540
control experiment with the patient’s normal cells (e.g., skin fibroblasts) as targets so the question of specificity cannot be resolved. A larg6 lymphocyte/tumour cell ratio was necessary for maximum cytotoxicity. Prolonged remission might thus be expected in lumphocyte-rich organs of the reticuloendothelial system, with relapse in organs poor in T lymphocytes such as the kidney and the intestines. Mathe et al.2 have suggested that G.V.L. reactions must occur in patients with prolonged remissions after marrow transplantation for leukaemia because the dose of X-irradiation is probably insufficient to kill all the leukaemia cells. Indeed, the Seattle group has recently reported a great difference in relapse time between transplanted leukaemic patients with mild (grade I) G.V.H. disease (294 days median) and those with no disease
(93 days).2t
be solid evidence for G.v.L. reactions we believe that our two cases suggest that there is a G.V.L. reaction in man. In animals G.V.H. and G.V.L. reactions appear to be separate, yet this form of immunotherapy has been unsuccessful. If the syndrome described here is a true G.v.L. reaction, it remains to be determined whether it is distinct from a more generalised G.V.H. reaction and involves a leukaemia-specific antigen, and whether it might be therapeutically useful. There appears
in
to
experimental animals and
This work was supported by grants (RR-69) from the General Clinical Research Centers Program of the Division of Research Resources, the National Institutes of Health, and U.S.P.H.S. Grants 1-P02CA-12247-01A1-CAP, CA-15564-01, and CA-20067. J.R.H. was the recipient of a Biological-Medical Award from the Swiss Academy of Medical Sciences. We thank Kathy McClure, Dr Gail Gardner, and the nursing staff of the Pediatric Clinical Research Center; Dr E. D. Thomas, Dr R. Storb, and their colleagues for advice; Dr M. Block for marrow-biopsy interpretations; and Dr R. Shikes and Dr B. Favara for histopathological interpretations. We thank Pat Johnston, Kathleen Hoyer, and Catherine Field for secretarial assistance and Nancy McPherson for preparing illustrations.
Reprint requests should be addressed to C. S. A., Children’s HospiPhiladelphia, One Children’s Center, 34th and Civic Center Boulevard, Philadelphia, PA 19104, U.S.A. tal of
REFERENCES
H., Corp, M. C., Loutit, J. F., Neal, F. E. Br. med. J. 1956, ii, 626. 2. Mathé, G., Schwarzenberg, I., Transplant. Proc. 1974, 6, 335. 3. Mathé, G. Ann. R. Coll. Surg. Eng. 1967, 41, 93. 4. Mathé, G., Schwarzenberg, L. Eur.J. Cancer, 1968, 4, 211. 5. Rumma, J., Davies, D. J., Cauchi, M. N. Cancer Res. 1971,37, 1389. 6. Bortin, M. M., Rimm, A. A., Saltzstein, E. C., Rodey, G. E. Transplantation, 1973, 16, 182. 7. Bortin, M. M., Truitt, R. L., Rose, W. C., Rimm, A. A., Saltzstein, E. C. in The Reticuloendothelial System in Health and Disease: Immunologic and Pathologic Aspects (edited by H. Friedman, M. R. Escobar, and S. M. Reichard); p. 331, New York 1976. 8. August, C. S., King, E., Githens, J. H., McIntosh, K., Humbert, J. R., Greensher, A., Johnson, F. B. Blood, 1976, 48, 491. 9. Gardner, G. G., August, C. S., Githens, J. H. Pediatrics, 1977, 60, 625. 10. Thomas, E. D., and others. New Engl.J. Med. 1975, 242, 832. 11. Storb, R., and others. J. Immun. 1974, 112, 1508. 12. Storb, R., and others. Blood, 1974, 44, 57. 13. Sharma, B., Terasaki, P I Cancer Res 1974, 34, 115. 14. Storb, R., and others. Blood, 1974, 43, 157. 15. Thomas, E. D., and others. New Engl.J. Med. 1975, 292, 895 16. Simone, J. V. Adv. Pediat. vol. 19 (edited by I. Schulman);p. 13, 1972. 1. Barnes, D. W.
17. 18. 19.
Humphrey, B. Unpublished.
Bach, F. H., Bach, M. L., Sondel, P. M. Nature, 1976, 259, 273. Eijsvoogel, V. P., duBois, R., Melief, C. J. M., Zeylemaker, W. P., Raat-Koning, L., deGroot-Kooy, L. Transplant. Proc. 1973, 5, 415. 20. Sondel, P. M., O’Brien, C., Porter, I.., Schlossman, S. F., Chess, L. J. Im-
mun. 1976, 117, 2197.
21. Thomas, E. D., and
others. Blood, 1977, 49, 511.
BACTERIAL ADHERENCE TO PERIURETHRAL EPITHELIAL CELLS IN GIRLS PRONE TO URINARY-TRACT INFECTIONS GUNILLA KÄLLENIUS
JAN WINBERG
Departments of Pædiatrics, Huddinge Hospital and Karolinska Hospital; Karolinska Institute, Stockholm; and Department of Bacteriology, National Bacteriological Laboratory, Stockholm, Sweden
Bacterial adherence to epithelial cells from the periurethral region of 48 healthy girls aged over 2 years and of 76 girls with repeated urinary-tract infections was investigated. The infection-prone girls had a significantly higher mean number of adhering bacteria than the healthy controls (P4 bacteria/cell are shown. For each girl 50 cells were examined. p0.05
is
used. In
regarded
as
non-significant. Results
Adhering Bacteria The
In Vivo
number of bacteria per epithelial cell was for patients (some infected and others nonregistered infected at the time of examination) and for controls (fig. 1). The median value for the mean number of bacteria per cell was 0.2 (range of means 0-73) for healthy controls and 2-0 (range 0-41) and 1.2 (range 0-47) for non-infected and infected patients, respectively. Thus, some preparations completely lacked adhering bacteria. The differences between mean values for controls and patients, whether non-infected or infected, were signifimean
cant.
Within each periurethral-cell preparation an uneven distribution of adhering bacteria was displayed, so that there were always some epithelial cells without any bacteria, whereas others could be covered with bacteria. Therefore the percentages of cells to which at least one bacterium had adhered (see table) were recorded for each preparation. There was again a significant difference between controls and patients. PERIURETHRAL EPITHELIAL CELLS WITH ADHERING BACTERIA
Controls v. infected patients, p
control experiment with the patient’s normal cells (e.g., skin fibroblasts) as targets so the question of specificity cannot be resolved. A larg6 lymphocyte/tumour cell ratio was necessary for maximum cytotoxicity. Prolonged remission might thus be expected in lumphocyte-rich organs of the reticuloendothelial system, with relapse in organs poor in T lymphocytes such as the kidney and the intestines. Mathe et al.2 have suggested that G.V.L. reactions must occur in patients with prolonged remissions after marrow transplantation for leukaemia because the dose of X-irradiation is probably insufficient to kill all the leukaemia cells. Indeed, the Seattle group has recently reported a great difference in relapse time between transplanted leukaemic patients with mild (grade I) G.V.H. disease (294 days median) and those with no disease
(93 days).2t
be solid evidence for G.v.L. reactions we believe that our two cases suggest that there is a G.V.L. reaction in man. In animals G.V.H. and G.V.L. reactions appear to be separate, yet this form of immunotherapy has been unsuccessful. If the syndrome described here is a true G.v.L. reaction, it remains to be determined whether it is distinct from a more generalised G.V.H. reaction and involves a leukaemia-specific antigen, and whether it might be therapeutically useful. There appears
in
to
experimental animals and
This work was supported by grants (RR-69) from the General Clinical Research Centers Program of the Division of Research Resources, the National Institutes of Health, and U.S.P.H.S. Grants 1-P02CA-12247-01A1-CAP, CA-15564-01, and CA-20067. J.R.H. was the recipient of a Biological-Medical Award from the Swiss Academy of Medical Sciences. We thank Kathy McClure, Dr Gail Gardner, and the nursing staff of the Pediatric Clinical Research Center; Dr E. D. Thomas, Dr R. Storb, and their colleagues for advice; Dr M. Block for marrow-biopsy interpretations; and Dr R. Shikes and Dr B. Favara for histopathological interpretations. We thank Pat Johnston, Kathleen Hoyer, and Catherine Field for secretarial assistance and Nancy McPherson for preparing illustrations.
Reprint requests should be addressed to C. S. A., Children’s HospiPhiladelphia, One Children’s Center, 34th and Civic Center Boulevard, Philadelphia, PA 19104, U.S.A. tal of
REFERENCES
H., Corp, M. C., Loutit, J. F., Neal, F. E. Br. med. J. 1956, ii, 626. 2. Mathé, G., Schwarzenberg, I., Transplant. Proc. 1974, 6, 335. 3. Mathé, G. Ann. R. Coll. Surg. Eng. 1967, 41, 93. 4. Mathé, G., Schwarzenberg, L. Eur.J. Cancer, 1968, 4, 211. 5. Rumma, J., Davies, D. J., Cauchi, M. N. Cancer Res. 1971,37, 1389. 6. Bortin, M. M., Rimm, A. A., Saltzstein, E. C., Rodey, G. E. Transplantation, 1973, 16, 182. 7. Bortin, M. M., Truitt, R. L., Rose, W. C., Rimm, A. A., Saltzstein, E. C. in The Reticuloendothelial System in Health and Disease: Immunologic and Pathologic Aspects (edited by H. Friedman, M. R. Escobar, and S. M. Reichard); p. 331, New York 1976. 8. August, C. S., King, E., Githens, J. H., McIntosh, K., Humbert, J. R., Greensher, A., Johnson, F. B. Blood, 1976, 48, 491. 9. Gardner, G. G., August, C. S., Githens, J. H. Pediatrics, 1977, 60, 625. 10. Thomas, E. D., and others. New Engl.J. Med. 1975, 242, 832. 11. Storb, R., and others. J. Immun. 1974, 112, 1508. 12. Storb, R., and others. Blood, 1974, 44, 57. 13. Sharma, B., Terasaki, P I Cancer Res 1974, 34, 115. 14. Storb, R., and others. Blood, 1974, 43, 157. 15. Thomas, E. D., and others. New Engl.J. Med. 1975, 292, 895 16. Simone, J. V. Adv. Pediat. vol. 19 (edited by I. Schulman);p. 13, 1972. 1. Barnes, D. W.
17. 18. 19.
Humphrey, B. Unpublished.
Bach, F. H., Bach, M. L., Sondel, P. M. Nature, 1976, 259, 273. Eijsvoogel, V. P., duBois, R., Melief, C. J. M., Zeylemaker, W. P., Raat-Koning, L., deGroot-Kooy, L. Transplant. Proc. 1973, 5, 415. 20. Sondel, P. M., O’Brien, C., Porter, I.., Schlossman, S. F., Chess, L. J. Im-
mun. 1976, 117, 2197.
21. Thomas, E. D., and
others. Blood, 1977, 49, 511.
BACTERIAL ADHERENCE TO PERIURETHRAL EPITHELIAL CELLS IN GIRLS PRONE TO URINARY-TRACT INFECTIONS GUNILLA KÄLLENIUS
JAN WINBERG
Departments of Pædiatrics, Huddinge Hospital and Karolinska Hospital; Karolinska Institute, Stockholm; and Department of Bacteriology, National Bacteriological Laboratory, Stockholm, Sweden
Bacterial adherence to epithelial cells from the periurethral region of 48 healthy girls aged over 2 years and of 76 girls with repeated urinary-tract infections was investigated. The infection-prone girls had a significantly higher mean number of adhering bacteria than the healthy controls (P4 bacteria/cell are shown. For each girl 50 cells were examined. p0.05
is
used. In
regarded
as
non-significant. Results
Adhering Bacteria The
In Vivo
number of bacteria per epithelial cell was for patients (some infected and others nonregistered infected at the time of examination) and for controls (fig. 1). The median value for the mean number of bacteria per cell was 0.2 (range of means 0-73) for healthy controls and 2-0 (range 0-41) and 1.2 (range 0-47) for non-infected and infected patients, respectively. Thus, some preparations completely lacked adhering bacteria. The differences between mean values for controls and patients, whether non-infected or infected, were signifimean
cant.
Within each periurethral-cell preparation an uneven distribution of adhering bacteria was displayed, so that there were always some epithelial cells without any bacteria, whereas others could be covered with bacteria. Therefore the percentages of cells to which at least one bacterium had adhered (see table) were recorded for each preparation. There was again a significant difference between controls and patients. PERIURETHRAL EPITHELIAL CELLS WITH ADHERING BACTERIA
Controls v. infected patients, p
