Thymosin activity in patients with cellular immunodeficiency

Screening tests for cell-mediated immunodeficiency diseases

As our knowledge of immunology has become more sophisticated we have had to alter our ideas of the etiology of many immune deficiency diseases. Indeed, current concepts now prevalent have led to reclassification of a number of disease entities. In order to keep our diagnostic efforts abreast of the information being generated by the extensive immunology research programs now in progress, the clinical laboratory has been required to offer a new array of sophisticated tests on a relatively routine basis. This article is intended to serve as a brief review of immunobiology and immunodeficiency diseases with an indepth coverage of specialized tests generally available at the large centers. With an understanding of the principles, procedures, and pitfalls of the tests carried out the laboratory scientist is in a better position to assist the clinician in reaching the correct diagnosis. The detailed review is concerned with methods available to separate, classify, and subclassify lymphocytes and thereby allow a categorization of immune deficiency diseases. Toward that end there is a discussion of surface markers, rosetting, mitogenic and antigenic responsiveness as well as lymphokine production. With a view to present day research tests that might eventually find their way into the armamentarium of the clinical laboratory in the future, there is brief discussion of the methods presently used to classify T-cells as helper, suppressor, or effector cells, assays of some of the lymphokines, and measurement of antibody synthesis in cell culture.

Restoration of impaired immune functions in aging animals. III. Effect of mercaptoethanol in enhancing the reduced primary antibody responsiveness in vivo

The enhancing effect of 2-ME on the primary antibody forming capacity of young and old mice from 5 strains and hybrids was investigated by assessing the number of hemolytic antibody-forming spleen cells in response to sheep RBC stimulation. The following results were obtained: (1) the optimum dose of 2-ME is 4 micrograms per mouse; (2) the best time to administer 2-ME is just prior to, or at the same time as, antigen is given; (3) 2-ME can enhance response to suboptimum and optimum, but not supra-optimum doses of antigen; (4) 2-ME is effective in enhancing the primary antibody forming capacity of both young and old mice, with one exception, but the enhancement of old mice was greater than that of young mice (80% vs. 20%). The exception was old C57Bl mice, in which 2-ME was ineffective; (5) the level of primary antibody forming capacity of old mice can be restored to that of young mice by treating them with 3--4 weekly injections of 2-ME at a dose of 4 micrograms per injection.

Multiple biotin-dependent carboxylase deficiencies associated with defects in T-cell and B-cell immunity

Three siblings presented in early childhood with central-nervous-system (CNS) dysfunction, candida dermatitis, keratoconjunctivitis, and alopecia. Two were studied immunologically and had absent delayed-hypersensitivity skin-test responses and absent in-vitro lymphocyte responses to candida antigen. One of them had selective IgA deficiency and no antibody response to pneumococcal polysaccharide immunisation, and the other had a subnormal percentage of T lymphocytes in peripheral blood. The first two siblings died with progressive CNS deterioration and overwhelming infection. The third child, who presented with a periorificial candida dermatitis, alopecia, keratoconjunctivitis, and intermittent ataxia at eighteen months of age, had intermittent lactic acidosis and raised excretion of beta-hydroxyproprionate, methylcitrate, beta-methylcrotonylglycine, and beta-hydroxyisovalerate in urine. After four days of oral biotin, 10 mg/per day, the metabolites in her urine were significantly reduced, suggesting a biotin-responsive multiple carboxylase deficiency. These findings, taken with previous reports of immune defects in patients with disorders of branched-chain aminoacid catabolism, suggest a new biochemical basis for primary immunodeficiency disease.

In vitro induction of E-rosette formation in human bone marrow cells by the thymic proteins LSHr and LSHh

Two thymic factors, LSHh and LSHr, were found to be active in the induction of E-rosette formation. In vitro incubation of human bone marrow cells, isolated by Ficoll gradient centrifugation, with subnanogram quantities of either of these LSH proteins increased the number of E-rosette-forming cells in the bone marrow cultures by a factor of two. Kidney extract and bovine serum albumin did not show significant activity when tested as controls. Commercial thymopoietin II peptide was found to be active in the assay at comparable concentrations. The data allow a comparison of LHS proteins with other preparations tested in this manner.

Thymosin-inducible 'null' cells in atopic eczema

Thirty children with atopic eczema were compared with an equal number of age-matched healthy children. The mean peripheral blood T-lymphocyte level was lower in the eczema group (mean 1,197/mm2 as against 1,702/mm3; P = 0 . 003). This difference was abolished in vitro by thymosin, a thymic hormone extract. Positive correlations were found between eczema severity and: eosinophilia; hyperimmunoglobulinaemia E; but not T lymphopaenia. Thymosin-inducible T-cell (Ti) counts correlated with plasma IgE levels, suggesting that these Ti cells may be immature suppressor T cells. If this T-cell deficiency represents inadequate suppression of IgE responses, then a trial of treatment with thymosin appears to be warranted.

Enhanced T-cell rosette formation in shigellosis by the in vitro use of thymopoietin

The results from this study suggest that the large nul cell lymphocyte population seen in patients with Shigella dysentery, does contain a sub-population of cells that will respond in vitro to thymopoietin, a bovine thymic extract, by increased E-rosette formation. It is felt that this sub-population is in fact immature T-cells. A previous study has shown that an unusual leukaemoid reaction develops in a substantial number of patients with Shigella dysentery. The leukaemoid response was primarily granulocytic in nature but there was also a substantial increase in the mean number of lymphocytes. The proportion of the various populations of lymphocytes from leukaemoid and non-leukaemoid subjects were altered, B-cells remained constant, while the T-cells were depressed with a corresponding rise in the proportion of nul cells. The cumulative results of this and other studies demonstrate that the T-cell arm of immunity is compromised in shigellosis. Indeed the degree of compromise may ultimately be the decisive factor in determining the severity of this disease.

Thymic hormones

The thymus produces several polypeptides, which induce lymphocyte differentiation in vitro and in vivo. Several of these polypeptides have been chemically characterized, and three of them have been sequenced and synthesised (alpha 1 thymosin, thymopoietin and the serum thymic factor). Thymic hormones do not act identically on all T-cell subsets: they alter preferentially post-thymic precursor cells, and among mature T cells cytotoxic cells and suppressor cells. Their mode of action at the cellular level involves binding to specific cellular receptors and interaction with adenyl cyclase. Preliminary clinical trials with crude extracts have provided promising results in immunodeficient and cancer patients. The differentiation of T cells from stem cells has been the matter of considerable investigation over the last two decades, since it has been realized that the thymus and its products, the thymus-derived cells (T cells) play a central role in the generation of effector cells in cell-mediated immunity and in the regulation of the various categories of immune responses. That the thymus could act by the intermediate of humoral substances was precociously suggested by MILLER and OSOBA before the observation that thymuses grafted within a cell-impermeable Millipore diffusion chamber restored the immunocompetence of neonatally thymectomized (Tx) mice (1). However, although this experiment was ultimately confirmed by using chambers with well-controlled impermeability (2), MILLER did not pursue the idea of the humoral function of the thymus. Probably, the striking results obtained by DAVIES (3) and other workers, indicating direct migration of functional T cells from the thymus and the poor results initially obtained in trying to reconstitute the immune system of neonatally Tx mice by cell-free thymic extracts contributed to this disappointment. A new impetus was given to the subject in the early 70's when in vitro tests of lymphocyte function became available and when purified extracts of the thymus proved capable of restoring antigen-specific and non-specific immunocompetence of Tx mice. More recently, completely defined synthetic thymic hormones have been obtained. The question is no longer to decide whether thymic hormones exist, but rather to elucidate their biological significance and potential clinical applications. The multiplicity of available factors has created some confusion. It will be the aim of these few pages to review critically the various factors reported in the literature, giving particular emphasis to their pharmacology and their potential use in the modulation of immune responses.

Control of immunologic abnormalities associated with aging

In an attempt to encourage more intensive studies on the control of immunologic abnormalities associated with aging, the six different approaches which have been attempted are reviewed briefly. They are as follows: (a) internal body temperature control, (b) tissue ablation, (c) dietary manipulation, (d) genetic manipulation, (d) genetic manipulation (e) cell therapy and (f) chemical therapy. The first four are preventive and the latter two are restorative in approach. Many of these studies are very preliminary, but overall, the findings are most encouraging. These studies should resolve the extent to which decline in immunologic vigor with age influences the disease pattern of aging individuals and on their life expectancy.

Quantitation of B cells in peripheral blood by polyacrylamide beads coated with anti-human chain antibody

A method for quantitating peripheral blood B cells is described which utilizes anti-heavy chain specific antibody attached to polyacrylamide beads. The method has the advantages of ease of performance, of utilizing reagents which are commercially available and routine phase microscopy. In addition, the reagents are stable for prolonged periods of time and only small amounts are required. Utilizing this assay, the following percentages of B cells have been found in normals: IgG 6.3 +/- 0.6; IgM 4.3 +/- 0.5; IgA 4.0 +/- 0.5. The polyacrylamide beads may be phatocytized allowed recognition of certain phagocytic mononuclear cells.

The effect of thymosin on patients with disseminated malignancies. A phase I study

A Phase I clinical trial of thymosin administered in doses of 10 to 250 mg/M2 intramuscularly for seven days was undertaken in ten patients with disseminated malignancies and evidence of immunoincompetence. Toxicity was minimal; one patient experienced a mild urticarial rash which cleared spontaneously, two patients developed low grade fever and one patient experienced pain at the injection site. There was no evidence of systemic toxicity or parenchymal organ dysfunction. Thymosin administration was associated with an increase in the E-rosette forming capacity of the patient's lymphocytes and the development of new skin test reactivity to recall antigens in some of these patients. One objective tumor response was noted. These findings are preliminary but are encouraging for further utilization of thymosin as an immunostimulant in cancer patients with immunoincompetence.

Reconstitution of T-cell function in severe combined immunodeficiency disease following transplantation of early embryonic liver cells

In a 51/2-month-old male infant with adenosine deaminase-positive severe combined immunodeficiency disease, who had no suitable bone marrow donor, immunologic reconstitution was attempted with lymphoid cells obtained from the liver of a 4- to 5-week-old-male human embryo. A mild graft-versus-host reaction began three weeks later. T-cells, which were absent prior to infusion of hepatic lymphoid cells, rose to a maximum of 554/mm3 at 16 weeks post transplantation. A normal lymphocyte response to pokeweek mitogen was not present until 25 to 30 weeks and to allogeneic cells until 39 weeks. Postive in vitro lymphocyte responses to Candida albicans were found repeatedly after 52 weeks. Twenty months following transplantation the patient is free of clinical infection, although he requires regular injections of gamma globulin.

Severe disseminated adenovirus infection successfully treated with a thymic humoral factor, THF

Adenovirus and other usually benign viral infections may occasionally be associated with severe fulminant disease, often accompanied by acute acquired cellular immunodeficiency. Thymic humoral factor derived from calf thymuses has been demonstrated to have the capacity to restore the immunocompetence of immature, incompetent T cells. This factor was used in the treatment of a 3 1/2-year-old boy who was critically ill with an adenovirus infection and presented evidence of immunocellular deficiency. Within less than 48 hours after the institution of treatment with thymic humoral factor there was a dramatic, progressive clinical improvement, with restoration of the cellular immunocompetence. It is suggested that thymic humoral factor may be beneficial in the treatment of severe viral infections associated with depressed cellular immunocompetence.

Purine nucleoside phosphorylase deficiency associated with selective cellular immunodeficiency

We studied a 15-month-old girl who had normal T-cell and B-cell immunity at birth, after which a gradual decrease in T-cell immunity developed. This selective cellular immunodeficiency was inherited as an autosomal recessive trait: two older sisters had the same immunodeficiency. Adenosine deaminase activity was present in erythrocytes and lymphocytes of the patient, parents and a healthy brother. Purine nucleoside phosphorylase activity was not found in the patient's erythrocytes and lymphocytes (the parents and brother had intermediate values, indicating that the enzyme deficiency too was inherited as an autosomal recessive trait). Analysis of serum and urine from the patient and of serum from her two deceased sisters showed high levels of inosine and guanosine in addition to hypouricemia and hypouricosuria. The bone marrow was megaloblastic, and the blood hypochromic microcytic. The patient had spastic tetraparesis. Intoxication of the T lymphocytes after birth by metabolic products may explain the progressive cellular immunodeficiency.

Effect of thymosin in vitro on T cell levels during radiation therapy: correlations with radiation portal and initial T cell levels

The effect of thymosin in vitro on percent T cells was determined in 388 blood specimens from patients with head and neck, mediastinal, and pelvic malignancies during radiation therapy, in 94 untreated patients with these malignancies, and 277 normal adults. Changes in percent T cell levels after incubation of lymphocytes with thymosin did not correlate with tumor histology or cumulative radiation dose, but in all groups correlated with radiation portal and initial T cell levels. T cell levels increased by a similar increment in normals and in the untreated patients. During irradiation, the mean levels after incubation with thymosin did not change in patients with head and neck and pelvic malignancies, but in patients with mediastinal malignancies the levels increased significantly more than in normals. For a given T cell level, the increase in patients with mediastinal malignancies was greater than in patients with pelvic malignancies, and as a group was greater than in patients with head and neck malignancies. The results can be explained by an increase in circulating thymosin-responsive lymphocytes during mediastinal irradiation due to suppression of a function of the thymus important for maturation of these cells, and a decrease in these cells during pelvic irradiation due to a deleterious effect on precursors in pelvic bone marrow. The results thus provide a rationale for clinical trials to assess the efficacy of thymosin in averting declines of T cell levels in patients receiving mediastinal irradiation.

Thymosin reconstitution of T cell deficits in vitro in cancer patients

Thymosin, a soluble extract of fetal calf thymus, has increased cellular immunity in children with thymic deficiency. Prior to therapy, an increase in thymus-dependent lymphocyte (T cell) levels in vitro after incubation with thymosin correlated with a rise in peripheral blood T cell levels and improvement in other parameters of cellular immunity. These correlations constituted the basis for a study of the effects of thymosin on T cell levels in vitro in cancer patients. Groups studied were 350 untreated patients with local-regional solid malignancies, 157 patients cured of these tumors, 340 patients studied at 523 intervals during radiation therapy, 80 patients receiving chemotherapy for disseminated solid malignancies, and 427 normal volunteers. Although there were significant differences among the groups in mean leukocyte, lymphocyte and T cell levels, among those with low T cell levels in each group there was a significant inverse relation between T cell levels after incubation with thymosin in vitro and initial T cell levels, with the exception of patients receiving chemotherapy. In patients receiving chemotherapy, T cell levels increased independently of initial T cell levels. These in vitro observations are consistent with evidence that a major effect of thymosin is maturation of T cell precursors; however, the effect is that of reconstitution at low T cell levels, and not of elevation to levels significantly above normal. The results provide a rationale for clinical trials with thymosin to maintain immune competence during radiation therapy and chemotherapy, and for a two-phase approach to immunotherapy of cancer utilizing thymosin for reconstitution of cellular defects followed by administration of agents that potentiate cellular immunity.

Increase of cyclic GMP induced in murine thymocytes by thymosin fraction 5

Using a radioimmunoassay (RIA) for the determination of adenosine 3'5' cyclic monophosphate (cAMP) and an acetylation-RIA procedure to measure guanosine 3'5' cyclic monophosphate (cGMP), we observed that cGMP levels, but not cAMP levels, were significantly elevated in murine thymocytes which had been incubated with preparations containing the thymic hormone, thymosin. Stimulation of intracellular cGMP levels was seen as early as 1 minute after incubation with thymosin fraction 5 and was maximal at approximately 10 minutes. Dose response studies indicated an optimum stimulation of cGMP with a thymosin concentration of 100 microg/ml. A control spleen fraction prepared by an identical procedure as fraction 5 did not affect the levels of either cyclic nucleotide.

Modified E-rosette test for detection of total and active rosette-forming lymphocytes

The human peripheral blood T-lymphocyte population can be demonstrated with an economy of time by using brometlin-treated sheep red blood cells (SRBC). Similarity, the lower affinity, active T-cell population can be determined using intreated SRBC. Both tests are done without serum, or prolonged incubation of the cell mixture, using the same procedural steps reflecting changes as readily as longer test methods.