Impaired synthesis of polyclonal (non-paraprotein) immunoglobulins by circulating lymphocytes from patients with multiple myeloma Role of suppressor cells

Concanavalin-A-induced suppressor lymphocytes in normal individuals

Suppressor lymphocytes are now known to play an important role in the control of immune responses. It has been demonstrated that lymphocytes stimulated by the mitogen concanavalin A (Con A) have the ability to suppress the normal lymphocyte response to antigens. It has further been shown that this suppressive action is reduced when the suppressing lymphocytes are derived from patients with disorders (e.g. systemic lupus erythematosus) in which it has been suggested that suppressor cell function is abnormal. In this study we have examined several aspects of the Con A-induced suppression. The induction of suppression required viable cells, and both the induction and the action of the suppressor cells were radio-resistant. The induction of suppressor cells by Con A was independent of DNA synthesis but not of protein synthesis. The action of these suppressor cells was enhanced by the addition of prednisolone to the cultures. This latter observation is of interest in view of the action of steroids in diseases in which a defect of suppressor cells is suggested to be present and lends support to the importance of suppressor cells in the aetiology of these disorders.

Defective suppressor cell activity in cancer patients: a defect in immune regulation

Although suppressor cells appear to be involved in the normal regulatory mechanism of the lymphoid system, they are also considered to have a role in the immunosuppression of certain malignancies. Suppressor activity of lymphocytes can be reproducibly measured by use of the mixed lymphocyte culture-mitogen interaction (MLC-M) in which the stimulating cell either is in the basal state or has been induced by Concanavalin A. This yields a quantitative measure of resting suppressor cell activity as well as the maximum generation of suppressor activity as induced by Con A. This test was performed, using autologous and allogenic cell combinations in a group of 13 cancer patients and 18 normal controls. Normal lymphocytes activated by Con A in 48-hour lymphocyte cultures significantly decreased the mitogenic response of lymphocytes from healthy, male donors to phytohemagglutinin (PHA), Con A, and Pokeweed mitogen (PWM) in both autologous and homologous systems. In contrast, Con A activated lymphocytes from cancer patients demonstrated diminished suppressor activity compared with controls in autologous (P less than 0.01), and allogenic (P less than 0.005) systems. There was a correlation between the degree of immunosuppression and suppressor cell activation: i.e., the patients most depressed generally had the lowest suppressor cell activation. Untreated lymphocytes from cancer patients also exerted suppressive effects on normal lymphocyte responses, suggesting an increased resting level of suppressor cells. These data suggest that in addition to having depressed cellular immune responses, cancer patients frequently have reduced capability to generate suppressor cell activity, which implies a generalized defect in this aspect of immune regulation.

Subpopulations of T-lymphocytes in multiple myeloma

The percentage and absolute numbers of T lymphocytes bearing Fc receptor for IgG and IgM were evaluated in 13 patients with multiple myeloma and in a group of controls of the same age range. An increase in the percentage of the TG cells was found, whereas TM cell numbers were not different from those of the controls. In order to better define the properties of the TG lymphocytes, their ability to suppress the PWM-induced B cell differentiation was tested in an in vitro experimental assay. TG cells from multiple myeloma exert a suppressor activity as the TG of the controls in this system. The possible interpretation of suppressor T cell increases in these patients is discussed.

T lymphocyte subpopulations in the bone marrow and peripheral blood of untreated patients with myeloma

The quantitative distribution of the two main T lymphocyte subsets, recognizable by the 'high' and "low-affinity' E rosette-forming cell technique of West, was studied in both the bone marrow and peripheral blood from ten untreated multiple myeloma (MM) patients. A reduced total T lymphocyte count, with a relative predominance of 'low-affinity' T lymphocytes (putative suppressor T cells), was found in the peripheral blood. Within a normal total T lymphoid cell count, a predominance of the T lymphocyte subset with 'low-affinity' characteristics was also observed in the bone marrow. An inverse correlation, that was statistically significant, was seen between the monoclonal malignant cellular B component and the 'low-affinity' T cell percentage in all cases. It is concluded, therefore, that such an imbalance between the 'high' and "low-affinity' T subsets, with the latter predominating, could be of importance in the regulation of the growth rate of the monoclonal cellular B component.

Abnormal regulation of in vitro IgG production in multiple sclerosis

A pokeweed mitogen-stimulated IgG synthesis assay was used to evaluate T suppressor cell function in peripheral blood lymphocytes (PBL) obtained from multiple sclerosis (MS) patients. Autochthonous cultures of fractionated and recombined MS B and T cells exhibited less suppression of IgG synthesis than similar cultures of PBL from control subjects. No difference occurred in the levels of suppression among MS patients grouped according to disease states. When allogenic cultures of MS B and normal T cells or normal B and MS T cells were compared to autochthonous cultures of control cells, no differences were observed. The results suggest that the lower levels of suppression observed in autologous MS cell cultures are not a result of T suppressor cell dysfunction alone.

Immunoregulatory T cell function in multiple myeloma

Multiple myeloma is a malignancy characterized by uncontrolled monoclonal B cell differentiation and immunoglobulin production. In most instances, there is concomitant reduction in polyclonal differentiation and immunoglobulin synthesis both in vivo and in vitro. In in vitro pokeweed mitogen-induced B cell differentiation assays, proliferation and polyclonal immunoglobulin secretion optimally requires T cell help and can be inhibited both by monocytes and suppressor T cells. Helper function and monocyte-mediated suppression are relatively radio-resistant whereas T suppressor function is sensitive to 2,000 rad x-irradiation. We have examined myeloma T cell subset function in this assay using recombinations of isolated patient and normal B cells, T cells, and T cell subsets. Monocytes were removed by a carbonyl iron ingestion technique, normal and myeloma T cells were fractionated on the basis of Fc receptors for immunoglobulin (Ig) G (Tgamma) or IgM (Tmu or T non-gamma), and proliferation and IgG secretion after co-culture determined by [(3)H]thymidine incorporation and radio-immunoassay, respectively. Myeloma B cells demonstrate quantitatively and qualitatively normal blastogenic responses and are appropriately regulated by either autologous or allogeneic T helper and suppressor subsets. Despite normal proliferation, however, myeloma B cells remain deficient in subsequent differentiation and immunoglobulin secretion even when co-cultured in the absence of monocytes or suppressor T cells and the presence of normal helper cells. Myeloma T cell populations, in contrast, are entirely normal in helper capacity over a range of T:B ratios but are markedly deficient in radiosensitive and concanavalin A-induced suppressor activity. T suppressor cell dysfunction in multiple myeloma is apparently due to a deficit in the T non-gamma suppressor subset, whereas Tgamma cells, although proportionately reduced, are functionally normal. This unique T suppressor deficit reflects the heterogeneity of suppressor mechanisms in this disease and may represent a compensatory response to the monoclonal proliferation or the involvement of regulatory T cells in the pathogenesis of the malignancy.

Role of adherent suppressor cells in the depression of cell-mediated immunity in Hodgkin's disease and lung carcinoma

The mechanism of the depression of cell-mediated immunity (CMI) in patients with Hodgkin's disease (HD) and lung carcinoma (LC) was investigated before any treatment. In 9 patients out of 14 with HD and in 4 patients out of 14 with LD, a depressed lymphocyte reactivity to phytohaemagglutinin (PHA) was observed. In 3 out of 9 patients with HD and in 2 out of 4 patients with LC who exhibited a depressed lymphocyte response to PHA, suppression caused by adherent cells and mediated by prostaglandins was evidenced. No relationship was found between this mechanism of suppression and depression of CMI in vivo as judged by skin tests to common recall antigens.

Con A-induced suppressor cells in man. II. Role of monocytes and their interaction with soluble inhibitory factors

Monocyte dependence of Con A-induced suppression was studied in co-cultures of normal human lymphocytes. Con-A-pretreated (25 microgram/ml for 48 hours) peripheral blood mononuclear (MN) cells inhibited the 3H-thymidine uptake by fresh autologous or allogeneic lymphocytes stimulated with Con A. Monocyte-depleted lymphocytes pretreated with 25 microgram/ml of Con A failed to exhibit the suppressor properties. Supernatants of MN cell activated with 25 microgram/ml Con A for 72 hours inhibited the mitogenic response of fresh allogeneic cells when added in proportion 1:1 to the culture medium. No inhibition was observed when supernatants of monocyte-depleted, Con A activated cultures were tested. The short preincubation with suppressive supernatants rendered blood adherent mononuclear cells suppressive for 3H-thymidine incorporation by autologous MN cells stimulated with Con A. These studies indicate that monocytes are essential for induction of suppressor cells in Con A stimulated cultures. The suppressor cells produce a soluble inhibitory factor(s) which has the property of binding to the surface of fresh monocytes. Such monocytes become responsible for suppression of mitogenic response of autologous lymphocytes.

Myeloproliferative and lymphoproliferative disorders in the same patient

A 67-year-old man developed a Philadelphia-negative myeloproliferative disorder which initially manifested as marked thrombocytosis, followed two years later by marked leucocytosis. He subsequently developed an IgG lambda plasma cell dyscrasia together with a monoclonal proliferation of circulating lymphocytes with IgM kappa surface immunoglobulin. The lymphoid neoplasm was associated with a rapidly progressive and fatal course.

Spectrum of immunodeficiencies with Hodgkin's disease

The role of six suppressor mechanisms upon T and B cell responses was studied on 17 untreated patients with Hodgkin's disease. Proliferative hyporesponsiveness to mitogen was greatly impaired in 8 of the 13 patients. 10 of these patients had an excessive degree of suppression by cells that adhered to foreign surfaces. Suppression by adherent cells correlated with impairment of proliferative responses and, in some instances, suppression was largely inhibited with indomethacin. Likewise, adherent cells suppressed immunoglobulin synthesis. A correlation was evident between suppression of T and B cell responses by adherent mononuclear leukocytes from individual patients. This suppression coincided with elevated percentages of monocytes in the patient mononuclear cell preparations. This excess of monocytes was not the result of a circulating monocytosis. The monocyte excess may have been acquired during isopyknic cell separation. A second form of suppression was observed in 5 of the 11 patients affected by a lymphocyte that neither adhered to glass wool nor required preactivation. It did not inhibit allogeneic lymphocytes, which contrasts with the suppressor abnormality of monocytoid cells.

Nonspecific immunosuppression by cultured lymphocyte supernates of cancer patients

A nonspecific immunosuppressive factor, lymphocyte immunosuppive substance (LIS), has been correlated with cancer patients. Significant suppression of IgM antibody production of sheep erythrocyte immune Swiss mice lymphocytes was found when the immune lymphocytes were treated with cultured peripheral blood lymphocyte supernates of tumor-bearing patients. A lesser amount of LIS activity was also demonstrated with patients who had cancer in the past, but were clinically free of disease at the time of testing. This suppressive activity has been demonstrated with several solid tumors including breast CA, colon CA, melanoma, uterine CA, and ovarian CA. A possible use of this suppression test for detecting recurrences is suggested from the data.

Multiple myeloma: current concepts in diagnosis and management

The basic pathologic process in multiple myeloma is the neoplastic proliferation of a single clone of plasma cells. Although the events which trigger autonomous cell growth are not well understood, the secretion of an M component, a serum or urinary immunoglobulin molecule or a light chain fragment by the vast majority of myeloma cells has provided a biologic marker which has greatly facilitated the study of this disease Some of the more recent clinical concepts which have evolved from studies on the plasma cell and the immunoglobulin molecule are discussed.

The plasma cell dyscrasias: diverse presentations, pathophysiology, and management

The plasma cell dyscrasias have in common the proliferation of a single clone of plasma cells, but have disparate manifestations and natural histories. Multiple myeloma can present in protean ways, and early diagnosis is vital because timely supportive therapy and chemotherapy can give patients longer, better lives. Waldenström's macroglobulinemia may be manifested by the hyperviscosity syndrome, which responds to plasmapheresis. Patients with benign monoclonal gammopathy as strictly defined fare very well without therapy, but some asymptomatic patients with a serum monoclonal protein have incipient myeloma, so periodic reevaluation is essential.

In vitro suppression of T-cell mitogenic response and tumor cell proliferation by spleen macrophages from normal chickens

Adherent cells isolated from spleen of normal specific pathogen-free chickens inhibited mitogen-induced blastogenesis of autochthonous, syngeneic, or allogeneic lymphocytes. The adherent cells were also inhibitory to in vitro proliferation of cells of a rapidly dividing tumor line, MDCC-MSB-1, derived from a lymphoma induced by Marek's disease virus. The effector cell of suppression of both lymphoprolifrative functions appeared to be a macrophage because the suppressive activity of adherent cells could be abrogated by pretreatment with carrageenan but not with antisera specific to chicken T or B cells. The proportion of macrophages needed for effective suppression was substantially higher than the proportion of macrophages ordinarily present in spleen of normal, unstimulated chickens. This heretofore unrecognized suppressive capability of normal, presumably resting macrophages have been detected in certain infections.

[In vitro studies on two cell lines from patients with Hodgkin's disease (author's transl)]

Two cell lines (Ma,Bi) were established in vitro from pleura effusions from two patients with Hodgkin's disease. After some months the monolayer line Ma spontaneously became nonadherent and proliferated in suspension. Immunological properties, enzyme activities, surface characteristics and chromosomal analyses suggested that the culture Ma is composed of lymphoid cells and macrophages. Line Bi propagated attached to the glass and had properties typical for macrophages only.

Diminished synthesis of immunoglobulin by peripheral lymphocytes of patients with idiopathic membranous glomerulonephropathy

Some studies of animal models of serum-sickness nephritis have shown that the lesions of membranous nephropathy develop in animals exhibiting a poor antibody response to the administered antigen (if given in constant amounts). It is postulated that patients with idiopathic membranous nephropathy may share a similar characteristic, namely, a diminished capacity to produce sufficient amounts of antibody. To test this hypothesis, we examined the ability of lymphocytes isolated from 11 patients with this disorder to produce immunoglobulin (Ig)G and IgM on stimulation with a polyclonal B-cell activator, pokeweed mitogen. The peripheral blood lymphocytes (2 x 10(6) cells) from 24 normal individuals had geometric mean production rates of 1,779 ng for IgG, and 2,940 ng for IgM after 7 d of culture in the presence of pokeweed mitogen. By contrast, under identical conditions, lymphocytes from the 11 patients with membranous nephropathy produced significantly lower quantities of both immunoglobulins, with geometric mean concentrations of 511 ng for IgG and 439 ng for IgM. When lymphocytes from patients with membranous nephropathy were co-cultured with normal lymphocytes, the production of immunoglobulin by normal lymphocytes was depressed by 22-82%, suggesting that a population of suppressor cells was responsible for this disturbance in B-cell function. By co-culturing normal lymphocytes with patient lymphocytes depleted of either T cells or monocytes, the suppressor cell was identified as a monocyte.

Effects of levamisole on in vitro suppressosr cell function in normal humans and patients with systemic lupus erythematosus

Levamisole-treated mononuclear cells from normal volunteers or from patients with systemic lupus erythematosus (SLE), when cultured with normal allogeneic lymphocytes, did not significantly influence the ability of the latter cells to proliferate when stimulated with either phytohemagglutinin (PHA) or concanavalin A (Con A). Levamisole, furthermore, did not influence the ability of Con A to induce suppressor cell function from normal mononuclear cells. When mononuclear cells from patients with SLE were treated with therapeutic concentrations of levamisole in the presence of Con A, the drug was unable to restore the ability of the Con A to induce normal suppressor cell function. SLE cells treated with a high concentration of levamisole (60 micrograms/ml) in the presence of Con A did show some suppressor cell activity on normal autologous mononuclear cells activated by Con A, but not by PHA. Although the significance of this latter finding is unclear it appears that levamisole at therapeutic concentrations does not influence in vitro suppressor cell function of normal or SLE mononuclear cells.

Suppressor monocytes in human disease: a review

Suppressor monocytes have been found in a number of human diseases most of which are associated with lymphopenia and deficiences in cell mediated immunity. In our studies both quantitative and qualitative differences in monocytes were detected in certain patients with advanced Hodgkin's disease or tuberculosis. In certain patients lymphocyte activating factor production by monocytes was severely depressed in part secondary to decreased activation by suppressed T cells, although at times primary impairment of macrophage function was also probably contributory. Mononuclear cell cultures from patients with advanced Hodgkin's disease also manifested excessive prostaglandin secretion; however, the association of this with monocyte suppression and deficient LAF production was inconstant. Furthermore, reversibility of monocyte suppression could not regularly be achieved by inhibition of prostaglandin synthetase with indomethacin suggesting that excessive production of prostaglandins is unlikely to be the sole mechanism of monocyte inhibition of lymphoproliferation. It also remains to be established whether the inhibition of lymphoproliferation in vitro is important to in vivo delayed hypersensitivity or whether the mechanism is related to other macrophage effects such as tumor cytostasis and cytolysis.

Alveolar macrophage--induced suppression of the immune response

Alveolar macrophages were shown to suppress the in vitro immune response of rabbit lymphoid cells stimulated with heterologous erythrocytes. Suppression was associated with an adherent, phagocytic cell that was resistant to the effects of irradiation and treatment with anti-thymus serum. Suppression was mediated by a soluble factor whose production was independent of antigen and required an interaction of viable alveolar macrophages and lymphocytes. Suppression was associated with an early event in the induction of the PFC response and appeared to affect lymphocyte proliferation. Suppression could not attributed to cytotoxicity, sequestration of antigen, depletion of nutrients or release of prostaglandins, arginase or thymidine. These results, taken together, provide additional information regarding immunological function of alveolar macrophages and suggest that they play a regulatory role in the immune response.

[Unusual location of extramedullary plasmacytomas (author's transl)]

Two cases of solitary extramedullary plasmacytoma, one of the nasopharynx and one of the tongue are reported. Although there was no paraprotein secretion present, we were able to demonstrate an intracytoplasmic monoclonal immunoglobulin (type IgG-kappa) by immunohistochemical methods. Twelve months following surgical treatment both patients locally and by serum controls are free of residual disease. We confirm former studies in the literature that the prognosis of solitary extramedullary plasmacytomas seems to be good after surgical or radiation therapy. Continuous individual follow-up including serum and X-ray controls are obligatory.

Immunoglobulin synthesis by cord blood lymphocytes

The IgG, IgA and IgM synthesis by adult peripheral blood and cord blood lymphocytes incubated alone and with pokeweed mitogen was quantitated. The cord blood lymphocytes produced no immunoglobulin even with mitogen stimulation while the adult peripheral blood lymphocytes responded to the mitogen with a significant (p less than 0.04) increase in immunoglobulin production.

Light chain isotype-associated suppression of normal plasma cell numbers in patients with multiple myeloma: Medical Research Council's Working Party for Leukaemia in Adults and the Oxford Lymphoma Group

The number of plasma cells in the lamina propria of the gut has been assessed in patients with multiple myeloma and other B-cell neoplasms. The total number of these plasma cells was reduced in most patients with myelomatosis and one-third of patients with lymphoplasmacytoid tumours. This reduction was not, however, seen in patients with other neoplasms of B-cell origin, although hypogammaglobulinaemia was common to all groups of patients. The depletion of gut plasma cell numbers was not uniform in myelomatosis patients. They showed selective loss of plasma cells with the same light chain isotype as that produced by the neoplastic clone.

The kinetics of immunoglobulin synthesis by pokeweed mitogen stimulated peripheral blood lymphocytes in multiple myeloma

As a means of investigating the immunoglobulin (Ig) deficiency in multiple myeloma, the effects of pokeweed mitogen (PWM) on morphologic transformation and concomitant immunoglobulin synthesis and secretion kinetics were studied in peripheral blood lymphocytes (PBL) of normals and patients with myeloma. Lymphocyte Ig production kinetics, both in the unstimulated state and after five days of culture with PWM, were evaluated by 3H-leucine incorporation. B-lymphocytes were found to be decreased by EC3 rosetting in the myeloma patients studied. In addition their lymphocytes had a mean of 30% transformation compared to 53% for normals (P less than 0.005). After five days of mitogen stimulation in culture, myeloma PBL failed to show the rise in intracellular Ig production seen in normal PBL under similar conditions. Thus, myeloma patients were found to have decreased numbers of EC3 rosetting B-cells, decreased morphologic transformation rate in response to mitogenic stimulation, and failure to increase intracellular Ig after mitogenic stimulation. Possible etiologic mechanisms for the decreased Ig production are discussed.

Antibody response to infection in multiple myeloma. Implications for vaccination

We report the humoral immune response of a patient with multiple myeloma to rapidly successive episodes of meningococcal and pneumococcal meningitis. Specific antibody responses included a high bactericidal titer (1:640) against the infecting meningococcus and a sharp increase (from 198 to 8,097 ng/ml antibody nitrogen) in antibody to the type-specific capsular polysaccharide of the infecting pneumococcus. These data, showing the production of protective antibodies against the two pathogens, suggest that some patients with multiple myeloma might also respond to appropriately administered bacterial vaccines. This fact should be ascertained because vaccination could potentially reduce the high rate of bacterial infections associated with this disease.

Human B cell function in a polyclonally induced plaque forming cell system. Cell triggering and immunoregulation

The use of a sensitive PFC assay against a specific antigenic determinant (SRBC) following polyclonal triggering of human lymphocytes has provided a unique insight into the complex mechanisms of triggering of human B cells. The system is under the strict regulation of a delicate balance between helper and suppressor influences reflecting in certain circumstances the activity of distinct subsets of immunoregulatory cells. Lymphoid cells in certain diseases characterized by disordered immunoregulation, when as system, may in effect be manifesting an abnormal expression of immunoregulatory mechanisms operable in normal immune responses. In vivo activation of lymphoid cells by PBAs may have an important role in disease states as well as in the subsequent in vitro expression of B cell function. Furthermore, it is quite possible that under certain circumstances some B cell responses which appear to be purely antigen-specific may be reflections of synergy between PBA substances and specific antigen. The use of PBAs as probes and sensitive PVC systems as assays has already proven fruitful in the dissection of the complex mechanisms of nonspecific B cell triggering in man and may indeed ultimately lead to an understanding of the mechanisms of specificity of immune reactivity.