Fifty patients with bronchial asthma were divided into four groups according to the amount of expectoration per day: 0-24, 25-49, 50-99 and 100+ ml/day. Clinical features of patients with mucus hypersecretion (more than 50 ml/day of expectoration) were evaluated by age, severity of disease, cellular composition of bronchoalveolar lavage (BAL) fluid, and ventilatory function. 1. The proportion of patients with steroid-dependent intractable asthma (SDIA) in each group increased with increase in mucus hypersecretion. 2. Many of the patients with mucus hypersecretion (more than 50 ml/day) were over the age of 40. 3. The proportion of BAL eosinophils was significantly higher in patients with hypersecretion (more than 50 ml/day) than in those with expectoration of less than 49 ml/day. There was a significant correlation between the proportion of BAL eosinophils and the amount of expectoration per day (r = 0.48, p < 0.05). Proportions of lymphocytes and neutrophils in the BAL fluid were not related to the amount of expectoration per day. 4. There was no significant correlation between the amount of expectoration per day and ventilatory function in patients with asthma in this study.
Summary Immunolatex particles were used as markers for IgE receptors on basophils using electron‐microscope scanning. These particles appeared to bind specifically to basophils. Basophils from atopic asthma patients showed greater binding to latex particles than those from intractable asthma patients or healthy subjects. Cap and patch formations on IgE receptors were frequently found in basophils of atopic asthmatics, and cap formation was observed only on basophils that were pear‐shaped. The redistribution of IgE receptors, such as that by cap formation, may be a significant triggering mechanism for basophil activation. The latex density on basophils pre‐treated with anti‐human IgG was much greater in intractable asthmatics than in atopic asthmatics or healthy subjects, and almost all basophils with increased immunolatex particles were pear‐shaped, suggesting the presence of some IgG receptors on the surface, and such receptors may play an important role in intractable asthma.
The eosinophil is a well-known leukocyte acting as an effector cell in the allergic reaction mechanism. The application of appropriate materials has led to more exact results from allergic examinations. In an effort to further improve analysis, we established a novel purification method for eosinophils using the flow cytometry (PCM) of peripheral blood and bronchoalveolar lavage fluid (BALF) leucocytes from healthy and allergic subjects. We examined the function of these cells in chemotaxis by platelet activating factor (PAF) and recombinant human (rh) IL-5. We obtained following results. First, we were able to separate human eosinophils containing autofluorescence substance, which was detectable by FCM employing a 450 nm argon ion laser. Second, the purity and recovery rate of the eosinophils were 90.1 +/- 4.2% and 32.1 +/- 7.6% in the healthy subjects who had no peripheral eosinophilia (< 6%) and 93.7 +/- 4.4% and 37.2 +/- 7.5% in the allergic subjects who had eosinophila (> 6%). A relationship was readily apparent between the peripheral and purified eosinophil counts in the healthy subjects (r = 0.62). Autofluorescence of the eosinophil fraction on PCM was further found to be decreased in patients with marked eosinophilia because of an increase in hypodense eosinophils. Third, highly purified eosinophils (76%) were also obtained from the 6.5% eosinophils present in the bronchoalveolar lavage fluid of one bronchial asthma patient. Fourth, the maximal chemotaxis of these eosinophils was shown at 10(-6) M of platelet activating factor (PAF) and at 1 micrograms/ml of IL-5 in a dose-dependent manner. This activity in allergic patients was accelerated compared with that in healthy subjects.(ABSTRACT TRUNCATED AT 250 WORDS)
Eosinophils play an important role in the field of allergy, and release several kinds of granule proteins, leukotrien and superoxide. The most popular method to measure superoxide is utilizing SOD-inhibitable reduction of ferricytochrome c. And recently, the microplate reader enables us to measure superoxide generation from eosinophils more easily using this method. To measure superoxide, we must pay attention to obtain a high purity of eosinophils and not to damage cells. It is also possible to measure eosinophil peroxidase (EPO) using the microplate reader. We are measuring EPO with colorimetric assay using OPD (o-phenylenediamine). OPD is specific to EPO and has no cross reaction to myeloperoxidase. We, now have numerous methods to evaluate eosinophil function, so a selection must be made to select the most correct method.
To predict the clinical efficacy of house dust mite immunotherapy (IT), clinical factors before IT were analyzed in relation to clinical efficacy in bronchial asthmatics treated by standard IT method. In 111 asthmatics treated by IT, 88 cases (80%) obtained favorable results over a one-year period, while only 39% of asthmatics without IT showed clinical improvement (p < 0.05, chi 2 test). Factors including severity, skin test threshold, age, age at which IT was started, duration of asthma, onset of asthma, FEV1.0% and serum IgE levels before IT were analyzed. Severity showed the most significant influence on clinical efficacy (r = 0.412, p < 0.01). A study to determine whether some specific criteria could be used to predict the clinical efficacy of IT was then carried out. Using multivariate analysis with the factors above mentioned, the clinical efficacy ranging from deteriorated to good response could be expressed as a formula with a multi-regression coefficient of 0.56, p < 0.05. Moreover, the application of linear discriminating analysis gave an 80% true positive discriminating rate in 75 asthmatics. In both methods, severity seemed to be the most important factor, skin test threshold next and FEV1.0% third. The other factors were not significant. Hopefully, the use of this formula in clinical practice will improve the efficacy of IT, thus providing further therapeutic benefits to bronchial asthmatics.
