Expression of activation markers on CD4+ and CD8+ cells from synovial fluid, synovial tissue, and peripheral blood of patients with inflammatory arthritides

We studied the expression of the Tac antigen, the transferrin receptor (Tfr-R), HLA class II antigens (DR, DQ, DP), CD30, and Act 1 on purified CD4+ and CD8+ cells isolated from synovial fluid (SF), synovial tissue (ST), and peripheral blood (PB) of patients with rheumatoid arthritis (RA) and with non-RA inflammatory arthritides (not ST). Subfractionated T cells of PB from healthy individuals served as controls. SF CD4+ cells from RA and non-RA arthritides expressed the Tac antigen much more frequently than corresponding CD8+ cells (54 and 58% versus 16 and 17%). In contrast, SF CD8+ cells of both patient groups expressed the HLA class II antigens rather more frequently than the corresponding CD4+ cells (88 and 68% versus 72 and 40%). Tfr-R expression was low on CD4+ and CD8+ SF T cells from both patient groups. SF T cells did not express CD30, and their expression of Act 1 did not differ from that of normal PB T cells. The RA ST findings were similar to those of RA SF. The overall expression of activation markers on PB T cells of patients was slightly higher than on those of normal controls, and the RA group was slightly higher than the non-RA group. The results show that intra-articular T cells in arthritis are activated and that CD4+ and CD8+ subsets differ in their expression of Tac antigen and HLA class II antigens. There were also similar patterns of activation markers on both CD4+ and CD8+ SF cells from RA and non-RA arthritis patients, suggesting that several types of arthritis display a similar immunopathogenesis in the joints.

alpha-Linolenic acid and long-chain omega-3 fatty acid supplementation in three patients with omega-3 fatty acid deficiency: effect on lymphocyte function, plasma and red cell lipids, and prostanoid formation

alpha-Linolenic acid deficiency is described in three patients. Observed clinical symptoms were hemorrhagic dermatitis, hemorrhagic folliculitis, skin atrophy, and scaly dermatitis. Supplementation with ethyl alpha-linolenate followed by a purified fish oil (EPA-oil) began to normalize symptoms within 10 d. The mitogenic response in isolated lymphocytes was reduced whereas the number of T lymphocytes increased significantly. Serum thromboxanes, urinary excretion of 2,3-dinor-6-keto-prostaglandin F1 alpha (PGI2-M), and bleeding time were unaffected. The results indicate that omega-3 fatty acids are essential for normal accumulation of erythrocyte omega-6 acids. The dietary intake of long-chain omega-3 acids required to obtain midnormal concentrations of omega-3 acids in plasma and erythrocyte lipids was estimated to be 350-400 mg/d (0.4% of calories), whereas the corresponding mean intake of alpha-linolenic acid was 990 mg/d (1.0% of calories). It is suggested that essential fatty acid requirement should be stated as grams or milligrams per day, similarly to other essential nutrients.

Positive selection of antigen-specific B lymphocytes by means of immunomagnetic particles

This paper presents a method for the isolation of highly enriched antigen-specific B lymphocytes from peripheral blood mononuclear cells (PBMC) by means of an immunomagnetic procedure. The method is illustrated by the isolation of B cells positive for rheumatoid factors (RF) from patients with rheumatoid arthritis and healthy blood donors. After Epstein-Barr virus transformation of isolated cells, more than 90% of the generated immunoglobulin-secreting cells produced RF in several experiments. Compared to the low frequency of B cells positive for RF in PBMC, this represents a 10(3)- to 10(4)-fold enrichment of antigen-specific B cells.

Quantitation of rheumatoid factors (RF) of IgM, IgA and IgG isotypes by a simple and sensitive ELISA. Discrimination between false and true IgG-RF

An enzyme-linked immuno-sorbent assay (ELISA) for quantitation of rheumatoid factors (RF) of IgM, IgA and IgG isotypes has been established. A complex of human serum albumin (HSA) and rabbit IgG anti-HSA antibodies is used as antigen for RF. The binding of RF is detected by stepwise additions of biotinylated monoclonal antibodies specific for human IgM, IgG or IgA, alkaline phosphatase-conjugated streptavidin, and substrate. The assay is simple and applicable to routine testing of large numbers of sera. It discriminates between false and true IgG-RF by papain digestion of sera that turn out positive by the screening for IgG-RF. Of 241 randomly selected patients with rheumatoid arthritis (RA) as well as other rheumatoid and infectious diseases, 110 were Waaler-Rose-positive while 127 were IgM-RF-positive in ELISA. The correlation between the Waaler-Rose test and IgM-RF ELISA was highly significant (r = 0.82). By testing 65 of these sera (all IgM-RF positive), 25 (39%) were also true IgG-RF positive (42 (64%) in the screening). When 40 Waaler-Rose-positive RA patients were tested, 20 and 21 were also positive for IgG- and IgA-RF, respectively. Eight IgM-, one IgA- and no IgG-RF positive tests were recovered when 48 Waaler-Rose negative RA patients were studied.

IgA and rheumatoid factor in ankylosing spondylitis

The elevated serum IgA in seronegative arthritis and psoriasis is not well understood. We examined 112 patients with ankylosing spondylitis for IgA RF, IgG RF and IgM RF by an ELISA method. Two, two and ten patients were RF positive in each Ig class, respectively. Presence of RF was not correlated with Ig concentrations, with presence of HLA-B27, nor with clinical disease signs. It was concluded that RF may be seen in ankylosing spondylitis, but the increased IgA concentrations in such patients are not IgA RF.

Immunoregulatory lymphokines in rheumatoid joints. III. B cell growth promoting activity of cells eluted from rheumatoid synovial tissue

Synovial fluid (SF) from rheumatoid arthritis patients (RA) and culture-supernatants of synovial tissue (ST) cells from RA patients and juvenile rheumatoid arthritis (JRA) patients were examined for their ability to promote B cell growth. SF was not suitable for studying B cell growth promotion because with the anti-mu driven assay system employed, all 15 samples strongly inhibited B cell proliferation. Supernatants of in vitro unstimulated ST cells from RA and JRA patients affected B cell growth in different ways, ranging from strong inhibition to moderate stimulation. Supernatants of unstimulated peripheral blood mononuclear cells (MNC) from healthy donors did not influence B cell proliferation. After phytohaemagglutinin (PHA) stimulation of the ST cells and normal MNC, culture supernatants of RA ST cells and normal MNC all stimulated B-cell growth, while culture supernatants of PHA-stimulated JRA ST cells displayed a variable picture. The differences between PHA-supernatants from RA, JRA and normal MNC were not statistically significant. These results indicate that the inflamed synovia of JRA and RA patients contain cells that can produce soluble factors with B cell growth promoting activity. Some of the data in the study suggest that these factors are produced in vivo and thus might be responsible for the observed B-cell activation in joints of these patients.

Immunoregulatory lymphokines in rheumatoid joints. II. Production by and responsiveness to interleukin-2 of eluted synovial tissue cells

Since the role of interleukin-2 (IL-2) in rheumatoid synovial joints has been debated, we examined IL-2 production by, and IL-2 responsiveness of, cells eluted from synovial tissue (ST) of patients with rheumatoid arthritis (RA) and juvenile rheumatoid arthritis (JRA). IL-2 was not detected in unstimulated cell-culture supernatants from any of the four RA patients tested, but it was present in small amounts in supernatants of unstimulated cultures derived from three of seven JRA patients studied. After PHA stimulation, IL-2 was detected in corresponding supernatants from all RA and JRA patients and from normal mononuclear cells (MNC). There was no significant difference in IL-2 activity between supernatants of normal MNC and supernatants from either RA or JRA patients. The eluted cells showed a proliferative response to recombinant IL-2. Rheumatoid ST cells are thus able to produce and respond to IL-2. Since non-T cells present in the eluates might interfere with IL-2 metabolism, one cannot yet say whether T cells of rheumatoid ST themselves produce and respond to IL-2 in a normal or abnormal way.

Immunoregulatory lymphokines in rheumatoid joints. I. Search for interleukin 2 in synovial fluid

Since there have been conflicting findings about the presence of interleukin 2 (IL-2) in synovial fluid (SF) of patients with rheumatoid arthritis (RA), we decided to study this subject ourselves. In a sensitive assay utilizing CTLL-2 as indicator cells, no IL-2-like activity was found in SF from any of the 15 RA patients studied. Treatment of SF with hyaluronidase, dialysation, heating to 56 degrees C for 1 h, preincubation of CTLL-2 with SF prior to washing and incubation all resulted in no detection of any IL-2. SF itself did not inhibit the CTLL-2 assay. Failure to detect IL-2 may to some extent be explained by in vivo absorption of any IL-2 by IL-2 receptor-positive T cells in SF. The failure is discussed along with new evidence from various reports suggesting that impaired IL-2 production by activated T cells may be a feature of several autoimmune diseases.

Immunological aspects of the rheumatoid synovium

The characteristics of the immunocompetent lymphoid cells which have invaded the synovial membrane during rheumatoid arthritis, juvenile rheumatoid arthritis and related disorders are briefly reviewed. Various functional aspects of these cells are also discussed.

T-cell immunoregulatory functions in rheumatoid arthritis patients

We have studied the immunoregulatory function of T8+ (suppressor/cytotoxic) and Leu3a+ (inducer/helper) T cells from rheumatoid arthritis (RA) patients by measuring the effect of these T-cell subpopulations on the generation of immunoglobulin-secreting cells by normal allogeneic B cells after stimulation with pokeweed mitogen (PWM) in vitro. When T8+ or Leu3a+ cells from blood or synovial tissue from nine patients were substituted for T8+ or Leu3a+ cells, respectively, from normal blood mononuclear cells (MNC), RA T8+ cells showed an increased suppressor activity, whereas RA Leu3a+ cells were, except for one patient, weak augmentors. Unreplaced normal MNC and MNC replaced with allogeneic normal T-cell subpopulations responded equally to PWM. When T8+ plus Leu3a+ cells from the same patient replaced normal T cells, high B-cell responses were detected. Normal T8+ plus Leu3a+ cells generally supported the response to a lower degree. Substitution with two allogeneic T-cell subpopulations did not result in a B-cell response to PWM. Thus, whereas RA T8+ seemed to be strong suppressors and RA Leu3a+ cells weak augmentors by themselves, together they are possibly able to generate a B-cell stimulatory potential that might be of pathogenetic significance in the patients.

Eluted rheumatoid synovial tissue T cell subsets and HLA-DR bearing cells at different stages of fractionation

By using monoclonal antibodies of the OK series in the indirect immunofluorescence technique we wanted to enumerate T cell subsets and HLA-DR-bearing cells of patients with classical rheumatoid arthritis after the cells were eluted from rheumatoid synovial tissue and at different stages of two cell fractionation procedures. The procedures were an overnight incubation on plastic flasks or a brief (7 min) fractionation on nylon wool columns, both followed by Isopaque-Ficoll gradient centrifugation. 70-90% HLA-DR+ cells and 15-30% T3+ (T cells) were initially observed. Plastic flask incubation and gradient centrifugation reduced the mediam number of HLA-DR+ cells to 55% while the number of T3+ cells increased to 60-75%, the number of T4+ (helper/inducer T cells) and T8+ (cytotoxic/suppressor T cells) usually being about equal. The other fractionation procedure left essentially the same relative proportions of cells bearing these markers even though the cell yield was 5-10 times greater than for the plastic flask fractionation. About 30% of the T cells were calculated to bear HLA-DR antigens, indicating local activation in vivo.

A rapid rosette technique for quantitation and separation of mononuclear cell subsets using monoclonal antibodies

We present a rapid and simple method for simultaneous quantitation and separation of mononuclear cell (MNC) subsets. When lymphoid cells are sensitized with monoclonal antibodies of the OK and Leu series, they rapidly form rosettes with ox erythrocytes (ORBC) coated with affinity-purified rabbit IgG against mouse IgG. Rosette-forming cells (RFC) may then be counted and separated from non-rosetting MNC by Isopaque-Ficoll gradient centrifugation. The yield and viability are close to 100% after ORBC lysis. Adherent cells do not interfere. Isolated T8+ and Leu3a+ cells were further tested: the purity was 97-99%, and the cells were functionally intact with respect to their modulating activity on the generation of immunoglobulin-secreting cells by MNC after stimulation with pokeweed mitogen.

Quantitation of cells secreting immunoglobulins after elution from rheumatoid synovial tissue

Mononuclear cells (MNC) eluted from rheumatoid synovial tissue of 16 patients with rheumatoid arthritis were examined for immunoglobulin-secreting cells (ISC). Immediately after elution and separation synovial tissue MNC contained considerable numbers of ISC. IgG and IgA ISC were more abundant than IgM ISC. At the same time there were low numbers of ISC in blood. Synovial tissue ISC were lost during incubation with pokeweek mitogen (PWM), possibly because tissue MNC were already maximally triggered in vivo. This was in contrast to blood MNC, in which the number of ISC increased significantly during incubation with PWM.

Natural killer (NK) cell activity of peripheral blood, synovial fluid, and synovial tissue lymphocytes from patients with rheumatoid arthritis and juvenile rheumatoid arthritis

Natural killer (NK) cell activity was investigated in peripheral blood, synovial fluid, and synovial tissue lymphocytes from patients with rheumatoid arthritis (RA) and juvenile rheumatoid arthritis (JRA). Unfractionated lymphocytes, T lymphocytes, and non-T lymphocytes from the 3 compartments of JRA patients had reduced activity compared with that of normal peripheral blood lymphocytes (with p values usually between 0.05 and 0.1). Unfractionated synovial tissue lymphocytes of RA patients also showed reduced cytotoxicity (0.05 less than p less than 0.1), whereas peripheral blood lymphocytes exerted normal NK cell activity. The NK activity was exerted by cells both with and without Fc gamma receptors. The highest cytotoxicity was observed in Fc gamma receptor-positive cells, both in peripheral blood and synovial fluid, since more than 70% reduction in NK activity was found after depletion of Fc gamma receptor-positive cells. No evidence of lymphocytotoxic antibodies or other factors with influence on NK cells was observed in the patients' sera.

Demonstration of immunoglobulin-secreting cells in a sensitive reversed hemolytic plaque assay

A sensitive modification of a reversed hemolytic plaque assay demonstrating individual immunoglobulin-secreting cells (ISC) is presented. The test is performed by adding test cells to a monolayer of indicator sheep erythrocytes coated with an IgG fraction of rabbit antiserum against the F(ab')2 portion of human immunoglobulins (Ig). After having added a developing antiserum and complement, hemolytic plaques with a central ISC could be counted in an inverted microscope. In addition, when ISC were killed and fixed in situ in the monolayer, the cells could be further studied by immunofluorescence of their cytoplasmic Ig.

Autologous mixed lymphocyte reactions in patients with rheumatoid arthritis and juvenile rheumatoid arthritis: both non-T cells and in-vivo-activated T cells can act as stimulator cells

The lymphocyte responses in autologous mixed lymphocyte reactions (AMLR) between irradiated non-T and T lymphocytes from the peripheral blood (PB) of rheumatoid arthritis (RA) and juvenile RA (JRA) patients were decreased compared with the AMLR responses of normal PB lymphocytes. Normal AMLR responses were seen in synovial tissue and the synovial fluid lymphocytes from RA and JRA patients. The lymphocyte responses were also decreased in AMLR between irradiated non-T cells from peripheral blood and T cells from synovial tissue (ST) in RA patients and between irradiated non-T from PB and synovial fluid (SF) T cells in JRA patients. However, when irradiated non-T cells from ST of RA patients or from SF of JRA patients were mixed with autologous PB T lymphocytes, increased lymphocyte responses were observed. SF T lymphocytes and ST T cells were also shown to stimulate autologous PB T lymphocytes.

Deposition of immunoglobulin and complement in mucocutaneous lesions related to treatment with D-penicillamine

A 23-year-old man suffering from sero-negative rheumatoid arthritis developed severe penicillamine-induced mouth ulcerations and erythematous macules. Immunohistochemical staining in a biopsy specimen from the affected lingual mucosa showed substantial deposition of IgM and C3 in vessel walls below the necrotic epithelium. In the affected skin, irregular granular staining for IgG and IgM along the epidermal basement membrane zone was noted, and granular deposits of IgM were present in small vessels of dermal papillae. The mouth ulcerations healed promptly after withdrawal of the drug, whereas the macules persisted for some months. The immunohistochemical findings indicated that the drug eruptions were related to a vasculitis induced by deposition of immune complexes.

Detection of T-lymphocyte subpopulation in the peripheral blood and the synovium of patients with rheumatoid arthritis and juvenile rheumatoid arthritis using monoclonal antibodies

Monoclonal antibodies with specificities for various human T-cell antigens were used in direct immunofluorescence to quantify the proportions of T lymphocytes with suppressor/cytotoxic-cell markers and with helper/inducer-cell markers and of T lymphocytes with HLA-DR antigens. Normal percentages of lymphocytes with suppressor/cytotoxic-cell markers were detected in the peripheral blood synovial fluid and synovial tissue lymphocytes from patients with juvenile rheumatoid arthritis (JRA) and rheumatoid arthritis (RA), respectively. Normal percentages of T lymphocytes with helper/inducer-cell markers were seen in the peripheral blood of RA and JRA patients and in the synovial tissues of RA patients. Slightly decreased percentages of cells with the helper/inducer-cell marker were detected in the synovial fluids of JRA patients. The proportions of HLA-DR-positive T lymphocytes were highly increased in the synovial fluid and synovial tissue, whereas the numbers of these cells in the peripheral blood were normal. No significant differences in T gamma cells were detected between peripheral blood, synovial fluid and synovial tissue of JRA patients or between peripheral blood and synovial tissue of RA patients.