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Introduction:Secondary inflammation is a well-established cause of injury in intracerebral hemorrhage (ICH). One potential treatment for ICH limits inflammation through targeted metabolic modulation of immune cells, but leukocyte activation states in ICH are poorly defined. Using single-cell RNA sequencing (scRNA-seq) of patient hematoma evacuates, we characterized the inflammatory and metabolic profile of over a dozen identifiable leukocyte populations. This research provides insight into the dynamics of immune activation in ICH.Methods:Evacuated hematoma and peripheral blood samples from 8 ICH patients (62 ± 2.1 years) were collected via minimally invasive surgery (n=5) or craniotomy (n=3) (Fig. 1a). Collection time ranged from 0 to 4 days after ICH onset (1.5 ± 0.5 days). scRNA-seq was done on the 10X Genomics platform and analyzed using Seurat. Human monocyte-derived macrophage cultures were stimulated with S100A9 and IL-1β, two ICH-relevant inflammatory molecules, or LPS. Echinomycin and 2-deoxy-D-glucose were used to inhibit HIF signaling and glycolysis respectively.Results:Clustering revealed over a dozen transcriptionally distinct CNS-resident and immune cell types, many of which have little prior study in ICH (Fig. 1b). 3,395 differentially expressed genes between hematoma and peripheral blood (p<0.05) were found in CD14+monocytes and 932 in CD4+effector T cells. Pathway analysis found upregulation of HIF signaling, glycolysis, and correlated networks of cytokine expression in the hematoma. The findings were significant across all immune populations but most prominent in myeloid cells (Fig. 1c). Inhibition of HIF and glycolysis in human macrophages in-vitroabrogated inflammatory and reparative cytokine production following inflammatory stimulation. In conclusion, this work highlights the interplay of inflammation and metabolism at a single cell level in ICH, contributing to knowledge of the immune response to brain injury.

Mast cells are increasingly recognized as critical players in elicitation and maintenance of different inflammatory related disorders, like allergy, autoimmne diseases and cancer. Mast cells maturate within the tissue and are able to adapt to microenvironmental changes. Together with the ability to produce multiple pro- and anti-inflammatory mediators upon activation, mast cells are highly capable of exerting immunomodulatory functions. Cross-linking of receptor bound IgE is the best known mechanism of antigen-specific mast cell activation. In this review we focus on a different route of activation, via immunoglobulin free light chains (FLCs). Here, we describe current knowledge and concepts on FLCs based on preclinical models and data on human subjects, after briefly recapitulating early research findings on FLCs. Furthermore, because FLC research mainly focuses on mast cells, several mast cell mediated pathologies and mouse models for mast cell research will be discussed. Whether targeting of mast cells is beneficial for the treatment of specific disorders has to be addressed in future studies. Specific inhibition of FLC-mediated mast cell activation may be an interesting avenue to treat chronic inflammatory diseases.

Gamma interferon (IFN-) plays a critical role in the early eradication of Anaplasma phagocytophilum. However, the mechanisms that regulate IFN- production upon infection remain poorly understood. Here we show that c-Jun NH2-terminal kinase 2 (JNK2) inhibits IFN- production during A. phagocytophilum infection. jnk2-null mice were more refractory to infection with A. phagocytophilum and produced increased levels of IFN- after challenge with the pathogen. The resistance of jnk2-null mice to A. phagocytophilum infection was due to elevated levels of IFN- secreted by conventional and natural killer (NK) T cells. The administration of -galactosylceramide, a strong NK T-cell agonist, increased IFN- release and protected mice from A. phagocytophilum, further demonstrating the inhibitory effect of JNK2 on IFN- production. Collectively, these findings provide strong evidence that JNK2 is an important regulatory protein for IFN- secretion upon challenge with A. phagocytophilum.

T cell recruitment to elicit contact sensitivity (CS) requires a CS-initiating process mediated by B-1 cells that produce IgM, which activates complement to promote T cell passage into the tissues. We now show that Vα14i NKT cells induce B-1 cell activation likely by releasing IL-4 early postimmunization. The CS initiation process is absent in Jα18−/− and CD1d−/− NKT cell–deficient mice and is reconstituted by populations enriched for Vα14i NKT cells. Transfers are not effective if cells are derived from IL-4−/− mice. Staining with specific tetramers directly showed that hepatic Vα14i NKT cells increase by 30 min and nearly double by 2 h postimmunization. Transfer of immune B-1 cells also reconstitutes CS responses in NKT cell–deficient mice. The B-1 cells act downstream of the Vα14i NKT cells to restore CS initiation. In addition, IL-4 given systemically to Jα18−/− or CD1d−/− NKT cell–deficient mice reconstitutes elicitation of CS. Further, splenocytes from immune Jα18−/− mice produce less antigen (Ag)-specific IgM antibodies compared with sensitized WT mice. Together these findings indicate that very early after skin immunization Vα14i NKT cells are stimulated to produce IL-4, which activates B-1 cells to produce Ag-specific IgM, subsequently needed to recruit effector T cells for elicitation of CS responses.

Preincubation of peritoneal macrophages and their subsequent culture with recombinant soluble T cell receptor (sTCR) results in significant increase of: TNF-α, IL-1β, IL-6, IL-10, IL-12 production and nitric oxide (NO) synthesis and this phenomenon was dose dependent. Moreover, treatment of macrophages with sTCR showed two to three fold increase of luminol dependent chemiluminescence (LCL) when compared to untreated macrophages (Mf). In contrast, in our study we did not find any influence of sTCR on co-stimulatory (B7.1 and B7.2), adhesion molecule (ICAM-1) or FcRII/lll expression by macrophages. However, macrophages treated with control supernatants received after phosphatidylinositol-specific phospholipase C (PI-PLC) treatment of BW1100 cells or thymocytes termed s-BW or s-Th did not influence their biological activity.

Topical cutaneous painting with chemically reactive haptens induces the ability to subsequently elicit contact sensitivity (CS) responses in the skin. These CS responses are in vivo examples of acquired, antigen (Ag)-specific T cell immunity, and are a form of delayed-type hypersensitivity (DTH). In contrast, high dose i.v. administration of the hapten can induce Ag-specific tolerance. In some instances this specific immune hyporeactivity is due to suppressor T cells. We investigated the effect of IL-12 on reversal of tolerance due to suppressor T cells that were induced by i.v. administration of hapten in either normal TCRα+/+, or in immunodeficient TCRα-/- mice. In the TCRα+/+ mice, tolerance is mediated by TCRαβ+ suppressor T cells, while in the TCRα-/- mice the tolerance is due to suppressive TCRγδ+ cells. Treatment with IL-12 reversed suppressor mediated by the TCRαβ+ cells, but did not affect tolerance due to TCRγδ+ suppressor cells. Another difference was that the αβTCR+ suppressor cells produced a soluble suppressor factor that could replace the surppressor cells, while γδTCR+ suppressor cells did not. We hypothesized that IL-12 may strengthen responses of target CS-effector T cells influenced by the hapten-MHC-specificity of αβ suppresssor cells, or suppressor factor. On the other hand, γδTCR+ suppressive cells likely have specificity for the hapten alone, and are not MHC-restricted, and therefore probably do not operate via peptide-MHC interactions, that could be strengthened by IL-12. The ability of IL-12 to strengthen the resistance of CS-effector T cells to αβ TCR suppressor cells, may be due to the ability of IL-12 to increase T cell costimulation mediated by signaling mechanisms acting via B7.1 and B7.2. In contrast, αβTCR+ suppressor cells, that are largely hapten-specific, probably do not interact with peptide/MHC complexes on APC, and thus are not affected by IL-12 strengthening of co-stimulation.

Contact sensitivity (CS) is a cutaneous T(h)1 response that is induced by skin painting with reactive hapten. In prior in vivo studies of CS, we showed that recombinant soluble alphabetaTCR (sTCR) acted non-specifically to protect CS-effector T cells from suppression, but no molecular mechanism was determined. In the current study, we employed an in vitro system to investigate the mechanism of how sTCR protect CS-effector T cells from suppression. Immune CS-effector cells and appropriate hapten-conjugated antigen-presenting cells (APC) were incubated together with down-regulatory culture supernatant produced by suppressive spleen cells from mice tolerized i.v. with specific hapten, which produced strong inhibition of IFN-gamma production by the CS-effector cells. Importantly, addition of two different sTCR, of unrelated specificity, reversed this down-regulation and thus restored IFN-gamma production. We found that the APC, and not the CS-effector T cells, were the locus of the sTCR-mediated protection and showed direct binding of sTCR to APC by flow cytometry. Further, addition of anti-IL-12 showed that sTCR protection was due to IL-12 induced by sTCR and released by the APC, and was confirmed by ELISA measurement of IL-12 induced in APC supernatants by sTCR incubation. These results indicated a possible new regulatory loop in which suppression was reversed by IL-12 derived from APC, following direct surface binding of sTCR, and enhanced by IFN-gamma production from the T(h)1 CS-effector cells.

Interspecies differences create important shortcomings in existing animal models used to describe in vivo events responsible for allograft rejection. Alloimmune destruction of human dermal microvessels, histologically consistent with rejection, has been demonstrated in human skin-grafted severe combined immunodeficient (SCID) mice receiving allogeneic human peripheral blood mononuclear cells (PBMC). We have now documented human alloimmune injury in a vascularized, SCID-human arterial transplantation model.

Delayed-type hypersensitivity (DTH) is defined as the recruitment of T cells into tissues to be activated by antigen-presenting cells to produce cytokines that mediate local inflammation. CD8+ T cells are now known to mediate DTH responses in allergic contact dermatitis, drug eruptions, asthma, and autoimmune diseases. This inflammatory effector capability of CD8+ cytotoxic T cells was previously poorly recognized, but there is now considerable evidence that these diseases may be mediated by CD8+ DTH. The difference between CD8+ T cells and CD4+ T cells mediating DTH relates to the molecular mechanisms by which antigens are processed and presented to the T cells. Antigens external to the cell are phagocytosed and processed for presentation on MHC class II molecules (eg, HLA-DR) to CD4+ T cells. In contrast, internal cytoplasmic antigens are processed by the endogenous pathway for presentation on MHC class I molecules (eg, HLA-A, -B, and -C) to CD8+ T cells. External allergens can also enter the endogenous pathway to be presented to CD8+ T cells. These include many contact sensitizers, chemical and protein respiratory allergens, viral antigens, metabolic products of drugs, and autoantigens. The resulting CD8+ T-cell response explains the role of CD8+ T-cell DTH mechanisms in allergic contact dermatitis, asthma, drug eruptions, and autoimmune diseases. (J Allergy Clin Immunol 1999;103:192-9.)

We have analyzed the mechanism of human endothelial injury in a human peripheral blood lymphocyte-severe combined immunodeficient (huPBL-SCID) mouse/human skin graft model of allograft injury and examined the effect of immunosuppressive drugs on this process. In this model, split-thickness human skin containing the superficial dermal microvessels was grafted onto immunodeficient C.B-17 SCID or SCID/beige mice and allowed to heal. Human peripheral blood mononuclear cells (PBMCs) allogeneic to the skin, when subsequently introduced by intraperitoneal injection, caused destruction of the human dermal microvasculature by day 16, evident as endothelial cell sloughing and thrombosis. In the same specimens, mouse microvessels that invaded the human skin graft were uninjured. Human microvascular cell injury was accompanied by a mononuclear cell infiltrate consisting of approximately equal numbers of human CD4+ and CD8+ T cells, some of which contained perforin-positive granules. We found no evidence of human natural killer cells and noted occasional human, but not mouse, macrophages at a frequency indistinguishable from that resident in skin on animals not receiving human PBMCs. These human T cell infiltrates did not extend into adjacent mouse skin. Human immunoglobulin G antibody was detected in the blood and was diffusely present throughout mouse and human tissues in SCID mice receiving PBMCs. Mouse C3 was detected on human dermal vessels in both unreconstituted control animals and those that received PBMCs. Blood and tissues from mice injected with PBMCs depleted of B cells showed no human immunoglobulin, but circulating CD3+ cells were detected by flow cytometry at levels comparable with those of animals receiving whole PBMCs. Significantly, skin graft infiltration by human T cells and human dermal microvascular injury were equivalent in the B cell-depleted and whole-PBMC-reconstituted mice. Mice inoculated with PBMCs depleted of CD8+ T cells developed microvascular injury and infiltrates containing perforin-expressing CD4+ T cells. These data suggested a cytolytic T cell-dependent mechanism of microvessel injury. We then tested the ability of T cell immunosuppressants, cyclosporine and rapamycin, to attenuate vessel damage. Neither cyclosporine nor rapamycin alone effectively reduced either mononuclear cell infiltration or vascular injury. However, a combination of the two agents reduced both parameters. We conclude that the huPBL-SCID/skin allograft model may be used both to study cytolytic T cell-mediated rejection and to test the effect of immunosuppressive drug strategies in vivoin a small-animal model of human immune responses.

• In the immunodeficient patient, surgery for chronic ear disease is often unsuccessful. Early recognition of the immune deficiency is of paramount importance in minimizing bacterial infection within the postoperative surgical field. The intravenous administration of immunoglobulins via plasma transfusions, intramuscular injections of γ-globulin, and the selective use of immunoglobulin applied directly to the healing wound seem useful in achieving beneficial surgical results by containment of infection.(Arch Otolaryngol 107:82-86, 1981)

Addition of 10−3to 10−6M histamine (H)3to mixed leukocyte cultures (MLCs) inhibited primary in vitro induction of cytotoxic T lymphocytes (CTLs) specific for either allogeneic or trinitrophenol-modified syngeneic target cells. The use of specific H agonists implicated H2but not H1receptor triggering in the mediation of these effects. Unlike in vivo-induced allogeneic CTLs, the addition of H to assay culture failed to influence the effector functionof in vitro-induced CTLs of either specificity. Kinetic studies showed that this difference might be due to loss of functional H receptors after the initiation of the in vitro MCL, and demonstrated that H interferes with an early event in the generation of CTLs. These data indicate that H receptors are not merely markers for CTL precursors, but that they are functional receptors, and suggest that H may play an important role in regulating both the generation and effector function of CTLs in vivo.

The skin sites of the mouse where delayed-type hypersensitivity (DTH) reactions are most easily elicited (foot pads and ears) are particularly rich in 5-hydroxytryptamine (5-HT)-containing mast cells. Since mice are deficient in circulating basophils, which play a role in at least some DTH reactions, we investigated the possibility that the mast cells were playing an important role in the evolution of the skin reactions of DTH in mice. We found that reserpine, a drug which depletes mast cells of 5-HT, abolished the ability of the mouse to make DTH reactions in the skin. The suppressive effect of reserpine could be partially blocked by monoamine oxidase inhibitors which prevent the degradation of 5-HT in the cytosol of the mast cell. Spleen cells of immune, reserpine-treated mice transferred DTH reactions to nonimmune mice normally, indicating that the reserpine treatment did not affect immune T cells. DTH reactions could not be transferred into reserpine-treated mice. We suggest that T cells are continually emigrating from the blood, through postcapillary venule endothelium, by a mechanism which does not depend on vasoactive amines. If they are appropriately immune and meet the homologous antigen in the tissue, they induce mast cells to release vasoactive amines which cause postcapillary venule endothelial cells to separate, allowing the egress from the blood of cells which ordinarily do not recirculate. The secondarily arriving vasoactive amine-dependent cells are responsible for the micro- and macroscopic lesions of DTH reactions. Chemotactic factors may also be involved in bringing cells to the DTH reaction sites but we propose that T-cell regulation of vasoactive amine-containing cells allows the effector cells to pass through the endothelial gates after they are called.

A human skin allograft injury model in immunodeficient mice, engrafted with human peripheral blood mononuolear cells from a different donor, has been used to test whether reagents that block human T cell CD2 Interactions with its principal ligand, LFA-3 (CD58), can inhibit immune reactions in vivo. In this model, human skin grafts show a reproducible pattern of progressive human T-cell infiltration and human graft microvascular injury that resembles human first-set skin graft rejection. Murine Mab to human LFA-3 or human LFA-3-lgG1 fusion protein, but not isotype-matched control antibodies, each markedly protected skin grafts from leukocyte infiltration and injury. These data provide the first evidence that LFA-3 functions in vivo and establish the ability of this new model to test human-specific immune modulators.

The purpose of this study was to determine the utility of skin testing and erythrocyte sedimentation rate (ESR) as measures of immune function in a population undergoing stress. Eight women were tested one week prior to breast biopsy and six were retested at least four weeks later. All biopsies were negative for malignancy. Control subjects were also tested four weeks apart. ESR values were elevated with stress but the magnitude of this effect was small. There were no differences between groups in skin test responses. Skin testing and ESR may have limited usefulness in the study of immune function in populations under stress.

Three outcomes pertinent to contact sensitivity (CS) follow immunization with various forms of trinitrophenylated (TNP) substrates: (a) specific immunological unresponsiveness for CS is induced when immunization favors activation of splenic suppressor cells. This state is achieved by intravenous injection of trinitrophenyl-conjugated to various types of cells, such as peritoneal exudate cells (PEC). (b) A short-lived or evanescent form of CS is induced when immunization reduces activation of the suppressor circuit. This can be achieved by subcutaneous immunization with trinitrophenyl conjugated to syngeneic PEC, by pretreatment with cyclophosphamide to diminish suppression before intravenous immunization, or by altering the mode of antigen presentation by using TNP-substrate that has undergone phagocytosis. (c) A long-lived form of CS is induced when trinitrophenyl is presented to the immune system on skin cells either by contact skin painting with reactive trinitrophenyl, or by subcutaneous, or even intravenous injection of trinitrophenyl-conjugated epidermal cells. In fact, trinitrophenyl-conjugated epidermal cells induced CS even when the suppressor circuit was activated by intravenous coadministration of TNP-PEC. This implies that antigen presentation on epidermal cells induces sensitized cells that are relatively resistant to suppression. The cell type(s) in the skin that are primarily responsible for this potent form of antigen presentation are most likely Langerhans cells, because they can be concentrated by virtue of their Fc receptors and they are Ia positive. Thus, both the anatomical site where antigen is first encountered by the immune apparatus, as well as the nature of the cells which present the antigen, determine whether a CS response will ensue, as well as whether it will be evanescent or long-lasting.

In four different systems it was shown that murine delayed-type hypersensitivity (DTH) responses at 18-48 h were preceded by early 2-h responses. CBA mice immunized with picryl chloride, BDF1 mice immunized with oxazolone, BALB/c mice immunized with dinitrofluorobenzene, and C57BL/6 mice immunized with L5178Y lymphoma cells, and challenged with the appropriate specific antigen, all gave rise to expected 18-48 h delayed-in-time hypersensitivity reactions, but all of these responses were preceded by early hypersensitivity reactions that peaked at 2 h. These early 2-h reactions are transferable with T cells or with a T cell-derived, antigen-binding factor and are antigen-specific. The early and late components of DTH reactions are mast cell dependent since neither are elicited in mast cell deficient W/Wv or Sl/Sld mice. The T cell activity mediating the early component of DTH is demonstrable as early as 24 h after immunization, while the classical late component of DTH is not demonstrable until days 3-4. The difference in onset after immunization of the early and late components of DTH, and the different kinetics of these components in recipients of cell transfers that were challenged immediately or 24 h after transfer, led to the hypothesis that immunization for DTH leads to rapid induction in lymphoid organs of a certain population of T cells to produce an antigen-binding factor. This factor sensitizes peripheral tissues, probably mast cells, and local challenge with appropriate antigen leads to mast cell activation and release of the vasoactive amine serotonin, resulting in increased permeability of the local vasculature. This allows other circulating antigen-specific T cells, which are induced later after immunization, to enter the tissues and interact with antigen, resulting in production of chemoattractant lymphokines that recruit accessory leukocytes such as monocytes and polymorphs to enter the tissues via gaps between endothelial cells. These inflammatory cells, that are recruited to the site via two different T cell activities, constitute the characteristic infiltrate of DTH responses. Identification of an early 2-h component of DTH that is T cell- and mast cell-dependent provides evidence that the tissue-sensitizing, antigen-binding, T cell factor probably functions in vivo in the early phases of DTH responses.

Mice immunized with more SRBC than are required to produce optimal delayed-type hypersensitivity reactions, developed good antibody responses and poor delayed foot pad reactions. Cyclophosphamide treatment in low doses (20 mg/kg) before immunization, augmented the delayed-type hypersensitivity without affecting antibody responses. Cyclophosphamide did not augment delayed responses to optimal doses of SRBC (0.01%), but did augment the delayed hypersensitivity response of mice immunized with a suboptimal antigen dose (0.001%); which produced no detectable antibody response with or without cyclophosphamide pretreatment. These results suggest that antibody feedback is not the sole regulator of delayed reactions; the possibility that suppressor T cells may also be involved is discussed.

The elicitation in immunized mice of delayed-type hypersensitivity (DTH) responses to nickel sulfate (NiSO₄) was found to be mediated by the sequential activities of two different antigen-specific Thy-1⁺ cells. Early-acting (2-hr) NiSO₄-specific, DTH-initiating cells were required for elicitation of subsequent 24-hr NiSO₄-specific DTH and had an unusual phenotype for an antigen-specific cell (Thy-1¹, CD5¹, CD3, CD4, CD8 CD23¹, CD45RA¹ (B220¹), IL-2R, IL-3R¹, sig, MHC Class II^-, Mel-14^-, CD44⁺ (Pgp-1¹), J11d⁺ (HSA⁺), MAC-1¹, LFA-1, and FcγII-R⁺). In contrast, the late-acting, NiSO₄-specific DTH-effector T cells were: Thy-1⁺, CD5⁺, CD3⁺, CD4¹, CD8^-, CD23^-, B220-, IL-2R¹, IL-3R^-, sIg^-, MHC Class II^-, Mel-14⁺, CD44^- (Pgp-1^-), J11d^- (HSA^-), MAC-1^-, LFA-1⁺, and FcγII-R^-. Our results led us to surmise that the early-acting DTH-initiating cells were necessary to locally recruit the late-acting effector T cells. Relatively high doses of anti-B220 (CD45RA) and anti-CD23 (IgE FcɛRII receptor) monoclonal antibodies were necessary to completely eliminate all DTH-initiating cells, and therefore completely block subsequent expression of some late NiSO₄-specific DTH activity that was due to the late-acting DTH effector T cells. In addition, we found that mast cells were important for expression of early-acting, DTH-initiating cell activity in this NiSO₄-specific, DTH system. This was probably due to the absence of mast cells in mast cell-deficient WBB6F₁-W/W^v mice. Our results indicated that two different antigen-specific Thy-1⁺ cells are necessary to elicit NiSO⁴-specific DTH in mice and that mast cells are necessary for expression of the early component that is due to early-acting, DTH-initiating cells. Copyright 1995, 1999 Academic Press

Contact sensitivity (CS) responses, induced by skin painting with reactive haptens like picryl chloride or oxazolone, are classical examples of in vivo immunity mediated by αβ T cells. Our previous studies showed that γδ T cells were required to assist the αβ CS-effector T cells in the successful adoptive cell transfer of CS responses. These spleen and lymph node-derived γδ+ CS-assisting regulatory cells were CD3+, CD4-CD8+, non-antigen-specific, and non-MHC-restricted, and preferentially expressed Vγ5 and Vδ4 variable regions.In the current study we show that systemic treatment of mice in vivo with anti-γδ mAb, produced a similar positive influence on CS responses in two different systems: i.e. active sensitization, or adoptive cell transfer. In addition to augmented CS responses produced by treatment with pan anti-γδ TCR mAb, anti-γδ-V region mAb were examined, and augmentation of CS also was produced by anti-Vγ5 and anti-Vδ4 mAb, the V regions determined previously to be preferentially expressed on γδ CS-assisting cells.We speculate that the positive influence of anti-γδ mAb was not caused by quantitative changes in γδ T cells, because FACS studies demonstrated a lack of in vivo depletion of peripheral blood and lymphoid γδ T cells, and also no depletion of epidermal dendritic γδ T cells (DETC), in mice treated with anti-γδ TCR mAb. Instead, our data favor the hypothesis that CS-assisting γδ T cells can be activated in vivo by anti-γδ TCR mAb interacting with their γδ TCR, at least with the short term protocols we employed, resulting in augmentation of CS responses perhaps by releasing positively-acting factors, such as certain cytokines.

Cutaneous basophil hypersensitivity, an immune inflammatory reaction characterized by infiltrates of basophils and a delayed time-course, was studied in guinea pigs contact sensitized with oxazolone. Routine histological techniques, employing ordinary paraffin sections, were modified to study this reaction. When biopsies of contact lesions were processed by these methods dense infiltrates of basophils could be demonstrated. Animals sensitized with complete Freund's adjuvant emulsified with oxazolone-keyhole limpet hemocyanin conjugates also developed delayed-in-time responses to contact challenge with oxazolone but not to picryl chloride. These hapten-specific delayed-in-time reactions also contained substantial numbers of basophils. Transfer of serum from actively sensitized guinea pigs resulted in specific accumulation of basophils at challenge sites of recipients. Thus, in this experimental system, cutaneous basophil hypersensitivity was found to be a hapten-specific delayed-in-time reaction that could be transferred with immune serum.

Heparin-induced thrombocytopenia (HIT) is the most common drug-related thrombocytopenia. Thromboembolic complications occur in approximately 50% of patients with HIT and result in limb amputation and death in up to 20% and 30% respectively. Because patients with a history of HIT may require future intravenous anticoagulation but have a high-risk of thromboembolism if re-challenged with heparin, alternative therapies are necessary when further anticoagulation is indicated. The use of direct thrombin inhibitors in HIT patients who also require thrombolytic therapy offers unique challenges to anticoagulant monitoring and safety. We present a case of progressive ileofemoral deep venous thrombosis in a patient with a history of HIT in order to review the combined use of hirudin and thrombolysis in this setting.