New HLA DNA polymorphisms associated with rheumatoid arthritis

Studies of restriction enzyme fragment length polymorphisms (RFLP) have further clarified two DNA polymorphisms detected in DR4 positive individuals with a DQ beta probe. These patterns have been designated DQ beta omega, characterized in the Dw4 homozygous typing cell (HTC) BM14 and DQ beta phi, characterized in the Dw4 HTC MCF, and so do not correspond with different Dw types. These patterns clearly segregate in families with HLA haplotypes. We suggest that omega and phi may be polymorphisms of the DX beta gene. The previously reported DX alpha polymorphisms U and L were found with all DR types and in association with DQ beta omega (U) and DQ beta phi(L). In addition DQ beta phi was found to be strongly associated with TA10 positively (a subdivision of DQw3) although this association was not absolute. Associations between RFLP and other HLA Class II and I antigens seen in DR4 patients and DR4 controls suggest the existence of at least two preferential allelic associations (PAA), one containing omega/U and the other phi/L. PAA1: DX alpha U-DQ beta omega-TA10 negative-DQw3-Dw4-DR4----Bw62-Bw6-Cw3-A2 PAA2: DX alpha L-DQ beta phi-TA10 positive-DQw3-Dw4-DR4----B44-Bw4-Cw3-A2 The frequency of the omega pattern was higher, although not significantly in the RA patients compared with controls. However, a significantly higher frequency of omega was found in RA patients with extra-articular manifestations (EA) compared (a) with controls (p less than 0.04) and (h) with those patients without EA (p less than 0.05). In addition the frequency of phi was significantly higher in RA patients with nodules and/or erosions (N/ER) compared with patients without these features (p less than 0.008). When cumulative scores were assigned to patients after assessing the number of components fulfilled for each PAA, PAA1 appeared to be pronounced in patients with EA and PAA2 in patients with N/ER. The frequency of a previously reported DQ beta T6 band found with the enzyme Taq 1 and DQ-beta probe was found at a higher frequency in RA patients compared with controls. In addition a significantly higher frequency of this band was found in female RA patients compared to males.

HLA-A,-B, and -DR antigens in relation to gold and D-penicillamine toxicity in Greek patients with RA

Ninety-five rheumatoid arthritis patients treated with aurothiomalate and/or D-penicillamine have been studied for possible associations between HLA-A, -B, -DR antigens and various toxic reactions to the above drugs. HLA-DR3 and -DRw6 had a higher frequency in patients with toxic reactions (all types) than in patients without toxic reactions (28.5 per cent vs 13.0 per cent and 26.5 per cent vs 4.3 per cent, chi 2 = 2.6 and 7.2, respectively). HLA-B8 was found at a higher frequency in patients with proteinuria and other types of renal involvement (20.0 per cent vs 7.4 per cent in controls), whereas skin manifestations were mainly associated with the presence of HLA-DRw6. The lowest frequency of side-effects was seen in patients with HLA-DR1 and DR2 (10.2 per cent vs 28.3 per cent and 28.5 per cent vs 54.3 per cent, chi 2 = 3.9 and 5.5, respectively). In addition, seropositive patients possessing HLA-DR1, showed toxic reactions less frequently.

HLA associations are with severe rheumatoid arthritis

Rheumatoid arthritis (RA) has been studied in 17 multicase families from the North East of England. The families comprised 281 individuals, 51 of whom had classical or definite RA, 18 had probable RA, and six were classified as previous RA. The association of classical and definite RA with HLA-DR4 was confirmed, and homozygosity for DR4 was more strongly associated than heterozygosity. There was a trend towards negative association with HLA-DR2 and DR7. Homozygosity for DR4 and possession of the haplotype most frequently inherited with RA in a particular family showed association with more severe disease. HLA-DR2 and DR7 tended to associate with less severe disease. It is therefore likely that HLA association is with the severity of disease rather than disease susceptibility.

[Expression of class I and class II markers on populations of leukemic cells]

The study of class I and class II antigen expression on leukemic cells brought the following conclusions: most of the leukemic cells show a slower number of class I antigenic sites than normal peripheral blood lymphocytes (PBL) but, in most cases, this does not hinder HLA typing; contrarily to normal PBL, leukemic cells seem to carry "non HLA" antigens (and/or non classical HLA antigens) which are probably responsible of the false positive reactions frequently observed at the time of HLA typing; most of the leukemic cell types express DR antigens (except those belonging to the T lineage) but DQ antigen expression (and in some cases MT antigen expression) varies depending on the cell type studied: well defined on mature B hemopathies, DQ expression is often lower than DR expression on acute leukemic cell types.

Multiple HLA associations and disease susceptibility

A strong association between a particular HLA antigen and a given disease may mask a secondary, weaker association. Applying a stepwise analysis to published HLA-DR frequencies in rheumatoid arthritis demonstrates an increased frequency of DRI not otherwise apparent.

Extended haplotypes in rheumatoid arthritis and preliminary evidence for an interaction with immunoglobulin genes

The incidence of extended haplotypes of the Major Histocompatibility Complex was compared between 20 probands with RA, their unaffected family members, and 42 controls. One haplotype only, HLA-Bw62 BfS C4A*3 C4B*3 DR4 GLO2, was significantly increased in the patient group, whereas HLA-B7 BfS C4A*3 C4B*1 DR2 GLO1, which was the most common haplotype in the control groups, was absent. The immunoglobulin allotype Glm(2) was significantly increased in frequency in the RA patients, and analysis showed that of the seven patients carrying Bw62-DR4, five were G1m(2) positive. Further, the increase in frequency of the phenotype Gm(1,2,17,21,3,5,23) was also significant and was carried by two of four probands with the extended haplotype HLA-Bw62 BfS C4A*3 C4B*3 DR4 GLO2 and by one proband also bearing this haplotype but with a null allele at the C4A locus. The striking association of G1m(2) and Bw62 with DR4 in our patients suggests that in interaction of immunoglobulin genes with DR4 is stronger when DR4 is associated with particular haplotypes rather than with DR4 in general.

HLA studies in familial and sporadic rheumatoid arthritis

Fifty-eight unrelated patients with familial (36) and non-familial (22) rheumatoid arthritis (RA) have been studied for HLA-A, B, C, and DR antigens. Among the 36 probands of families with multiple cases of RA (Group I) 73 per cent are DR4 positive, and 60 per cent of the DR4 negative probands possess DR1. The corresponding frequencies among the 22 patients with non-familial (sporadic) RA (Group II) are 59 per cent and 56 per cent, respectively, DR4 and/or DR1 are present in 89 per cent of patients in Group I and 82 per cent in Group II. Homozygosity for DR4 has been definitely established by family studies in six of the 26 DR4 positive patients (23 per cent) in Group I, and a further two patients are possible homozygous. Family studies have not been performed in sporadic RA patients but two of 13 DR4 positive patients in this group are possibly homozygous for DR4. HLA haplotypes A1, Cw7, B8, DR4; and A2, Cw3, B15, DR4 are shared by two or more unrelated probands of multicase families.

A possible haplotype association in Felty's syndrome

The HLA-B7/DR association was examined in a normal British population and in seven HLA-B7-positive patients with Felty's syndrome. After the exclusion of the most frequent A3-B7-DR2 association, a significant A2-B7-DR4 association was evident. This was present in six of the seven HLA-B7-positive Felty's patients and might indicate that the A2-B7-DR4 haplotype is prevalent in some forms of rheumatoid arthritis.

HLA and rheumatoid arthritis: an analysis of multicase families

In a study of multicase RA families, significantly raised frequencies of the HLA antigens DR4, DR1, Bw62, Cw3, A2, A31 and significantly lower frequencies of DR2, DR3, and B8 were found in probands compared to normal controls. When haplotype frequencies were compared between probands and controls, two haplotypes A2-B44-DR4 and A2-Bw62-DR4 were at higher frequency in probands. These differences no longer reached significance when only DR4-containing haplotypes were compared between probands and controls. A significantly lower haplotype frequency of A1-B8-DR3 was observed in probands compared to controls. This difference did not remain significant when only non-DR4 haplotypes were compared. Using an affected sibling pair ratio method, significant linkage between HLA and RA was found (P less than 0.01). Significant linkage was also observed between HLA and seropositivity. Analysis of Hardy-Weinberg equilibrium for the DR locus did not support the suggestion that DR4-associated RA susceptibility was inherited as a dominant trait. In addition it did not support the notion of an additive effect of DR4 and DR1 in RA susceptibility as these antigens were not found together more frequently than predicted by their individual gene frequencies.

Phenotypic analysis of alveolar macrophages in normal subjects and in patients with interstitial lung disease

Cytospin preparations of mononuclear inflammatory cells were made from bronchoalveolar lavage fluid obtained from 15 patients with interstitial lung disease (nine patients with sarcoidosis and six patients with cryptogenic fibrosing alveolitis) and six control subjects. These preparations were examined with a panel of monoclonal antibodies that have been shown to distinguish subpopulations of macrophage like cells in normal tissues. The lysosomal acid phosphatase activity of the cells was also assessed. Phenotypically distinct subpopulations of alveolar macrophages were identified in all samples studied. The results showed that all cell populations identified in bronchoalveolar lavage fluid from the groups with interstitial lung disease could be identified in the lavage fluid from normal volunteers. Some quantitative differences in the proportions of cells identified with particular reagents emerged. In each of the groups with interstitial lung disease increased proportions of cells were identified with RFD1 (interdigitating cell marker; p less than 0.01) and in the cryptogenic fibrosing alveolitis group an increased proportion of alveolar macrophages was identified with RFD7 (tissue macrophage marker; p less than 0.05). The possibility that quantitative changes in alveolar macrophage subsets observed in the interstitial lung disease groups are relevant to the pathogenesis of these conditions is discussed.

[HLA typing in patients with chronic adenopathies in a population at risk for AIDS]

HLA-A B and DR typing were performed in 77 patients with AIDS related complex (ARC)--69 lymphadenopathy associated syndrome and 8 thrombocytopenic purpura LAV/HTLV III related--and 21 symptom free homosexual males. A significant increase in the frequency of HLA DR5 antigen was observed in patients with ARC mainly in purpura thrombocytopenic patients. We suggest that increase of HLA DR5 antigen support the view that DR5 antigen could be one of the factors necessary at the spreading out clinical symptoms.

Analysis of the HLA association with rheumatoid arthritis

Definitive determination of the HLA linked gene or genes for susceptibility to RA will be achieved (1) by the accumulation of an adequate body of data on the haplotype frequencies in a random set of RA patients and controls and (2) by further study of other loci in the DR region, involving the use of DNA probes as well as conventional techniques. Indirect evidence is here put forward to suggest that it may turn out that some part of DR4 specificity itself may be directly involved in increasing susceptibility and that DR1 epitopes may be involved in a similar way.

Histocompatibility antigens in adult obliterative bronchiolitis with or without rheumatoid arthritis

We compared HLA antigens in 28 patients with obliterative bronchiolitis (16 with rheumatoid arthritis) with those in 150 normal controls, to determine their relationship to drug toxicity and to the pathogenesis of obliterative bronchiolitis (OB). There was a significantly increased prevalence of HLA-B40 in the whole group and in patients with OB and rheumatoid arthritis (RA). There was increased frequency of HLA-A2 and A28 within the whole group and in those with OB alone. HLA-A3 and B5 were completely absent in our patients. Of those antigens most frequently associated with RA, DR4 was significantly more prevalent in patients with OB, with or without RA, but DR1 occurred more frequently only in those with RA-associated OB. Increased prevalence of DR4 may indicate an association between the pathogenesis of both OB and RA and the HLA-DR locus. Although D-penicillamine has been implicated in the pathogenesis of OB our patients did not show an increase in those antigens associated with other gold/penicillamine toxicity (i.e. DR2/3), suggesting that they may constitute a distinct group.

Genetic analysis of families with multiple cases of rheumatoid arthritis

We examined the inheritance of susceptibility to RA in families with multiple cases of RA, and studied existence of any linkage between the putative RA disease susceptibility locus and the HLA-DR locus. A pedigree analysis programme, PAP, was used for both analyses. Our investigation suggests that familial RA is the effect, in part, of an inherited autosomal dominant susceptibility gene with incomplete penetrance rather than that of a recessive gene. Linkage analysis indicates a tight linkage between the putative RA disease susceptibility locus and the HLA-DR locus under an autosomal dominant mode of inheritance.

HLA and rheumatoid arthritis: susceptibility or severity?

An analysis of data collected on 440 British Caucasoid rheumatoid arthritis patients has confirmed positive association with HLA-DR4, Dw4, DRw53, and A2 and negative associations with HLA-DR2, 3, and 7. HLA-DR4 is more associated with RA 'severity' than with RA 'susceptibility', when measured by the parameters of ARA classification, seropositivity, severity of erosions and extra-articular manifestations. The association between HLA-A2, Cw3, Bw62, DR4, DRw53, and Dw4 and extra-articular disease has been confirmed in this study. The analysis of HLA and RA severity with respect to sex showed high frequencies of DR4, Dw4, and DRw53 in females, which increased in those with severe erosions, seropositivity or extra-articular disease. In males with RA, the disease appears to be associated not only with DR4, Dw4 and DRw53, but also with A2, Cw3 and Bw62. However, no significant differences in these antigen frequencies were found between male patients with severe RA and those without. Despite a significant decrease in the frequencies of DR3, B8 and A1 in most RA patient subsets, RA patients with Sjogren's syndrome showed a marked increase of A1 and B8 and patients with auto-antibodies had a significant increase in HLA-DR3 frequency when compared with patients without these features.

Epidemiological aspects of family studies in rheumatoid arthritis

The study of multicase families is of value in the analysis of genetic association between rheumatoid arthritis and markers such as HLA. There are a number of ways that multicase families arise but it is likely that the affected individuals within these families are not genetically distinct from sporadic cases. More problematic, however, is the nature of the disease itself. Its variable presentation, at any age, and the existence of self-limiting forms renders classification of individuals within families complex. In the absence of continuous life-long observation the only reasonable alternative is to use all available data for analysis and not be constrained by rigid criteria developed for other purposes.

Genetic heterogeneity of rheumatoid arthritis

In a population survey in The Netherlands we investigated 6584 individuals for the presence of rheumatoid diseases and their determinants. We observed no overall association of rheumatoid arthritis (RA) with HLA-DR4 or GM. This result is in contrast to the marked association of HLA-DR4 with RA found in studies based mainly on hospital rheumatology clinics. The findings thus suggest a genetic basis for the disease heterogeneity. A study of 16 multicase RA families showed a co-segregation of RA with the DR4 carrying haplotype from the unaffected parent, whereas the non-DR4 haplotype was preferentially segregating to the healthy siblings (p = 0.001). These data suggest that HLA-DR4 is associated with disease susceptibility rather than with a disease modifying factor. In a further attempt to define a genetic basis for disease heterogeneity we compared five well-defined clinical groups of patients with RA. Although the frequency of HLA-DR4 was significantly elevated in all patient groups as compared to healthy controls, we observed a preferential association of HLA-DR4 with severe extra-articular manifestations as compared to patients without extra-articular manifestations (p = 0.002). These results provide an immunogenetical basis for the disease heterogeneity observed in RA and further extend the immunological analogy between RA and leprosy.

HLA frequency and haplotype analysis in a family study of adult onset rheumatoid arthritis

Twenty-five families with probands who have rheumatoid arthritis (RA) were studied for clinical evidence of disease and for HLA status. This confirmed an association between RA and DR4 in 19/25 probands (76 per cent, p = 0.008). These 19 probands carried 24 haplotypes which contained DR4. There was no significant increase of DR4 haplotypes bearing B15(Bw62) or B44 when compared with published control haplotype data. The rare complement allele C4 B3 was detected as part of the extended haplotype A2 Cw3 B15(Bw62) DR4 C4 A*3B*3 in three probands with severe RA. Further studies to examine disease severity and autoantibody expression are in progress.

Analysis of genetic susceptibility to familial rheumatoid arthritis

We have studied HLA-A, B, C, and DR antigens in 37 unrelated Caucasian families with multiple cases of definite or classic rheumatoid arthritis (RA). HLA-DR4 was observed in 26 of 36 probands tested (73 per cent); and six of the 10 DR4 negative probands possessed DR1. HLA haplotype sharing among affected siblings was more often observed than would be expected if RA and HLA haplotype were segregating independently (p = 0.041). In families with a DR4-heterozygous parent, the affected parent's HLA haplotype co-segregates significantly with RA among the offspring (p less than 0.005); and in families where both parents are unaffected, occurrence of RA among the offspring co-segregates significantly with DR4 haplotype (p = 0.004). Our data strongly indicate that at least one genetic determinant for susceptibility to RA resides in the HLA region, closely linked to the DR locus, or that the susceptibility determinant may be an epitope or structure that is commonly found on DR4 molecules but occasionally on other DR molecules.

Two dimensional gel analysis of HLA-DR2 associated HLA-D clusters

Five cell lines with different cellular HLA-D specificities associated with HLA-DR2, i.e. Dw2, Dw12, MN2, DB9 and D2J, displayed structural variation in the products of the DR and DQ loci. Analyses of immunoprecipitated DR molecules from HLA-D homozygous B-lymphoblastoid cell lines by two dimensional polyacrylamide gel electrophoresis showed variable patterns with one set of DR beta chains. Another set of DR beta chain products, however, was homogeneous in all cell lines studied. In addition, analyses of DQ molecules showed extremely variant DQ beta chains, and slightly variant DQ alpha chains.

Interleukin-1 production and antigen presentation by normal human peritoneal macrophages

Human peritoneal macrophages from healthy females have been investigated for their capability to produce interleukin-1 (IL-1), their expression of HLA-DR and -DQ, and for their antigen-presenting capacity in concanavalin A, tetanus toxoid (TT), and autologous T-cell proliferative responses. Fifteen out of thirty macrophage populations produced IL-1 but the activity was 1/5 to 1/10 that of peripheral blood mononuclear cells stimulated under similar conditions. High levels of HLA-DR were expressed on all macrophages while lower and more variable levels of DQ were found. All macrophages induced mitogen-dependent T-cell proliferation while the ability to induce a proliferative response to TT was variable, 12/23 tests were positive. In five samples stimulatory capacity of macrophages in the absence of TT was as strong as in the presence of the stimulus, suggesting that in vivo processed immunogen could be responsible for the proliferative response. The surface density of HLA-D-region-determined antigens was not indicative of the macrophages' ability to induce antigen-specific proliferation. IL-1 production, however, correlated with this function. Antigen presentation was not confined exclusively to peritoneal populations consisting of recently immigrant monocyte-like cells, nor were all young macrophages able to present antigen. This may reflect on the diversion of macrophage function by the local environment.

Immunological abnormalities in a child with constitutional aplastic anemia

This case report describes a child with severe constitutional hypoplastic anemia and Seckel's syndrome. Immunological analysis on mononuclear peripheral blood cells revealed an abnormally low ratio of T-helper to T-suppressor/cytotoxic cells and a highly increased number of HLA-DR-positive T suppressor/cytotoxic cells. Interferon-gamma and interleukin-2 production by mitogen-stimulated peripheral blood mononuclear cells was slightly reduced, and no spontaneous production of these lymphokines was seen. The immunological abnormalities demonstrated in this case of constitutional aplastic anemia may indicate common features with acquired aplastic anemia.

Rheumatoid arthritis with pleural effusion includes a subgroup with autoimmune features and HLA-B8, Dw3 association

Twenty-eight patients with rheumatoid pleural effusion were investigated to examine the frequency of HLA antigens as compared with 56 rheumatoid arthritis (RA) patients without this intrathoracic manifestation of RA and with 283 healthy controls. HLA-B8 was strongly associated with the presence of pleural effusion (PE) in RA patients. A high prevalence (71%) of B8/Dw3 was found among male RA patients of the PE group in whom the joint disease had begun at an age over 50 years and who also had besides pleuritis other intrathoracic manifestations of RA associated with high rheumatoid factor titres and low complement (C4) levels in sera. Actually, the HLA-B8 association was not seen in the rest of the PE group. The finding may be related to the heterogeneity of RA, a male subgroup of the disease being characterized by multiple intrathoracic manifestations and genetically associated with the large group of autoimmune disorders, such as SLE, characterized by high prevalences of HLA-B8 and D(R)3.

HLA-D antigens in rheumatoid arthritis and toxicity to gold and penicillamine

The frequencies of HLA-D antigens were investigated in 77 Finnish patients who met the ARA criteria of classical or definite rheumatoid arthritis. The control material consisted of healthy blood donors. HLA-Dw4 was significantly (p less than 0.01) increased and HLA-Dw2 significantly (p less than 0.01) decreased in the patients. All HLA-Dw4-positive patients belonged to the seropositive group and in comparison with controls HLA-Dw4 antigen was increased highly significantly (p less than 0.001) in the seropositive patients. With respect to HLA-Dw4 antigen, the seropositive and the seronegative group differed significantly (p less than 0.05). All patients had received penicillamine treatment and 75 of them gold treatment before penicillamine. No significant associations were noted between any HLA-D antigen and gold or penicillamine toxicity. The previous gold toxicity seemed to be a significant factor with respect to the subsequent penicillamine toxicity.

BCG immunotherapy in stage I melanoma patients. Does it influence prognosis determined by HLA-DR expression in high-risk primary tumors?

Previously, we have provided evidence for a positive correlation between HLA-DR expression in primary melanoma and early metastasis. In the present study we investigated whether this relationship was modified by adjuvant BCG immunotherapy. The study comprised 107 patients with a stage I high-risk melanoma; 44 patients had been treated with BCG, whereas the remaining patients had not received any adjuvant therapy. There was no difference in disease-free survival between BCG-treated and untreated patients. Disease-free survival was significantly shorter in patients with high expression of HLA-DR antigens in the primary tumor. Subgrouping BCG-treated and control patients according to HLA-DR phenotype of the melanoma revealed a prolongation of disease-free survival in the subgroup of BCG-treated patients with no or low expression of HLA-DR antigens in the primary melanoma. BCG therapy apparently did not influence prognosis of patients with high expression of HLA-DR antigens in the tumor.

Quantitative analysis of T6-positive Langerhans cells in human skin cancers

Epidermal Langerhans cells (LC) are required for antigen-presentation and for stimulating antigen-specific T cell activation. Similar functions may be important in the immune response to malignant skin tumours. Monoclonal anti-T6 antibody was used to examine LC population in basal and squamous cell carcinomas. Positive control labeling was performed with monoclonal anti-HLA-DR antibody. The number of T6-positive LC per mm2 of section was significantly decreased (p less than 0.01) in the tumour group in comparison with a sex and age-matched control group. The number of sun-exposed and covered regions was taken into consideration in each respective group. Within the tumours, LC were found more frequently in the tumour periphery and in most differentiated tumour areas (horn pearls) than in the rest of the tumour mass. T6-positive LC were rarely found in the dermis. Moreover, LC exhibited morphological changes in specimens from tumours. Staining with anti-HLA-DR antibody revealed less numerous positive cells within tumour nests than labeling with OKT6. A relationship between T6-positive LC quantities and extent of HLA-DR-positive infiltrates around tumours could not be established. These results suggest that immunological surveillance of neoantigen-bearing tumour cells may be impaired in skin cancer. A reason for the reduced LC number may be an altered microenvironment in tumour tissue.

Unfavorable presenting clinical and laboratory features are associated with CALLA-negative non-T, non-B lymphoblastic leukemia in children

Twenty-four (5.7%) of 424 children with newly diagnosed acute lymphoblastic leukemia (ALL) were found to have blast cells that expressed HLA-DR antigens but not the common ALL antigen (CALLA), E-rosette receptors, T-cell antigens, or cytoplasmic or surface immunoglobulins. Each of the eight cases tested expressed the B-cell associated antigen B4, but not B1 or B2 antigen. Myeloid-associated antigens were not present in any of the 10 cases tested. By comparison with common (CALLA+ B-cell precursor) ALL, patients having this immunophenotype were more likely to be children less than 2 yr of age (p less than 0.001), to have higher initial leukocyte counts (p less than 0.001), and to have blast cells with a DNA index less than 1.16 (p = 0.05), a pseudodiploid karyotype (p = 0.01) and a chromosomal translocation (p = 0.003). The presence of any chromosomal translocation in these CALLA- ALL was related to measures of increased leukemic cell burden including higher leukocyte counts, larger liver and spleen sizes and higher serum lactic dehydrogenase levels. While the patients were entered into several treatment arms of two protocols, the CALLA- cases appeared to have lower remission rate (p = 0.06) and shorter event-free survival time (p = 0.05) than did those with common ALL. The association with clinical and laboratory features of known adverse prognostic significance provides some explanation for the poor treatment outcome of CALLA- ALL.

HLA-DR4 as a predictor of outcome three years after onset of rheumatoid arthritis

Data from 59 patients with early rheumatoid arthritis were analysed to determine the predictive value of the possession of HLA-DR4 for disease severity and functional outcome at 3 years after disease onset. The previously reported association of that antigen with seropositive disease was confirmed. Conversely, however, there was no evidence that functional outcome was worse in the HLA-DR4 positive group as measured by the Stanford Health Assessment Questionnaire. The mean articular index was lower in the HLA-DR4 group which also had a smaller proportion with limited wrist extension. In addition, both patient and physicians' global assessment of disease status were better in the HLA-DR4 group. It is concluded that HLA-DR4 is not a useful predictor of poor outcome at 3 years.

Differential susceptibility to modulation by recombinant immune interferon of HLA-DR and -DQ antigens synthesized by melanoma COLO 38 cells

Recombinant immune interferon (IFN-gamma) induced a dose-related increase in the synthesis and expression of HLA class II antigens by the cultured melanoma cells COLO 38. Although IFN-gamma-treated melanoma cells COLO 38 continue to express higher levels of HLA-DR antigens than of HLA-DQ antigens, the effect of IFN-gamma was more marked on HLA-DQ antigens than on HLA-DR antigens, as indicated by the dose and incubation time required to induce the changes and by the extent and duration of the increase. The effect of IFN-gamma on HLA class II antigens is significantly higher than that of leukocyte and fibroblast interferons. Analysis by one- and two-dimensional gel electrophoresis of antigens synthesized by melanoma cells COLO 38 in the presence of IFN-gamma did not detect any significant change in the structural profile of the subunits of HLA-DR and -DQ antigens.

Monoclonal antibody patterns in lymphomatoid papulosis

Atypical cells resembling Reed-Sternberg cells are a characteristic histologic feature of lymphomatoid papulosis. Thus far no consistent data are available on the nature of these cells, or a possible antigenic relationship between them and Reed-Sternberg cells. Twenty-four biopsy specimens from 14 patients with lymphomatoid papulosis were immunolabeled with antibodies against Ki-1 and other Reed-Sternberg cell-associated antigens. In all cases a proportion of the large, atypical cells expressed the Ki-1 antigen. In contrast, in 20 biopsy specimens of benign inflammatory skin lesions or mycosis fungoides, Ki-1-positive cells were absent or only occasionally present. Furthermore, the large atypical cells of lymphomatoid papulosis also expressed other antigens (for example, T3, T4, HLA-DR, IL-2 receptors) that have previously been demonstrated on Reed-Sternberg cells. Our findings, together with the observation that the Ki-1 antigen can be induced on peripheral blood lymphocytes after prolonged phytohemagglutinin stimulation, suggest that the Ki-1-positive cells in lymphomatoid papulosis are activated T cells closely related to the Reed-Sternberg cells of Hodgkin's disease.

HLA-DR antigens in epithelioid cell granulomas of sarcoidosis, using semithin frozen sections. A concept about granuloma formation

Mediastinal lymph nodes of 11 patients with Sarcoidosis were studied. The immunoperoxidase technique using monoclonal antibody to HLA-DR antigen revealed on conventional frozen sections epithelioid cell granulomas with intense staining. Localization of this HLA-DR + material on or in cells in these granulomas was possible with 1 mu semithin frozen sections. Epithelioid cells as well as multi nuclear giant cells were seen in these sections with membrane bound HLA-DR antigens. Some problems about HLA-DR antigens in relation with antigen handling, the presence on epithelioid, (and) giant cells and granuloma formation will be discussed.

Insulin dependence: problems with the classification of 100 consecutive patients

We have evaluated the clinical and immunogenetic features of 100 consecutive patients presenting to an adult diabetic clinic who were judged clinically to need insulin therapy but were not sufficiently ill to be admitted to hospital. Over this same period 15 newly diagnosed patients (aged 13-70 years) were started on insulin as in-patients of whom ten were in ketoacidosis. The 100 out-patients, aged 11-75 years at the time of starting insulin, were followed for at least a year. Fifty-six had islet cell antibodies and/or were heterozygous for HLA DR3 and DR4 (Group A) whereas 44 had neither of these markers (Group B). Islet cell antibodies and/or DR3, DR4 heterozygosity were most common in the 70 patients diagnosed below the age of 40 years but were also found in older patients. Patients in Group A were significantly younger at diagnosis (29 vs. 43 years), had a shorter duration of symptoms (17 vs. 61 weeks), were more likely to have ketonuria, and had a lower random C-peptide level at diagnosis (0.2 vs. 0.31 nmol/l). The two groups could not be distinguished by weight, haemogloblin A1 or blood glucose at diagnosis or by diabetic control or insulin dose after one year. The National Diabetes Data Group (NDDG) definition of insulin dependence stresses the importance of HLA types and islet cell antibodies although we found their prevalence to be low in the 30 patients diagnosed over 40 years who clinically were indistinguishable from the younger patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Human B-blast specific target determinants in CML: a panel study

The B blast specific target determinant phenotype defined by cytotoxic lymphocytes and the HLA-DR phenotype was tested for correlation in two panel studies. First, CTL reagents with B blast specificity were selected from CTLs educated between HLA-A, B, (C) identical unrelated donors giving no cytotoxicity with specific T blasts, resulting in free selection of panel B blasts used as targets. Second, CTLs educated between HLA non-identical unrelated donors giving cytotoxicity against specific T as well a B blast targets could be seen with negative reactions against T blasts but positive reactions against B blasts of selected panel members giving, in this set up, a free selection of donors cocultured for education of CTLs. These panel studies showed that HLA-DR associated B blast specific target determinants can be identified by CTLs, indicating that the HLA system codes for these determinants either through gene products of a locus closely linked to or identical with the HLA-DR locus.

Use of monocytes in HLA-A, B, C and DR typings

A simple method of improved serologic typing of monocytes for HLA-A, B, C and DR specificities is described. The method employs monocytes recovered from frozen samples of peripheral blood mononuclear cells; it chiefly involves pretreatment of monocytes with 0.01% iodoacetamide (IAA) prior to typing. The advantage of this method lies principally in the lowering of the background nonspecific cytotoxicities and false positive readings upon IAA addition to the monocyte preparations. Using this method monocytes can be typed for HLA-A, B, C determinants. Although the addition of IAA results in substantial typing improvements, we found the assignment of A, B, C specificities difficult due to the presence of extra positive reactions when monocytes were compared to T lymphocyte typings. probably due to the presence of DR or monocyte specific antibodies in the routinely used HLA antisera. This method proved to be most useful in DR typings where mono cytes in the presence of IAA were compared with autologous B cells in the absence of IAA. The differences in typings due to a decrease in false positive cytotoxic readings were significantly in favor of using IAA treated monocytes in DR typings (P < 0.0001). The use of IAA in the course of B cell or T cell typings bad no adverse consequences on either A, B, C or DR typings, respectively. Our results indicate a potential usefulness for the use of IAA in typing monocytes HLA determinants in general and for the DR determinants in particular.

Human B-blast specific target determinants in CML: a methodological study

A method for preparation of purified human PWM stimulated B lymphoblasts and their usefulness as targets in CML is described. The purified B lymphoblasts were found to carry surface membrane immunoglobulin (SmIg) and HLA-DR antigens and were non E-rosette forming. In contrast, PHA-stimulated lymphoblasts were found to be E-rosetting, SmIg negative and without serologically detectable HLA-DR antigens, and thus were characterized as T lymphoblasts. Using B and T lymphoblasts in parallel as targets in CML, it was possible to demonstrate target determinants exclusively expressed by the B lymphoblasts.

Alloantibodies that react with subsets of human T cells

Using the two color fluorescence (TCF) method, alloantibodies against subsets of T cells could be detected in sera from pregnant women with strong HLA antibodies. To preclude interference of these HLA antibodies with the recognition of the T cell antibodies, serum donors were selected which were HLA-Al, -B8, -DRw3. Their sera were tested on a panel of individuals homozygous for HLA-Al, -B8, -DRw3. By enriching peripheral mononuclear blood lymphocytes for Tgamma cells it could be shown that some of the sera reacted mainly with Tgamma and others with Tmu lymphocytes, while some sera reacted with both.

Primary biliary cirrhosis associated with HLA-DRw3

Twenty-one unrelated Caucasian patients with Primary Biliary Cirrhosis were typed for HLA-A, B, C and HLA-DRw antigens. The antigens HLA-Al, HLA-B8 and HLA-DRw3 were found in increased frequency in relation to the control group. When the P values were corrected for the number of antigens tested only the increase of HLA-DRw3 remained significantly different from the control group (P crr. < 0.004). The antigen HLA-DRw3 was carried by 12 out of 21 patients (57.1%) in comparison to 11 out of 74 (14.8%) normal unrelated Caucasian subjects.