Splenic foci of cytotoxic lymphocytes in a graft-versus-host reaction

It has been established that cytotoxic lymphocytes are generated in discrete foci in the spleens of mice undergoing a graft-versus-host reaction. The foci segregated randomly in such spleens. 2.8 X 10(4) lymph node cells, 2.3 X 10(5) spleen cells and 2.7 X 10(6) thymus cells from CBA mice generated a mean of one focus in lethally irradiated (CBA X DBA)F1 recipient mice. Cytotoxic foci were detected when cytotoxicity was measured by two different cytotoxicity assays, the release of [51Cr]-sodium chromate from [51Cr]-labelled target cells and colony inhibition. The seeding efficiency of cytotoxic focus-forming cells has been estimated at 19%.

Experimental models for prevention of graft-versus-host reaction in bone marrow transfusion. II. Inability to prevent graft-versus-host reaction in an H-2 identical combination

Splenomegaly was strong in the degree and continued for a long period of time in adult F1 hybrids between AKR (H-2k) and C3H/He (H-2k) mice after transfer of spleen cells from normal C3H/He mice. In spleen cells of such F1 recipients, cytotoxicity was detected by an in vivo neutralization test using methylcholanthrene-induced sarcoma or AKR origin as target cells. All of newborn F1 recipients died within 17 days after cell transfer. Induction of splenomegaly and cytotoxicity was not prevented by repeated pretreatments of donors with sonicated AKR spleen cells in saline, which suppressed completely such phenomena of graft-versus-host reaction in an H-2 nonidentical combination. Induction of cytotoxicity in the spleen of F1 recipients was not prevented by a pretreatment of donors with AKR spleen cells in complete Freund's adjuvant, which suppressed the induction of cytotoxicity in an H-2 nonidentical combination. Graft-versus-host reaction appears to be stronger in a combination between parental strains of which major histocompatibility antigens were identical.

Ultrastructural findings in the mouse exocrine pancreas during graft-versus host reaction

12- to 36-hours-old newborn CBA mice were intraperitoneally injected each with 10 X 10(6) allogeneic spleen cells of adult C57Bl mice. Control mice received syngeneic spleen cells of adult CBA mice either in the same way or remained untreated. The animals were killed 1, 3, 7, 14 or 21 days after the spleen cell injection. The pancreas was studied histologically and electron microscopically by common methods. Together with an interstitial lymphohistiocytic infiltration of the pancreas different acinar cell alterations were observed in the mice treated with allogeneic spleen cells: 1. Acute lethal pancreatic cell damages on the day after the intraperitoneal injection of allogeneic spleen cells. 2. Membrane-lined inclusion vacuoles between the 7th and 21st experimental day. 3. Atrophy of pancreatic acinar cells in the terminal stage of a severe graft-versus-host disease. The pathogenesis of the observed pancreatic changes seems to be due to nonimmunological and immunological processes. The membrane-lined inclusion vacuoles of the acinar cells could be the consequence of a cell-mediated immune process in the graft-versus-host reaction.

Analysis of the major histocompatibility complex in Syrian hamsters. I. Skin graft rejection, graft-versus-host reactions, mixed lymphocyte reactions, and immune response genes in inbred strains

Five inbred strains of Syrian hamsters (Mesocricetus auratus) were examined for the presence of disparity at a genetic region similar to the major histocompatibility complex in other species. Vigorous reciprocal alloreactions developed in several strain combinations, which resulted in acute skin graft rejection, strong mixed lymphocyte reactions, and potent graft-versus-host reactions. In addition, we found evidence for an immune response gene which controls the antibody response to bovine serum albumin. Patterns of alloreactivity observed for skin graft rejection, graft-versus-host reactivity, and mixed lymphocyte reactivity are compatible with the hypothesis that hamsters possess a major histocompatibility complex, but the absence of discernable disparity at a serologically defined locus makes a definitive statement premature.

Reconstitution in severe combined immunodeficiency by transplantation of marrow from an unrelated donor

A patient with severe combined immunodeficiency received seven transplants of bone marrow from an HLA-B-compatible and HLA-D-compatible unrelated donor in an attempt to provide immunologic reconstitution. The first four transplants achieved restricted engraftment with evidence of rudimentary immunologic function. A fifth transplant, given after low-dose cyclophosphamide, produced reconstituion of cell-mediated immunity. Marrow aplasia developed after recontamination with a nonpathogenic microflora. Transplantation of marrow previously stored in liquid nitrogen was ineffective. A subsequent transplant, administered after high-dose cyclophosphamide, achieved durable engraftment, with complete hematopoietic and immunologic reconstitution. Seventeen months after transplantation, full functional engraftment persists. Graft-versus-host disease has been chronic and moderately severe, but limited to the skin and oral mucosa. Transplantation of marrow from unrelated histocompatible donors may provide a useful treatment for patients with severe combined immunodeficiency or aplastic anemia who lack a matched sibling or related donor.

A prospective analysis interstitial pneumonia and opportunistic viral infection among recipients of allogeneic bone marrow grafts

A prospective study of 80 bone marrow transplant recipients with acute leukemia and aplastic anemia employed serial viral cultures, determination of complement-fixing antibody to cytomegalovirus (CMV), and study of material obtained from open lung biopsy and autopsy. There were 43 episodes of interstitial pneumonia, 28 of which were fatal. About 40% of the cases were idiopathic. CMV was the most common candidate pathogen, present in 47% of affected lungs. By a median of 53 days following transplantation, 46% of the recipients were shedding CMV from some site. This event was three times more frequent among recipients who had positive titers of antibody to CMV before transplantation than among seronegative recipients. Failure to respond werologically to CMV infection markedly increased the hazard of dying of interstitial pneumonia. Graft-vs-host disease significantly increased the incidence and lethality of interstitial pneumonia. The presence of leukemia (rather than aplastic anemia) and/or certain factors in the technique of preparation for engraftment may have been significant.

Sjögren-type syndrome after allogeneic bone-marrow transplantation

Four patients, treated for hematologic disorders with bone-marrow transplants from HLA-identical siblings, spontaneously complained of dry eyes 8 to 12 months after transplantation. Four allograft recipients and two recipients of autologous bone-marrow transplants were evaluated for xerophthalmia and xerostomia. Three allogeneic marrow recipients had evidence of keratoconjunctivitis sicca, and two had decreased parotid gland function. All four allograft recipients had minor salivary gland histopathology identical to that of Sjögren's syndrome. The severity of symptoms and histologic lesions corresponded with the severity of chronic graft-versus-host disease. In addition, one patient developed sclerodermatous skin changes, another had discoid lupus erythematosus, and two patients had laboratory evidence of cholestasis. None of the patients had autoantibodies but all had hypergammaglobulinemia. In contrast, none of the recipients of autologous bone marrow had clinical, laboratory, or histologic findings resembling Sjögren's syndrome.

The skin biopsy in the diagnosis of acute graft-versus-host disease in man

Criteria for diagnosis of acute graft-versus-host disease (GVHD) using skin biopsies were derived from a) general experience with more than 300 human marrow grafts and b) the results of "blind" studies of skin biopsy specimens of patients grafted with either allogeneic or syngeneic marrow. Large doses of cytotoxic drugs and irradiation given before grafting can produce transient skin changes interfering significantly with the diagnosis of GVHD. Artifacts can also cause difficulty. Epidermal cytologic atypia, dyskeratosis, and satellitosis were present both in allografted patients with acute clinical GVHD of multiple systems and in patients given autologous or syngeneic marrow. Due to the marked overlap in histopathologic findings between these two types of skin injury, frequent serial skin biopsies must be combined with all other available clinical and biopsy data to provide reliable diagnosis of acute GVHD in man.

Scleroderma, Sjögren-like syndrome, and chronic graft-versus-host disease

A patient with acute myelogenous leukemia treated with an allogeneic bone marrow transplant developed acute graft-versus-host disease manifested by severe diarrhea, hepatitis, and a cutaneous eruption. As the graft-versus-host disease progressed to the chronic phase, the patient developed marked cutaneous sclerosis and symptoms of xerophthalmia and xerostomia. Biopsy of his indurated skin showed features of both graft-versus-host disease and scleroderma. Results of Schirmer's tests, corneal fluorescent studies, parotid flow-rate testing, and a lip biopsy were consistent with Sjögren's syndrome. Possibly, activated lymphocytes may have a role in the pathogenesis of graft-versus-host disease, scleroderma, and Sjögren's syndrome.

Tritiated thymidine incorporation and cell-mediated lympholysis as correlates of acute graft-versus-host reaction

The graft-versus-host (GVH) reaction remains a serious consequence of administration of allogeneic immunocompetent cells to an immunosuppressed host even if donors and recipients are matched for major histocompatibility loci. This report describes a murine model for acute GVH reactions. Spleen cells from C3H/He (H-2k) mice, after intravenous injection of BALB/c (H-2d) spleen cells, were specifically cytotoxic for C3H target cells in vitro 4 days after irradiation and reconstitution. The cells in the recipients apparently are of donor genotype. The spleen cells exhibited rapid proliferation in vitro as measured by the uptake of 3H-TdR. The in vitro proliferation was distinguished from erythropoiesis by an assay of 59Fe incorporation. The kinetics of the in vitro incorporation of 3H-TdR and the in vivo uptake of 59Fe are reported.

Demonstration and characterization of a serum factor produced by activated T cells

Spleen rosette forming cells (RFC) from adult thymectomized mice have a low sensitivity to inhibition by anitheta serum (AOS) and azathioprine (AZ) in comparison with normal spleen or thymus RFC. Thymus extracts and normal mouse serum (but not spleen extracts or thymectomized mouse serum) correct this abnormality after a 30 min in vitro incubation with spleen cells. We report here the existence of a serum factor produced in allogeneic reactions with the same activity on rosettes as thymic factor (TF). This 'allogeneic' factor (AF) is detectable in mice undergoing a graft versus host reaction (GVHR), rejecting skin allografts or allogeneic cells or responding to thymus-dependent antigens such as heterologous red blood cells or BSA. The T-cell origin of AF is indicated by AF presence in nude mice submitted to the same allogeneic stimuli as listed above and in normal mice injected with PVP or LPS. AF is distinct from the thymic factor as shown by differences in electric charge. Moreover, in contrast with TF there is no specific high molecular weight inhibitor of AF. Preliminary biochemical studies indicate that AF is probably a peptide of low molecular weight (greater than 5000 daltons). Its target cell is probably a T-cell precursor.