Mechanism of action of migration inhibitory factor (MIF). I. Evidence for a receptor for MIF present on the peritoneal macrophage but not on the alveolar macrophage

The initial interaction between migration inhibitory factor (MIF) and the guinea pig alveolar and peritoneal macrophage was studied. MIF-containing supernatants were generated from sensitized lymph node lymphocytes obtained from guinea pigs immunized with bovine gamma globulin in complete Freund's adjuvant. MIF-containing supernatants were markedly inhibitory for the migration of the peritoneal macrophage but had no effect on the alveolar macrophage. A linear relationship was observed between per cent inhibition of migration and serial twofold dilution of supernatant. Reexpressed in arbitrary MIF units, this relationship reflects a dose-response relationship with saturation characteristics. Pulse exposure of peritoneal macrophages to MIF resulted in adsorption of MIF onto both viable and nonviable cells with corresponding depletion of supernatant MIF. The alveolar macrophage did not adsorb MIF. Pulse adsorption of MIF onto the peritoneal macrophage is dependent on time, temperature, and cell number. Pretreatment of the cells with proteolytic enzyme prevents the adsorption of MIF while leaving migration unaffected. These observations support the existence of a specific cell surface receptor for MIF. The existence of such a receptor provides selectivity of immune modulation of macrophage populations by lymphocytes in delayed hypersensitivity reactions.

Evaluation of the leucocyte migration test as a measure of delayed hypersensitivty in man. Suppression of migration inhibition by puromycin

The response of peripheral blood leucocytes to PPD was studied in vitro by means of the leucocyte migration test, using Mantoux-positive and -negative subjects. The migration of leucocytes from 83% of the positive subjects was significantly inhibited when a concentration of 100 μg PPD/ml was used in the chambers. Leucocytes from the majority of these subjects were also inhibited at a lower concentration of 50 μg PPD/ml and one strongly positive subject showed inhibition at all concentrations tested, down to 1 μg PPD/ml. Stimulation of migration was not observed with leucocytes from any of the positive subjects even when the lowest concentration of PPD was used. Inhibition of migration with PPD was prevented by the addition of puromycin, suggesting that the response is dependent on protein synthesis and may be mediated by a soluble factor produced by sensitized lymphocytes.

Cell-mediated immune responses in chronic liver diseases

Studies of the cell-mediated response to liver antigens, using the leucocyte migration test, in 163 patients with various liver disorders showed that abnormal responses were almost confined to active chronic hepatitis (53% abnormal), primary biliary cirrhosis (64%), and cryptogenic cirrhosis (29%). The test was also abnormal in five out of seven patients with jaundice due to drug hypersensitivity and in one patient with acute infectious hepatitis at a time when mitochondrial antibodies were present in the serum. More of those with active chronic hepatitis on prednisone or azathioprine had normal tests than of those who were untreated, and in 8 out of 10 examined serially during therapy there was an accompanying improvement in leucocyte migration. Abnormal responses to salivary gland or kidney antigens were also found in nearly half of those with features of Sjögren's syndrome or renal tubular acidosis as part of a multisystem involvement-this, though occurring in cryptogenic cirrhosis, was found with greater frequency in active chronic hepatitis and primary biliary cirrhosis. These cell-mediated immune responses, perhaps triggered by the initial damage to the liver from viral or other agents, may be responsible both for the perpetuation of the liver disease and, because of common surface antigens, for the damage to other organs.

75se-selenomethionine in the scintiscan diignosis of primary hepatocellular carcinoma

Forty-eight patients with ;cold areas' on (99m)Tc sulphur colloid liver scintiscans were scanned again using (75)Se-selenomethionine. In 11 patients with primary hepatocellular carcinoma considerable uptake of (75)Se-selenomethionine could be demonstrated in the area of the tumour and uptake of (75)Se-selenomethionine was also observed over extrahepatic metastases in two of these cases. In contrast uptake was low in cholangiocellular carcinoma, Kupffer cell sarcoma, and secondary hepatic deposits (excepting melanoma metastases). No cause for the ;cold area' on the (99m)Tc scan could be discovered in 16 of 25 patients with cirrhosis and in these patients the uptake of the two isotopes in the area of the ;false positive' filling defect was almost equal. Positive identification of primary hepatocellular tumours using this dual scanning technique can be of value in determining and assessing treatment by surgery or cytotoxic therapy.

Changes in leucocyte migration after renal transplantation

The leucocyte migration test, an in-vitro measure of cellular immunity, has been used to follow the changes in cell-mediated hypersensitivity to kidney and histocompatibility antigens in three patients after renal transplantation.Inhibition of leucocyte migration, indicating strong sensitization to the antigens used, occurred in each patient, starting five to seven days after transplantation. Satisfactory renal function had not been established in any of the patients at this time. In one case inhibition of leucocyte migration persisted almost continuously until the 24th day and was associated with poor renal function proved histologically to be due to rejection. Treatment with increased dosage of prednisone was associated with a rapid reversion to normal of the migration index and improvement in renal function. Later, inhibition of migration occurred again, and shortly afterwards the graft ceased to function. In the other two cases the migration index became normal without alteration in immunosuppressive therapy and a satisfactory diuresis followed. It is suggested that this simple test should prove useful in the specific diagnosis of rejection and in control of immunosuppressive therapy.

Significance of increased "splenic uptake" on liver scintiscanning

Peak activity over the spleen as a percentage of peak activity over the liver was measured in 265 (99m)Technetium sulphur colloid liver scintiscans. The value exceeded 70% in 50 cases. In 32 of these cirrhosis was present; the other 18 scans were from patients with a wide variety of conditions, including secondary deposits, hepatitis, and diseases involving the reticuloendothelial system. A measure of the total activity in the spleen was derived from the peak activity and the length of the spleen. In cirrhosis this was closely related to the finding of oesophageal varices thus showing the importance of a collateral circulation (which allows colloid to bypass the liver) in the increased uptake of colloid by the spleen. In eight patients with hepatosplenomegaly due to blood dyscrasia or disease involving the reticuloendothelial system, total activities in the liver and spleen were estimated from the anteroposterior colour dot scan, and both liver and spleen blood flow were measured by methods independent of reticuloendothelial cell function. The results showed that the main factor causing increased uptake of colloid by the spleen in these diseases was an increased blood flow in the spleen relative to that in the liver.

Liver transplantation in man--3, Studies of liver function, histology, and immunosuppressive therapy

The experience gained from 13 hepatic transplant operations is described, with particular reference to the findings in nine patients who survived the immediate operative period. A major problem was found to be infection. Fulminant pneumonia caused death in two adults, at a time when liver function was virtually normal. Infection related to bile fistula and sepsis may be overcome by an improved method of biliary drainage by cholecyst-dochostomy, which was carried out in the last two patients. Jaundice in the second week due to rejection was observed in several patients. The striking histological change was centrilobular cholestasis. The jaundice, which was not prevented by administration of antilymphocyte globulin, was rapidly controlled by temporarily increasing die dose of prednisone. One patient who survived for four and a half months and who had a poor tissue match subsequently developed chronic rejection with progressive cholestatic jaundice. Five of the patients were able to go home and at time of publication two are alive and well 14 and 20 weeks after treatment.

The value of liver scanning

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