- Email: [email protected]
HLA-DR ANTIBODIES AND HTLV-III ANTIBODY ELISA TESTING
157 in ltaly4 but greater than the figure for the UK.’ The prevalence of infection by HTLV-III has been increasing in Spain since 1983 and is linked to the length of the history of drug addiction (see table).
Supported by
grants from Consellena de Sanitat, Treballa y
Seguretat
Social, Generahtat Valenciana.
J. M. RODRIGO Gastrointestinal Service and Haematology and Medical Oncology Service, Hospital Clinico Universitario, Valencia 46010, Spam
M. A. SERRA E. AGUILAR J. A. DEL OLMO V. GIMENO L. APARISI
Cheinsgsong-Popov R, Weiss RA, Daglish A, et al. Prevalence of antibodies to human T-lymphotropic virus type II in AIDS-risk patients in Britain. Lancet 1984; ii:
1
477-80. 2. Landesman SH, Ginzburg HM, Weiss SH. The AIDS epidemic. N Engl J Med 1985, 312: 521-24. 3. Schupbach J, Haller O, Vogt M. Antibodies to HTLV-III in Swiss patients with AIDS and pre-AIDS and m a groups at risk for AIDS. N Engl J Med 1985; 312: 265-69. 4 Lazzarin A, Parravicini CL, Meola G, Moroni M. AIDS in an Italian drug addict. Lancet 1984; ii: 1155
HLA-DR ANTIBODIES AND HTLV-III ANTIBODY ELISA TESTING
SIR,-People at increased risk of AIDS have anti-HLA antibodies frequently than the general population do. The H9 cell line,
more
which is used to prepare large quantities of human T-cell lymphotropic virus type III (HTLV-III), has been HLA typed in our laboratories and found to be Al, Bw62, Bw6, Cw3, DR4, DQw3. As part of our evaluation of the prototype HTLV-III antibody ELISAwe found that HLA typing sera directed against the HLA class II antigens of the H9 cell exhibited only minor reactivity by ELISA and were negative by the western blot HLA typing sera directed against class I and confirmation other class II specificities were negative by ELISA. Dr Kuhni and colleagues (May 25, p 1222) report that 10/37 (27%) of DR4 typing sera were positive for HTLV-111 antibody in two commercial screening assays. This underscores the importance of confirmatory tests beyond simple screening assay replication.3,4 However, insofar as DR4-positive individuals, and especially risk group members, may concomitantly have true HTLV-III antibodies, we believe that determination of HLA antibody status would be an inadequate substitute for direct confirmation for diagnostic purposes.
assay.3
Environmental Epidemiology Branch, National Cancer Institute, Bethesda, Maryland 20205, USA
STANLEY H. WEISS
Laboratory of Human Carcinogenesis,
used topically and sytemically as a wound healing agent,5,6 and its low polarity gives the ZAC molecule good bioavailability. The importance of mucosal protective mechanisms and the numbers of non-hypersecretory duodenal ulcer patients led us to try ZAC in acute duodenal ulcer. beneficial effects of Zn in human gastric ulcer have already been reported7,8 Thirty outpatients with endoscopically proven duodenal ulcers took part in a 1 month randomised double-blind trial. Fourteen patients took ZAC 300 mg three times daily after meals; sixteen patients received placebo capsules, indistinguishable from those containing ZAC. Both groups were comparable in age, sex, duration of disease and symptoms, and alcohol and tobacco consumption (table). Clinical assessments were done on entry to the trial and at 7, 14, 21, and 30 days. Endoscopy and laboratory checks were done before treatment and after 30 days. The healing rate was significantly greater in the group treated with ZAC. Pain disappeared in 6 patients (43%) at the end of the first week of treatment with ZAC, but in none of those treated with placebo. 10/16.plaebo patients and all 14 ZAC patients were free of all symptoms at the end of the trial. No patient complained of serious side-effects. 1 in each group complained of constipation. No changes in laboratory tests were observed. These encouraging results with ZAC support the role ofZn in the synthesis and actions of the prostaglandins (PG).9 The decrease of PG concentration of gut without any change in ability of mucosal synthesis in Zn deficiency suggests an active process ofPG secretion
involving Zn.lo Further studies are needed to confirm that ZAC, a drug with a mechanism of action, is an alternative in the treatment of ulcer disease treatment. new
Zinc acexamate and
placebo capsules were kindly provided by Laboratorios
Vinas SA.
Department of Gastroenterology, Hospital Provincial, Madrid, Spain, and Department of Internal Medicine, Complutensis University,
R. ALCALÁ-SANTAELLA D. CASTELLANOS J. L. VELO V. GONZÁLEZ LARA
DEAN L. MANN
Madrid
Uniformed Services University of the Health Sciences, Bethesda
CHRISTINE MURRAY
Tumor Cell National Cancer Institute
MIKULAS POPOVIC
1. Prasad AS. Zinc deficiency in human subjects. In: Prasad AS, Cavdar AO, Brewer GJ, Aggentt PJ, eds Zinc deficiency in human subjects. New York: Alan R Liss, 1983 1-33 2 Pfeiffer CJ, Cho CH. Mechanisms of protective action of zinc on experimental ulcer In: Umehara S, Ito H, eds Advances in experimental ulcer. Tokyo: IVth International Conference for Experimental Ulcer (ICEU), 1982· 532-42. 3. Lloris JM, Marti-Bonmati E, Aliño SF, Narbona B Esplugues J. Preventive and curative action of zinc sulphate on varios experimental gastrointestinal mucosal injuries in rats. IRCS Med Sci-Biochem 1980; 8: 622. 4. Esplugues JV, Bulbena O, Escolar G, Martí-Bonmatí E, Esplugues J. Effects of Zn acexamate on gastric mucosal resistance factors. Eur J Pharmacol 1985; 109: 145-51. 5 Cornadeu JJ. L’utilisation de l’acide N-acetyl-amino-6-hexanoique dans la cicatrisation de plais et des brûlures. Inform Ther 1968; 6: 20-22. 6. D’Alessio E, Coppola M, Verde S. Esperienza clinica sull’uso dell acido N-acetilamino-6-esanoico (plastenan) in soluzione per uso orale, come coadiuvante nella terapia degli ustionati e nella cicatrizzatione cutanea. Minerva Med 1968; 70: 3576-86. 7 Fraser PM, Doll R, Langman MJS, Misiewicz JJ, Shadon HH. Clinical trial of a new carbenoxolone analogue (BX24), zinc sulphate, and vitamin A in the treatment of gastric ulcer. Gut 1972, 13: 459-63. 8 Frommer DJ The healing of gastric ulcers by zinc sulphate Med J Austr 1975; ii: 793-96. 9 Cunnane SC, Huang YS, Horrobin DF, Davignon J. Role of zinc in linoleic desaturation and prostaglandin synthesis. Proc Lipid Res 1981; 20(1-4) 157-60. 10. Meydani SN, Dupont J. Effect of zinc deficiency on prostaglandin synthesis in different organs of the rat J Nutr 1982; 112: 1098-104.
National Cancer Institute
Labotorary of
Biology,
RC, Masur H, Spira TJ. Lymphocyte-reactive antibodies in acquired immune deficiency syndrome J Clin Immunol 1984; 4: 118-23. Sarngadharan MG, Popovic M, Bruch L, Schupbach J, Gallo RC Antibodies reactive with human T-lymphotropic retrovirus (HTLV-III) in the serum of patients with
1 William
2
AIDS Science 1984, 224: 506-08. 3 Weiss SH, Goedert JJ, Sarngadharan MG, et al Screening test for HTLV-III (AIDS agent) antibodies: Specificity, sensitivity, and applications. JAMA 1985; 253: 221-25 4 Landesman SH, Ginzburg HM, Weiss SH. The AIDS epidemic. N Engl J Med 1985; 312: 521-25
ZINC ACEXAMATE IN TREATMENT OF DUOCENAL ULCER
SIR,-Gastrointestinal disorders have been reported in zinc (Zn) An action of Zn in maintaining the integrity of the gastrointestinal tract is suggested by the fact that intraperitoneal administration of Zn protects rats against ulcerogenic agents in a dose-related manner.2,3 These effects have also been seen with oral
deficiency.’
administration of Zinc
acexamate
(ZAC).4 Acexamic acid has been
Supported by
grants from Consellena de Sanitat, Treballa y
Seguretat
Social, Generahtat Valenciana.
J. M. RODRIGO Gastrointestinal Service and Haematology and Medical Oncology Service, Hospital Clinico Universitario, Valencia 46010, Spam
M. A. SERRA E. AGUILAR J. A. DEL OLMO V. GIMENO L. APARISI
Cheinsgsong-Popov R, Weiss RA, Daglish A, et al. Prevalence of antibodies to human T-lymphotropic virus type II in AIDS-risk patients in Britain. Lancet 1984; ii:
1
477-80. 2. Landesman SH, Ginzburg HM, Weiss SH. The AIDS epidemic. N Engl J Med 1985, 312: 521-24. 3. Schupbach J, Haller O, Vogt M. Antibodies to HTLV-III in Swiss patients with AIDS and pre-AIDS and m a groups at risk for AIDS. N Engl J Med 1985; 312: 265-69. 4 Lazzarin A, Parravicini CL, Meola G, Moroni M. AIDS in an Italian drug addict. Lancet 1984; ii: 1155
HLA-DR ANTIBODIES AND HTLV-III ANTIBODY ELISA TESTING
SIR,-People at increased risk of AIDS have anti-HLA antibodies frequently than the general population do. The H9 cell line,
more
which is used to prepare large quantities of human T-cell lymphotropic virus type III (HTLV-III), has been HLA typed in our laboratories and found to be Al, Bw62, Bw6, Cw3, DR4, DQw3. As part of our evaluation of the prototype HTLV-III antibody ELISAwe found that HLA typing sera directed against the HLA class II antigens of the H9 cell exhibited only minor reactivity by ELISA and were negative by the western blot HLA typing sera directed against class I and confirmation other class II specificities were negative by ELISA. Dr Kuhni and colleagues (May 25, p 1222) report that 10/37 (27%) of DR4 typing sera were positive for HTLV-111 antibody in two commercial screening assays. This underscores the importance of confirmatory tests beyond simple screening assay replication.3,4 However, insofar as DR4-positive individuals, and especially risk group members, may concomitantly have true HTLV-III antibodies, we believe that determination of HLA antibody status would be an inadequate substitute for direct confirmation for diagnostic purposes.
assay.3
Environmental Epidemiology Branch, National Cancer Institute, Bethesda, Maryland 20205, USA
STANLEY H. WEISS
Laboratory of Human Carcinogenesis,
used topically and sytemically as a wound healing agent,5,6 and its low polarity gives the ZAC molecule good bioavailability. The importance of mucosal protective mechanisms and the numbers of non-hypersecretory duodenal ulcer patients led us to try ZAC in acute duodenal ulcer. beneficial effects of Zn in human gastric ulcer have already been reported7,8 Thirty outpatients with endoscopically proven duodenal ulcers took part in a 1 month randomised double-blind trial. Fourteen patients took ZAC 300 mg three times daily after meals; sixteen patients received placebo capsules, indistinguishable from those containing ZAC. Both groups were comparable in age, sex, duration of disease and symptoms, and alcohol and tobacco consumption (table). Clinical assessments were done on entry to the trial and at 7, 14, 21, and 30 days. Endoscopy and laboratory checks were done before treatment and after 30 days. The healing rate was significantly greater in the group treated with ZAC. Pain disappeared in 6 patients (43%) at the end of the first week of treatment with ZAC, but in none of those treated with placebo. 10/16.plaebo patients and all 14 ZAC patients were free of all symptoms at the end of the trial. No patient complained of serious side-effects. 1 in each group complained of constipation. No changes in laboratory tests were observed. These encouraging results with ZAC support the role ofZn in the synthesis and actions of the prostaglandins (PG).9 The decrease of PG concentration of gut without any change in ability of mucosal synthesis in Zn deficiency suggests an active process ofPG secretion
involving Zn.lo Further studies are needed to confirm that ZAC, a drug with a mechanism of action, is an alternative in the treatment of ulcer disease treatment. new
Zinc acexamate and
placebo capsules were kindly provided by Laboratorios
Vinas SA.
Department of Gastroenterology, Hospital Provincial, Madrid, Spain, and Department of Internal Medicine, Complutensis University,
R. ALCALÁ-SANTAELLA D. CASTELLANOS J. L. VELO V. GONZÁLEZ LARA
DEAN L. MANN
Madrid
Uniformed Services University of the Health Sciences, Bethesda
CHRISTINE MURRAY
Tumor Cell National Cancer Institute
MIKULAS POPOVIC
1. Prasad AS. Zinc deficiency in human subjects. In: Prasad AS, Cavdar AO, Brewer GJ, Aggentt PJ, eds Zinc deficiency in human subjects. New York: Alan R Liss, 1983 1-33 2 Pfeiffer CJ, Cho CH. Mechanisms of protective action of zinc on experimental ulcer In: Umehara S, Ito H, eds Advances in experimental ulcer. Tokyo: IVth International Conference for Experimental Ulcer (ICEU), 1982· 532-42. 3. Lloris JM, Marti-Bonmati E, Aliño SF, Narbona B Esplugues J. Preventive and curative action of zinc sulphate on varios experimental gastrointestinal mucosal injuries in rats. IRCS Med Sci-Biochem 1980; 8: 622. 4. Esplugues JV, Bulbena O, Escolar G, Martí-Bonmatí E, Esplugues J. Effects of Zn acexamate on gastric mucosal resistance factors. Eur J Pharmacol 1985; 109: 145-51. 5 Cornadeu JJ. L’utilisation de l’acide N-acetyl-amino-6-hexanoique dans la cicatrisation de plais et des brûlures. Inform Ther 1968; 6: 20-22. 6. D’Alessio E, Coppola M, Verde S. Esperienza clinica sull’uso dell acido N-acetilamino-6-esanoico (plastenan) in soluzione per uso orale, come coadiuvante nella terapia degli ustionati e nella cicatrizzatione cutanea. Minerva Med 1968; 70: 3576-86. 7 Fraser PM, Doll R, Langman MJS, Misiewicz JJ, Shadon HH. Clinical trial of a new carbenoxolone analogue (BX24), zinc sulphate, and vitamin A in the treatment of gastric ulcer. Gut 1972, 13: 459-63. 8 Frommer DJ The healing of gastric ulcers by zinc sulphate Med J Austr 1975; ii: 793-96. 9 Cunnane SC, Huang YS, Horrobin DF, Davignon J. Role of zinc in linoleic desaturation and prostaglandin synthesis. Proc Lipid Res 1981; 20(1-4) 157-60. 10. Meydani SN, Dupont J. Effect of zinc deficiency on prostaglandin synthesis in different organs of the rat J Nutr 1982; 112: 1098-104.
National Cancer Institute
Labotorary of
Biology,
RC, Masur H, Spira TJ. Lymphocyte-reactive antibodies in acquired immune deficiency syndrome J Clin Immunol 1984; 4: 118-23. Sarngadharan MG, Popovic M, Bruch L, Schupbach J, Gallo RC Antibodies reactive with human T-lymphotropic retrovirus (HTLV-III) in the serum of patients with
1 William
2
AIDS Science 1984, 224: 506-08. 3 Weiss SH, Goedert JJ, Sarngadharan MG, et al Screening test for HTLV-III (AIDS agent) antibodies: Specificity, sensitivity, and applications. JAMA 1985; 253: 221-25 4 Landesman SH, Ginzburg HM, Weiss SH. The AIDS epidemic. N Engl J Med 1985; 312: 521-25
ZINC ACEXAMATE IN TREATMENT OF DUOCENAL ULCER
SIR,-Gastrointestinal disorders have been reported in zinc (Zn) An action of Zn in maintaining the integrity of the gastrointestinal tract is suggested by the fact that intraperitoneal administration of Zn protects rats against ulcerogenic agents in a dose-related manner.2,3 These effects have also been seen with oral
deficiency.’
administration of Zinc
acexamate
(ZAC).4 Acexamic acid has been