Clonal and frequency analyses of tumor-infiltrating T lymphocytes from human solid tumors

A limiting dilution analysis (LDA) was used to assess the functional profiles of tumor-infiltrating lymphocytes (TIL) recovered from 15 human solid tumors. The microculture system applied in this study has been shown to allow virtually all normal peripheral blood T lymphocytes (PBL-T) to undergo clonal proliferation and was applied to obtain estimates of the frequency of both proliferating and cytolytic cells among the TIL population. A total of 624 microcultures proliferating in the presence of irradiated allogeneic spleen cells and interleukin 2 (IL 2) were expanded for clonal analysis. These TIL microcultures were assessed for surface antigen phenotype, IL 2 production (helper function) and for their cytolytic capabilities against the human erythroleukemic line K562 (natural killer (NK)-like activity) and P815, a mouse mastocytoma line, in the presence of phytohemagglutinin (PHA), i.e., lectin-dependent cell cytotoxicity (LDCC) which allows the detection of cytolytic activity irrespective of the antigenic specificity of the effector cells. Whenever feasible, cytolytic activity against autologous and allogeneic tumor cells was tested. LDA first demonstrated that the proliferative potential was decreased in T lymphocytes infiltrating human solid tumors (approximately 1 in 50 to 1 in 2 proliferating T lymphocyte precursors (PTL-P) in this series) as compared to normal PBL-T (1 in 2 to 1 in 1 PTL-P). The growth pattern in the titration cultures showed a remarkable agreement with the single-hit Poisson model implying that third party cells are unlikely to be involved in the reduced proliferative potential. Quantitative estimates of functional precursors showed that, in spite of reduced proliferative potential, cytolytic T lymphocyte precursors (CTL-P) against unknown antigens (LDCC-reactive) accounted for a considerable part of the microcultures in many cases. The precursor frequency of T lymphocytes with NK-like activity was usually low in situ (with the exception of glioma), whereas it was in the normal range in the patient's autologous PBL-T. In four evaluable cases, quantitative assessment showed that 1 in 200 to 1 in 1000 T lymphocytes from TIL was cytolytic against allogeneic tumor cells, which is in the range of alloreactive cytolytic T lymphocytes (CTL) generated in the mixed lymphocyte culture from normal PBL. Cytolytic activity against autologous target cells could not be quantitatively estimated but out of 88 clones from 4 patients, 3 clones originating from 2 glioma patients showed high lytic values against autologous tumor.(ABSTRACT TRUNCATED AT 400 WORDS)

Clonal and frequency analyses of tumor-infiltrating T lymphocytes from human solid tumors

A limiting dilution analysis (LDA) was used to assess the functional profiles of tumor-infiltrating lymphocytes (TIL) recovered from 15 human solid tumors. The microculture system applied in this study has been shown to allow virtually all normal peripheral blood T lymphocytes (PBL-T) to undergo clonal proliferation and was applied to obtain estimates of the frequency of both proliferating and cytolytic cells among the TIL population. A total of 624 microcultures proliferating in the presence of irradiated allogeneic spleen cells and interleukin 2 (IL 2) were expanded for clonal analysis. These TIL microcultures were assessed for surface antigen phenotype, IL 2 production (helper function) and for their cytolytic capabilities against the human erythroleukemic line K562 (natural killer (NK)-like activity) and P815, a mouse mastocytoma line, in the presence of phytohemagglutinin (PHA), i.e., lectin-dependent cell cytotoxicity (LDCC) which allows the detection of cytolytic activity irrespective of the antigenic specificity of the effector cells. Whenever feasible, cytolytic activity against autologous and allogeneic tumor cells was tested. LDA first demonstrated that the proliferative potential was decreased in T lymphocytes infiltrating human solid tumors (approximately 1 in 50 to 1 in 2 proliferating T lymphocyte precursors (PTL-P) in this series) as compared to normal PBL-T (1 in 2 to 1 in 1 PTL-P). The growth pattern in the titration cultures showed a remarkable agreement with the single-hit Poisson model implying that third party cells are unlikely to be involved in the reduced proliferative potential. Quantitative estimates of functional precursors showed that, in spite of reduced proliferative potential, cytolytic T lymphocyte precursors (CTL-P) against unknown antigens (LDCC-reactive) accounted for a considerable part of the microcultures in many cases. The precursor frequency of T lymphocytes with NK-like activity was usually low in situ (with the exception of glioma), whereas it was in the normal range in the patient's autologous PBL-T. In four evaluable cases, quantitative assessment showed that 1 in 200 to 1 in 1000 T lymphocytes from TIL was cytolytic against allogeneic tumor cells, which is in the range of alloreactive cytolytic T lymphocytes (CTL) generated in the mixed lymphocyte culture from normal PBL. Cytolytic activity against autologous target cells could not be quantitatively estimated but out of 88 clones from 4 patients, 3 clones originating from 2 glioma patients showed high lytic values against autologous tumor.(ABSTRACT TRUNCATED AT 400 WORDS)

Analysis of intestinal lymphocyte subpopulations in patients with acquired immunodeficiency syndrome (AIDS) and AIDS-related complex

Lymphocyte subpopulations in the intestinal tissues of seven patients with acquired immunodeficiency syndrome (AIDS) or AIDS-related complex (ARC) were studied by immunohistologic technics at two different locations, the small bowel and the rectum. Intraepithelial and lamina propria lymphocyte subsets stained with monoclonal antibodies T11, T4, T8, and B1 were enumerated in the patients and different normal and patient control groups. Intraepithelial T11+ cells were decreased (P less than 0.05) in the small bowel of AIDS and ARC patients, primarily because of the near complete absence of T4+ lymphocytes. In the lamina propria of these patients, a depletion of T4+ cells (P less than 0.05), an increase in T8+ cells (P less than 0.05), and a reversal of the T4/T8 ratio were observed (e.g., the small bowel ratio was 0.1 +/- 0.02 vs. the normal ratio of 2.3 +/- 0.2 and the rectal ratios were 0.2 +/- 0.06 vs. normal 2.6 +/- 0.3). The T-lymphocytes in the intestine of AIDS and ARC patients did not express the receptor for interleukin-2 (IL-2). A near complete absence of T4+ lymphocytes was also seen in lymphoid follicles in the rectum. B1+ cells were not depleted. The reversal of the T4/T8 ratio, which is a hallmark of AIDS, occurs not only in the circulation but also in the gastrointestinal tissues of patients with AIDS and ARC.

Double immunoenzyme staining method for analysis of tissue and blood lymphocyte subsets with monoclonal antibodies

Double immunoenzymatic method for sequential staining with two different monoclonal murine antibodies and two different enzymes was shown to be useful in defining hematopoietic cell subpopulations in human tissues and blood. The method allows for the identification, localization, and enumeration in the same section of distinct cell populations. Air-dried smears of cell mixtures can be stained. The optimal sequence of enzymes/substrates was: horseradish peroxidase/3-amino-9-ethylcarbazole followed by the alkaline phosphatase-anti-alkaline phosphatase complex/naphthol AS-MX phosphate. Red-and blue-colored reaction products are easy to view in a light microscope. Combinations of two different mouse monoclonal antibodies or of a mouse monoclonal antibody and polyclonal antiserum made in rabbits or goats can be sequentially applied to the same section or smear thus facilitating a definition of the distribution of two cell populations reactive with these antibodies. The relative distribution patterns in tissues of cells bearing distinctive antigens are important in studies of cellular differentiation and of human pathogenetic processes including neoplasia and transplant rejection.

Production of a glycosaminoglycan stimulatory factor by cloned human T lymphocytes activated in vitro

Supernatants of mitogen-activated mononuclear cells contain a factor which stimulates, up to fifteen-fold, the synthesis of glycosaminoglycan (GAG) by cultured normal dermal fibroblasts. To demonstrate that the GAG stimulatory factor is a product of T lymphocytes, we cloned normal peripheral blood T lymphocytes that were activated in mixed lymphocyte culture. Selected alloreactive T cell clones were expanded in the presence of original stimulator cells and T cell growth factor. Only supernatants of the clones that were reactivated with irradiated stimulators (allogeneic peripheral blood lymphocytes of B cell lines) were capable of increasing, 3-7-fold, the GAG synthesis by dermal fibroblasts. The production of GAG stimulatory activity by alloreactive T cells was restricted by HLA-DR allorecognition. Alloactivated T cell clones produced more GAG stimulatory activity on a per cell basis than did concanavalin A-activated mononuclear cells. These results show that cloned, activated T lymphocytes are capable of releasing soluble factors that modulate GAG synthesis by normal dermal fibroblasts.

Separation of tumor-infiltrating lymphocytes from tumor cells in human solid tumors. A comparison between velocity sedimentation and discontinuous density gradients

The separation of viable tumor-infiltrating lymphocytes (TIL) from surgical biopsies of human solid tumors was achieved by velocity sedimentation at unit gravity or by discontinuous density gradients. The two methods were adapted to small volumes and cell numbers not exceeding 1 X 10(8). The recovery, purity and composition of the TIL-enriched fractions were comparable in the two methods. Density gradients were more rapid, simpler and more practical for preparation under sterile conditions of TIL from clinical material than velocity sedimentation. Lymphocytes in the TIL-enriched fractions obtained by either of the methods were poorly responsive to mitogens. This poor responsiveness is a characteristic of the human TIL and seems to be related to effects exerted by tumor cells.

Separation, phenotyping and limiting dilution analysis of T-lymphocytes infiltrating human solid tumors

Tumor-infiltrating lymphocytes (TIL) were obtained by a combination of mechanical release and enzymatic disaggregation from 35 human solid tumors. The number of lymphocytes in TIL-enriched suspensions varied from 1 X 10(4) to 7.6 X 10(6) per wet gram of tumor. The TIL preparations separated by differential centrifugation on Ficoll-Hypaque gradients contained 10-95% of T11+ cells (mean 50%), and tumor cells accounted for the other major cellular component. Macrophages, NK cells, B cells and granulocytes were infrequently seen. Morphologically, TIL-T were small non-activated cells. They expressed the T11 and T3 antigens but not the receptor for IL-2 (IL-2R) or HLA-DR antigens as determined by double immunofluorescence staining. Rare T11+/IL-2R+ cells were recovered only from colon and lung carcinomas. The mean T4/T8 ratio in 12 TIL preparations was 1.1 +/- 0.8. Immunohistology with monoclonal antibodies (MAbs) performed in 31/35 tumors confirmed that the T11+ cells infiltrating solid tumors rarely expressed the IL-2R and that the cell content of suspensions enriched in TIL was comparable to that determined in situ. The recovered TIL were cloned in a microculture system that permits proliferation of nearly all normal peripheral blood T lymphocytes (PBL-T). Under these culture conditions, frequencies of the proliferating T lymphocyte precursors (PTL-P) were depressed in both the TIL preparations (less than 0.01 to 0.39) and patients' PBL-T (0.05 to 0.5). These low frequencies of PTL-P were seen in patients with all tumor types, both primary and metastatic.

Functional properties of tumor-infiltrating and blood lymphocytes in patients with solid tumors: effects of tumor cells and their supernatants on proliferative responses of lymphocytes

Tumor-infiltrating lymphocytes (TIL) were obtained from 22 humans with solid tumors. In three cases only, one colon and two lung carcinomas, TIL which contained from 3 to 10% of T cells expressing the interleukin 2 receptor (IL 2R) were obtained, and these proliferated in the presence of exogenous IL 2. In most TIL preparations, however, the T lymphocytes did not express the IL 2R and failed to proliferate in response to IL 2. In contrast, TIL were able to proliferate in response to irradiated allogeneic spleen cells in mixed lymphocyte culture. Proliferative responses of autologous PBL were not inhibited by the addition of TIL. In most tumors, the TIL showed no response or had significantly lower (p less than 0.01) responses to PHA, Con A, and the phorbol ester TPA than did autologous peripheral blood lymphocytes (PBL). A limiting-dilution microculture system which allows clonal growth of every T cell was used to demonstrate decreased responses of the TIL to PHA at a single-cell level. In contrast to normal PBL-T with proliferating frequencies from 0.46 to 1.0, those for T cells in three TIL preparations were zero, 0.005, and 0.01. Normal PBL exposed in vitro to tumor cells or their supernatants lost the ability to respond to mitogens and to clone normally (e.g., proliferating frequency of 0.147 vs 0.863 in control). The TIL isolated from solid tumors resemble normal PBL exposed in vitro to tumor cells or their supernatants in terms of decreased responses to mitogens and poor clonogenicity in the PHA-dependent microculture system. It is possible that tumor cells may inhibit certain functions of the TIL in human solid tumors.

Functional properties of tumor-infiltrating and blood lymphocytes in patients with solid tumors: effects of tumor cells and their supernatants on proliferative responses of lymphocytes

Tumor-infiltrating lymphocytes (TIL) were obtained from 22 humans with solid tumors. In three cases only, one colon and two lung carcinomas, TIL which contained from 3 to 10% of T cells expressing the interleukin 2 receptor (IL 2R) were obtained, and these proliferated in the presence of exogenous IL 2. In most TIL preparations, however, the T lymphocytes did not express the IL 2R and failed to proliferate in response to IL 2. In contrast, TIL were able to proliferate in response to irradiated allogeneic spleen cells in mixed lymphocyte culture. Proliferative responses of autologous PBL were not inhibited by the addition of TIL. In most tumors, the TIL showed no response or had significantly lower (p less than 0.01) responses to PHA, Con A, and the phorbol ester TPA than did autologous peripheral blood lymphocytes (PBL). A limiting-dilution microculture system which allows clonal growth of every T cell was used to demonstrate decreased responses of the TIL to PHA at a single-cell level. In contrast to normal PBL-T with proliferating frequencies from 0.46 to 1.0, those for T cells in three TIL preparations were zero, 0.005, and 0.01. Normal PBL exposed in vitro to tumor cells or their supernatants lost the ability to respond to mitogens and to clone normally (e.g., proliferating frequency of 0.147 vs 0.863 in control). The TIL isolated from solid tumors resemble normal PBL exposed in vitro to tumor cells or their supernatants in terms of decreased responses to mitogens and poor clonogenicity in the PHA-dependent microculture system. It is possible that tumor cells may inhibit certain functions of the TIL in human solid tumors.

Persistence of scleroderma-like phenotype in normal fibroblasts after prolonged exposure to soluble mediators from mononuclear cells

Supernatants of mononuclear cells (MNC-SN) were shown to increase synthesis of glycosaminoglycan (GAG) by cultured normal dermal fibroblasts. Fibroblasts from the skin of patients with progressive systemic sclerosis (PSS, scleroderma) were hyporesponsive. We exposed fibroblasts outgrowing from explants of normal adult skin to MNC-SN for up to 30 generations in culture. MNC-SN were obtained by incubating normal MNC with concanavalin A. Four experimental, 4 normal control, and 3 PSS control lines were passaged by trypsinizing and splitting the cultures 1:2 every 7 days. At the third and fifth passages, portions of the experimental fibroblasts were removed from MNC-SN, then passaged in medium alone. Cell counts, assays for GAG, and electron microscopy were performed and increases in GAG after brief reexposure to MNC-SN were determined at the third, fifth, and eighth passages. In normal dermal fibroblasts, baseline GAG production, measured by 3H-glucosamine uptake, was low and increased as much as 15 times after reexposure to MNC-SN. In contrast, production was high in both experimental and PSS lines, and increases after reexposure to MNC-SN were consistently small. This PSS-like behavior persisted in experimental fibroblasts removed from MNC-SN at the third and fifth passages. Growth of experimental and scleroderma fibroblasts was slower than that of control fibroblasts. Ultrastructurally, both scleroderma and experimental dermal fibroblasts differed from normal fibroblasts by their oval cellular shape, indentations in nuclear membrane, numerous organelles and bundles of microfilaments, prominent Golgi, and intranuclear inclusions. These experiments indicate that normal adult dermal fibroblasts subjected to MNC-SN in vitro acquire a scleroderma-like phenotype that persists for many generations.

Clonal analysis and in situ characterization of lymphocytes infiltrating human breast carcinomas

T lymphocytes were isolated from tumor biopsies in 13 patients with breast carcinomas. Immunohistology with monoclonal antibodies confirmed the presence of mononuclear cell infiltrates composed primarily of T lymphocytes in all tumors studied. While the proportion of T lymphocytes expressing the T4 or the T8 surface marker varied from tumor to tumor as determined by morphometric analysis, T8+ cells were more numerous than T4+ cells in 8/12 breast tumors studied. Relatively few T cells (less than 10% in 11/12 tumors) were in an activated state as judged by the surface expression of HLA-DR antigens or the receptor for interleukin-2 (IL-2). In 1 case 20% of the infiltrating mononuclear cells were expressing the IL-2 receptor. The tumor infiltrating lymphocytes (TIL) recovered from 10 tumors were cloned in a microculture system that permits proliferation of nearly 100% of normal peripheral blood T lymphocytes (PBL-T). In contrast to normal and autologous PBL-T, frequencies of proliferating T lymphocyte precursors (PTL-P) were depressed (less than 0.01) in 7/10 TIL preparations indicating a decreased responsiveness of TIL to phytohemagglutinin at the single-cell level. The frequency of PTL-P was noticeably higher in 2 cases (0.03 and 0.09) and close to normal in 1 case (0.39). A total of 170 clones were expanded in vitro and analyzed for different functional capabilities. Most of these clones expressed the T4+/T8-phenotype (73%) and strikingly 53% of these T4+/T8- clones were cytolytic in a lectin-dependent assay, a functional subset which is uncommon among normal PBL-T. Some clones (10%) lysed allogeneic breast tumor cells (MCF7). Only 15% of the clones displayed natural killer activity. Among the cytolytic clones, 17 of 31 tested were also IL-2 producers irrespective of the T4 or T8 phenotype. Our results show that human mammary carcinomas contain many infiltrating T cells with cytolytic potential. Interestingly, among the proliferating cytolytic T cell clones (56% of the microcultures), many expressed the T4+/T8- phenotype. These findings may indicate that the in situ cytolytic reaction (against unknown antigens) is associated preferentially with class II antigens.

Immunologic analysis of mononuclear cells in liver tissues and blood of patients with primary sclerosing cholangitis

Using monoclonal antibodies to surface antigens, we typed and quantitated the mononuclear cells (MNCs) infiltrating liver tissues from 23 patients with primary sclerosing cholangitis. The circulating T lymphocytes were also enumerated by flow cytometry in 12 of these patients. In blood, T lymphocytes and especially T8+ cells were decreased. T cells were the major components of MNCs (78%) in portal tracts. Few of these cells were Tac+ or HLA-DR+. Total MNCs (929 +/- 90 vs. 106 +/- 18 in controls) included 11% M1+ and 8% B1+ cells. Aggregates of T4+ and T8+ cells were common in portal areas. The portal T4/T8 ratio of 1.27 +/- 0.1 was significantly (p less than 0.01) different than that around proliferating bile ductules (0.8 +/- 0.1). The T8+ and M5+ cells localized in these areas of proliferation and infiltrated ductal epithelium. On the other hand, T4+ cells accumulated on the parenchymal side of fibrosed tissue and densely surrounded certain intralobular bile ducts. Even late in the disease, variability in the extent of MNCs infiltration, ductal proliferation and periductal fibrosis was seen in each biopsy.

Soluble mediators from mononuclear cells increase the synthesis of glycosaminoglycan by dermal fibroblast cultures derived from normal subjects and progressive systemic sclerosis patients

Dermal fibroblast cultures from patients with progressive systemic sclerosis (PSS) synthesize up to 5 times more glycosaminoglycan (GAG) than normal cultures. In an in vitro model of fibroblast-lymphocyte interactions, we show that the supernatants of activated mononuclear cells (MNC) modulate GAG synthesis, as measured by the incorporation of 3H-glucosamine into GAG following incubation of the confluent fibroblast monolayers with active supernatant preparations. GAG accumulation was selectively increased up to 18 times in normal dermal fibroblast cultures. Cell viability was not affected, and 3H-thymidine uptake and cell numbers were depressed in cultures treated with the supernatants. In contrast to normal dermal fibroblast cultures, PSS fibroblasts responded to MNC supernatants by only a 1-2-fold increase in GAG. Supernatants of concanavalin A-activated PSS MNC had higher stimulatory activity than those of normal MNC. Supernatants made with MNC that had been depleted of monocytes on Sephadex G-10 columns were only minimally stimulatory. The GAG-stimulatory supernatants modulated the synthesis, but not the degradation of GAG. Gel filtration on a calibrated Sephadex G-100 column indicated the presence of stimulatory activity in both the 50,000 and 15,000 molecular weight fractions. These activities were trypsin-sensitive, but had different susceptibilities to heat. The active column fractions also contained interleukin-1 activity, as shown in an assay measuring proliferation of mouse thymocytes. Like our factors, interleukin-1 preparations increased GAG in normal and PSS dermal fibroblasts. Products of activated MNC may modulate normal and pathologic processes in human skin.

Products of activated mononuclear cells modulate accumulation of collagen by normal dermal and scleroderma fibroblasts in culture

Supernatants of human mononuclear cells activated with concanavalin A contain soluble factors that modulate accumulation of collagen in human dermal fibroblasts in culture. The supernatants decreased collagen accumulation by 67% in normal fibroblast lines and by greater than 80% in lines established from skin of patients with scleroderma. Collagen was measured by incorporation of 3H-proline into collagenase-sensitive protein. The inhibitory activity of collagen was optimal after a 24-hour incubation of confluent fibroblast monolayers with unfractionated mononuclear cell supernatants. Kinetic studies of this response showed a delay in accumulation of collagen-sensitive protein in supernatant-treated cultures. The 3H-thymidine uptake and fibroblast cell count and viability were only minimally altered. Noncollagen protein was inhibited by 30% to 40%. The presence of serum in fibroblast cultures did not affect this activity. The inhibitory factors were produced by purified T-lymphocyte subpopulations. Supernatant inhibitory activity was present after removal of monocytes from mononuclear cell cultures. By gel filtration on Sephadex G-100, active supernatants fractionated into at least three peaks of activity with molecular weight of 50,000, 30,000, and 15,000 daltons. Interleukin 1 might be one of the factors in mononuclear cell supernatants that modulates production of collagenase-sensitive protein in human dermal fibroblasts. Factors modulating collagen-sensitive protein are important in processes leading to excessive accumulation of the connective tissue and fibrosis in certain diseases.

T-lymphocyte subsets in liver tissues of patients with primary biliary cirrhosis (PBC), patients with primary sclerosing cholangitis (PSC), and normal controls

T lymphocytes infiltrating hepatic tissues were typed and enumerated in liver biopsies of patients with primary biliary cirrhosis (PBC), patients with primary sclerosing cholangitis (PSC), and normal controls using monoclonal antibodies and the avidin-biotin-immunoperoxidase technique. The peripheral blood mononuclear cells were studied also by flow cytometry. In PBC, T lymphocytes were decreased (P less than 0.001) in the blood [absolute number was 426 +/- 200 (SE) vs 1351 +/- 416 in 15 controls], as was the helper/suppressor (T4/T8) ratio (1.0 +/- 0.1 vs normal 2.3 +/- 0.3). T lymphocytes were the most numerous mononuclear cells infiltrating portal areas of PBC livers: 749 +/- 93/5 high-power fields (HPF) in PBC vs 98 +/- 15/5 HPF (P less than 0.01) in controls. The T4/T8 ratios varied from 0.9 to 2.3 (mean, 1.8 +/- 0.1) in the portal triads (normal mean, 1.6 +/- 0.1), with the T4+ cells accounting for more than 75% of infiltrating T cells. In contrast, the mean T4/T8 ratio in portal triads of PSC was reduced (1.0 +/- 0.3) due to a significant increase (P less than 0.001) in the number of T8+ cells. The T cells around and in the walls of bile ducts in PBC were mostly T8+, and the T4/T8 ratio was 0.8 +/- 0.2. No T8+ cells were seen in this location in PSC and normal livers. Few mononuclear cells were present in hepatic lobules. Subtyping of T lymphocytes in liver tissues of patients with PBC and PSC may be helpful in the differential pathologic diagnosis. In patients with advanced PBC, a decrease in T4+ cells in the blood appeared to be accompanied by their accumulation in the portal triads. In contrast, T8+ cells accumulated preferentially around bile ducts.

Lymphocytes in the skin of patients with progressive systemic sclerosis. Quantification, subtyping, and clinical correlations

Mononuclear cells (MNC) present in the dermis of the forearm and in the blood of patients with progressive systemic sclerosis (PSS) were quantified and analyzed for subsets using monoclonal antibodies. The findings were correlated with cutaneous and systemic features of the disease. Total T lymphocytes and their subsets, B cells, and macrophages were enumerated in the skin samples of 21 patients with PSS. The dermal MNC infiltrates consisted mostly of activated T lymphocytes with a mean T helper/T suppressor (T4/T8) ratio of 2.4 +/- 1.3 SD. Few B1-positive or T6-positive cells (macrophages) were observed. There was no correlation between the skin or blood T4/T8 ratios and the degree of skin thickening. On histologic examination, 58 of 115 (50%) untreated patients with PSS had prominent dermal MNC infiltration. Significant correlations between the degree of MNC infiltration and both the degree (P less than 0.05) and progression (P less than 0.05) of skin thickening were observed. No correlations with other systemic disease features of PSS were noted. These results suggest that cutaneous T lymphocytes may play a role in mediating dermal sclerosis in PSS.

Mononuclear-cell subsets in human idiopathic crescentic glomerulonephritis (ICGN): analysis in tissue sections with monoclonal antibodies

Mononuclear inflammatory cells (MIC) were analyzed in renal biopsies from 16 patients with ICGN (7 with glomerular immune complex deposits, 3 with anti-GBM disease, and 6 without immune deposits) by the avidin-biotin-immunoperoxidase technique utilizing monoclonal antibodies to cell surface antigens: T11 (total T), T4 (inducer/helper T), T8 (suppressor/cytotoxic T), B1 (B cells), M1 (monocytes/granulocytes), and Leu 7 [natural killer (NK) cells]. Total MIC were significantly increased in both glomeruli and interstitial tissues of the patients. Interstitial MIC consisted mainly of lymphocytes (80%) and monocytes (19%), with small numbers of B and NK cells present. In contrast, MIC in renal glomeruli of patients with ICGN were composed of monocytes (65%) rather than T lymphocytes (34%). A majority of T lymphocytes found in renal tissues of patients and controls had the helper/inducer phenotype. Tissue T4/T8 ratios were not significantly different in the glomeruli and interstitium. Monocytes and T lymphocytes accumulating in renal tissues of patients with ICGN may mediate glomerular injury in all forms of human ICGN.

Lymphocyte subpopulations at the site of "piecemeal" necrosis in end stage chronic liver diseases and rejecting liver allografts in cyclosporine-treated patients

Mononuclear cells in the areas of "piecemeal" necrosis in hepatic tissues from patients with different liver diseases were subtyped using monoclonal antibodies and the avidin-biotin-peroxidase complex method. T lymphocytes were the predominant infiltrating cell type in this lesion (greater than 75% of mononuclear cells) regardless of the etiology of the liver disease. M1-positive cells represented about 20% of the infiltrate. B cells were absent and rare Leu-7-positive cells (killer, natural killer) showed random tissue distribution in both the periportal areas and the parenchyma. In contrast, the T8+ (suppressor-cytotoxic) lymphocytes accumulated selectively in the areas of piecemeal necrosis, where the tissue T4/T8 ratios were consistently less than 1. T8+ lymphocytes were also more numerous than T4+ cells around the hepatitis B surface antigen-positive hepatocytes in piecemeal necrotic areas of livers from patients with hepatitis B surface antigen-positive chronic active hepatitis. In liver tissues of patients with primary biliary cirrhosis, alcoholic cirrhosis, chronic active hepatitis, and rejecting liver allografts, selective accumulations of T8+ lymphocytes at the sites of hepatocyte necrosis were a characteristic and uniform finding. This subpopulation of lymphocytes may be an important part of the immunologically mediated destruction of hepatocytes that occurs in chronic active liver diseases and is characterized by piecemeal necrosis.

Studies of lymphocyte subpopulations in the liver tissue and blood of patients with chronic active hepatitis (CAH)

Monoclonal antibodies to antigens on the surfaces of mononuclear cells (MNC) were used to characterize lymphocyte subpopulations infiltrating portal areas and parenchyma of livers in 31 patients with chronic active hepatitis (CAH). The distribution and numbers of infiltrating lymphocytes were determined in serial sections immunostained by the avidin-biotin-peroxidase complex method. T lymphocytes were the major component of inflammatory cells in the portal tracts. In the peripheral blood and portal areas, T helper-inducer (T4+) cells were the more numerous subpopulation. However, the hepatic lobules and areas of "piecemeal" necrosis always contained more T suppressor-cytotoxic (T8+) cells. The latter were demonstrated in contact with HBsAg-containing hepatocytes in tissues of patients with HBsAg-positive CAH. The mean numbers of T lymphocytes infiltrating the portal and periportal areas of livers from patients with HBsAg-negative and HBsAg-positive CAH were not different. Large numbers of B cells forming distinct follicles were seen in tissues from patients with HBsAg-positive CAH. The presence of increased numbers of portal T and B lymphocytes correlated with progressive liver damage as observed in two patients studied at yearly intervals.

Lymphocyte subsets studied with monoclonal antibodies in liver tissues of patients with alcoholic liver disease

In order to determine the nature of T lymphocytes accumulating in hepatic tissues of patients with alcoholic liver disease, we phenotyped these cells in situ, using monoclonal antibodies to lymphocyte surface antigens and the avidin-biotin-peroxidase complex (ABC) technique. In portal areas of cirrhotic livers, a significant increase (p less than 0.001) in T lymphocytes was observed as compared to livers showing only fatty changes and normal liver tissues. The T cells accumulating in cirrhotic livers comprised T helper-inducer (T4) and T suppressor-cytotoxic (T8) subsets with the T4/T8 ratio of 1.4 +/- 0.5 (SD, n = 14). In contrast, the T lymphocytes in the cellular projections which extended into the parenchyma consisted mostly of suppressor-cytotoxic cells. The relative enrichment in T8+ lymphocytes among the cells invading the parenchyma suggests that they may be important in the mediation of a cytotoxic injury of hepatocytes in advanced alcoholic liver disease and in regulating an immunologic challenge possibly initiated in response to alcoholic hyaline.

Suppressor cell function and T lymphocyte subpopulations in peripheral blood of patients with progressive systemic sclerosis

Three different in vitro assays--immunofluorescence with monoclonal anti-T cell reagents, enumeration of T gamma cells, and nonspecific suppressor cell function--were used for the analysis of suppressor lymphocytes in the circulation of 28 patients with progressive systemic sclerosis (PSS, scleroderma) and 20 normal individuals. Both OKT8+ and T gamma lymphocytes were significantly reduced (P less than 0.001 and P less than 0.02, respectively) in patients with PSS compared with controls. The OKT4/OKT8 ratio was increased (P less than 0.02). However, the mean suppressor cell index (SCI) of 1.9 (range 0.4-6.6) for patients with PSS was not significantly different (P greater than 0.05) from the SCI of 2.9 (range 1.2-14) for controls. Eleven of the patients had depressed suppressor cell function as indicated by the index value of less than 1.2. In only 5 of these patients, simultaneously measured T gamma and OKT8+ cells were reduced and OKT4+ lymphocytes were concomitantly increased. There were no significant correlations between the numbers of T gamma or OKT8+ cells and the SCI in patients and controls. Neither depressed suppressor cell function nor the OKT4+/OKT8+ ratio greater than 4.2 (greater than 2 SD of normal) in the patients could be related to other immunologic findings, to disease duration and severity, or to involvement of internal organs. These results suggest that depressed suppressor cell activity and immunoregulatory T cell imbalance in PSS may not be directly related to the pathogenesis of the disease.

Selective distribution and quantitation of T-lymphocyte subsets in germinal centers of human tonsils. Definition by use of monoclonal antibodies

The distribution and quantitation of T-lymphocyte subpopulations of human tonsils were studied in situ by the avidinbiotin-peroxidase technique, using monoclonal antibodies to total, helper, and suppressor T cells. Primary follicles contained few T lymphocytes. The germinal centers of secondary follicles contained numerous T cells: in the periphery, 14.2% +/- 1.7% (mean +/- SD), and in the central area, 2.4% +/- 0.7%, of follicular lymphocytes counted were T lymphocytes. The mantle zone had fewer T lymphocytes (7% +/- 0.9%). Most of the T lymphocytes found in the germinal centers had the helper-cell phenotype. There were fewer than 1% of suppressor T lymphocytes in the germinal centers. An occasional secondary follicle could contain up to 10% of suppressor cells (range, 0% to 9.7%). The interfollicular areas contained preponderantly T lymphocytes, a majority of which reacted with monoclonal antibodies to helper cells. The distribution and enumeration of T lymphocytes in normal reactive lymphoid tissue provide a basis for studies of pathological specimens.

Tissue distribution of human NK cells studied with anti-Leu-7 monoclonal antibody

The distribution and numbers of human natural killer (NK) cells in different lymphoid tissues and several tumors were determined with the use of monoclonal antibody to the Leu-7 antigen and immunohistologic methods. Anti-Leu-7 reacts with large granular lymphocytes containing most of NK activity in the peripheral blood. The Leu-7+ cells were found mainly in the germinal centers of secondary follicles in lymph nodes, spleens, and tonsils. The mean number of Leu-7+ cells in 40 germinal centers was 223 +/- 103 SD. Only rare cells were found in the thymus. In the follicles studied in serial sections, the distribution of the Leu-7+ cells was distinctly different from that of T cells, B cells and Ia+ cells. The Leu-7+ cells did not react with OKT 6 antibody specific for immature (control) thymocytes and Langerhans' cells. By double staining techniques, two populations of Leu-7+ cells were identified in lymphoid tissues: those that did and did not express the Ia-like antigen. The numbers and localization of the Leu-7+ cells varied in different tumors, but often the Leu-7+ cells surrounded the neoplastic nodules or were seen in contact with individual cancer cells. Anti-Leu-7 may be a useful reagent for monitoring the presence and localization of NK cells in normal and malignant human tissues.

Tissue distribution of human NK cells studied with anti-Leu-7 monoclonal antibody

The distribution and numbers of human natural killer (NK) cells in different lymphoid tissues and several tumors were determined with the use of monoclonal antibody to the Leu-7 antigen and immunohistologic methods. Anti-Leu-7 reacts with large granular lymphocytes containing most of NK activity in the peripheral blood. The Leu-7+ cells were found mainly in the germinal centers of secondary follicles in lymph nodes, spleens, and tonsils. The mean number of Leu-7+ cells in 40 germinal centers was 223 +/- 103 SD. Only rare cells were found in the thymus. In the follicles studied in serial sections, the distribution of the Leu-7+ cells was distinctly different from that of T cells, B cells and Ia+ cells. The Leu-7+ cells did not react with OKT 6 antibody specific for immature (control) thymocytes and Langerhans' cells. By double staining techniques, two populations of Leu-7+ cells were identified in lymphoid tissues: those that did and did not express the Ia-like antigen. The numbers and localization of the Leu-7+ cells varied in different tumors, but often the Leu-7+ cells surrounded the neoplastic nodules or were seen in contact with individual cancer cells. Anti-Leu-7 may be a useful reagent for monitoring the presence and localization of NK cells in normal and malignant human tissues.

Clinical and serologic study of Sjögren's syndrome in patients with progressive systemic sclerosis

Fifty-eight patients with progressive systemic sclerosis (PSS) were evaluated clinically and by biopsy of the minor salivary glands of the lips for the presence of Sjögren's syndrome. Clinical findings included dry eyes in 38%, dry mouth in 32%, parotid enlargement in 4%, and an abnormal Schirmer's test in 34%. Histologic changes in lip biopsies included lymphocytic infiltrates characteristic of Sjögren's syndrome in 17 individuals (29%). In 19 (33%) there was periglandular and intraglandular fibrosis (PSS-fibrosis) without significant inflammation, an alteration characteristic of PSS per se. In the remaining 22 patients (38%) with PSS, no abnormality was found. Of those with PSS and Sjögren's syndrome, 53% had serum antibodies to SS-A and/or SS-B, while only 1 patient with a normal biopsy had either of these antibodies. Anti-SS-A and anti-SS-B were not detected in patients with glandular fibrosis alone. The mortality rate of the PSS-fibrosis group was higher due to a variety of severe internal manifestations related to PSS. Antibodies to SS-A and SS-B are useful serologic markers of the presence of Sjögren's syndrome in patients with PSS.

HLA-DR antigens in progressive systemic sclerosis (scleroderma)

Typing at the HLA-DR locus was performed in 125 North American white patients with progressive systemic sclerosis (PSS). We could not confirm associations of PSS with the HLA-DR5 antigen or the HLA-B8/DR3 haplotype. A weak association of the DR1 antigen and PSS with diffuse scleroderma (27.5% vs 11.5% in local controls (corrected p less than 0.05) was observed. HLA-DR1 was significantly associated with the presence of anticentromere antibodies (p less than 0.05), and this combination was found more frequently in individuals with the CREST syndrome variant of PSS. This study failed to identify a clear-cut association between PSS and a genetic factor linked to the major histocompatibility complex.

IgA-containing circulating immune complexes in patients with igA nephropathy

The role of circulating immune complexes in the pathogenesis of IgA nephropathy (Berger's disease) is controversial. Previous studies have shown that a minority of these patients have immune complexes, but the methods used have been able to detect only IgG- or IgM-containing circulating immune complexes. Using a sensitive specific Raji cell radioimmunoassay for IgA-containing circulating immune complexes, we have examined serum specimens from 12 patients with IgA nephropathy for the presence of IgA-containing circulating immune complexes. In addition, the Raji cell IgG assay and the 125I-C1q binding assay were used for the detection of IgG- or IgM-containing circulating immune complexes. Purified monoclonal antibodies against human IgA1 and IgA2 were used to determine the subclass of IgA present in renal biopsy specimens from five of these patients. Six of 12 (50 percent) patients had IgA-containing circulating immune complexes, whereas only two of 12 (17 percent) had positive results in the Raji IgG assay and one of 12 (8 percent) in the 125I-C1q binding assay. There was no correlation between serum IgA, C3 C4, or factor B levels and the presence or level of IgA-containing circulating immune complexes. None of the three patients with renal failure had circulating immune complexes of any type. Of the seven patents with disease duration of two years or less, five (71 percent) had IgA-containing circulating immune complexes and three (43 percent) had IgG- or IgM-containing complexes. In all five renal biopsy specimens examined for IgA subclass, diffuse heavy, mesangial deposits of IgA1 were seen, whereas IgA2 staining was absent or present in only trace amounts. These findings suggest that IgA1 is the predominant antibody in renal biopsy specimens from patients with IgA nephropathy. The finding of IgA-containing circulating immune complexes in these patients--and their more frequent occurrence in patients with early stages of the disease--suggests that IgA-containing circulating immune complexes may play a role in the pathogenesis of IgA nephropathy.

Histocompatibility antigens in progressive systemic sclerosis (PSS; scleroderma)

Patients with progressive systemic sclerosis (PSS; scleroderma) were typed for the HLA-A, -B, and -DR antigens. No significant differences in the frequencies of any HLA-A or -B antigen were found. In the subgroup of patients with PSS and diffuse scleroderma (PSS-DS), the frequency of Bw35 was increased (0.30 vs 0.17 in controls; p less than 0.005, corrected P greater than 0.2). Although patients with PSS-DS also had an increased frequency of DR1 antigen (0.27 vs 0.12 in local controls; P less than 0.005, corrected P less than 0.05), no association between Bw35 and DR1 antigens could be detected. We found no increase in the frequencies of the DR3 or DR5 antigens in patients with PSS. However, in a subset of PSS patients with pulmonary fibrosis, an increase in DR3 and a decrease in DR4 antigens (P less than 0.005) were observed. Serum antibodies to centromere occurred more frequently in DR1-positive than DR/-negative patients (0.46 vs 0.18; P less than 0.005). This study of a large number of patients with PSS failed to confirm previously reported associations of PSS with the HLA-B8/DR3 haplotype of HLA-DR5 antigen.

Sex differences in prognosis of childhood T-cell leukemia

Bone marrows of 41 untreated children and adolescents with acute lymphocytic leukemia were studied by combined immunologic and histochemical methods at the time of diagnosis. Eleven were classified as T-cell lymphoblastic leukemias (27%) on the basis of cytochemical stains and E-rosette assay. The patients in this group has low median age of 8 years, relatively low median WBC of 13.4 x 10(3)/cc, 6/11 were female, and only 2/5 males had a mediastinal mass. The girls had a lower median age than boys (7 vs 9 years), none had mediastinal masses or extramedullary involvement, and their survival was greater than 27 months compared to 14 months for the boys (P less than 0.01). All patients were enrolled and treated on the (then) currently active CCSG protocols for ALL. This study emphasizes the fact that not all patients with T-cell ALL have poor prognosis, that sex could be an important factor affecting survival, and that the difference in survival could not be adequately explained by differences in the initial WBC.

Imbalance of T-cell subpopulations does not result in defective helper function in chronic lymphocytic leukemia

The T-lymphocyte subpopulations identified by the Fc receptors for IgG (TG cells) and IgM (TM cells) in 12 patients with B-cell chronic lymphocytic leukemia (CLL) were quantitated and studied for functional capabilities in an in vitro assay. The TG cells in patients were elevated in relation to age- and sex-matched normal controls (P less than 0.05) resulting in an altered TM/TG ratio of 1.8 +/- 0.76 in CLL versus 5.9 +/- 3.7 in controls (mean +/- SD, P less than 0.001). Despite this altered of B cells was found to be normal as reflected by the mean helper-suppressor score of 0.77 +/- 0.13 (+/- SEM) obtained for both patients and controls. This unimpaired capacity of the T cells from CLL patients to help normal B cells mature into immunoglobulin-secreting cells indicated that hypogammaglobulinemia and monoclonal serum immunoglobulins in these patients may be a result of either an intrinsic defect in the B lymphocytes or their replacement by a neoplastic clone rather than a defect in the immunoregulatory T cells.

Circulating and deposited immune complexes in patients with glomerular disease: immunopathologic correlations

The presence of circulating immune complexes (ICs), and alterations of serum immunoglobulins G, A, and M, properdin factor B, and C3 and C4 levels were correlated with glomerular immune deposits in 50 consecutive renal biopsy patients. Urine from 25 of these patients was also examined for ICs. Agarose gel zone electrophoresis (AGE) was used for IC screening. This method detects greater than or equal to 200 ng of IC per 1.5 microliter sample application (approximately equal to 130 micrograms/ml of serum immune complexes) and gives some indication of antigen or antibody excess in the ICs. Glomerular immune deposits were detected by immunofluorescence and electron microscopy in 72% (36/50) of these patients. Circulating and/or urinary IC were found in 69% (25/36) of patients with positive immunofluorescence and 78% (11/14) of patients with negative immunofluorescence. Five of 11 patients with circulating IC but no renal deposition presented with idiopathic crescentic glomerulonephritis (ICGN). These results indicate that IC that persist in the circulation and/or pass renal glomeruli with minimal deposition may result in tissue injury. Circulating IC in antibody excess were detected in all patients with membranous glomerulonephritis. ICs were also found in 55% of patients with IgA nephropathy. Our observations support the hypothesis of an immune complex pathogenesis for these diseases. Determination of circulating and urinary IC in patients with glomerular disease may help in clinical assessment and provide information concerning the pathogenesis of these diseases in humans.

Abnormalities of T lymphocyte subsets in patients with progressive systemic sclerosis (PSS, scleroderma)

Thirty-one patients with PSS (scleroderma) were examined for evidence of abnormalities in T lymphocyte subsets. TG and TM subpopulations of peripheral blood T lymphocytes were enumerated by rosetting techniques. The helper-suppressor functions of these lymphocytes were studied in the PWM-activated in vitro assay. The absolute numbers of TG cells in patients with DS as well as those with the CREST syndrome variant of PSS were decreased in comparison with those in age-matched healthy controls (p < 0.05). The numbers of TM and T "null" cells were not significantly altered (p > 0.05). The reduction in the number of TG cells was not caused by lymphocytotoxic antibodies. The mean helper-suppressor scores for patients with PSS and DS (1.25) and those with CREST syndrome (1.36) were higher (p < 0.05) than the mean score for healthy individuals (0.80). No relationship between the immunoregulatory abnormality and the presence or titer of CICs, ANAs, hypergammaglobulinemia, or various clinical manifestations of PSS could be demonstrated in individual patients. The finding of abnormalities in T lymphocyte subpopulations and the demonstration of their altered functional expression in patients with PSS indicate that immunoregulatory mechanisms may play an important role in this connective tissue disease.

Crithidia luciliae assay for antibodies to native DNA in procainamide-induced lupus erythematosus

Sera from 49 patients with procainamide-induced lupus erythematosus or circulating antinuclear antibodies were found to be negative for antibodies to native DNA by the CL immunofluorescence assay. This finding suggests that the CL assay is helpful in discriminating between procainamide-induced and naturally occurring systemic lupus erythematosus. The results further confirm the relatively high degree of specificity of the CL assay for SLE.

Mechanisms of tissue injury in desquamative interstitial pneumonitis

To evaluate a contribution of immunologic factors to the pathogenesis of desquamative interstitial pneumonitis (DIP), lung biopsy specimens from four patients were studied for immunoglobulin deposits in tissue and cellular characteristics by immunologic, ultrastructural and histochemical methods. Accumulations of large cells with vacuolated cytoplasm within the distal air spaces and marked increase in the numbers of type II pneumocytes lining pulmonary alveoli were observed in all cases. The cells in air spaces were identified as macrophages containing intracellular lysozyme and alpha-naphthyl acetate esterase. Deposits of immunoglobulin G(IgG) and the third component of complement were found in distal air spaces and on the surfaces of the accumulated macrophages. The interstitial fibrosis was not a significant feature in out patients. Circulating immune complexes and a decreased IgG level were detected in serum during the acute phase of the disease. IgG levels returned to normal and were no longer detectable during convalescence in one patient followed sequentially. The formation and deposition of complement-fixing antibody and/or immune complexes may be responsible for the local accumulation and activation of macrophages and for tissue damages. Release of lysosomal enzymes by alveolar macrophages phagocytosing the complexes could also contribute to the alveolar injury, whereas the proliferation of type II pneumocytes may be a reparative tissue reaction to immunologically-mediated injury.

Clinical usefulness of the Crithida luciliae test for antibodies to native DNA

The Crithidia luciliae assay (CL-IF) for antibodies to native DNA was found to be significantly more sensitive and specific for systemic lupus erythematosus (SLE) than the Farr radioimmunoassay (RIA). High titers of antibodies to native DNA were seen exclusively in patients wtih SLE using the CL-IF test. The titers correlated with the activity of SLE and nephritis, in that the highest titers occurred in patients with active disease and severe nephritis, the lowest in patients with inactive lupus and normal renal function. Favorable responses to therapy were associated with decreases in CL-IF titers. The CL-IF assay can detect complement-fixing antibodies to native DNA. Their presence correlated with the disease activity and nephritis in SLE patients. The simple and inexpensive CL-IF test could either replace the RIA in clinical laboratories or be used in conjunction with the RIA as a confirmatory test for antibodies to native DNA.

Diagnostic significance of carcinoembryonic antigen levels in serous effusions. Correlation with cytology

Carcinoembryonic antigen (CEA) determinations were performed in 86 malignant and 103 benign serous fluids submitted for routine cytologic examination. Cytology alone identified 54 (63%) of the malignant fluids. The remaining 32 (37%) had elevated CEA levels but no detectable malignant cells. In nearly half of 67 effusions with CEA greater than 2.5 ng/ml and negative cytology, elevated CEA concentrations were confirmed to be associated with malignancy. Most (92.5%) cytologically positive serous fluids also had elevated levels of CEA. Elevated CEA assay may raise the suspicion of malignancy in serous fluids that are negative cytologically. Increased CEA concentrations alone, however, cannot be used for confirming malignancy because CEA levels greater than 2.5 ng/ ml (mean, 10.5 +/- 8.2) were found in 50% of the fluids proven to be nonmalignant. Fluid CEA was more consistently elevated in tumors of gastrointestinal tract (greater than 25 ng/ml), lung (11.2 +/- 8.9) and breast (11.6 +/- 7.7) than in lymphomas or sarcomas (3.6 +/- 1). Paired plasma and fluid CEA levels may be particularly helpful in confirming a clinical diagnosis of malignancy in cases with negative fluid and biopsy findings.

Correlations of immunologic markers with histologic features of human non-Hodgkin's lymphomas

Twenty-five lymph nodes from patients with non-Hodgkin's lymohomas were evaluated by immunologic technics applied to cell suspensions and tissue sections. Malignant lymphomas with cytologic characteristics similar to those of neoplastic cells were found to be immunologically heterogeneous. The distribution as well as the number of neoplastic cells with distinctive immunologic surface markers could not be related to the cytologic type of malignant lymphomas. The number of malignant cells simultaneously expressing the T- and B-cell markers was increased in malignant lymphoma nodes. Cells positive for the triple markers (Ig+, EAC+, T+, where Ig = immunoglobulin, EAC = erythrocytes sensitized with antibody and complement, and T = T marker) represented the predominant population in these nodes, and the distributions of these cells were useful in diagnosis. Monoclonal immunoglobulins were detected in all lymphoma cells but not in the patients' sera. The tissue distribution of EAC-positive cells may have a prognostic significance. The paucity of cells with the Fc receptors was a characteristic feature of all lymphoma cells studied. Evaluations of immunologic markers on lymphoma cells in conjunction with the histologic characteristics may provide a sounder basis for diagnosis.

Immunodiagnosis of mesothelioma: use of antimesothelial cell serum in an indirect immunofluorescence assay

Cells isolated from human serous effusions were cultured in vitro. Monolayers of large multipolar cells were established. Antisera to the cultured cells were prepared in rabbits and rats. The antisera were absorbed with human red cells, liver powder and MOLT-4F cell line lymphocytes. Specificity of the absorbed antisera for human mesothelial cells were demonstrated in an indirect immunofluorescence assay. The antisera were used to confirm the diagnosis of mesothelioma in two cases. In both the patients, the morphologically identifiable malignant cell populations in the effusions stained positively with the antimesothelial cell serum thus establishing their mesothelial origin. Normal nonmesothelial tissue and known nonmesothelial tumors failed to react with the antisera thus confirming the specificity of the antisera.

Differentiation between benign and malignant human lymph nodes by means of immunologic markers

A surface-marker assay combining immunofluorescence with anti-human immunoglobulin or anti-human brain serum (AHBS) and the formation of rosettes with untreated (E), antibody-sensitized (EA) and complement-coated (EAC) sheep erythrocytes was used to study mononuclear cell suspensions of human lymph nodes. The frequency of cells expressing more than one marker was increased in lymphoma nodes as compared to normal and hyperplastic nodes. The cells which simultaneously expressed complement receptors, surface immunoglobulin and the marker identified by AHBS represented the most prominent and characteristic subpopulation identified in neoplastic nodes. Distributions of cells with double and triple markers were studied by combining immunofluorescence with rosetting on frozen tissue sections. The multiple-marker cells had distributions that were characteristic in different human lymphomas. Benign and malignant human nodes could be distinguished on the basis of frequency and distribution of mononuclear cell populations carrying distinctive combinations of T- and B-cell surface markers.

Lateral and transmembrane redistribution of tissue-specific antigens in single cells and monolayers

Tissue-specific antigens in the membranes of corneal endothelial cells react with anti-tissue antibodies only in metabolically active monolayers and dispersed cells. After metabolic inhibition by exposure of these preparations to cold, the antigen-antibody complexes, like free antigens, undergo transmembrane redistribution leading to their internalization by the cells. This transmembrane redistribution is reversible and can be followed by using fluorescein-labeled antibodies. Reexpression of the complexes on the cell surfaces occurs after return from metabolic inhibition to metabolic activity. Dispersed corneal endothelial cells are also capable of lateral redistribution (capping) of the complexes although cells in monolayers do not share this capability. Capping in the dispersed cells occurs only at ambient temperatures and, because it results in shedding of the complexes, is irreversible. The data indicate that macromolecules in the membranes of cells organized in tissues are restricted in their movement as compared to the macromolecules of cells functioning in a dispersed state.

Hairy cell leukaemia: seven cases with probable B-lymphocytic origin

Mononuclear cells from seven patients with hairy cells leukaemia were examined for features suggestive of either a lymphocytic or monocytic origin. Immunofluorescent staining of both methanol fixed and incubated cells, using monospecific antisera, revealed a predominant cell-associated immunoglobulin in each case. Three were positive for mu and kappa chains, two for gamma and kappa chains, one for delta and kappa chain determinants and one reacted only with antigamma chain serum. Formation of EAC rosettes, a feature of both B lymphocytes and monocytes, was variable. T cells, as judged by E rosettes, were not elevated in any patient. Phytohaemagglutinin reactivity was normal in six and depressed in one case. With the exception of minimal activity in assays for glass adherence and latex particle phagocytosis, none of the cells showed features typical of monocytes. Hairy cells were negative by peroxidase stain and lacked the electron microscopic characteristics of monocytes. They did not react in either rosette or phagocytic assays with anti-A or anti-D coated erythrocytes nor did they elaborate granulocyte colony stimulating factor, a monocyte-derived in vitro granulopoietin. Although unequivocal classification of these abnormal cells is not possible, the data storngly suggests that this represents a variant of a B lymphocytic neoplasm.

T-cell and B-cell identification in the diagnosis of lymphoproliferative disease. A review

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