B7-1 (CD80) as target for immunotoxin therapy for Hodgkin's disease

In this preclinical study, the potential applicability of an anti-B7-1 immunotoxin (IT) for the treatment of Hodgkin's disease (HD) was investigated. Immunohistochemical analysis demonstrated strong expression of B7-1 on Hodgkin and Reed-Sternberg (R-S) cells and clear expression on dendritic cells, macrophages and some B-cells in tissues, but not on other tissue cells. Flow cytometric analysis demonstrated that B7-1 was expressed on a few monocytes, but not on CD34+ cells from bone marrow, resting T- or B-cells from peripheral blood or epithelial and endothelial cell lines. An anti-B7-1 immunotoxin containing the anti-B7-1 monoclonal antibody (MAb) B7-24 and saporin as toxin moiety was constructed and showed an affinity similar to that shown by the native MAb. It exhibited strong cytotoxicity against the B7-1+ B-cell line Raji (IC50 10(-11) M), R-S cell lines HDLM2, KM/H2 and L428 and also against a B7-1-transfected epithelial cell line, A431, whose parental line lacks expression of B7-1. In clonogenic assays with Raji cells or KM/H2 cells, a 3- or 4-log kill, respectively, was observed. No cytotoxicity was found against the B7-1- epithelial and endothelial cell lines or against haematopoietic progenitor cells. In conclusion, an anti-B7-1 immunotoxin was developed that had good cytotoxicity against R-S cell lines and that may be used in the elimination of R-S cells in vivo. A concomitant elimination of activated antigen-presenting cells may avoid development of antitoxin and anti-mouse Ig responses and allow repeated administration.

Human B7-1 is more efficient than B7-2 in providing co-stimulation for alloantigen-specific T cells

Besides a signal via the T cell receptor/CD3 complex, an additional costimulatory signal is required for optimal T cell activation. This signal can be delivered by interaction of either B7-1 or B7-2 expressed by antigen-presenting cells with CD28 on the T cells. Comparison of the function of B7-1 and B7-2 in different experimental animal systems generated conflicting data on the roles for the co-stimulatory molecules. We therefore investigated whether there are differences between B7-1 and B7-2-mediated co-stimulation in an alloantigen-specific primary T cell response induced by B7-transfected human cell lines of epithelial origin. Both transfected keratinocyte cell lines efficiently induce T cell proliferation and the ratios of stimulator versus responder cells are similar. The kinetics of proliferation and interleukin (IL)-2, IL-4 and interferon-gamma production are also comparable between both transfectant lines. However, despite equal B7 expression levels, it is consistently found that the magnitude of the B7-1-induced T cell proliferation was higher than that of B7-2. Comparison of precursor frequencies of helper T lymphocytes responsive with either B7-1 or B7-2 revealed that the frequency of B7-1-responsive T cells was higher than that of B7-2, and that the frequency of cells activated by a combination of B7-1 and B7-2 did not differ significantly from that of B7-1 alone. We therefore conclude that the B7-2-responsive T cells are part of the B7-1-responsive population, and that B7-1 on keratinocytes is more efficient in providing co-stimulation for alloantigen-specific T cells.

Alloantigen-specific T-cell anergy induced by human keratinocytes is abrogated upon loss of cell-cell contact

The activation of primary human T cells largely depends on the expression of both major histocompatibility complex (MHC) class II and B7 molecules on antigen-presenting cells (APC), whereas APC expressing HLA class II but not B7 antigens are expected to induce anergy. According to this concept, interferon-gamma (IFN-gamma)-activated keratinocytes (KC) expressing HLA class II but not B7 costimulatory antigens should be able to induce anergy. However, in terms of anergy versus activation contradicting data have been published on the outcome of interaction between T cells and human KC. In addition, it has been shown that human KC can express a B7-like molecule with unknown function, whereas MHC expression may be functionally impaired. To evaluate this item we transfected the human A431 KC cell line with B7-1 coding sequences and up-regulated HLA-DR by treatment with IFN-gamma, yielding A431DR,B7-1 cells. Irradiated A431DR,B7-1 cells were found to be capable of inducing vigorous proliferative primary T-cell responses in resting allogeneic T cells, whereas A431DR cells could induce proliferation only when interleukin-2 (IL-2) was added. These data indicate that KC can present alloantigens, and that lack of costimulatory molecules on KC is the main reason why these cells cannot induce primary T-cell responses. Surprisingly, however, no evidence could be obtained of stable anergy induction by A431DR cells, as T cells contacted with A431DR cells and then transferred to A431DR,B7-1 cells clearly demonstrated alloresponsiveness. T-cell non-responsiveness was maintained only when T cells remained in contact with A431DR cells. These data indicate that, despite expression of HLA class II in the absence of B7 costimulatory molecules, human KC cannot induce stable anergy but rather induce short-term anergy in primary resting T cells.

Prospects of immunotherapy for rheumatoid arthritis

The main challenge in the development of new modalities for the treatment of rheumatoid arthritis is to enhance the specificity while reducing the adverse side-effects of therapeutics. Biotechnology provides a variety of reagents, such as monoclonal antibodies, recombinant cytokines, cytokine antagonists, and small peptides, with the potential to interfere with selected stages of the disease process in a highly specific manner. In addition, several new therapeutic approaches have emerged as a result of extensive research with animal models of disease, including T-cell vaccination and bone marrow transplantation. This article discusses current insights into the pathogenesis of rheumatic diseases, focusing on rheumatoid arthritis. A number of new therapeutic modalities for rheumatoid arthritis, in particular those acting on the immune system, are discussed. Because it is not possible to provide a complete overview of all the developments in the field in limited space, a selection of strategies and modalities which are representative of the broad variety of immunotherapeutic approaches currently used are highlighted.

Clinical application of the polymerase chain reaction in the detection of HLA-B27 alleles

Most patients with ankylosing spondylitis (AS) express HLA-B27 antigens, which in routine clinical practice are conventionally detected by serological assays. Recent reports have been published demonstrating that HLA-B27 can also be detected by the polymerase chain reaction (PCR), with the purported advantages that the latter is faster, cheaper and more reliable than serological detection. In this study the technical reliability of HLA-B27 detection by PCR was demonstrated by the successful amplification of all the defined types of HLA-B27 alleles, while relevant non-HLA-B27 alleles could not be amplified. We have compared the sensitivity, specificity and practical applicability of HLA-B27 typing by serology versus PCR. HLA-B27 typing of 100 random individuals yielded identical results between serology and PCR, indicating that the sensitivity and specificity of serology and PCR are equal. Therefore, PCR with its practical advantages, may be considered the technique of choice for detecting HLA-B27 antigens.

Rheumatoid factor production in the joint

Mononuclear cells derived from bone marrow, synovium and peripheral blood of patients with rheumatoid arthritis (RA) were examined for their capacity to produce rheumatoid factor (RF) in order to investigate the origin of circulating RF. The results demonstrate that mononuclear cells derived from bone marrow are able to produce IgG-, IgA- and IgM-RF and that the amounts of RF produced by bone marrow cells are not significantly different from that by dissociated synovial cells. Since circulating immunoglobulins are mainly derived from the bone marrow this observation suggests that also RF circulating in RA patients mainly originates from the bone marrow.

Serology versus PCR-SSP in typing for HLA-DR and HLA-DQ: a practical evaluation

In this study, serological HLA-DR and -DQ typing results were compared to typing results obtained with sequence-specific primers in the polymerase chain reaction (PCR-SSP). HLA-DR typing was performed on a random caucasian population consisting of 31 patients and 73 healthy individuals. Considering HLA-DR1-10, differences in typing results were found in 3 out of 73 healthy individuals and 8 out of 31 patients. When HLA-DR1-16 alleles were taken into account, differences in typing results were found in 11 out of 31 patients and 14 out of 73 healthy individuals. Typing results of PCR-SSP, different from that of serology, were all confirmed by sequencing-based typing of HLA-DRB1 alleles. HLA-DQ1-3 typings were performed on 40 individuals consisting of 17 patients and 23 healthy individuals. Differences in typing results were found in 5 out of 17 patients and 1 out of 23 healthy individuals. From the results of this study it can be concluded that serology is a reliable technique, when restricted to identification of HLA-DR1-10 and HLA-DQ1-3 antigens in healthy individuals. By PCR-SSP, however, reliable HLA-DR1-16 and -DQ1-3 typings can be obtained both in patients and healthy individuals.

Rheumatoid factor production by mononuclear cells derived from different sites of patients with rheumatoid arthritis

To investigate the origin of circulating rheumatoid factor (RF) and the relation between RF production at different sites in patients with rheumatoid arthritis (RA), mononuclear cells derived from bone marrow, synovium and peripheral blood of patients with RA were examined for the presence of plasma cells and for their capacity to produce RF and other immunoglobulins in vitro. Analysis of culture supernatants for the presence of immunoglobulins demonstrated that cells derived from bone marrow, synovium and peripheral blood were all found to be capable of producing every immunoglobulin and RF isotype investigated. No significant correlations were found between concentrations of immunoglobulin isotypes produced by cells derived from different sites of one individual. Significant correlations were found, however, between concentrations of RF isotypes produced by cells derived from the three sites. These results indicate that the production of RF in the different compartments is not an autonomously regulated process. Mononuclear cells derived from bone marrow were found to be able to produce RF in similar quantities to cells dissociated from synovial tissue. In combination with the fact that circulating immunoglobulins are produced mainly in the bone marrow, this observation suggests that bone marrow is also a major source of circulating RF.

The relation between class-specific serum rheumatoid factors and age in the general population

Class-specific RFs were measured in serum samples obtained from 810 individuals in seven age categories between 20-100 yr old, who were randomly selected from the general population. There was a decline with age of the mean IgG-RF levels in the higher age categories, no change of the mean IgA-RF levels and a clear increase of the mean IgM-RF levels in the higher age categories. In most age categories, the percentage of increased levels of all three RF isotypes was higher in the general population than in the healthy control population, consisting of 100 blood donors. These observations suggest that reference values for serum RF should be age-specific and based on sera of individuals randomly selected from the population.

Rheumatoid factor isotypes in serum and salivary fluid of patients with primary Sjögren's syndrome

Salivary fluid and serum levels of immunoglobulin and rheumatoid factor (RF) isotypes were measured in patients with primary Sjögren's syndrome (SS) as well as in patients suspected of the syndrome in whom the diagnosis could be excluded (NON-SS) in order to investigate the site of RF production in primary SS and to determine the diagnostic value of determination of salivary fluid levels of RF. Increased salivary fluid levels of IgA-RF were found in 46% of 39 primary SS patients, 14% of 42 NON-SS patients, and in 2% of 41 healthy controls. Salivary fluid levels of other RF isotypes were not increased in the patient groups. The frequency of elevated titers of IgA-, IgG-, and IgM-RF in serum of primary SS patients was 51, 7, and 59%, respectively. The levels of IgA, IgG, and IgM in salivary fluid of primary SS patients were increased in 36, 31, and 23%, respectively. Comparison of RF levels in samples of serum and saliva from primary SS patients after correction for immunoglobulin levels indicated local production of IgA-RF in salivary glands. Significant positive correlations were found between IgA-RF levels in serum and saliva but not between the levels of immunoglobulin isotypes in the two compartments. The results of this study show that (1) increased levels of IgA-, but not IgG- and IgM-RF occur in saliva of primary SS patients; (2) IgA-RF is locally produced in the salivary glands; (3) the stimuli for IgA-RF production in the systemic and secretory compartment may be similar; and (4) measurement of both IgA- and IgM-RF in serum may be used as adjunctive diagnostic procedure for primary SS.

The diagnostic value of salivary fluid levels of beta 2-microglobulin, lysozyme and lactoferrin for primary Sjögren's syndrome

In search of a simple non-invasive diagnostic test for primary Sjögren's syndrome (SS) the concentration of beta 2-microglobulin (beta 2-m), lysozyme (LZM) and lactoferrin (Lf) was measured in stimulated parotid saliva of 39 patients with primary SS, 42 patients suspected of the syndrome in whom the diagnosis could be excluded (NON-SS) and in 41 normal control individuals. Salivary fluid levels of beta 2-m, LZM and Lf exceeding the mean + 2 x standard deviation of healthy control values were found in respectively 58%, 23%, and 26% of the primary SS patients and in 7%, 11% and 0% of the NON-SS patients. The results of this study indicate that due to the low sensitivity the tests are not suitable as a screening procedure for patients suspected of having primary SS. However, measurement of beta 2-m in stimulated parotid saliva may be used as an adjunctive diagnostic test for primary SS.

IgA rheumatoid factor in mucosal fluids and serum of patients with rheumatoid arthritis: immunological aspects and clinical significance

In order to gain insight into the production and clinical significance of IgA rheumatoid factor (IgA-RF) in mucosal fluids of patients with rheumatoid arthritis (RA), we examined tear fluid, saliva and serum from 80 patients with RA. Significant correlations were found between IgA-RF levels in tear fluid and saliva (P = 0.002, r = 0.57), saliva and serum (P < 0.001, r = 0.79), and serum and tear fluid (P < 0.001, r = 0.31). No significant correlations were found between total IgA levels in these fluids. Comparison between circulating and mucosal IgA-RF levels after correction for total IgA, revealed that mucosal IgA-RF levels are on average 2.5 times higher than circulating IgA-RF levels. Analysis of IgA-RF specificity showed that lacrimal and salivary IgA-RF reactivity with various IgG subclasses is similar and differs from serum IgA-RF specificity. These results indicate local production of IgA-RF in salivary and lacrimal glands and support the view of a common origin of IgA-RF producing B cells present in mucosal tissues. Mucosal and circulating levels of IgA and IgA-RF were not associated with tests that quantify tear fluid production. This indicates that mucosal and circulating levels of IgA and IgA-RF in patients with RA cannot be regarded as markers for the development of secondary Sjögren's syndrome.

Reactivity and self-association in vivo of a human monoclonal IgG rheumatoid factor

In order to study the pathogenic potential of IgG rheumatoid factor (IgG-RF) we generated a human monoclonal IgG4-RF-producing cell line, OR-1, by Epstein-Barr virus transformation of B cells derived from a healthy donor. Characterization of OR-1 RF specificity demonstrated that this RF binds only to IgG and not to dsDNA or seven different proteins tested. Although both OR-1 RF and C1q bind to the Fc part of IgG, no influence could be observed of OR-1 RF on the complement-fixing potential of heat-aggregated IgG, suggesting that OR-1 RF does not interfere with C1q binding to IgG. This was confirmed by blocking studies which showed that binding of OR-1 RF to IgG could be prevented by Staphylococcal protein A (SpA), but not by C1q. Comparison of OR-1 RF with SpA regarding their ability to bind to IgG derived from different species and human IgG subclasses demonstrated that OR-1 RF and SpA have an identical IgG specificity. The possibility that a structural homology exists between SpA and OR-1 RF was ruled out, however, by using affinity-purified chicken anti-SpA antibodies, which were not able to bind to OR-1 RF. The potential of self-recognition of OR-1 RF in vivo was examined by injecting OR-1 cells in SCID mice. Two months after injection IgG-RF was present in the circulation in monomeric, dimeric and polymeric forms whereas circulating IgG without RF activity, derived from an injected control cell line, was present in the monomeric form only. In vitro studies indicated that IgG-RF is secreted in monomeric form and that polymerization is a concentration-dependent phenomenon. The fact that IgG-RF is able to form immune complexes in vivo indicates that IgG-RF has a pathogenic potential by itself and therefore IgG-RF may play a role in the pathogenesis of RA.

Significance of rheumatoid factor isotypes in seronegative rheumatoid arthritis

In a cross-sectional study of 124 patients with definite or classical rheumatoid arthritis (RA) and negative agglutination assays, rheumatoid factor (RF) isotypes were measured using an ELISA technique. Elevated levels of IgA-RF were found in 55 patients (44%), IgG-RF in 99 (80%), and IgM-RF in 20 (16%). The levels of IgA- and IgM-RF correlated with each other (P less than 0.001). Elevated levels of IgM-RF were associated with a more severe disease course. Elevated levels of IgA-RF correlated with the occurrence of bone erosions. The results of this study suggest that in patients with RA and negative agglutination assays, both IgM- and IgA-RF are markers of disease severity.

Quantitative detection of class-specific rheumatoid factors using mouse monoclonal antibodies and the biotin/streptavidin enhancement system

An enzyme-linked immunosorbent assay (ELISA) for the quantitative detection of rheumatoid factors (RF) was developed using mouse monoclonal antibodies against human IgG, IgA and IgM together with the biotin/streptavidin enhancement system. One hundred and eight patients with rheumatoid arthritis (RA) of whom 47 had a positive serum latex agglutination assay, 100 healthy controls and 95 diseased controls (25 systemic lupus erythematosus (SLE), 25 ankylosing spondylitis, 20 osteoarthritis and 25 bronchial asthma) were evaluated for the presence of IgG-, IgA- and IgM-RF by ELISA. Elevated levels of IgG-, IgA-, and IgM-RF could be demonstrated in respectively 94%, 91% and 98% of serum samples from RA patients with a positive latex test and in 72%, 69% and 8% of serum samples from RA patients with a negative latex test. In the latter patient group, increased levels of one or more RF isotypes could be detected in 82% of the patients. Except for the presence of IgG-RF in serum of 20% of the SLE patients, increased levels of RF isotypes were present in less than 5% of the diseased controls. Highly significant correlations were found between serum IgM-RF levels as detected by ELISA and those of the latex and the Rose-Waaler agglutination assays. Positive correlations were also found between the serum levels of the three RF isotypes investigated and between the levels of RF isotypes as measured in serum and synovial fluid of the same patient. Compared to agglutination assays, the ELISA for the quantitative detection of RF isotypes is a more reproducible and sensitive test which avoids some of the problems encountered in earlier ELISA methods.