pp60c-src expression is induced by activation of normal human T lymphocytes

We have re-examined whether pp60c-src, the normal cellular homologue of the transforming protein of Rous sarcoma virus, is present in human T cells. By in vitro immune-complex kinase assay or Western blotting with the anti-pp60c-src mAbs 327 or GD11, pp60c-src was found to be present in lysates of T cell lines, including the Jurkat T cell line. The 327 and GD11 mAbs have been reported to be specific for pp60c-src and not to cross-react with other src family members or other kinases. Furthermore, the size of the pp60c-src bands present on Western blotting and in vitro kinase assay were clearly different from those of p56lck or p59fyn. In addition, pp60c-src is detected in the HTLV-I-derived T cell lines S1T and C8, which lack expression of p56lck and p59fyn. RNase protection assays confirmed that pp60c-src mRNA is present in Jurkat T cells. We also found pp60c-src protein to be constitutively present in freshly isolated thymocytes. In contrast, pp60c-src was absent, or present at extremely low levels, in normal, resting peripheral blood T lymphocytes, which is in agreement with previous findings. However, after stimulation of resting T cells with the mitogenic lectin PHA or with Ab to the TCR complex, pp60c-src expression is induced in both CD4+ and CD8+ T cell subsets, with peak expression detectable 12 to 24 h after T cell activation. The levels of pp60c-src are low in all T cells except Jurkat, where levels of pp60c-src are comparable to levels found in a glioblastoma cell line (T98G). Nevertheless, significant levels of pp60c-src kinase activity are readily detectable in thymocytes and activated normal T cells as well as in T cell lines. The finding that pp60c-src is inducible following activation through the TCR suggests that pp60c-src may play a specific role in the normal T cell activation pathway.

pp60c-src expression is induced by activation of normal human T lymphocytes

We have re-examined whether pp60c-src, the normal cellular homologue of the transforming protein of Rous sarcoma virus, is present in human T cells. By in vitro immune-complex kinase assay or Western blotting with the anti-pp60c-src mAbs 327 or GD11, pp60c-src was found to be present in lysates of T cell lines, including the Jurkat T cell line. The 327 and GD11 mAbs have been reported to be specific for pp60c-src and not to cross-react with other src family members or other kinases. Furthermore, the size of the pp60c-src bands present on Western blotting and in vitro kinase assay were clearly different from those of p56lck or p59fyn. In addition, pp60c-src is detected in the HTLV-I-derived T cell lines S1T and C8, which lack expression of p56lck and p59fyn. RNase protection assays confirmed that pp60c-src mRNA is present in Jurkat T cells. We also found pp60c-src protein to be constitutively present in freshly isolated thymocytes. In contrast, pp60c-src was absent, or present at extremely low levels, in normal, resting peripheral blood T lymphocytes, which is in agreement with previous findings. However, after stimulation of resting T cells with the mitogenic lectin PHA or with Ab to the TCR complex, pp60c-src expression is induced in both CD4+ and CD8+ T cell subsets, with peak expression detectable 12 to 24 h after T cell activation. The levels of pp60c-src are low in all T cells except Jurkat, where levels of pp60c-src are comparable to levels found in a glioblastoma cell line (T98G). Nevertheless, significant levels of pp60c-src kinase activity are readily detectable in thymocytes and activated normal T cells as well as in T cell lines. The finding that pp60c-src is inducible following activation through the TCR suggests that pp60c-src may play a specific role in the normal T cell activation pathway.

Hematopoietic progenitor cells are resistant to dimethyl sulfoxide toxicity

BACKGROUND

A direct chemical toxicity of dimethyl sulfoxide (DMSO) to hematopoietic progenitor cells has been suggested. However, a recent study failed to corroborate these earlier findings. Thus, a series of experiments was undertaken to address this issue.

STUDY DESIGN AND METHODS

Bone marrow was collected from 18 donors and cryopreserved with 10 percent (vol/vol) DMSO. Aliquots of frozen bone marrow were thawed, diluted with ACD-A to 8 percent (vol/vol) DMSO, and allowed to remain in DMSO for up to 2 hours before mononuclear cells were plated for colony-forming assays. After 14 days in culture, burst-forming units-erythroid, colony-forming units--granulocyte/macrophage, and colony-forming units--granulocyte/erythrocyte/macrophage/megakaryocyte colonies were enumerated.

RESULTS

There was no significant difference (p > 0.5) seen in colony formation over the 2-hour exposure to DMSO.

CONCLUSION

These results support and extend a previous study that bone marrow hematopoietic progenitor cells, including burst-forming units--erythroid, colony-forming units--granulocyte/macrophage, and colony-forming units--granulocyte/erythrocyte/macrophage/megakaryocyte are resistant to any toxic effects of 8- to 10-percent (vol/vol) DMSO during at least 2 hours of DMSO exposure.

Transmembrane signaling by the interleukin-2 receptor: progress and conundrums

Activation of the multicomponent interleukin-2 receptor (IL-2R) complex leads to a rapid increase in tyrosine phosphorylation of a number of cellular proteins including the IL-2R beta and IL-2R gamma chains of the IL-2R and the RAF-1 serine threonine kinase. In addition, phosphatidylinositol 3-kinase (PI-3K) protein and activity can be immunoprecipitated with anti-phosphotyrosine and anti-IL-2R beta antibodies from IL-2-activated but not resting T lymphocytes. We have demonstrated that the SH2 (SRC homology 2) domains of the 85 kDa subunit of PI-3K are sufficient to mediate binding of the PI-3K complex to tyrosine phosphorylated, but not non-phosphorylated IL-2R beta, suggesting that tyrosine phosphorylation is an integral component of the activation of PI-3K by the IL-2R. Since none of the members of the IL-2R complex contains an intrinsic tyrosine kinase domain, IL-2-induced tyrosine phosphorylation must be the consequence of activation of intracellular tyrosine kinases. SRC family members including lck, lyn and fyn have been demonstrated to associate with IL-2R beta through binding of the kinase domain to the acidic domain of IL-2R beta. However, we have demonstrated that the serine rich (SD) region of the cytosolic domain of IL-2R beta is also required for association of a tyrosine kinase with the IL-2R complex and that IL-2 can induce proliferation and tyrosine phosphorylation in cell lines which lack the known SRC family kinases expressed by T lymphocytes. Thus members of other kinase families besides SRC may also be involved in mediating IL-2 signal transduction. Biochemical studies and studies of cells expressing mutant IL-2 receptors indicate that IL-2-induced tyrosine kinase activation initiates a complex signaling cascade. The cascade includes SRC family kinase members such as lck, fyn, and lyn, activation of Raf-1 and PI-3K, and ras, and increased expression of the fos, fra-1, and jun protooncogenes. In addition, ligation of the IL-2R leads to rapid increases in myc expression and more delayed increases in the expression of the cdc2 and cdk2 kinases and the cyclins through a tyrosine phosphorylation independent pathway. Whether other biochemical processes initiated by IL-2R ligation, including activation of the MAP2, p70S6 and p90RSK serine threonine kinases, activation of NF-kappa B, and increased expression of Raf-1, Pim-1, bcl-2, IL-2R alpha and IL-2R beta, are consequences of the IL-2-induced tyrosine kinase cascade remains to be determined.(ABSTRACT TRUNCATED AT 400 WORDS)

Analysis of the synergistic stimulation of mouse macrophage proliferation by macrophage colony-stimulating factor (CSF-1) and tumor necrosis factor alpha (TNF-alpha)

Tumor necrosis factor alpha (TNF-alpha) more than doubles tritiated thymidine ([3H]TdR) uptake in mouse macrophages stimulated by macrophage colony-stimulating factor (CSF-1). However, nothing is known of how TNF-alpha affects this increase or even whether it is manifested by increased cellular proliferation. Here we characterize the effects of TNF-alpha on CSF-1-stimulated proliferation of both primary cells (bone marrow-derived macrophages, BMMs) and a cloned growth factor-dependent macrophage cell line (S1). We show that the TNF-alpha-induced increase in [3H]TdR uptake of CSF-1-stimulated macrophages is directly proportional to an increase in the DNA content of the culture and that the effects of TNF-alpha are direct and independent of cell number. TNF-alpha decreases the population doubling time of log-phase growing macrophages having quite different growth rates to the same (approximately 30%) extent: the doubling time of BMMs decreases from 24 to 17 h and that of S1 cells from 17 to 13 h. TNF-alpha exerts its effects on log-phase growth by increasing to the same proportion CSF-1-stimulated proliferation at all concentrations of CSF-1; that is, TNF-alpha does not shift, but rather amplifies, the CSF-1 dose-response curve. Although TNF-alpha alone does not stimulate macrophage proliferation, its presence in S1 cell cultures coming to quiescence after withdrawal of CSF-1 greatly increases subsequent CSF-1-stimulated [3H]TdR uptake as the cells reenter the cycle. Finally, we show that both human and mouse TNF-alpha increase CSF-1-stimulated log-phase growth and reentry of quiescent cells into the cycle equally on a molar basis (half-maximal stimulation of approximately 0.3 nM). The latter observation argues that the growth-stimulatory effects of TNF-alpha are mediated via the 55-60-kd TNF receptor. We conclude that TNF-alpha acts directly on growth-competent macrophages to decrease significantly the population doubling time in a manner that enhances the mitogenic effects of CSF-1.

A specific and reliable bioassay for the detection of femtomolar levels of human and murine tumor necrosis factors

A reliable, highly sensitive, cytolytic bioassay for the quantitation of both human and murine tumor necrosis factor (TNF) is described. The assay is 2-180-fold more sensitive than other currently described bio- or immunoassays (limits of detection: 500 fg/ml (29 fmol/l) human TNF-alpha, 200 fg/ml (12 fmol/l) murine TNF-alpha and 130 fg/ml (7 fmol/l) human TNF-beta). The assay, which uses L929-8, a newly isolated subclone of the murine fibroblastoid cell line L929, detects human TNF-alpha approximately 180-fold more sensitively than previously described L929 subclone assays. Maximum sensitivity is obtained by preincubating L929-8 cells at 37 degrees C with 2 micrograms/ml actinomycin D (1-2 h), then culturing with TNF at 40 degrees C for 20 h in medium containing high serum (15% FBS). Relative viable cell content in 96-well microtiter plates is determined colorimetrically by uptake of the non-carcinogenic dye neutral red. Other cytokines have no effect, either alone or in combination with TNF. Cytokines tested were IL-1 through IL-6, GM-CSF, G-CSF, CSF-1, LIF, TGF-beta, NGF, Epo or IFN-gamma, LPS, PGE2, dexamethasone and cyclosporin A, also have no effect, either alone or in combination with TNF. L929-8 cells maintain the above sensitivity to TNF for at least 4 months in continuous culture. Thus, the assay allows rapid, inexpensive, reliable and specific quantitation of rodent and human TNFs. Its very high sensitivity should allow accurate detection of biologically active TNF in biological fluids such as human serum.

Synergistic stimulation of macrophage proliferation by the monokines tumor necrosis factor-alpha and colony-stimulating factor 1

The effects of pure recombinant human tumor necrosis factor-alpha (TNF) on the CSF-1-stimulated proliferation of well-defined populations of murine macrophages are examined. Primary bone marrow-derived macrophages (BMM) from endotoxin-resistant C3H/HeJ mice were characterized for homogeneity in comparison with a cloned, growth factor-dependent macrophage cell line (S1) also derived from C3H/HeJ bone marrow cells. The mitogenic effects of each factor, alone and in combination, on the proliferation of both macrophage populations over a two-day culture period were studied. In contrast to CSF-1, TNF alone only slightly stimulated macrophage proliferation. However, the combination of CSF-1 and TNF stimulated proliferation of both primary BMM and S1 cells 1.5- to 2-fold greater than the sum of their predicted individual contributions. Such synergy was observed even at very high (plateau) levels of factors. TNF was found to transiently down-regulate CSF-1 receptor levels on both populations. Down-regulation was maximal at one hour; however, receptor numbers returned to initial, or greater, levels after 24 hours of incubation. Thus, TNF, an inducible monokine, greatly enhances the maximal mitogenic effects of CSF-1, an inducer of TNF production. These observations suggest an autocrine rule for TNF that involves synergy with (and perhaps obligatory cooperation with) CSF-1 in the regulation of macrophage proliferation.

High-titer, high-thermal-amplitude cold autoagglutinin not associated with hemolytic anemia

An example of an unusual cold autoagglutinin is reported. The antibody was monoclonal IgMKappa able to fix complement, and, in the presence of albumin, had both a high titer (greater than 4,096 at 4 degrees C) and a wide thermal range (4-37 degrees C). The patient was closely followed over a 3-year period with no evidence of hemolysis ever documented, despite a persistently positive direct antiglobulin test and the presence of the cold autoagglutinin. In contrast to previous reports regarding cold-agglutinin disease, this case demonstrates that in vivo hemolysis is not always associated with cold autoagglutinins that in vitro show a high thermal range in the presence of albumin.

Identification of an erythropoietin-sensitive cell line

The murine lymphoblastic cell line DA-1 has been characterized as dependent upon both interleukin-3 (IL-3, multicolony-stimulating factor [multi-CSF]) and granulocyte-macrophage colony-stimulating factor (GM-CSF) for survival and growth. Here we demonstrate that it is responsive to a third hematopoietic factor, the erythroid-specific hormone, erythropoietin (Epo). DA-1 cells are stimulated to proliferate by partly purified natural murine and human Epo, and pure recombinant human Epo. Antibody to Epo specifically blocks Epo-stimulated growth. Maximal growth stimulated by Epo and GM-CSF is similar, and considerably less than that stimulated by multi-CSF. Proliferation stimulated by Epo and GM-CSF is transient, decreasing within 24 to 48 hours of exposure. However, Epo acts cooperatively with GM-CSF to sustain proliferation. With or without GM-CSF, no obvious erythroid differentiation of DA-1 cells occurs after exposure to Epo for up to 72 hours. This is the first report of a growth factor-dependent cell line also responsive to Epo for survival and growth. The availability of this cell line model should greatly facilitate biochemical analysis of the mechanism of Epo growth-stimulating action.

Human granulocytes lack red cell Kx antigen

We have investigated the presence or absence of the red cell Kx antigen on human granulocytes by measuring specific uptake of anti-Kx using three techniques: direct measurement by 125I-staphylococcal protein A (125I-SPA) and avidin-biotin-complex (ABC) immunoperoxidase staining and also, an indirect measurement using granulocyte adsorption of anti-Kx. Our results with all three methods indicate that the Kx antigen is not present on normal human granulocytes. Prior to adsorption of the anti-Kx serum with purified, pooled, normal human granulocytes, 11 of 21 (53%) of normal granulocytes were non-reactive by 125I-SPA and 16 of 20 (80%) by ABC. This pattern of reactivity was shown to be due to contamination of our anti-Kx serum with an antibody to a granulocyte-specific antigen unrelated to the Kx antigen. After adsorption, there was no diminution in the reactivity of the adsorbed anti-Kx compared to the unadsorbed antiserum against red cells which express strong Kx antigen, i.e. Ko and DTT-modified normal human red cells, by either serologic or 125I-SPA techniques. Likewise, reactivity with McLeod red cells, which have weak expression of the Kx antigen, was not changed using either the unadsorbed or adsorbed anti-Kx. The adsorbed anti-Kx was nonreactive with all 12 normal donors' granulocytes tested by 125I-SPA and with 10 normal donors' granulocytes tested by ABC. Furthermore, granulocytes from a Ko individual were nonreactive using either unadsorbed or adsorbed anti-Kx. These studies indicate that Kx antigen is not present on normal human granulocytes. Further, additional adsorption studies using granulocytes from a boy with X-linked chronic granulomatous disease (CGD) indicated that these granulocytes also do not possess the Kx antigen. In contrast to previous reports, these data suggest that Kx antigen is most probably a red cell-specific antigen and that the red cell Kx antigen has no direct relationship to the biochemical defect in CGD.

Donor-derived red blood cell antibodies and immune hemolysis after allogeneic bone marrow transplantation

Six cases of immune hemolytic anemia attributed to donor-derived red cell antibodies after allogeneic bone marrow transplantation (BMT) are reported. In 2/6 cases, severe intravascular hemolysis was seen, 6/6 required increased red cell transfusion, and 1/6 was treated by plasma exchange. All recipients were receiving cyclosporine to prevent graft-v-host disease. Investigations showed that in each case, the donor lacked ABO or Rho(D) red cell antigens present in the recipient. The direct antiglobulin test was positive in 6/6. Relevant serum antibody (anti-A, four cases; anti-B, one case; anti-D, one case) was first detected one to three weeks after BMT. Eluates made from recipient red cells showed the same specificity as serum antibody. Maximum hemolysis occurred nine to 16 days after BMT, suggesting that active production of antibody by "passenger" donor lymphocytes was the likely mechanism of hemolysis, rather than passive transfer of antibody in the marrow infusion. Retrospective analysis of 21 consecutive cyclosporine-treated BMT patients receiving marrow lacking ABO or D antigens present in the recipient showed that (1) 15/18 patients tested had red cell antibody production against recipient red cell antigens; (2) despite the frequent presence of antibody specific for recipient red cell antigens, only 3/21 patients developed clinically significant hemolysis; (3) clinical hemolysis could not be predicted by donor or recipient red cell antibody titers. We conclude that although red cell antibody against recipient antigens is frequently produced after minor ABO and D mismatched BMT in cyclosporine-treated recipients, only 10% to 15% of cases develop clinically significant immune hemolysis. The data presented show that the most likely source of antibody is "passenger" donor lymphoid cells.

Immune response to moxalactam in rabbits and in humans

Three of 23 New Zealand white rabbits immunized with moxalactam or bovine serum albumin (BSA)-moxalactam conjugates produced specific antimoxalactam antibodies. Rabbits that produced antimoxalactam had been immunized, by a novel approach, with heat-aggregated BSA-moxalactam conjugates containing Corynebacterium parvum as adjuvant. Use of liposomes to augment antibody response in the rabbits was successful for the production of anti-BSA antibodies, but failed to result in production of antimoxalactam. One antimoxalactam was chosen for further study, was specifically inhibited with moxalactam (10(-5) mol/L), and did not cross-react with any of the 11 other cephalosporins or eight penicillins tested (in concentrations of 10(-2) mol/L). In addition, the antibody did not demonstrate any carrier specificity. One of eight humans receiving intravenous moxalactam therapy developed a low titer, low avidity antimoxalactam. This patient was a "good responder," inasmuch as he also produced three transfusion-stimulated alloantibodies to red cell antigens during the study. Although the patient developed the antimoxalactam antibody while the drug was being administered, there was no evident adverse clinical reaction. This is the first report of antimoxalactam produced either in experimental animals or in humans. Our data indicate that moxalactam may be a relatively poor immunogen in rabbits requiring special immunization protocols. The one antibody studied does not cross-react with other structurally related antibiotics. Although human antimoxalactam may be produced, no adverse effects were detected in the one case observed.

The red cell antigens A, B, D, U, Ge, Jk3 and Yta are not detected on human granulocytes

We report the inability to detect the following red blood cell antigens on human granulocytes: A, B, D, U, Gerbich (Ge), JkaJkb (Jk3) and Cartwright (Yta). To study each antigen, granulocytes were purified on density gradients, fixed in glutaraldehyde, and the uptake of specific antisera measured using two direct immunological techniques: 125I-staphylococcal protein A (125I-SPA) binding and avidin-biotin-complex (ABC) immunoperoxidase staining. Glutaraldehyde fixation was shown not to affect the antigenicity when the antisera were tested using red blood cells. Using three anti-A, three anti-B and three anti-A,B antisera, our 125I-SPA results of 47 tests with granulocytes from group A individuals and 39 tests with granulocytes from group B individuals indicate that A or B antigens are not expressed on human granulocytes. Tests using ABC were also negative with 37 and 36 granulocytes from group A or B individuals, respectively. In addition, no positive results using 125I-SPA were obtained with granulocytes from individuals having antigen positive red cells when tested with two anti-D (number of tests performed (n = 22), three anti-Ge (n = 22), three anti-U (n = 20), two anti-Jk3 (n = 17), and three anti-Yta (n = 25); control anti-NA1 or -NB1 antisera were invariably positive. Also, using these antisera, no positive results were obtained by ABC except with one anti-Yta antiserum which was positive with one of seven granulocytes tested. This anti-Yta was also positive with three of 10 granulocytes by 125I-SPA. This activity was shown to be due to a granulocyte-specific antibody; adsorption of the antiserum with human granulocytes removed all activity against granulocytes but did not reduce the activity against red cells. Thus, our results are in agreement with recent reports which demonstrated the absence of the A, B and D antigens on human granulocytes. However, we have been unable to confirm previous reports which indicated the presence of the U, Ge and Jk3 antigens on human granulocytes. Also, we have been unable to detect the Yta antigen on human granulocytes.

Autoimmune hemolytic anemia with both cold and warm autoantibodies

Of 144 patients with a positive direct antiglobulin test and having autoimmune hemolytic anemia (AIHA), 12 (8.3%) satisfied diagnostic criteria for both warm antibody AIHA and cold agglutinin syndrome. All 12 patients had IgG and C3d sensitizing their erythrocytes, and samples of their serum contained IgM cold autohemagglutinins optimally reactive at 4 degrees C, but with a high thermal amplitude to 37 degrees C, and IgG warm autoantibodies. All red blood cell eluates contained IgG warm autoantibodies. The 12 patients had severe hemolytic anemia that responded dramatically to corticosteroid therapy, with the mean hemoglobin level increasing from 6.3 to 12.9 g/dL. Five patients (42%) had systemic lupus erythematosus, one patient (8%) had a non-Hodgkin's lymphoma, and six patients (50%) had idiopathic AIHA; four patients (33%) had concomitant thrombocytopenia (Evans' syndrome). Nine patients (75%) were female. Four patients had unexpected alloantibodies potentially capable of in vivo hemolysis of transfused blood. Because of the severe hemolysis, the serologic findings, and the dramatic initial clinical response to corticosteroid therapy, these patients represent a distinct catagory of AIHA and should be given corticosteroid therapy quickly.

Unmasking of Kx antigen by reduction of disulphide bonds on normal and McLeod red cells

We have investigated the effect of dithiothreitol (DTT) treatment of human red cells upon the Kx blood group antigen. At low concentrations of DTT (less than or equal to 2 microM) there is enhancement of the Kx antigen concomitant with the complete denaturation of the Jsa and Jsb antigens of the Kell blood system. This unmasking of the Kx antigenic site is near maximal using 2 microM DTT. At this concentration of DTT, only the Jsa and Jsb antigens are completely denatured; all other Kell system antigens tested (K, k, Kpb, Ku) are essentially unaffected. These results argue against the Kx antigen serving strictly as a carbohydrate precursor substance involved in a sequential biosynthetic pathway of Kell blood group antigens. Also, McLeod red cells, after treatment with DTT, were found to contain Kx antigen, although in much lower density than normal red cells, indicating that, although not a typical carbohydrate precursor substance, Kx may, nevertheless, be essential for the serological expression of Kell related antigens. It is hypothesized that the Kx structure and the Kell blood group antigen structure are two separate subunits associated in a quaternary conformation involving at least one interchain S-S bond. Our results should allow for a clearer understanding of the relationship between the serological expression of the Kx antigen and the serologically observed reactivity of the Kell blood group antigens of individuals having normal, Ko and McLeod phenotypes.

Extravascular hemolysis following the administration of cefamandole

Hemolytic anemia occurred in a 70-year-old female after a five-day course of intravenous cefamandole. The patient's serum contained an IgG antibody which was reactive with red blood cells which had been coated in vitro with cefamandole but not with uncoated cells. An in vitro assay of allogeneic mononuclear phagocytosis of cefamandole-coated red cells sensitized with the patient's anti-cefamandole indicated that the anti-cefamandole could induce significant phagocytosis. The anti-cefamandole was easily inhibited in vitro by cefamandole as well as by a variety of related cephalosporins indicating broad cross-reactivity, with the antigenic site primarily the 7-amino-cephalosporanic acid nucleus. Penicillins could inhibit the anti-cefamandole but only when using concentrations 3-10 X those of cephalosporins. Eleven examples of anti-penicillin tested failed to react with cefamandole-coated red cells. Screening of 344 random sera from hospitalized patients found only five (1.5%) reactive with cefamandole-coated red cells; three of these sera were also reactive with penicillin-coated red cells. The patient's hemolysis subsided following cessation of the drug. This is the first report of anti-cefamandole-induced hemolytic anemia.

Erythrocyte depletion of ABO-incompatible bone marrow

Bone marrow transplantation results in the infusion of 150 to 360 ml of erythrocytes. While this poses no problem to a recipient of marrow from an ABO-compatible donor, it clearly represents a serious risk of intravascular hemolysis for the recipient of an ABO-incompatible marrow. Thus, there is a need for removing incompatible erythrocytes from the marrow preparation. We removed erythrocytes from the marrow preparations by automated centrifugation. The erythrocyte-depleted marrow (EDM) contained a mean of 5 ml erythrocytes, representing an average reduction of 98%. The mean mononuclear cell recovery was 88%, resulting in a mean infusion of 0.6 X 10(8) cells/Kg of recipient's body weight in a final average volume of 155 ml. EDM was infused into 22 ABO-incompatible marrow recipients (21 patients with hematologic malignancies and one patient with aplastic anemia) without clinical evidence of hemolysis. The isohemagglutinin titers of recipients ranged from 4 to 4096 and were not lowered prior to infusion. Engraftment (i.e., recovery of peripheral leukocyte and platelet counts) and incidence of graft versus host disease were similar to those observed in recipients of ABO-compatible marrow transplantation. Erythrocyte engraftment was significantly delayed in only one patient who had a high isohemagglutinin titer. The post-transplantation red cell requirement was increased in EDM recipients: 9 units compared to 6 units in ABO-compatible bone marrow transplanted patients with neither hemolysis nor interference with successful engraftment.

Two distinct categories of warm autoantibody reactivity with age-fractionated red cells

Using age-fractionated erythrocytes, warm autoantibodies can be classified into two distinct categories, depending on their reactivity with reticulocyte-enriched (younger) or reticulocyte-poor (older) red cell fractions. The strength of the direct antiglobulin test (DAT) on the age-fractionated red cells of 24 patients indicated that 19 (79%) had an IgG warm autoantibody that reacted preferentially with older red blood cells. In 7 of these 19 patients (37%), the DAT was negative using reticulocyte-enriched red cell fractions. We have termed this preferential reactivity of warm autoantibodies with older red cells as type I. Five of the 24 patients studied (21%) had an IgG warm autoantibody that demonstrated no preference for young or older red cells. We have termed this pattern of warm autoantibody reactivity as type II. All 5 patients having type II warm autoantibodies had severe anemia. In contrast, 6 of 19 patients having type I warm autoantibody did not have clinical evidence of anemia when tested, and 11 of the 19 had only slight to moderate anemia. Additionally, our results using type I warm autoantibody raise questions regarding the blood group specificity of warm autoantibodies. The antigen recognized by type I warm autoantibody may be a cryptantigen. Rh specificity or relative Rh specificity, often associated with warm autoantibodies, may simply be a coincidental finding.

In vitro determination of red cell alloantibody significance using an assay of monocyte-macrophage interaction with sensitized erythrocytes

One hundred and forty-eight red cell alloantibodies, of specificities generally considered to be of clinical significance, were studied in vitro for their ability to induce phagocytosis of sensitized red cells by allogeneic mononuclear phagocytes. Results indicate that only 53% of the alloantibodies studied mediated significant phagocytosis in vitro. The percentages for each blood group system were as follows: Kell, 73%; Jka, 32%; Jkb, 67%; D, 75%; E, 60%; Fya, 62%; Yta, 25%; Ge, 22%; and Vel, 25%. Significant phagocytosis was independent of the strength of the indirect antiglobulin test. The percentage of anti-Jka and anti-Fya mediating significant phagocytosis was increased when fresh complement was added during the sensitization procedure and/or red cells homozygous for the antigen in question were used. The in vivo clinical significance or lack of significance was documented for nine alloantibodies; five caused haemolysis and four did not. Those causing in vivo haemolysis mediated in vitro phagocytosis by monocyte-macrophages whereas the antibodies that did not result in haemolysis showed no increased in vitro phagocytosis. Autologous monocytes were more reliable than random allogeneic monocytes in that phagocytosis was increased over that obtained using allogeneic monocyte-macrophages with two of four alloantibodies having documented clinical significance. The use of target red cells homozygous for the antigen in question, the addition of fresh complement in the antibody sensitization procedure, and use of autologous and allogeneic monocyte-macrophages appear necessary for optimal results. Since 47% of those alloantibodies generally considered to be clinically significant failed to mediate phagocytosis in vitro, the monocyte-macrophage assay should not be considered a predictive assay of a given alloantibody's in vivo significance or lack of significance until more extensive correlation of these assays with in vivo red blood cell survival is obtained.

Discrepant in vitro versus in vivo interaction of M-positive donor red cells with IgG1 anti-M

Following massive transfusion and a suspected sepsis, a patient produced a potent, high titer IgG1 anti-M alloantibody reactive at 37 degrees C with an indirect antiglobulin test [IAT] titer using anti-IgG of 1:512 versus MM red blood cells (RBC). During pretransfusion tests, the antibody was strongly reactive with M+ RBC using IAT, however, transfused M+ RBC remained in circulation and demonstrated normal red cell survival. The direct antiglobulin test remained negative and no antibody activity was detectable in eluates prepared at various times from red cells obtained from the patient post transfusion. There was no direct agglutination of red cells obtained from the patient post transfusion with autologous serum, even at 4 degrees C. However, these samples contained donor M+ RBC as determined by tests using various examples of human and rabbit anti-M antisera. The extraordinary findings of transfused M+ RBC, highly incompatible pretransfusion using IAT, coexisting with potent warm reactive anti-M antibody without evidence of in vivo antibody-antigen interaction represents an unusual discrepancy. Although the explanation for these findings remains unclear, it may indicate antigen modification of donor red cells in vivo.