SUMMARY Ninety-two British, caucasian, alcoholic patients with liver disease were grouped on the basis of hepatic histology into fatty change, hepatitis with or without cirrhosis, and cirrhosis alone. Men with alcoholic hepatitis with or without cirrhosis showed an increased incidence of the histocompatibility antigen HLA-B8 (P < 0-02). Increased measles antibody titres were found in patients with cirrhosis with or without hepatitis and were associated with the B8 phenotype in both sexes. Rubella antibody titres and percentage DNA-binding were raised in patients with cirrhosis and showed no association with the B8 phenotype. Concentrations of 1gM and IgA were raised in patients with steatosis and with hepatitis, while in patients with cirrhosis IgG concentrations were also increased. Low titres of autoantibodies were found in all histological groups.It is possible that the development of hepatitis in response to alcohol abuse may be influenced, at least in men, by a gene linked to the B locus. Otherwise, immune processes associated with alcoholrelated liver disease are probably secondary phenomena.The liver damage seen in alcoholic subjects results from the direct hepatotoxic effect of ethanol.' The development of alcoholic cirrhosis is often preceded by alcoholic hepatitis,2 although alcoholic cirrhosis may develop without the hepatitic stage.3Only 20% of alcoholic subjects develop liver disease; therefore, constitutional or genetic factors may be concerned in this individual susceptibility to develop cirrhosis and may also influence the 'route' by which it develops.The role of genetically determined immunological factors in the pathogenesis of alcohol-related liver disease has recently received much attention. Conflict has arisen, in particular, regarding the prevalence and importance of the histocompatibility antigen HLA-B8.4-8We have therefore screened a group of 92 alcoholics with liver disease of varying severity for B8 in an attempt to clarify this situation. In addition, we have measured antibodies to rubella, measles, smooth muscle, nuclear and mitochondrial antigens, and serum immunoglobins for further evidence of an altered immune status in these patients. Particular attention has been paid to the relationship between these various indices and the histological changes on liver biopsy.Received for publication 13 November 1979 Patients and methods Ninety-two British, caucasian, alcoholic patients (68 men: 24 women) who had taken more than 100 g ethanol per day for at least five years were grouped, on the basis of liver histology, into fatty change only, alcoholic hepatitis with or without cirrhosis, or cirrhosis alone. All patients were abusing alcohol up to the time of hospitalisation, and liver biopsies were taken within one week of admission. Suitable investigations were undertaken to exclude other causes of liver disease.
SUMMARY Antibodies to cytomegalovirus (CMV) and Epstein-Barr virus capsid antigen (EBVCA) were examined in 41 patients with rheumatoid arthritis (RA), 26 patients with primary sicca syndrome, and 26 healthy subjects of similar age and sex. IgG antibody titres to EBVCA and CMV were similar in all three groups, apart from a trivial increase of antibodies to EBVCA in RA. False positive IgM anti-CMV antibodies detected in serum from one patient with sicca syndrome and 20 patients with RA were shown to be due to rheumatoid factors. These data did not support recent suggestions that patients with these diseases showed exaggerated immunological responses to either virus and emphasised the need to incorporate adequate laboratory and disease controls when seroepidemiological studies are performed on sera containing rheumatoid factors and autoantibodies.The Epstein-Barr virus (EBV) and cytomegalovirus (CMV) are candidate agents for the aetiology of rheumatoid arthritis (RA) and sicca syndrome (SS). Both viruses infect salivary glands and both, once infection has been established, persist for life and could act as triggers for the immunological abnormalities seen in these diseases.Seroepidemiological evidence for the involvement of EBV in RA has been suggested by the finding of higher antibody titres to Epstein-Barr viral capsid antigen (EBVCA),l-3 Epstein-Barr nuclear antigen (EBNA),4 and early antigen.23 However, in these studies the titre differences were small (usually about one doubling dilution) and there was disagreement about which of the EBV determined antigens represent the targets for this apparently exaggerated response. There has been agreement that antibodies to rheumatoid arthritis nuclear antigen (RANA), initially described as a precipitin reaction characteristic of RA,s are significantly raised, with values ranging from about 6x log2 in our own studies,6 to 16xlog2 compared with controls.Recent findings that RANA determinants appear to
The results of testing for rubella antibodies in over 6000 sera from women of child-bearing age are reported and analysed according to pregnant state, age, country of origin and social class. There was no difference between the rubella seroprevalence rates in women who were pregnant and in those who were contemplating pregnancy in the future. Likewise, women (either pregnant or non-pregnant) who were young enough to have been offered rubella vaccine at school were not more likely to be immune to rubella than were older women. Rubella seropositivity rates were not influenced by social class but significantly higher rates were found in women born in European or Arabian than in African or Asian countries. We conclude that the national scheme for rubella immunization has not reduced the number of women susceptible to rubella entering pregnancy in this Health District and that greater attention should be paid to immunization of women of child-bearing age from African or Asian countries.
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