[Herpes zoster in immunosuppressed patients with immuno-inflammatory disease]

We analysed 19 episodes of herpes zoster in 16 patients, who received cytotoxic drugs or cyclosporin for immuno-inflammatory disease. Reactivation of varicella-zoster virus was not associated with increased activity of the rheumatic disease nor with increased intensity of immunosuppressive therapy. Six of the patients who had received the largest cumulative doses of cytotoxic drugs had fever and/or vesicles outside the primarily affected dermatome. Two of these patients developed post-herpetic neuralgia. Although not encountered in this material, immunocompromised patients may develop severe complications of herpes zoster, and therefore prompt treatment with acyclovir is recommended in all cases. It is suggested that oral acyclovir therapy is sufficient in uncomplicated cases but this question has not been elucidated in controlled studies.

NcoI restriction fragment length polymorphism (RFLP) of the tumor necrosis factor (TNF alpha) region in four autoimmune diseases

The two-allele NcoI Restriction Fragment Length Polymorphism (RFLP) of the TNF alpha region yielding bands of 5.5 and 10.5 kb was investigated in patients with systemic lupus erythematosus (SLE), pauciarticular juvenile rheumatoid arthritis (P-JRA), rheumatoid arthritis (RA) and primary Sjögren's syndrome (pSS). In all four disease, we found a decreased frequency of the 10.5 kb allele which, however, was significant only in the SLE group. In all conditions except RA, the frequency of the 5.5 kb fragment was increased. In pSS and SLE, the frequency of HLA-B8 was increased in 5.5 kb fragment positive patients compared with corresponding controls and thus, the increase of this band and the decrease of the 10.5 kb band may be secondary to HLA-B8 associations owing to strong positive linkage disequilibrium between HLA-B8 and the 5.5 kb band.

A haemolytic plaque forming assay for identifying cells producing anti-DNA antibodies

A murine hybridoma cell line (aDNA35I9) secreting anti-DNA antibodies was used as a model for haemolytic plaque forming cells in an assay where DNA-conjugated sheep red blood cells (DNA-SRBC) were used as target cells. DEAE-dextran, employed to abolish the anti-complementary activity of agar gel, completely inhibited anti-DNA plaques. This problem was solved by using agarose instead of agar. Since the occurrence of small plaques may make reading of the test difficult, it was established that plaque size could be increased by decreasing the antigen density on the target cells. Free DNA in the gel inhibited plaque formation, indicating the specificity of the assay. Spleen cells from mice of the strains MRL/MP and NZB/W which are known to develop a stage of autoimmunity, produced plaques in numbers which were correlated to the age of the mice and to the anti-DNA antibody level in serum.

The occurrence of aminopeptidase N and desquamated cell proteins in intestinal perfusate of the rat

The in vivo release of a microvillar enzyme, aminopeptidase N (EC 3.4.11.2), and a cytosolic enzyme, lactate dehydrogenase (EC 1.1.1.27), into the intestinal lumen was measured to gain information on the fraction of desquamated cell protein in intestinal juice and on the mechanism of release of intestinal microvillar enzymes. 1.6% and 2.9% of the mucosal activities of aminopeptidase N and lactate dehydrogenase were released to the intestinal lumen per hour, respectively. The ratios between aminopeptidase N and lactate dehydrogenase in intestinal perfusates and mucosal homogenates were similar. This result is compatible with the view that aminopeptidase N in the rat small intestine is predominantly released into the intestinal lumen by desquamation of enterocytes. This conclusion was supported by the failure to demonstrate microvesiculation of the microvilli by electron microscopy. 30-40% of the aminopeptidase N in the intestinal lumen is membrane-bound indicating that partial solubilization occurs during desquamation. The addition of calcium ions did not augment the release of aminopeptidase N or the membrane-bound fraction in the lumen. 10-20% of the protein content in the intestinal lumen is due to extruded cell protein. This includes aminopeptidase N which constitutes 1% of the luminal protein.

Decreased B lymphocyte ecto-5'nucleotidase and increased adenosine deaminase in mononuclear cells from patients infected with human immunodeficiency virus

The levels of purine enzyme activities were studied in 10 patients with acquired immunodeficiency syndrome (AIDS) or AIDS related complex (ARC) and in 6 healthy individuals with antibodies against human immunodeficiency virus (HIV). All AIDS/ARC patients studied had ecto-5'nucleotidase (ecto-5'NUC) activity in B lymphocytes below the normal range and 4 out of 6 clinically healthy HIV-positive likewise had reduced activity. Increased numbers of activated B lymphocytes were found both in the group of healthy HIV positive individuals and in AIDS/ARC patients. Further studies are needed to define whether the decrease in ecto-5'NUC activity on the B lymphocytes is a result of increased activation of the cells or of a B cell defect. No significant changes were found in ecto-5'NUC levels in T lymphocytes or mononuclear cells (MNC), neither in the group of AIDS/ARC patients nor in the healthy HIV-positive group. Both AIDS/ARC patients and healthy individuals with antibodies against HIV had increased levels of adenosine deaminase (ADA) activity in mononuclear cells, but only in the group of AIDS/ARC patients was the increase significant. No changes were found in purine nucleoside phosphorylase (PNP) activity in the two groups tested. From these investigations of purine enzyme levels and other markers of immune function in both sick and healthy HIV infected individuals we conclude that the observed changes in ecto-5'NUC and ADA activities in HIV infected patients are not a direct result of the HIV infection but develop early in the course of the disease.

Modulation of natural killer cell activity in peripheral blood by physical exercise

The present study was designed to examine the effect of physical exercise on human natural killer (NK) cells. Six healthy volunteers underwent two different acute physical exercise tests with an interval of at least 1 week: (1) 60 min bicycle exercise at 80% of maximal oxygen uptake (VO2max) and (2) 60 min back-muscle training at up to 29% of VO2max; blood samples were collected before and during the last few minutes of exercise, as well as 2 h and 24 h afterwards. The NK cell activity (lysis/fixed number of mononuclear cells) increased during bicycle exercise, dropped to a minimum 2 h later and returned to pre-exercise levels within 24 h. Back-muscle exercise did not significantly influence NK cell activity. Plasma levels of adrenaline, noradrenaline, and cortisol were elevated during bicycling, but not during back-muscle exercise, indicating that exercise intensity is a determinant of NK cell activity. During bicycle exercise the NK cell subset (CD16- cells) of mononuclear cells increased significantly. Furthermore an improved interleukin 2 (IL-2) boosting of the NK cell activity was found during work as compared to IFN-alpha and indomethacin-enhanced NK cell activity. These results indicate that NK cells with a high IL-2 response capacity are recruited to the peripheral blood during exercise. The decreased NK cell activity demonstrated 2 h after work was probably not due to fluctuations in size of the NK cell pool, since the proportion of CD16+ cells was normal. The finding that indomethacin fully restored the suppressed NK cell activity in vitro and the demonstration of a twofold increase in monocyte (CD20+ cells) proportions 2 h after work, strongly indicate that prostaglandins released by monocytes during the heavy physical exercise are responsible for the down-regulation of the NK cells.

Immune hemolytic assay for identification of human anti-dsDNA antibodies with DNA-coated red blood cells as target cells

A hemolytic assay was developed with the primary aim of being able to identify human lymphocytes producing anti-dsDNA antibodies found in patients with systemic lupus erythematosus (SLE). The coating of sheep red-blood cells with DNA was performed after precoating the cells with poly-L-lysine. The DNA-SRBC were lysed by anti-DNA antibodies from SLE sera, and the percent hemolysis was found to correlate with the anti-DNA activity demonstrated by the Farr assay (r = 0.87). Single-stranded DNA at the surface of the coated cells could be removed after digestion with nuclease S1. The effect of the digestion was verified by SLE serum specific for single-stranded DNA. With slight modifications, the target cells may be used to determine not only the titer of anti-DNA antibodies but also the complement-consumption and immunoglobulin classes of the anti-DNA antibodies.

Depressed natural killer cell activity in acute myocardial infarction

Natural killer (NK) cell activity against K562 target cells was measured in patients within 24 h of acute myocardial infarction (AMI) and regularly thereafter for 6 weeks. NK cell activity was suppressed on days 1, 3, and 7 (P less than 0.01), day 14 (P less than 0.05) and at 6 weeks (P = 0.05) when compared to controls. Interferon, interleukin 2 and indomethacin enhanced NK cell activity on all days measured, but did not completely restore the defective NK cell activity. Serum from the patients did not suppress the NK cell activity of healthy mononuclear cells. The number of NK cells, identified as large granular lymphocytes (LGL), measured on days 1, 3, and 14 and at 6 weeks was not reduced in comparison to that of controls. Thus, the defective NK cell activity can be characterized as functional.

Conjugation of DNA to erythrocytes

DNA was conjugated to sheep red blood cells (SRBC) by chemical methods using CrCl3, poly-L-lysine or methylated bovine serum albumin as conjugation agents and by a physical method where conjugation was accomplished by incubation at 45 degrees C. The degree of conjugation was estimated using 32P-DNA (mean size 1 kbase pairs). Employing the CrCl3 method 5.8 +/- 3.6 micrograms DNA were conjugated per 10(8) SRBC at a concentration of 70 micrograms DNA/10(8) cells. At the same DNA concentration in the incubation medium 3.0 +/- 0.6 microgram DNA/10(8) cells were conjugated by poly-L-lysine, 4.1 +/- 0.8 microgram DNA/10(8) cells by methylated bovine serum albumin and approximately 4 micrograms DNA/10(8) cells when the cells were incubated at 45 degrees C. Cells conjugated with DNA by CrCl3 showed linearly increasing conjugation with increasing concentration of DNA. Cells conjugated by poly-L-lysine (pLL) or methylated bovine serum albumin seemed to be saturated by DNA at 30 micrograms DNA per 10(8) cells. At 45 degrees C the spontaneous adhesion of DNA to SRBC increased in the concentration range investigated. The degree of conjugation of DNA to SRBC was influenced by pH, and Ca2+.pLL-conjugated DNA-SRBC, but none of the other preparations were lysed in a hemolytic assay using anti-DNA antiserum from a patient with systemic lupus erythematosus.

Transport of the alpha-amino-mono-carboxylic acid L-alanine by the beta-alanine carrier of the rabbit ileum

The proposal that the beta-alanine carrier of the rabbit ileum is a high affinity carrier of the neutral amino acids was examined by means of measurements of influx across the brush border membrane of the intact epithelium using L-alanine as a representative of the neutral amino acids. Confirming the proposal, evidence was provided for mutual competitive inhibition between beta-alanine and L-alanine; and it was also demonstrated that a process contributes to the influx of L-alanine, which is characterized by a maximum rate of transport equal to that of beta-alanine and a Kt, which is equal to the Ki of L-alanine against the influx of beta-alanine. In the concentration range 0.01 to 0.125 mM the influx of L-alanine was found to be linearly related to the concentration indicating a significant unstirred layer influence on present and previous estimates of the Kt values for influx of amino acids across the brush-border membrane of intact intestinal epithelia.

Selective modulation of the CD4 molecular complex by Pseudomonas aeruginosa alkaline protease and elastase

The binding of monoclonal antibodies against CD4 was specifically inhibited by treatment of human CD4+ cells with either alkaline protease (AP) or elastase (Ela), purified from Pseudomonas aeruginosa. Binding of antibodies against CD3 (pan T), CD5 (pan T), CD8 (T suppressor/cytotoxic), HLA-ABC, HLA-DR, HLA-DQ, HLA-DP/DR, and beta 2 microglobulin was not inhibited by AP or Ela. Heat-inactivation of the proteases at 65 degrees C for 20 min or treatment with the metal chelator EDTA abolished the inhibitory activity of both proteases. These findings may serve to develop novel immunological methods for the isolation and study of the lymphocyte CD4 structure, which plays an important part in the immune response.

Influence of projection angles upon position of cementoenamel junction on radiographs

The CEJ on radiographs is often used as a reference point in the assessment of alveolar bone loss. The aim of the present study was to test the stability of the radiographic CEJ ("RCEJ") in relation to the alveolar crest under varying angulations of the central X-ray beam. In an experimental model four types of extracted teeth were radiographed at 0 degree and 20 degrees vertical angulation and at 15 horizontal angulations varying from a 17.5 degrees mesial view to a 17.5 degrees distal view. The buccal alveolar bone margin was simulated by a steel needle. RCEJ-"crest" distances were read at a X 10 magnification. Changing the vertical angulation from 0 degree to 20 degrees reduced the RCEJ-"crest" distances for all tooth types (range of average reduction 2.2-4.1 mm). Horizontal angulations without concomitant vertical angulation had a significant effect but were without clinical significance. Horizontal angulations in combination with a 20 degrees vertical angulation had a considerable influence; in a mesial view, mesial RCEJ-"crest" distances decreased and distal ones increased, and vice versa in a distal view. The deviations from the true CEJ-crest distance demonstrated may be of clinical significance, and a critical attitude to alveolar bone loss measures on radiographs using the RCEJ as reference point is recommended.

Erythrocyte CR1 (C3b/C4b receptor) levels and disease activity in patients with SLE

Fifty-four patients with systemic lupus erythematosus (SLE) were examined for (1) CR1 (C3b/C4b receptor) levels on erythrocytes by an enzyme-linked immunosorbent assay, (2) levels of circulating immune complexes (IC) by a polyethylene glycol precipitation complement consumption method, and (3) concentrations of C3d split products in plasma by intermediate gel rocket immunoelectrophoresis. A preponderance of low CR1 levels was found among patients with SLE (mean 40%, range 13-106) as compared with normal controls (mean 70%, range 24-130) (p less than 0.001). The concentrations of circulating IC were elevated in 38% of 58 samples. The concentrations of C3d were elevated in 72%, and were positively correlated with the levels of IC (tau = 0.28; p less than 0.005) and with disease activity as assessed by a modification of the UCH/Middlesex criteria. Negative correlations were seen between the CR1 numbers and disease activity (p = 0.01), concentrations of circulating IC (tau = -0.14; p less than 0.005), and C3d (tau = -0.21; p less than 0.005). The changes found in CR1 levels on repeated study were, however, relatively small (less than or equal to 27%; median 5), even during periods of changing disease activity.

Interleukin 2 augmentation of the defective natural killer cell activity in patients with primary Sjögren's syndrome

Natural Killer (NK) cell activity against K562 target cells was measured in 21 female patients with primary Sjögren's syndrome (primary SS) and in 20 female normal controls matched for age. The in vitro effect of alpha-interferon (IF) and interleukin 2 (IL-2) on NK cell activity was examined and the percentage of large granular lymphocytes (LGL) in blood was measured. Median baseline NK cell activity in primary SS was 15.4% versus 24.4% in the controls (P less than 0.05). Median IF-enhanced NK cell activity in the SS group was 35.5% versus 49.6% in the controls (P less than 0.02). IL-2-enhanced NK cell activity was 35.5% versus 37.6% in the controls (n.s.) The proportion of LGL did not differ in the two groups. Median LGL/lymphocytes was 4.0% in the primary SS patients versus 4.5% in the controls (n.s.). We conclude that the defective NK cell activity in patients with primary SS is functional, as the number of LGL is normal. Further the NK cell activity off SS was restored by IL-2.

Bradycardia after high-dose intravenous methylprednisolone therapy

In 5 consecutive patients with rheumatoid arthritis who received intravenous high-dose methylprednisolone (MP) therapy (1 g daily for 2 or 3 consecutive days), a decline in pulse rate was observed, most pronounced on day 4. In one of the 5 patients the bradycardia was associated with complaints of substernal pressure. Reversal to normal heart rate was found on day 7. Electrocardiographic registrations showed sinus bradycardia in all cases. No significant changes in plasma concentrations of electrolytes were found. Careful observation of patients receiving high-dose MP is recommended. High-dose MP may be contraindicated in patients with known heart disease.

Sézary syndrome: phenotypic and functional characterization of the neoplastic cells

Phenotypic properties of the neoplastic cells in skin, blood and lymph node specimens from 5 patients with the Sézary syndrome were examined by immuno-enzymatic and -fluorescence labelling of cells and tissue sections with a monoclonal antibody panel. In 3 cases, the in vitro functional properties of the neoplastic cells (isolated from blood specimens) were also analysed using a reverse plaque-forming cell assay. 3 different immunological categories were identified as follows: T-helper/inducer neoplasms (3 patients); T-suppressor/cytotoxic neoplasms (1 patient); and neoplastic T-cells demonstrating characteristics consistent with a concept of their derivation from inducible suppressor T-cells (1 patient). These data provide conclusive evidence that Sézary syndrome is heterogeneous with respect to the immunological characteristics of the neoplastic cells.

Interaction of human IgG preparations with polymorphonuclear leukocytes in vitro

The effect of purified human immunoglobulin G, prepared for intravenous administration by polyethylene glycol precipitation and ion exchange chromatography, on polymorphonuclear leukocytes (PMN) in vitro was studied. IgG induced a dose-dependent stimulation of the oxidative metabolism of the cells, as measured by release of superoxide anion and by chemiluminescence. The lowest concentration giving a detectable effect was 0.001 mg/ml. Two commercially available preparations of IgG for clinical intravenous use caused similar stimulation of the PMN although they differ in methods of isolation and purification. The addition of 10% maltose markedly reduced the stimulation by all three preparations of IgG. We suggest that i.v. infusion of purified IgG may lead to activation in vivo of host phagocytic cells without participation of complement, and that this interaction may be responsible for the hitherto unexplained side-effects caused by i.v. infusion of such preparations.

Hypogammaglobulinaemia in systemic lupus erythematosus: report of a case with evidence for spontaneously activated T suppressor cells

A patient with hypogammaglobulinaemia associated with systemic lupus erythematosus (SLE), a healthy HLA-A, B, C, D-identical and mixed lymphocyte culture (MLC)-negative sibling, and two mutually HLA-A, B, C, D-identical siblings were investigated. Blood mononuclear cells from the patient contained a high proportion of T lymphocytes with the suppressor/cytotoxic phenotype, and in vitro no development of Ig-secreting cells was observed in response to pokeweed mitogen (PWM) or to Epstein-Barr virus (EBV), as opposed to cell cultures from the siblings. In cell cultures from the two healthy HLA-identical siblings, T-lymphocytes as well as monocytes/macrophages (M phi's) could be replaced with corresponding cells from the sibling without major alterations of the pokeweed mitogen (PWM)-induced B cell response. In PWM-stimulated co-cultures of B cells from the patient with healthy HLA-identical T cells, moderate numbers of IgM-secreting cells developed, but not IgG- or IgA-secreting cells. T cells from the patient co-cultured with healthy HLA-identical B cells suppressed their Ig-secretion; this effect was abolished by irradiation of the T cells. The in vitro generation of T suppressor cells by concanavalin A (ConA) was normal. No evidence for abnormal suppressor function of monocytes/macrophages was obtained. Thus in this patient, spontaneously activated T suppressor cells as well as defective B cells were associated with hypogammaglobulinaemia.

Spontaneous in vitro immunoglobulin secretion at the diagnosis of insulin-dependent diabetes

Blood mononuclear cells obtained from 17 newly diagnosed insulin-dependent diabetic (IDDM) patients treated with insulin for 5-7 days were assessed for the number of spontaneous and pokeweed mitogen (PWM)-stimulated immunoglobulin-secreting cells in a reverse haemolytic plaque assay. The spontaneous in vitro immunoglobulin secretion was evanescent and decreased in individual patients within 1-4 months of insulin treatment. Compared to matched controls, 53% (9/17) of the IDDM patients had an elevated spontaneous secretion of immunoglobulin, 41% (7/17) for IgG, 35% (6/17) for IgM, and 35% (6/17) for IgA. The quantities of PWM-stimulated IgG, IgM, or IgA secreting cells in IDDM were comparable to the controls. The IDDM patients with spontaneous immunoglobulin secreting cells had higher fasting C-peptide levels compared to the patients with immunoglobulin-producing cells within the normal range (P less than 0.05). The average titre of islet cell cytoplasmic antibodies was 1:26 in (9 out of 9 were positive) patients with, compared to 1:1 in patients (4 out of 8 were positive) without spontaneous secretion (P = 0.025). These results suggest that the clinical onset of IDDM is associated with a polyclonal B lymphocyte activation and that higher levels of fasting C-peptide islet cell antibodies are associated with this immunoregulatory abnormality.

Induction of immunoglobulin secretion in cultured human lymphocytes by 4 Staphylococcus aureus strains and their extracts

Human blood lymphocytes were stimulated in vitro by four Staphylococcus aureus strains. Activation of immunoglobulin-secreting cells was determined by a reverse plaque forming cell (PFC) assay, and proliferation by quantitation of thymidine incorporation. Whole killed S. aureus were slightly more efficient than water-soluble preparations in the form of sonicated extracts and culture supernatants. Two S. aureus strains rich in protein A (Cowan I and E 2371) and one S. aureus strain deficient in protein A (E 1369) were potent B-lymphocyte stimulators inducing maximal activity on day 6 of culture. Another S. aureus strain deficient in protein A (Wood 46) did not possess++ human lymphocyte stimulating capacity.

Lymphocyte function and chromosome aberrations in patients with early mycosis fungoides and parapsoriasis en plaques

Thirteen patients with stage I or II mycosis fungoides (MF) and 10 patients with large-plaque parapsoriasis en plaques (PEP) were examined for immunologic and cytogenetic disturbances. Total lymphocyte counts and immunoglobulin concentrations in the blood were normal. In vitro lymphocyte responses to polyclonal activators and various antigens in standard concentrations were normal. However, titration of phytohemagglutinin and concanavalin A (ConA) disclosed significantly lowered responses to suboptimal concentrations in the patient group, most pronounced in patients with MF II. ConA-induced leukocyte migration inhibitory factor (LIF) production, tested in an indirect leukocyte migration inhibitory assay, was low in the patient group. Furthermore spontaneous LIF production in vitro and small amounts of serum LIF were demonstrated in a few patients. The chromosomal banding pattern, sister chromatid exchange, and break frequency were within normal limits except for 3 translocations in the MF group. It is concluded that even in early-stage MF a pathologic function of blood lymphocytes can be demonstrated, when sensitive methods are applied. The findings might be important for monitoring disease activity and effect of treatment.

Storage of protein A-conjugated sheep erythrocytes for use in plaque-forming cell (PFC) assays

Sheep red blood cells conjugated with protein A from Staphylococcus aureus were frozen in liquid nitrogen. After thawing these cells were used as indicator cells in a plaque-forming cell assay visualizing human B lymphocytes secreting IgG, IgM or IgA. The thawed erythrocytes performed as well in the assay as erythrocytes freshly conjugated with protein A. Recovery of conjugated erythrocytes after freezing and thawing averaged 66%. By the method described indicator cells for a number of PFC assays may be prepared in bulk, frozen in suitable portions and thawed when needed. This prevents possible batch-to-batch variations and saves time.

Suppression of B lymphocytes in mature newborn infants

The ability of cord blood lymphocytes to secrete immunoglobulins during in vitro culture was investigated by means of a reverse hemolytic plaque forming cell (PFC) assay. Mononuclear cord blood cells did not differentiate into immunoglobulin-secreting cells after stimulation with the polyclonal B lymphocyte activator pokeweed mitogen (PWM), contrary to the findings in normal adults. Mononuclear cord blood cells were then separated into T-enriched and T-depleted blood lymphocyte subsets. When these were co-cultured, the PWM-induced immunoglobulin secretion was still low; following irradiation of the T-enriched cells, the numbers of IgM-PFC but not of IgG- or IgA-PFC increased considerably. The effect of irradiation of the T-enriched cells on the PWM-induced IgM response was dose-dependent, with maximal effect at 2500 rad. It is concluded that the low PWM responses obtained using cord blood lymphocytes are in part due to suppression by radiosensitive T suppressor cells. Following removal of this suppression by means of irradiation, B lymphocytes can be induced to secrete IgM, but not IgG or IgA.

Immunological studies in two children with recurrent parotitis

In two children with recurrent parotitis, labial salivary gland biopsies showed chronic sialoadenitis. Immunofluorescence studies disclosed deposits of immunoglobulins and complement in juxta-acinar small vessels. Case 1 had gluten enteropathy, IgA deficiency and high titres of antinuclear antibodies (ANA), and in vivo fixation of ANA to nuclei of different cells in lip, skin and jejunum was present. Case 2 showed deposition of IgM in the dermo-epidermal junction of the skin. These findings suggest that autoimmune reactivity and immune complexes may play a role in the pathogenesis of this disorder.

Secretion of IgM-rheumatoid factor and IgM by blood lymphocytes in rheumatoid arthritis

A direct plaque forming cell (PFC) assay for the detection of complement fixing IgM-rheumatoid factor (RF) secreting lymphocytes was evaluated. The specificity of the RF-PFC assay was demonstrated by the inhibitory action of exogenous human IgG. The sensitivity of the RF-PFC assay was similar to that of a reverse PFC assay detecting all cells secreting IgM (IgM-PFC). In blood from 75% of seropositive patients with rheumatoid arthritis (RA) RF-PFC were demonstrated, median value 6.8 (range: 0.4-1477) RF-PFC/10(6) mononuclear cells. Practically no RF-PFC were detected in seronegative RA patients and controls. Despite the fact that most IgM-RF undoubtedly is produced outside the blood, a positive correlation was found between the number of RF-PFC and the Waaler-Rose titer in serum. The number of circulating IgM secreting cells did not differ significantly between seropositive RA patients, seronegative RA patients and controls. Comparison of RF-PFC and IgM-PFC in seropositive patients revealed that in mean 7% of IgM-secreting cells in blood secrete IgM-RF.

Synovial fluid and blood monocyte influence on lymphocyte proliferation in rheumatoid arthritis and traumatic synovitis

The influence of synovial fluid and blood monocytes on autologous lymphocyte proliferation in vitro was investigated in patients with rheumatoid arthritis (RA) and traumatic synovitis (TS). In cultures stimulated with PHA, PWM and ConA, thymidine incorporation by RA blood mononuclear cells (BMC) increased considerably in most cases after addition of 10% or 30% synovial fluid monocytes and a similar effect was seen after stimulation with Candida extract or PPD. A comparable helper activity was observed after addition of synovial fluid monocytes to monocyte-depleted blood cells in RA. The augmenting effect of synovial fluid monocytes was likewise demonstrated in TS patients. Synovial fluid mononuclear cells (SMC) from RA and TS patients displayed low proliferative responses to PHA and ConA in comparison with BMC, while the responses to microbial antigens were similar or greater. The proliferative activity of SMC or of monocyte-depleted synovial fluid cells after polyclonal and antigenic stimulation was not affected by addition of blood monocytes. This was observed in both RA and TS patients. It is concluded that the regulatory properties of synovial fluid monocytes in RA and TS do not explain the low proliferative responses of SMC to polyclonal activators.

Induction and abrogation of suppressor cell function in humans: effect on B cell activation by different polyclonal activators

In a reverse plaque forming cell (PFC) assay, the effect of concanavalin A (Con-A)-induced suppressor cells on polyclonally activated B lymphocytes was studied. Differentiation to PFC, as induced by pokeweed mitogen (PWM), Staphylococcus aureus or Epstein-Barr virus (EBV) was in all cases suppressed by the addition of ConA-pretreated cells. The EBV-stimulated cells showed the smallest PFC response and appeared least amenable to suppression. IgA-secreting cells were less suppressible than IgM- and IgG-secreting cells regardless of the polyclonal B lymphocyte activator used. The suppressor cells were radiosensitive.

Influence of autologous monocytes on the pokeweed mitogen-induced generation of immunoglobulin-secreting cells in man

The regulatory influence of autologous blood monocytes on the PWM-induced generation of Ig-secreting cells was assessed using a reverse haemolytic plaque forming cell (PFC) assay. The PWM-induced PFC responses of monocyte-depleted cells were low or absent in most cases. Addition of 12-42% freshly isolated monocytes fully reconstituted the IgM-, IgG- and IgA-PFC responses. With more monocytes added, the PFC responses declined. Monocytes precultured for 48 h supported the PFC responses of monocyte-depleted cells less well and addition of monocytes stimulated with phorbol myristate acetate (PMA) did not increase the response. The low responses of monocyte-depleted cells co-cultured with precultured monocytes were not increased by addition of supernatant from monocyte cultures. The PFC responses of mononuclear cells induced by PWM were significantly inhibited by unstimulated precultured monocytes, and to a larger degree by PMA-treated monocytes, indicating the presence of suppressor cells among the precultured monocytes. The PWM-induced thymidine incorporation by monocyte-depleted cells with precultured monocytes added was only slightly lower than that obtained with freshly isolated monocytes added, suggesting that the suppressive role of precultured monocytes was not due to cytotoxicity.

In vitro lymphocyte proliferation in response to polyclonal activators and microbial antigens, and production of immunoglobulins stimulating thyroid adenylate cyclase in Graves' disease

Cultures of blood lymphocytes from 16 patients with Graves' disease (GD) and 14 matched controls were studied. Incorporation of [14C]thymidine was significantly increased in unstimulated cultures of GD lymphocytes, while the incorporation after stimulation with polyclonal activators (concanavalin A, pokeweed mitogen, phytohaemagglutinin), microbial antigens (E. coli, Candida albicans extract, purified protein derivative of tuberculin, Yersinia enterocolitica serotype 3) and subcellular fractions of human thyroid antigens did not differ from the controls. Due to the increased incorporation in unstimulated cultures, stimulation index is not suitable as an indicator of lymphocyte sensitization. After polyclonal activation or stimulation with thyroid antigens the lymphocytes were cultured for up to 21 days, and the supernatants were investigated for thyroid adenylate cyclase stimulating immunoglobulins (TACSI). No TACSI were demonstrated in supernatants of the lymphocyte cultures neither afer polyclonal activation nor after specific stimulation with several thyroid antigens.

Production and secretion of immunoglobulins by in vitro-activated human B lymphocytes

Activation induced by pokeweed mitogen in cultures of mononuclear cells from human blood was followed sequentially by simultaneous quantitation of live cells, thymidine incorporation, cells displaying cytoplasmic, IgM, IgG, IgA or IgD, cells secreting IgM, IgG or IgA and cumulated IgM secretion. Maximal cellular activity was found after 7 days of cultures, with means of 16000 IgM-, 20700 IgG- and 9900 IgA-secreting cells per 10(6) originally cultured cells. The cumulated IgM secretion after 21 days of culture averaged 10400 ng per 10(6) originally cultured cells. A close correlation was found between the number of IgM-secreting cells and the cumulated IgM secretion.

Functional characteristics of synovial fluid and blood mononuclear cells in rheumatoid arthritis and traumatic synovitis

The activity of blood mononuclear cells (BMC) and synovial fluid mononuclear cells (SMC) from patients with rheumatoid arthritis (RA) and traumatic synovitis (TS) was assessed by means of [14C]thymidine incorporation and production of leukocyte migration inhibitory factor (LIF). When compared with normal controls, spontaneous LIF production by BMC was found in 5 of 9 TS patients, whereas spontaneous LIF production by rheumatoid arthritis BMC and by SMC from both patient groups was infrequently seen. ConA-induced LIF production by BMC and SMC from both patient groups did not differ significantly from that of normal controls. Thymidine incorporation by unstimulated SMC and BMC was low in both patient groups. After stimulation with polyclonal activators, SMC showed significantly reduced proliferation in comparison with BMC, but the responses to microbial antigens were equal to or higher than those of BMC. The proliferative responses of stimulated SMC from TS patients were higher than the responses displayed by stimulated SMC from RA patients.

Specificity of lymphocyte stimulation in vitro by microbial preparations: importance of antigen concentration

Blood mononuclear cells were stimulated in vitro by 7 different microbial preparations, and thymidine incorporation was investigated in 7 groups of persons sensitized to the microorganisms and in 7 groups of controls. The sensitized persons were: 18 BCG-vaccinated, 13 with previous Mycoplasma pneumoniae pneumonia, 22 who had serum antibodies to Herpes simplex virus, 14 with previous typhoid fever, 13 with previous acute pyelonephritis caused by Eschrerichia coli, 6 with previous Haemophilus influenzae meningitis, and 15 tetanus-vaccinated persons. Employing microbial preparations corresponding to the type of sensitization, higher responses were obtained with PPD, Mycoplasma pneumoniae, Herpes simplex virus, Salmonella typhi and tetanus toxoid in sensitized than in controls, but the responses to E. coli and H. influenzae were similar. In each experiment a dose titration of the microbial preparation was carried out. The best separation between sensitized and non-sensitized persons was obtained at low concentrations, giving submaximal stimulation. It is concluded that lymphocyte responses to many microbial preparations are combined of antigen-specific components and of responses to cross-reacting or polyclonally activating moieties, and that the antigen-specific response is best investigated at low concentrations of these preparations.

Possible role of histamine in rheumatoid arthritis. Treatment with cimetidine and mepyramine

Basophilocytes from patients with rheumatoid arthritis (RA) responded to leukocyte nuclei from normal persons with histamine release; a similar histamine release induced by the nuclear components RNA and DNA has been demonstrated previously. A role of histamine in RA is also supported by the findings of clinical improvement during treatment with H1 and H2 antihistamines in six of 12 patients with RA in active phase, whereas four showed definite deterioration.

The invitro response of lymphocytes from adenoid vegetations and tonsils to PPD. Influence of autologous blood monocytes, T lymphocytes and unseparated lymphocytes

Thymidine incorporation in lymphocytes obtained from adenoids (AVL), tonsils (TL) and blood (PBL) and stimulated by PPD was compared in 19 BCG-vaccinated patients. Responses were approximately tenfold higher in vaccinated than in unvaccinated patients. The responses obtained for AVL/TL were lower than for PBL in BCG-vaccinated as well as in unvaccinated patients. In autologous mixtures of AVL/TL and PBL a linear increase in thymidine incorporation was obtained with increasing numbers of PBL. The monocyte concentration in cell suspensions obtained from adenoid and tonsil tissue was lower than in cells prepared from blood; addition of autologous monocytes purified from blood to cultures of AVL and TL was followed by a small increase in response to PPD, but not to the level of responsiveness of PBL. Addition of autologous T lymphocytes purified from blood to cultues of AVL and TL was followed by a small increase in thymidine incorporation, of similar proportions in cultures with and without PPD. It is concluded that the proportion of PPD-sensitized lymphocytes is smaller in AVL/TL than in PBL.