Agammaglobulinaemia with B lymphocytes. Specific defect of plasma-cell differentiation

Lymphocyte surface immunoglobulins: detection, characterization, and occurrence in disease of the lymphoid system

Surface immunoglobulins (Igs) of lymphocytes are of considerable interest because these molecules probably function as receptors for antigen, and knowledge of their molecular properties should provide information on the mechanisms of immune differentiation. The density and types of surface Ig on a cell provide markers useful in indicating the class of a lymphocyte and its stage of maturity. Moreover, knowledge of the specificities of the surface Ig of neoplastic lymphocytes might suggest the nature of agents involved in the generation of the disease. Two broad classes of lymphocytes, bone marrow-derived lymphocytes (B cells) active in antibody secretion, and thymus-derived lymphocytes (T cells) which mediate cellular immune reactions, and their subpopulations must be considered with reference to the nature, origin, and function of their surface immunoglobulin. This article analyzes direct and indirect methods for the demonstration of surface Igs and describes certain physicochemical properties of isolated surface Ig molecules. Roles of these surface molecules in recognition of antigen, initiation of all differentiation, and cooperation among lymphocytes and accessory cells are discussed.

Polyclonal activation of bone-marrow-derived lymphocytes from human peripheral blood measured by a direct plaque-forming cell assay

A culture and assay system for the stimulation of human peripheral blood lymphocytes with polyclonal activators of bone-marrow-derived lymphocytes (B cells), such as pokeweed mitogen and Escherichia coli lipopolysaccharide, and subsequent measurement of single cell antibody production by a hemolysis-in-bel direct plaque-forming cell assay against sheep erythrocytes has been established. The critical culture requirements have been delineated and a new highly sensitive ultrathin gel assay method has been described. Under these conditions a substantial and highly reproducible plaque-forming cell response was detected in normal human peripheral blood. This system can be readily used to explore the complex events associated with activation of human B cells.

Idiopathic late-onset immunoglobulin deficiency. Clinical observations in 50 patients

Fifty patients with late-onset idiopathic immunoglobulin deficiency were studied and the frequency of various clinical associations and complications was observed. Men and women were equally affected, although the age at onset in men peaked in the third decade whereas it was more uniformly distributed in women. Sinobronchopulmonary infections were common and were caused by Haemophilus influenzae. Diplococcus pneumoniae, Streptococcus pyogenes and Staphylococcus aureus: bronchiectasis occurred in 28 per cent. Thirty patients (60 per cent) had diarrhea, which was often associated with steatorrhea, giardiasis, achlorhydria, abnormal Schilling tests and morphologic abnormalities on small bowel biopsy specimens, including nodular lymphoid hyperplasia; three patients had pernicious anemia. In the 20 patients without diarrhea these abnormalities were not observed except for giardiasis in one patient and achlorhydria in two patients. Cholelithiasis occurred in both groups in about a third of the patients tested. A high degree of susceptibility to neoplasia was noted. Thyroid abnormalities, including primary hypothyroidism and Graves' disease, were observed in six patients. Additional occasional findings were vitiligo, keratoconjunctivitis sicca and arthritis. Splenomegaly occurred in 14 (28 per cent) patients. The percentage of B lymphocytes in the blood was determined in 10 patients; it was normal or slightly decreased in eight patients and low in two patients.

Failure of heavy chain glycosylation of IgG in some patients with common, variable agammaglobulinemia

Four patients with common, variable agammaglobulinemia were preveiously reported to have normal numbers of circulating B lymphocytes which synthesized normal amounts of IgG in tissue culture but failed to secrete the newly synthesized IgG. The B lymphocytes of these patients fail to incorporate [3H]mannose and/or [3H]glucosamine into newly synthesized IgG, whereas such incorporation appears to occur just before IgG secretion in cultures of normal B lymphocytes.

Selective immunoglobulin M (IgM) deficiency in two immunodeficient adults with recurrent staphylococcal pyoderma

Two adult men with recurrent pyoderma due to Staphylococcus aureus and a selective deficiency of immunoglobulin M (IgM) antibody synthesis are described. An analysis of each patient's polymorphonuclear leukocyte chemotaxis, phagocytosis and killing of Staph. aureus, serum opsonizaiton of Staph. aureus, and serum and lymphocyte-mediated responses to antigenic stimulation was performed. Family studies revealed a possible autosomal dominant inheritance pattern with heterogenetic expression of various dysgammaglobulinemic states in each patient's first degree relatives. In vivo studies of delayed hypersensitivity and in vitro studies of polymorphonuclear leukocyte and lymphocyte function were normal. A defect in IgM, but not in IgG (immunoglobulin G), antibody synthesis to a number of antigens, and a mild decrease in serum opsonic activity to Staph. aureus correctable by heat inactivated normal human serum were found in each patient. In these patients, the recurrent staphulococcal pyoderma prompted an investigation of host defense mechanisms and revealed low to absent IgM levels and a defect in IgM antibody synthesis.

[Separation and immunological characterization of lymphocytes isolated from human appendix (author's transl)]

The isolation of viable lymphocytes from fresh human appendices is described. Under standardized experimental conditions of cell preparation no selective enrichment of either T- or B-lymphocytes was observed. The mean percentage of T-lymphocytes as judged by spontaneous rosette formation found in 34 appendices examined was 50.0%. After overnight incubation surface-Ig was detected by immunoradioautography on 46.8% of the recovered lymphocytes from 10 appendices. For the detection of surface-Ig specifically purified antibodies to heavy chains mu, gamma and alpha were used. Of the 46.8% surface-Ig positive lymphocytes the class distribution was as follows: IgM 17.7%, IgG 24.4% and IgA 4.7%. The isolated lymphocytes showed a variable mitotic response to PHA (stimulation index ranging from 3.3 to 200.9) as well as to allogeneic lymphocytes in a one-way mixed lymphocyte culture. So far, a distinct correlation could not be found between the histological degree of inflammation and the class or mitotic response of appendix lymphocytes.

IgA deficiency, epilepsy, and phenytoin treatment

In a prospective study of thirty-two children with seizures treated with phenytoin (diphenylhydantoin), five had low levels of serum-IgA before treatment. All of these were among the fifteen who had had febrile convulsions in infancy. IgA levels fell significantly during 6 months treatment in the fourteen patients studied sequentially. Treated children with low serum-IgA had normal numbers of lymphocytes with surface IgA. This suggests that phenytoin causes failure of terminal differentiation of B lymphocytes, and is the first known cause of this, the commonest mechanism of immunoglobulin deficiency.

Quantitation of the biosynthesis of immunoglobulin in peripheral blood lymphocytes of normal and immunodeficient patients

A solid phase radioimmunoassay was applied to the study of biosynthesis of immunoglobulins in lymphocytes cultured from peripheral blood of normal and immunodeficient patients. Total immunoglobulin and IgG were readily detected in lymphocyte culture fluids in studies of all normal individuals (age range 28 weeks, gestation to adulthood). In contrast, synthesis of immunoglobulins was absent or markedly reduced in cultures from patients with humoral immunodeficiencies. Inasmuch as this method requires relatively small amounts of blood, it may be of particular value in the diagnosis of humoral immunodeficiencies in infants and young children.

Familial variable immunodeficiency: autosomal dominant pattern of inheritance with variable expression of the defect(s)

In 1963, Rosen and Bougas reported the case of a woman with recurrent infection, marked elevation of 19S, and virtual absence of 7S gamma globulin. Recently, members of her family were found to have similar abnormalities: Ten of the 37 family members tested had elevated levels of serum IgM accompanied by a combined deficiency of IgG and IgA in three, and by a deficiency of either IgG or IgA in two. In five, an increase in IgM was the sole abnormality. Two children had deficiencies of IgG and IgA with normal serum levels of IgM. Ten of the 12 affected individuals had no IgD detectable by radial immunodiffusion and six had a low percentage of IgG-bearing B lymphocytes. A lack of correlation between the immunochemical abnormalities and either the presence or severity of clinical illness was observed. The presence of immunodeficiency in three generations and in both sexes of this family suggests an autosomal dominant mode of inheritance with variable penetrance of the defect.

Immunologic characterization of the mononuclear cell infiltrates in rheumatoid synovia, in rheumatoid nodules, and in lip biopsies from patients with Sjögren's syndrome

Two subcutaneous rheumatoid nodules and 8 rheumatoid synovia from patients with rheumatoid arthritis (RA); and 2 parotid glands, 1 "pseudolymphoma," and 6 lip biopsies from patients with Sjogren's syndrome (SS) were studied to identify mononuclear cells. The palisading mononuclear cells in subcutaneous nodules had a surface membrane receptor for complement. B lymphocytes surrounded by larger numbers of non-B lymphocytes were found in RA synovium and between salivary ducts of SS lip biopsies. A "pseudolymphoma" obtained from a patient with SS consisted primarily of B lymphocytes. The predominant mononuclear cell in rheumatoid synovia and salivary glands in patients with RA and SS do not have surface membrane receptors from complement and are thus probably T lymphocytes or null cells.

Membrane-associated immunoglobulin determinants on bone marrow and blood lymphocytes in the pediatric age group and on fetal tissues

Lymphocytes from bone marrow and blood of infants and children and from various tissues of seven fetuses between 13 and 25 weeks of gestational age were studied by immunofluorescence for the presence of membrane-associated immunoglobulins. Cells with mu and delta determinants prevailed, and these immunoglobulins were usually present on the same cell. The bone marrow specimens of all age groups contained more mu-positive cells without delta determinants than did the samples from the peripheral blood. Such mu(+)delta(-) cells were also found in tissues of young fetuses. These cells were postulated to represent the first stage of B cells displaying Ig receptors. Other tests with double staining showed that cells with delta determinants, but without the presence of other H chains, are rare, if they exist at all. This finding supports the idea that the role of IgD could be one of regulation of antibody secretion rather than of antibody activity. The number of cells that displayed alpha determinants was first observed to rise after birth, and only in the bone marrow, where it reached an average maximum of 16%. The relative number of such cells in the blood never exceeded a few percent.

Nodular lymphoid hyperplasia of the stomach and small intestine with hypogammaglobulinaemia

A 16-year old youth who presented with haematemesis and melaena from a duodenal ulcer was found to have multiple polyposis of the stomach and small intestine due to nodular lymphoid hyperplasia with hypogammaglobulinaemia.

Lymphocytes in patients with variable immunodeficiency and panhypogammaglobulinemia. Evaluation of B and T cell surface markers and a proposed classification

Peripheral blood lymphocytes from 15 patients with variable immunodeficiency and severe panhypogammaglobulinemia were evaluated for B and T cell surface markers. B cells were enumerated by immunofluorescent detection of both surface immunoglobulin (Ig) and the ability to bind aggregated Ig complexes. T cells were identified by their ability to form nonimmune rosettes with sheep red blood cells. Four distinct patterns were observed which were designated types I-IV. Type I: six patients had normal percentages (8.5-19.0%) of Ig-bearing B lymphocytes. Type II: four patients were observed to have B lymphocytes (4.5-15.0%) which lacked fluorescence-detectable surface Ig. Type III: the peripheral blood of these four patients contained a subpopulation (11.3-20.0%) of lymphocytes which apparently lacked both B and T cell markers ("null" cells). Type IV: one patient's blood was characterized by a subpopulation (18.0-22.0%) of lymphocytes which bore both B and T cell markers. Patients of each type had some clinical features in common. It is concluded that evaluation of lymphocyte surface markers provides a means of separating patients with variable immunodeficiency and panhypogammaglobulinemia into distinct groups which appear to differ in the nature of their fundamental defect.

Differentiation capacity of cultured B lymphocytes from immunodeficient patients

Peripheral blood lymphocytes from 27 healthy individuals and from 18 patients with a diverse spectrum of defects in humoral immunity were examined for their capacity to undergo terminal differentiation in vitro. Pokeweed mitogen induced cells from normal persons to synthesize and secrete IgM. IgG, and IgA as detected by Immunofluorescence and incorporation of [(14)C]amino acids, Lymphocytes from three boys with X-linked agammaglobulinemia were stimulated to proliferate, but did not synthesize immunoglobulin. Lymphocyte cultures from three of four patients having agammaglobulinemia with B lymphocytes produced different immunoglobulin classes in ratios similar to the in vivo distribution of classes of B lymphocytes, Lymphocytes from a dysgammaglobulinemic boy deficient in serum IgG and IgA, but who had normal numbers of IgM-, IgG-, and IgA-bearing B lymphocytes, could not be stimulated by pokeweed mitogen to make IgG and IgA. Synthesis and secretion of IgA, as well as IgM and IgG, was detected in cell cultures from each of 10 patients with isolated IgA deficiency. The results suggest that deficiencies in immunoglobulin synthesis may reflect either (a) failure to develop B lymphocytes, (b) arrested development of B lymphocytes due to intrinsic metabolic abnormalities, or (c) disturbance of factors extrinsic to the B lymphocyte which are essential for normal induction of plasma cell maturation.

B lymphocytes in untreated patients with malignant lymphoma and Hodgkin's disease

B and T lymphocytes in 37 untreated patients with malignant lymphoma and Hodgkin's disease were studied. B cells in the peripheral blood were investigated with respect to surface immunoglobulins and in a few patients with respect to intracytoplasmic immunoglobulins by means of immunofluorescence. T cell function was studied by direct phytohemagglutinin (PHA) microtest (from the same sample of whole blood), mixed lymphocyte culture (MLC), and by delayed hypersensitivity to various antigens. In the 13 patients with Hodgkin's disease the histologic subtype was nodular sclerosis in nine, lymphocyte predominant in two, mixed cellularity in two. Only one of these patients had disseminated disease (stage IV); he showed impaired cellular immunity, a very low percentage of B cells and low levels of serum immunoglobulins. Of the remaining patients with Hodgkin's disease, with one exception, normal percentages but rather low absolute numbers of B lymphocytes per mm(3) of blood were found. One patient with a low percent and low absolute number of B lymphocytes showed very high serum IgG. Of 24 patients with non-Hodgkin's malignant lymphoma, seven (29%) showed monoclonal B cell proliferation in the peripheral blood (five mukappa, two gammakappa). By morphologic criteria, 14 patients had involvement of bone marrow, five of these had involvement of peripheral blood. Four of the latter five patients showed marked increases in percentages and absolute numbers of B lymphocytes in the peripheral blood reflecting the monoclonal proliferation. In three additional patients monoclonal proliferation of lymphocytes was found by immunofluorescence although the blood smears appeared morphologically normal. Serum immunoglobulin abnormalities without monoclonal B cell proliferation in the peripheral blood were observed in six patients.

Comparative study of bone marrow and blood B cells in infantile and acquired agammaglobulinemia. Possible role of circulating anti-IgM in pathogenesis

The status of immunoglobulin (Ig) receptors of the bone marrow dependent (B) cells present in either the bone marrow (BM) or peripheral blood (PB) of three patients with infantile agammaglobulinemia (I-AGG), or seven patients with acquired agammaglobulinemia (A-AGG) is compared with those of 12 controls. Quantitative and qualitative changes of the different classes of Ig receptors on B cells were evaluated by their capacity to bind [(125)I]anti-Ig, to be stained with fluorescinated anti-Ig and their in vitro proliferative capacity upon incubation with the anti-Ig. Patients with I-AGG lacked B cells in both the BM and PB. Whereas BM cells of patients with A-AGG carried receptors similar to control cells, their blood B cells had fewer IgM, IgG, and IgA cells which failed to proliferate in vitro in the presence of the anti-Ig. An anti-IgM of the IgG class was detected in the sera of patients with A-AGG but not in sera of I-AGG. The isolated anti-IgM agglutinated human red cells coated with IgM. The anti-IgM partially blocked the binding of fluorescinated or radiolabeled anti-IgM to IgM peripheral blood lymphocytes of normal controls. The eluted anti-IgM in presence of complement was partially cytotoxic to normal cells. It is concluded that I-AGG-B cell defect is due to failure of B cell development in the bone marrow compartment whereas the peripheral exclusion of IgM cells by an anti-IgM with the subsequent failure of differentiation of both IgG and IgA cells could be an important mechanism in A-AGG-B cell defect.