T lymphocyte subpopulations in synovial fluid of patients with rheumatic disease

Phytohaemagglutinin induced proliferation of lymphocytes from patients with rheumatoid arthritis and iron deficiency

The response of peripheral blood lymphocytes to stimulation by mitogens such as phytohaemagglutinin (PHA) is commonly depressed in both rheumatoid arthritis and iron deficiency, and as many rheumatoid patients are anaemic with evidence of abnormal iron metabolism it is possible that the same mechanism underlies the observed suppression in both conditions. In the present study the mitogenic response to PHA of lymphocytes from three rheumatoid patients, who were also iron deficient, and two healthy controls has been shown to be significantly less in iron deficient than iron containing media (p less than 0.001). In addition, iron deficient sera from these patients reduced the PHA induced proliferation of lymphocytes from a normal subject (p less than 0.01), an effect which was prevented by prior addition of iron to these serum samples. In iron containing media lymphocytes from five patients and two controls showed no difference in their response to PHA for both the minimum mitogen concentration which enhanced transformation and the peak [3H]thymidine uptake; but patients' lymphocytes showed significantly less response to PHA concentrations of 5 and 10 mg/l (p less than 0.02), resulting in a reduction in the area under the dose response curves up to 20 mg/l (p less than 0.05). These findings show both that iron deficient sera can impair PHA induced lymphocyte transformation and that lymphocytes from iron deficient rheumatoid patients have impaired responsiveness to PHA. Iron is known to be required intracellularly for the enzyme ribonucleotide reductase, which is important for DNA synthesis, and reduced activity of this enzyme could explain these observed effects.

T-cell helper activity and B-cell function of synovial and blood lymphocytes from patients with rheumatoid arthritis or other forms of chronic arthritis

The helper effect of T cells on B-cell immunoglobulin (Ig) responses induced by pokeweed mitogen (PWM) or purified protein derivative of tuberculin (PPD) was studied in lymphocytes from synovial fluid (SF) and blood of nine patients with rheumatoid arthritis (RA) and eight patients with other forms of chronic arthritis. In PWM cultures the helper effect of SF T cells on Ig responses (IgG, IgM, IgA) of autologous and allogeneic blood B cells was lower than that of blood T cells (P less than 0.01). This decrease was more pronounced in patients with RA than in patients with non-RA. In PPD cultures no significant difference was found between the helper effect of SF T cells and blood T cells on the Ig responses of allogeneic blood B cells or on the IgG response of autologous blood B cells, whereas the helper effect of SF T cells on the IgM and IgA responses of autologous blood B cells was decreased. The Ig responses to PWM or PPD in cocultures of autologous blood B and T cells were not significantly different between patients and healthy controls. The PWM- and PPD-induced Ig responses of SF B cells were lower than those of blood B cells when cocultured with autologous blood T cells. SF B cells produced IgG but usually little IgM and IgA. Thus there was a dysfunction of SF B cells and of SF T cells in a PWM-driven system, but a fairly good helper function of SF T cells in a PPD-driven system.

Suppressor T cell function in patients with rheumatoid arthritis complicated by vasculitis

Concanavalin A (Con A)-induced suppressor T cell activity was determined in 10 rheumatoid arthritis (RA) patients with vasculitis, 34 RA patients without vasculitis, and 10 healthy individuals. The percent Con A-induced suppression in RA patients with vasculitis was 24.6. In contrast, it was 68.4% in those RA patients without vascular lesions. Further, the proportion of T cells reactive with OKT8 monoclonal antibody was also decreased in RA patients with vasculitis. Accordingly, the reduced Con A-induced suppressor T cell activity in these RA patients resulted, in part, from the reduction in the number of cells of the suppressor T cell subset. Those patients with vascular lesions also had a higher percentage of positive antilymphocytotoxic antibodies than RA patients without vasculitis. Since the differences in Con A-induced suppressor T cell activity and frequency of positive antilymphocytotoxic antibodies were so great, we believe RA patients with vasculitis could be recognized as a disease group distinct from RA patients without vasculitis.

Lymphocyte subpopulations in rheumatoid arthritis. An immunological, enzyme histochemical and morphological study

Peripheral blood lymphocytes (PBL) and synovial fluid lymphocytes ( SFL ) of patients with rheumatoid arthritis (RA) were examined with monoclonal antibodies, with coated ox red blood cells for the expression of Fc receptors for IgG or IgM (T mu and T gamma cells), and incubated for the demonstration of alpha- naphtyl acetate esterase and acid phosphatase. Equal percentages of OKT4 and OKT8 PBL were found in clinically active and inactive RA patients, and in healthy controls, but decreased percentages of OKT4 and increased percentages of OKT8-positive lymphocytes were found among the SFL . The percentages of T mu and T gamma cells, the presence of HLA-DR membrane antigens on T lymphocytes as well as the staining pattern for the enzymes revealed that SFL of patients with RA were highly activated, compared to PBL of RA patients and healthy controls. It can be concluded from this study that a single determination of OKT4 and OKT8-positive lymphocytes in the peripheral blood of RA patients has no predictive value for disease activity. However, the results of the experiments on T lymphocyte-activation clearly showed preferential activation of SFL compared to PBL, indicating that activation of lymphocytes occurs at the site of inflammation.

Increased DNA and/or RNA content of synovial fluid cells in rheumatoid arthritis: a flow-cytometry study

Flow-cytometry studies of DNA and RNA content were carried out in acridine orange-stained synovial fluid lymphocytes from 11 patients presenting with classical or definite rheumatoid arthritis. Monoclonal antibodies were used to detect specific T cell surface antigens (OKT3, OKT4, OKT8) and antigens associated with lymphocyte activation (OKIa 1, OKT10). T3 positive cell percentages were comparable to those of normal blood, although T4/T8 ratios were decreased in 4 out of 5 cases, and HLA-DR positive cells increased. Six out of 11 patients showed percentages of dividing cells varying from 2.2 to 7.2% as compared with less than 1% in the other patients and in normal blood. Nondividing cells were characterised by an increase in their RNA content compared with normal blood. A greater increase of RNA content was observed in patients with lower percentages of dividing cells, suggesting a G1/S block. Changes in cellular DNA and/or RNA contents provide a valuable parameter of lymphocyte activation, not necessarily linked to the expression of differentiation antigens by activated cells.

T lymphocyte subclasses in rheumatoid synovia as analysed with monoclonal antibodies and functional in vitro tests

Inflammatory synovial T lymphocytes were released by mincing rheumatoid arthritis (RA) affected synovium, by digesting the material with collagenase plus DNAse, and isolating by sheep red cell rosetting and density centrifugation. There was a wide variation in the T-helper (Tm, OKT4) and T suppressor (Tg, OKT8) lymphocyte ratio in the individual synovia, ranging from 0.55 to 1.57. The mean ratio of Tm/Tg lymphocytes as well as OKT4/OKT8 lymphocytes was somewhat lower in the synovium (and in the blood) of RA patients than in the blood of healthy persons, but the differences were not significant (p = 0.56 and 0.09, respectively). The helper and suppressive capacity of synovial T lymphocytes on T-dependent B-cell maturation to immunoglobulin synthesis was analysed by co-culturing them with normal B or (unseparated) T+B cells in the presence of pokeweek mitogen. Eluates where the helper/suppressor ratio was above 1.2 produced at least some T cell help and lacked suppressor capacity, whereas eluates with a T helper/suppressor ratio below 1.20 provided a strong suppression and lacked the capacity of T-cell help. On the whole, we were unable to demonstrate any uniform pattern of inflammation with regard to T-cell subsets in the rheumatoid synovium. However, it seems that monoclonal antibodies provide good markers with which to analyse the inflammatory T cells in situ, and that these markers correlate well to the functional capacity of these cells in vitro.

Effect of stimulated neutrophils from the synovial fluid of patients with rheumatoid arthritis on lymphocytes--a possible role of increased oxygen radicals generated by the neutrophils

Neutrophils from the synovial fluid (SFN) of 10 patients with active rheumatoid arthritis (RA) were investigated to determine the generation of oxygen intermediates (OI) (O2-, H2O2, OH .), chemiluminescence, and lysosomal enzymes (lysozyme and beta-glucuronidase). Lymphocytes from healthy individuals were cocultured at 37 degrees C for 17 hr with SFN from the patients and the number of OKT4+, OKT8+, and OKT3+ cells and the response to mitogens were determined. A markedly increased OI and slightly elevated lysosomal enzyme levels were observed in SFN from patients. Coculture of lymphocytes with SFN resulted in a decreased number of OKT4+ and OKT8+ cells and a greatly reduced response to Con A and mildly diminished response to PHA, while OKT3+ cells were not affected. The simultaneous addition of superoxide dismutase and catalase restored the impairment of monoclonal antibody reaction and lymphocyte responsiveness almost to control levels. It is suggested that the disturbed immunoreactivity of synovial fluid lymphocytes from RA patients may be due to increased OI generated by stimulated neutrophils.

Changes of blood T cell subsets following radiation therapy for breast cancer

The changes of the size of various T cell subsets in the blood, as defined by monoclonal antibodies and Fc-receptors for IgG and IgM, were examined in 11 women after postoperative radiation therapy (45 Gy) for breast cancer. All subsets of T cells were significantly reduced at completion of irradiation. The most extensive depletion was noted in a subset with receptors for IgG, which may exert suppression. Approximately 1 year later this subset had recovered significantly in parallel with another subset, also rich in suppressor T cells, which was detected by monoclonal antibodies. On the contrary, T cell subsets rich in cells with helper activity did not exhibit any significant recovery.

High incidence of spontaneous Ig-producing lymphocytes in peripheral blood and synovial fluid of patients with active seropositive rheumatoid arthritis

Numbers of in vitro spontaneous IgG, IgM and IgA plaque-forming cells (PFC) as assessed by a modification of the protein A haemolytic plaque assay were determined in the blood and synovial fluid of patients with seropositive rheumatoid arthritis (RA) and compared with those of control groups. The total numbers of PFC were significantly higher in the peripheral blood of patients with active seropositive RA than in that of normal controls. In addition, most B lymphocytes in the synovial fluid of patients with active seropositive RA were active immunoglobulin (Ig) producers, whereas synovial fluid lymphocytes from patients with inactive seropositive RA and seronegative arthritis were not. In general, IgA PFC were relatively high in blood, whereas IgG PFC dominated in the synovial fluid. IgM PFC appear to be relatively low in blood and synovial fluid. However, a relative increase of IgG PFC was noted in the peripheral blood of patients with active RA. To test for polyclonality of the increased Ig synthesis, we tested the sera of patients and controls for the presence of polyclonal antibodies against sheep erythrocytes (SRBC) and SRBC modified by fluorescein isothiocyanate (FITC) and trinitrophenyl (TNP). No differences were observed with SRBC and TNP-SRBC agglutinin titres between patients and controls, but patients with RA had higher titres of FITC-SRBC agglutinins than normal sera. This finding supports the concept of a polyclonal nature of antibody production in RA patients.

Multiple sclerosis: heterology among early T cells and Tg cells

Circulating early T cells and TG cells were estimated simultaneously in 100 patients with multiple sclerosis and 21 controls. The results were analyzed from individual patients, from patients grouped according to disease activity, and from some patients studied longitudinally. Previously documented fluctuations in these two T cell populations were confirmed. By comparing the fluctuations and by examining the distribution of TG cells in suspensions of isolated early and isolated late T cells, it was found that TG cells are a T cell subpopulation distinct from early T cells.

Characterisation of blood and synovial fluid lymphocytes from patients with rheumatoid arthritis and other joint diseases by monoclonal antibodies (OKT series) and acid alpha-naphthyl esterase staining

Mononuclear cell preparations from peripheral blood (PBL) and synovial fluid (SFL) of 27 Patients with rheumatoid diseases (15 patients with definite rheumatoid arthritis (RA), 10 with other inflammatory joint diseases (OJD), 1 with sarcoid arthritis (SA) and 1 with traumatic arthritis (TA) were examined for lymphocyte subpopulations determined by monoclonal antibodies of the OKT series and by the dot-like, acid alpha-naphthyl esterase staining (ANAE) activity. In patients with classic, active RA, blood T cells carrying the OKT8+ (suppressor/killer) phenotype were significantly reduced leading to an elevated OKT4/OKT8 ratio of 4.1 +/- 0.4 compared with 2.1 +/- 0.1 in healthy controls. In 10 patients with OJD this diminution of OKT8+ cells in peripheral blood was less pronounced or absent. As regards SFL subpopulations, patients with RA and OJD exhibited a similar distribution pattern with an elevation of OKT8+, Ia+ and ANAE negative cells and a similar OKT4/OKT8 ratio of 1.5 +/- 0.3 and 1.6 +/- 0.4, respectively. Similar results were also obtained in the only patient with TA, whereas the patient with SA and one RA patient with relapse after surgical synovectomy exhibited high OKT4/OKT8 ratios, both in synovial fluid and peripheral blood. Neither the OKT markers nor the dot-like ANAE staining pattern were significantly correlated to parameters of systemic or local disease activity as estimated by erythrocyte sedimentation rate and a local disease activity index.

Distribution of IgG and IgM receptors on human peripheral natural killer cells measured on the level of the single effector cell

Using an agarose single-cell cytotoxicity assay simultaneously with the antibody-coated ox erythrocyte assay for detecting Fc receptor (FcR)-positive cells, the number of natural killer (NK) cells in fresh human peripheral blood which bear FcR for IgG or IgM have been determined. Of the target binding blood which bear FcR for IgG or IgM have been determined. Of the target binding cells (TBC) which form conjugates with NK-sensitive target cell lines Molt 4, 1301 and Hd-Mar, 55% had FcR for IgG and 24% had FcR for IgM. In the active NK cell population, which amounts to about 6% in nylon wool column-passed peripheral lymphocytes, cells with FcR for IgG account for 60% and cells with FcR for IgM for 17% of the total killing. Even though there is an increase in the number of FcR-IgM-positive cells from fresh peripheral blood after overnight incubation at 37 degrees C, no increase was found in FcR-IgM-positive NK cells. The reasons why FcR for IgM have not been described earlier on human NK cells are discussed, as well as the functional implications of these and their probable expression on other types of cytotoxic effector cells.

Relationship between HLA-DR-expressing cells and T lymphocytes of different subsets in rheumatoid synovial tissue

An immunohistochemical double staining technique was used to study the relationships between HLA-DR-expressing, mostly macrophage-like cells, and different populations of T lymphocytes in frozen sections of synovial tissue from patients with inflammatory joint disease, particularly rheumatoid arthritis. Substantial T-lymphocyte infiltration as measured by Leu 1 antibody binding was found, especially adjacent to HLA-DR-expressing cells near the synovial cavity and around small vessels. Most of the T cells reacted with Leu 3a ('helper/inducer'-cell-specific) antibodies, whereas relatively few cells were Leu 2a ('cytotoxic/suppressor' T-cell-specific)-positive.

T gamma lymphocytes of peripheral blood and synovial fluid in rheumatoid arthritis: quantitative determination and qualitative analysis

The distribution of T gamma lymphocytes in the peripheral blood of one group of rheumatoid patients and in the synovial fluid in a second group was determined. The results were compared to those found for peripheral blood (PB) lymphocytes of normal subjects and for synovial fluid lymphocytes of osteoarthrosis and meniscitis patients. Besides recording percentage and absolute number, we also used cytofluorographic analysis to determine individual capacity of PB T gamma cells to bind heat-aggregated IgG (agg-IgG). The following results were found: 1) there is no significant difference between the percentage and absolute number of PB T gamma lymphocytes of rheumatoid arthritis (RA) patients and those of controls, 2) individual RA PB T gamma cells had a greater number and/or avidity of Fc receptor for IgG than those cells of controls, and 3) the percentage of RA T gamma lymphocytes in synovial fluid, revealed by IgG-EA ox rosetting, is significantly lower than that found in control patients. The factors that may determine a similar lymphocyte picture in RA are discussed.

T-lymphocyte subpopulations in the peripheral blood of patients with Crohn's disease

Samples of peripheral blood from 26 patients with Crohn's disease (CD) and 26 healthy age- and sex-matched controls were tested simultaneously for B and T lymphocytes and T-lymphocyte subpopulations with receptors for IgM (TM) and IgG (TG). Patients with CD had reduced proportions of T lymphocytes, and this reduction showed a significant correlation to the CD activity index (r = -0.65, p less than 0.01). There was slight reduction of TM only (p less than 0.05) inpatients with highly active disease but not in the total population of patients studied. Proportions of B and TG cells were similar in patients and controls. Patients with no clinical or radiological but histological signs of active disease had T lymphocytes and subpopulations like patients with inactive disease. This suggests that the reduction of T cells and T-cell subpopulations in CD are secondary effects. With regard to T-lymphocyte subpopulations, our results are in contrast to a recently published report and do not suggest that analysis of T cells according to the expression of Fc receptors helps in the understanding of functional changes in the T-cell system in patients with CD.

Subpopulations of T lymphocytes in patients with ankylosing spondylitis

Subpopulations of human blood T lymphocytes were determined in 20 patients with ankylosing spondylitis and in 20 healthy individuals. The proportion of T lymphocytes with receptors for the Fc portion of IgG (TG cells) was increased in 9 patients. The proportion of T lymphocytes bearing receptors for the fc portion of IgM (TM cells) was within the range found in healthy controls in all but 4 patients, who had a decreased level of TM cells.

Impaired antigen-specific suppressor cell activity in patients with rheumatoid arthritis

Antigen-specific suppressor cell activity of peripheral blood mononuclear cells was investigated in 20 patients with rheumatoid arthritis (RA) and 16 age- and sex-matched healthy controls. Suppressor cell activity was generated by priming peripheral blood mononuclear cells with high dose antigen (ovalbumin) and adding the washed primed or control (unprimed) cells to autologous, optimally stimulated, target plaque forming cell (PFC) cultures. The ability of the primed cells to interfere with an optimal ovalbumin specific PFC response in the target culture was used as a measure of antigen-specific suppressor cell activity. The results demonstrated that the mean (+/- SE) PFC response of the rheumatoid patients (669 +/- 76 PFC/10(6) cells) was not statistically different from that of the normal controls (722 +/- 83 PFC/10(6) cells), P = 0.1. However, reduced suppressor cell activity was observed in the rheumatoid patients relative to controls (46.4 +/- 4.2% versus 64.6 +/- 2.7% suppression, respectively; P < 0.001). No correlation was demonstrated between suppressor cell activity in rheumatoid patients and disease activity or therapy.