Oral contraceptive hormones, folate metabolism, and the cervical epithelium.
The currently available evidence concerning disorders of folate metabolism in women taking oral contraceptives has been reviewed. A disturbance in folate balance serious enough to cause symptoms (i.e., megaloblastic anemia) occurs very rarely. In some series, but not in others, serum and/or red cell folate concentrations have been reduced in oral contraceptive users. It is doubtful whether sex steroids affect polyglutamate folate absorption. About 20 percent of women taking contraceptive hormones manifest mild megaloblastic changes on Papanicolaou smears of the cervicovaginal epithelium which disappear after folic acid therapy. The current evidence, however, would not indicate that any significant benefit would ensue from routine folate supplementation in women on oral contraceptives. (+info
Megaloblastic erythropoiesis and macrocytosis in patients on anticonvulsants.
The results of deoxyuridine suppression tests on the bone marrow cells of 14 patients on anticonvulsant drugs, 11 of whom had evidence of megaloblastic erythropoiesis, indicated that the megaloblastic changes and macrocytosis encountered in treated epileptics are often not caused either by folate deficiency or by drug-induced impairment of the 5, 10-methylenetetrahydrofolate-dependent methylation of deoxyuridylate to thymidylate. A folate-related abnormality in the methylation of deoxyuridylate was found in only two of the 11 patients with megaloblastic erythropoiesis. (+info
Interrelationships between the B-vitamins in B12-deficiency neuromyelopathy. A possible malabsorption-malnutrition syndrome.
Five patients presenting clinically with a form B12-deficiency neuromyelopathy, with cord involvement in all and proximal muscle weakness in two of them, were investigated for their neurologic, hematologic and vitamin status. Megaloblastosis and achlorhydria were present in all, and impaired absorption of 57Co vitamin B12 and of D-xylose was detected in four. Total cyanide extracted vitamin B12 (A) was lowered in all cases and noncyanide extractable (B) in four of the five, being zero in three. All five responded to injections of hydroxocobalamin. In two patients sequential estimations showed that both A and B, especially the latter, rose steeply initially, normalizing at 50% of A after some weeks. Moiety B is suggested to be physiologically the more active and dissociable form of vitamin B12. Markedly elevated initial serum folate levels, and their subsequent fall under treatment with B12, indicated the operation of the "methyltetrahydrofolate trap". Blood levels of thiamin, nicotinic acid and pantothenic acid were within normal limits. However, serum riboflavin (B2) total vitamin B6 and pyridoxal were reduced in all where tested. Vitamin B6 deficiency could have resulted from its own malabsorption and have contributed to be B12 deficiency. Vitamin B2 and B6 levels also corrected themselves on B12 therapy. The B-vitamin deficiencies in our patients probably resulted from intestinal malabsorption, with a possible factor of malnutrition consequent to their strictly vegetarian diet. (+info
Megaloblastic hematopoiesis in vitro. Interaction of anti-folate receptor antibodies with hematopoietic progenitor cells leads to a proliferative response independent of megaloblastic changes.
We tested the hypothesis that anti-placental folate receptor (PFR) antiserum-mediated effects on hematopoietic progenitor cells in vitro of increased cell proliferation and megaloblastic morphology were independent responses. We determined that (a) purified IgG from anti-PFR antiserum reacted with purified apo- and holo-PFR and specifically immunoprecipitated a single (44-kD) iodinated moiety on cell surfaces of low density mononuclear cells (LDMNC); (b) when retained in culture during in vitro hematopoiesis, anti-PFR IgG (in contrast to PFR-neutralized anti-PFR IgG and nonimmune IgG) consistently led to increased cloning efficiency of colony forming unit-erythroid (CFU-E), burst forming unit-E (BFU-E), CFU-granulocyte macrophage (CFU-GM), and CFU-GEM megakaryocyte (CFU-GEMM), and objectively defined megaloblastic changes in orthochromatic normoblasts from CFU-E- and BFU-E-derived colonies; (c) when anti-PFR antiserum was removed after initial (less than 1 h) incubation with LDMNC, a cell proliferation response was induced, but megaloblastic changes were not evident. (d) Conversely, delay at 4 degrees C for 24 h before long-term plating with antiserum resulted in megaloblastosis without increased cell proliferation; (e) however, 500-fold molar excess extracellular folate concentrations completely abrogated the expected anti-PFR antiserum-induced megaloblastic changes, without altering cell proliferative responses. Thus, although cell proliferative and megaloblastic changes are induced after short-term and prolonged interaction of antibody with folate receptors on hematopoietic progenitors, respectively, they are independent effects. (+info
DNA ploidy and cell cycle analyses in the bone marrow cells of patients with megaloblastic anemia using laser scanning cytometry.
BACKGROUND: Megaloblastic anemias are characterized by several hematopoietic cells with dysplastic nuclear morphology. The analyses of DNA ploidy and cell cycle of these cells are important to understand the property of such diseases. METHODS: As laser scanning cytometry (LSC) is a useful tool to evaluate the morphology of the cells fixed on the slide glass together with the quantitative analysis of the fluorescence information of each cell by rapid scanning of the specimens, the authors examined the DNA ploidy and cell cycle of six cases with megaloblastic anemia using LSC. RESULTS: Giant neutrophilic series such as giant metamyelocytes and giant band cells were found to have extraordinarily higher DNA ploidy, while hypersegmented neutrophils represented the normal diploid pattern like normal neutrophils. As to megaloblasts, cell cycle analysis showed that the proportion of the cells in S phase was increased as compared with the case of normal erythroblasts. CONCLUSIONS: The present study clearly demonstrates the abnormal aspects of the hematopoietic cells with megaloblastic anemia from the viewpoint of the DNA ploidy and cell cycle analyzed by the use of LSC. (+info
Natural autoantibodies may play a role in ineffective erythropoiesis during megaloblastic haemopoiesis.
Marrow aspirates from 11 patients with megaloblastic haemopoiesis and from 14 healthy individuals with normoblastic haemopoiesis were studied for antibodies associated with polychromatic/orthochromatic erythroblasts, using an 125I-labelled anti-human immunoglobulin reagent and autoradiography. In addition, the expression on these cells of receptors for FcIgG (FcR) and of the type I receptor for fragments of the third complement component (CR1) were investigated with receptor-specific monoclonal antibodies, 125I-labelled anti-mouse immunoglobulin and autoradiography. The percentages of immunoglobulin-positive erythroblasts were significantly greater in the megaloblastic than in the normoblastic marrows. Abnormally high percentages of labelled erythroblasts were present in patients without any manifestations of an autoimmune disorder. The percentage of labelled erythroblasts in the marrows of the patients correlated well with the degree of anaemia. FcR were absent on the majority of megaloblasts or normoblasts while the expression of CR1 was similar in both types of cell. The difference between the percentage labelling of megaloblasts and normoblasts was therefore unlikely to be due to greater binding of immune complexes with or without associated complement to megaloblasts than normoblasts. The megaloblast-bound immunoglobulin is, therefore, likely to have recognized abnormally expressed epitopes on the surface of megaloblasts. The results suggest that natural autoantibodies play a role in the destruction of erythroblasts during megaloblastic haemopoiesis. (+info
Reversible bone marrow dysplasia in patients with systemic lupus erythematosus.
OBJECTIVE: Several reports of bone marrow dysplasia in patients with systemic lupus erythematosus (SLE) have been published. However, the reports are restricted primarily to descriptions of the erythroid lineage; no follow-up studies have been reported, and the clinical significance of the dysplasias is unknown. Therefore, in the present study, the dysplasias noted in bone marrow aspirates obtained from SLE patients were characterized. PATIENTS AND METHODS: The smears of bone marrow aspirates obtained from 17 SLE patients who had bone marrow aspiration due to cytopenia (WBC < 1,500/microl, or Hb < 10.5 g/dl, or platelet count < 10 x 10(4)/microl) were examined retrospectively. Of the 17 patients, 4 had a repeat bone marrow aspiration during follow-up. Clinical and laboratory data were obtained from the medical records. RESULTS: Of the 17 SLE patients, 12 had dysplasias, including: erythroid cell multinuclearity (trinuclear or more) (5 patients), megaloblastoid changes (4), pseudo-Pelger abnormalities (6), annular nuclear myeloid cells (2), separated nuclear megakaryocytes (4), and micromegakaryocytes (5). In the 4 patients who had follow-up bone marrow aspiration, these dysplasias were correlated with disease activity; some abnormalities disappeared with remission of SLE. Diffuse proliferative glomerulonephritis (3 patients) and cerebral lupus/neuropsychiatric lupus (4 patients) were seen only in patients with dysplasia. CONCLUSION: This study found that bone marrow dysplasia can be observed in all lineage cells of SLE patients, and that the dysplasia is reversible during the course of the disease. The presence of dysplasias appears to be associated with disease severity. (+info
Metabolism of thymine nucleotides synthesized via the 'de novo' mechanism in normal, megaloblastic and methotrexate-treated human cells and in a lymphoblastoid cell line.
Human bone-marrow cells and lymphocytes were incubated with [3H]deoxyuridine (dU) to study the metabolism of thymine nucleotides labelled via the thymidylate synthase (5,10-methylenetetrahydrofolate:dUMP C-methyltransferase, EC 188.8.131.52) step of the 'de novo' biosynthetic pathway. (1) Continuous labelling with [3H]dU was used to compare incorporation of label into DNA with the specific radioactivities of thymine nucleotides separated by paper chromatography. (2) Cells were also labelled with [3H]dU at 13 degrees C, and 'chased' in unlabelled medium at 37 degrees C in order to quantify the proportion of thymine nucleotides incorporated into DNA and the proportion degraded. Only 40% of labelled thymine nucleotides were incorporated into lymphocyte DNA during a 'chase', whereas 100% were incorporated by MOLT 4 cells (a lymphoblastoid cell line of thymic origin, Thy-ALL line). Unincorporated nucleotides were rapidly degraded in lymphocytes, but degradative activity was very low in MOLT 4 cells. The results described here reinforce our previous conclusions [Taheri, Wickremasinghe & Hoffbrand (1981) Biochem. J. 194, 451-461] that there is a single thymine nucleotide compartment in Thy-ALL cells, but at least two pools in lymphocytes and bone-marrow cells. This compartmentation of nucleotides in human cells is consistent with a model which proposes that deoxyribonucleotides are localized near replication forks by the activity of multienzyme complexes [Mathews, North & Reddy (1978) Adv. Enz. Regul. 17, 133-156]. Our results also suggest that thymine nucleotides derived by the 'de novo' mechanism may be more highly localized than those derived by salvage. In cells from patients with megaloblastic anaemia owing to deficiency of vitamin B12 or folate or in normal cells treated with methotrexate, there was a massive accumulation of labelled dUMP and decreased incorporation of label into DNA. There was no measurable incorporation of labelled deoxyuridine residues into DNA of megaloblastic cells, but deoxyuridine residues were detected in DNA of cells treated with methotrexate. (+info