Autonomic neuropathy in Fabry disease: a prospective study using the Autonomic Symptom Profile and cardiovascular autonomic function tests

Background  

Fabry patients have symptoms and signs compatible with autonomic dysfunction. These symptoms and signs are considered to be due to impairment of the peripheral nervous system, but findings indicative of autonomic neuropathy in other diseases, such as orthostatic intolerance and male sexual dysfunction, are infrequently reported in Fabry disease. The aim of our study was to investigate autonomic symptoms and cardiovascular autonomic function in a large cohort of male and female Fabry patients.     

Direct and cooperative mechanisms of lymphocyte triggering in liquid and solid cultures.

The role of cell interactions in lymphocyte stimulation was analyzed by studying the kinetics of lymphocyte proliferation at different cell concentrations, and also by a lymphocyte microculture technique in solid medium. An absolute requirement for cell interactions was found in lymphocyte responses to concanavalin A, pokeweed mitogen, sodium periodate, purified protein derivative from Mycobacterium tuberculosis, and zinc chloride. No requirement for cell interactions was found in lymphocyte responses to calcium ionophore A23187. The existence of lymphocyte subpopulations with different requirements for cell interactions was observed in lymphocyte responses to phytohemagglutinin P, phytohemagglutinin HA 17, tetradecanoyl-phorbolacetate, antiserum to MOLT-4 lymphoblasts, antiserum to B411-4 lymphoblasts, antiserum to human embryo lung fibroblasts, and antiserum to HeLa cells infected with Herpes simplex virus. Lymphocyte responses to phytohemagglutinin P were potentiated by incorporation into the solid cultures of red blood cells of their membrane preparations suggesting that membrane-membrane interactions, either directly, or through soluble mediators are likely to be the basis of cell cooperation in this system. In solid cultures, phytohemagglutinin P, phytohemagglutinin P plus red blood cells, phytohemagglutinin HA 17, tetradecanoyl-phorbol-acetate and antiserum to MOLT-4 lymphoblasts were found to stimulate mainly thymus-dependent lymphocytes, whereas antiserum to Hela cells infected with Herpes simplex virus stimulated mainly non-thymus-dependent lymphocytes. Antiserum to B411-4 lymphoblasts stimulated both thymus-dependent and non-thymus dependent lymphocytes.     

Immunosuppressive effect of graft-versus-host reaction

GVHR was elicited in adult F₁ hybrids by iv injection of parental spleen cells. The F₁ hybrids were then immunized with θ-AKR antigen. Plaque-forming cells (PFC) producing antibodies lytic for AKR thymocytes were enumerated in spleens of experimental animals using the method of cytolysis in agar-gel. The number of PFC found in spleens of animals grafted with parental cells was significantly lower than the number in spleens of animals grafted with syngeneic cells. The degree of suppression of immune response to θ-AKR depended on: (1) the duration of GVHR at the time of immunization, (2) the parental strain and the number of parental cells grafted to evoke GVHR, and (3) the source of cells grafted. Thymus and bone marrow cells when grafted together showed a synergistic effect in suppression of the host's immune response. Immunosuppression of the response to θ-AKR seems to be a more sensitive indicator of GVHR in adult F₁ hybrids than splenomegaly, which is commonly used as a means of assessment of GVHR. The possible role of immunosuppression in the pathogenesis of GVHR is briefly discussed.