. AXFORD F. C. HAY University College and Middlesex School of Medicine, London W1P 9PG
SiR,—Dr Axford and colleagues (Dec 26, p 1486) report reduced B-cell galactosyltransferase activity in rheumatoid arthritis. Tomana et aP previously showed that reduced numbers of galactose residues are a feature of chronic inflammatory disease and not just rheumatoid arthritis. It would therefore be inappropriate to implicate this abnormality in the pathogenesis of rheumatoid arthritis. Centre for Rheumatic Diseases,
R. MADHOK H. A. CAPELL
Royal Infirmary, Glasgow G4 0SF
M, Schrohenloher RE, Koopman WJ, Alarcon GS. Decreased galactosylation of serum IgG from patients with rheumatoid arthritis (RA) and other chronic inflammatory diseases. Arthritis Rheum 1986; 29 (suppl 4): S41.
1. Tomana
*t*This whose
letter has been shown
to
Dr Axford and his
colleagues,
reply follows.-ED.L.
Sip,—Were the abstract by Tomana et al’ the only evidence available, we would have some sympathy with Dr Madhok and Dr Capell regarding the implications of galactose deficiency in IgG for the
pathogenesis of rheumatoid arthritis. While there is no disagreement that galactose content in the serum IgG is decreased in patients with rheumatoid arthritis, there is over such a deficiency in systemic lupus erythematosus (SLE) .1-3 Tomana et al report a drop of 06 residue/molecule of galactose in IgG patients with SLE, which they report to be "comparable" to changes in their rheumatoid arthritis (RA) group. In contrast, Mullinax et aP found a 33% reduction in galactose content of IgG from patients with SLE, compared with a 54% reduction for their RA group, our figures being 10% (not significant) and about 50%, respectively.
L. MACKENZIE D. A. ISENBERG P. M. LYDYARD I. M. ROITT
Department of Medical Microbiology, University College and Middlesex Hospital School of Medicine
G. ROOK
Glycobiology Unit, University of Oxford
T. W. RADEMACHER R. B. PAREKH R. A. DWEK
M, Schrohenloher RE, Koopman WJ, Alarcon GS. Decreased galactosylation of serum IgG from patients with rheumatoid arthritis (RA) and other chronic inflammatory diseases. Arthritis Rheum 1986, 29: S41. Parekh RB, et al. Association of rheumatoid arthritis and primary osteoarthritis with changes in the glycosylation pattern of total serum IgG. Nature 1985; 316: 452 Mullinax F. Molecular site and enzymatic origin of IgG galactose deficiency in rheumatoid arthritis and SLE Arthritis Rheum 1975; 18: 417 Axford JS, Mackenzie L, Lydyard PML, Hay FC, Isenberg DA, Roitt IM Reduced B-cell galactosyltransferase activity in rheumatoid arthritis. Lancet 1987, ii 1486 Parekh RB, Isenberg DA, Dwek RA, Roitt IM, Rook GAW, Rademacher TW A comparative analysis of disease associated changes in N-glycosylation of serum IgG. Br JRheum 1987; 26: 112
1 Tomana
2
GALACTOSE RESIDUES IN CHRONIC INFLAMMATORY DISEASE
-
We have now measured IgG G(0) percentages in over 300 sera from 25 different disease statesand conclude that the G(0) glycosylation defect is confined to juvenile and adult RA, SLE associated with Sjogren’s syndrome, active Crohn’s disease and untreated pulmonary tuberculosis. Normal G(0) values were obtained not only in primary SLE but also in primary Sjogren’s
3 4. 5
TRANSDERMAL GLYCERYL TRINITRATE AS PREDICTOR OF OUTCOME OF LUMBAR SYMPATHECTOMY
SIR,-Patients with serious distal limb ischaemia beyond the help of direct arterial surgery are often considered for lumbar sympathectomy (surgical or chemical). Transdermal glyceryl trinitrate (GTN) causes local vasodilatation1.2 and sublingual GTN increases blood flow while decreasing venous tone and arteriolar resistance in the forearm.3 Therefore we hypothesised that the response to transdermal GTN might predict the outcome of lumbar sympathectomy in patients with distal limb ischaemia. We studied 16 patients who required lumbar sympathectomy. The patients were assessed on admission and a ’Transiderm Nitro-10’ self-adhesive patch (Ciba-Geigy), which releases 10 mg GTN daily at a continuous rate, was placed on the dorsum of the foot of the diseased limb. The patients were reassessed 24 h later and the patch was removed. The next day the same patients underwent lumbar sympathectomy and were reassessed 24 h later by an independent observer. The patients were all men with a median age of 72 (range 60-84). 11 patients reported improvement of symptoms with the use of the GTN patch and had a good response to the lumbar sympathectomy. 4 patients had no symptomatic relief from the patch and also did not respond to the lumbar sympathectomy. 1
1
f
*Not significant.
GCLO before biopsy. GCLOs were determined on paraffin sections from formalin-fixed tissue stained with haematoxylin and eosin. Any. antropyloric ulcer or chronic superficial gastritis according to the Whitehead classifications was also noted. GCLOs were identified in 53 patients (48%) in 1977 and 35 patients (32%) in 1987 (table). GCLOs were found in 33 of 46 (72%) patients with an antropyloric ulcer in 1977 and in 17 of 25 (68%) with the same lesion in 1987. The prevalence of GCLO did not differ significantly in the two groups when compared by the Mantel-Haenszel test adjusted for the presence of gastroduodenal lesions (X2 MH = 1,40, 95% confidence interval 0-61-3-02). Thus, in our population, the prevalence of GCLO was similar ten years ago, which suggests that GCLOs were unknown because pathologists did not look for them in gastric biopsy samples. Anatomy and Pathology Laboratory, and Hepatogastroenterology Service, Hôpital Antoine Béclère, 92141 Clamart, France; and Anatomy and Pathology Laboratory, Hôpital Bicêtre, Le Kremlin Bicetre, France
P. BEDOSSA T. POYNARD
J.-C. CHAPUT E. MARTIN
JL. Spirochaetes in gastric glands of macacus rhesus and humans without definite history of related disease. Proc Soc Exp Biol Med 1938; 38: 536-38. 2. Freedberg AS, Baron LE. The presence of spirochetes in human gastric mucosa. Am J Dig Dis 1940; 7: 443-45. 3. Warren JR. Unidentified curved bacilli on gastnc epithelium in active chronic gastritis. Lancet 1983; i: 1273 4. Marshall B. Unidentified curved bacilli on gastric epithelium in active chronic gastritis. Lancet 1983; i: 1273-75. 5 Whitehead R. Mucosal biopsy of the gastrointestinal tract. Philadelphia: WB Saunders, 1979. 1. Doenges
Our patients with primary SLE had no signs of Sjogren’s syndrome as established by lip biopsy and by reduction in lacrimal and salivary secretions. However, the individual oligosaccharide chains in IgG (on average 2’8/molecule) are bi-antennary and each branch may contain a galactose residue; thus, there are varying proportions of chains with two (G[2]), one (G[l]), or no (G[0]) galactose residues (compare structures shown in Axford et al4). Using analytical methods which provide this information, we consistently fmd that values of G(0) for IgG from active RA patients are unequivocally higher than for age-matched normal controls, whereas the G(0) for IgG from the SLE patients described above are within the normal range for age-matched controls. Parekh et all also reported an increased G(0) in patients with RA. From the above discussion, there need be no direct relationship between G(0) and galactose content.
syndrome, ankylosing spondylitis, psoriatic arthropathy, myositis, scleroderma, leprosy, klebsiella infection, and other disorders. Thus, the data from our laboratories shows that this exciting defect is not a characteristic feature of the chronic inflammatory state in general, but has important disease restriction. Department of Rheumatology Research, J. S. AXFORD F. C. HAY University College and Middlesex School of Medicine, London W1P 9PG
SiR,—Dr Axford and colleagues (Dec 26, p 1486) report reduced B-cell galactosyltransferase activity in rheumatoid arthritis. Tomana et aP previously showed that reduced numbers of galactose residues are a feature of chronic inflammatory disease and not just rheumatoid arthritis. It would therefore be inappropriate to implicate this abnormality in the pathogenesis of rheumatoid arthritis. Centre for Rheumatic Diseases,
R. MADHOK H. A. CAPELL
Royal Infirmary, Glasgow G4 0SF
M, Schrohenloher RE, Koopman WJ, Alarcon GS. Decreased galactosylation of serum IgG from patients with rheumatoid arthritis (RA) and other chronic inflammatory diseases. Arthritis Rheum 1986; 29 (suppl 4): S41.
1. Tomana
*t*This whose
letter has been shown
to
Dr Axford and his
colleagues,
reply follows.-ED.L.
Sip,—Were the abstract by Tomana et al’ the only evidence available, we would have some sympathy with Dr Madhok and Dr Capell regarding the implications of galactose deficiency in IgG for the
pathogenesis of rheumatoid arthritis. While there is no disagreement that galactose content in the serum IgG is decreased in patients with rheumatoid arthritis, there is over such a deficiency in systemic lupus erythematosus (SLE) .1-3 Tomana et al report a drop of 06 residue/molecule of galactose in IgG patients with SLE, which they report to be "comparable" to changes in their rheumatoid arthritis (RA) group. In contrast, Mullinax et aP found a 33% reduction in galactose content of IgG from patients with SLE, compared with a 54% reduction for their RA group, our figures being 10% (not significant) and about 50%, respectively.
L. MACKENZIE D. A. ISENBERG P. M. LYDYARD I. M. ROITT
Department of Medical Microbiology, University College and Middlesex Hospital School of Medicine
G. ROOK
Glycobiology Unit, University of Oxford
T. W. RADEMACHER R. B. PAREKH R. A. DWEK
M, Schrohenloher RE, Koopman WJ, Alarcon GS. Decreased galactosylation of serum IgG from patients with rheumatoid arthritis (RA) and other chronic inflammatory diseases. Arthritis Rheum 1986, 29: S41. Parekh RB, et al. Association of rheumatoid arthritis and primary osteoarthritis with changes in the glycosylation pattern of total serum IgG. Nature 1985; 316: 452 Mullinax F. Molecular site and enzymatic origin of IgG galactose deficiency in rheumatoid arthritis and SLE Arthritis Rheum 1975; 18: 417 Axford JS, Mackenzie L, Lydyard PML, Hay FC, Isenberg DA, Roitt IM Reduced B-cell galactosyltransferase activity in rheumatoid arthritis. Lancet 1987, ii 1486 Parekh RB, Isenberg DA, Dwek RA, Roitt IM, Rook GAW, Rademacher TW A comparative analysis of disease associated changes in N-glycosylation of serum IgG. Br JRheum 1987; 26: 112
1 Tomana
2
GALACTOSE RESIDUES IN CHRONIC INFLAMMATORY DISEASE
-
We have now measured IgG G(0) percentages in over 300 sera from 25 different disease statesand conclude that the G(0) glycosylation defect is confined to juvenile and adult RA, SLE associated with Sjogren’s syndrome, active Crohn’s disease and untreated pulmonary tuberculosis. Normal G(0) values were obtained not only in primary SLE but also in primary Sjogren’s
3 4. 5
TRANSDERMAL GLYCERYL TRINITRATE AS PREDICTOR OF OUTCOME OF LUMBAR SYMPATHECTOMY
SIR,-Patients with serious distal limb ischaemia beyond the help of direct arterial surgery are often considered for lumbar sympathectomy (surgical or chemical). Transdermal glyceryl trinitrate (GTN) causes local vasodilatation1.2 and sublingual GTN increases blood flow while decreasing venous tone and arteriolar resistance in the forearm.3 Therefore we hypothesised that the response to transdermal GTN might predict the outcome of lumbar sympathectomy in patients with distal limb ischaemia. We studied 16 patients who required lumbar sympathectomy. The patients were assessed on admission and a ’Transiderm Nitro-10’ self-adhesive patch (Ciba-Geigy), which releases 10 mg GTN daily at a continuous rate, was placed on the dorsum of the foot of the diseased limb. The patients were reassessed 24 h later and the patch was removed. The next day the same patients underwent lumbar sympathectomy and were reassessed 24 h later by an independent observer. The patients were all men with a median age of 72 (range 60-84). 11 patients reported improvement of symptoms with the use of the GTN patch and had a good response to the lumbar sympathectomy. 4 patients had no symptomatic relief from the patch and also did not respond to the lumbar sympathectomy. 1