Cellular mechanisms of restricted immunoglobulin formation in the human neonate

Placental transfer of maternally-derived IgA precludes the use of guthrie card eluates as a screening tool for primary immunodeficiency diseases

There is a need for neonatal screening tools to improve the long-term clinical outcome of patients with primary immunodeficiency diseases (PID). Recently, a PCR-based screening method for both TRECs and KRECs using Guthrie card samples has been developed. However, the applicability of these excision circle assays is limited to patients with severe T or B cell lymphopenia (SCID, XLA and A-T), whereas the most common forms of PID are not detected. Absence of serum IgA is seen in a major fraction of patients with immunological defects. As serum IgA in newborns is considered to be of fetal origin, eluates from routinely collected dried blood spot samples might thus be suitable for identification of children with PID. To assess the applicability of such screening assays, stored Guthrie card samples were obtained from 47 patients with various forms of primary immunodeficiency diseases (SCID, XLA, A-T, HIGM and IgAD), 20 individuals with normal serum IgA levels born to IgA-deficient mothers and 51 matched healthy newborns. Surprisingly, normal serum IgA levels were found in all SCID, XLA, A-T and HIGM patients and, additionally, in all those IgAD patients born to IgA-sufficient mothers. Conversely, no serum IgA was found in any of the 16 IgAD patients born by IgA-deficient mothers. Moreover, half of the IgA-sufficient individuals born by IgA-deficient mothers also lacked IgA at birth whereas no IgA-deficient individuals were found among the controls. IgA in neonatal dried blood samples thus appears to be of both maternal and fetal origin and precludes its use as a reliable marker for neonatal screening of primary immunodeficiency diseases.

Low expression of the interleukin (IL)-4 receptor alpha chain and reduced signalling via the IL-4 receptor complex in human neonatal B cells

Diminished neonatal antibody responses following infection or immunization may stem in part from intrinsic characteristics of neonatal B cells. In this study, we used B-cell subset sorting combined with gene expression assays to investigate major differences in the expression of host genes in neonatal and adult naïve B cells. We discovered significantly reduced expression of the interleukin (IL)-4 receptor alpha chain and reduced IL-4-induced signalling in neonatal B cells. Neonatal naïve B cells were susceptible to more rapid and more profound levels of apoptosis when cultured in vitro. They also exhibited a limited response to IL-4 treatment compared with adult cells. The expression level of the IL-13 receptor alpha 1 chain, a key component of the IL-13 receptor/IL-4 type II receptor, and the response to IL-13 treatment for protection against apoptosis in neonatal B cells were similar to those of the adult B cells. These studies suggest a possible mechanism underlying the limited magnitude and durability of neonatal antibody responses.

Effect of neonatal treatment with a GnRH antagonist on development of the cell-mediated immune response in marmosets

PROBLEM

We examined the effect of neonatal treatment with a gonadotropin-releasing hormone (GnRH) antagonist (antide) on the development of cell-mediated immunity in male marmosets.

METHOD OF STUDY

Neonatal marmoset twins were treated with either vehicle or antide, and the proliferative response (PR) of lymphoid tissue to mitogens was assessed during infancy, the peripubertal period, and adulthood.

RESULTS

Basal proliferation of peripheral blood mononuclear cells (PBMC) from treated peripubertal twins was elevated above control values, but the PR of the cells to T and B cell mitogens was subnormal. Conversely, PBMC from treated infants exhibited an enhanced PR to some of the mitogens employed. In vitro culturing of thymocytes (control or treated) from the three developmental stages with either antide or a GnRH agonist increased basal proliferation, but decreased the PR to mitogens by 60-80%.

CONCLUSION

Neonatal treatment with antide alters development of, but does not permanently impair, cell-mediated immunity in the marmoset. GnRH appears to modulate immune responses throughout development in the primate.

Characterization of early activation events in cord blood B cells after stimulation with T cell-independent activators

Human neonates are immunologically immature, particularly in their humoral antibody responses to T cell-independent antigens, as exemplified by their increased susceptibility to infections with polysaccharide-encapsulated bacteria. To clarify the mechanism(s) underlying the unresponsiveness of neonates to polysaccharide antigens, we used an in vitro model with neonatal cord blood cells that has been shown to mimic surface Ig-dependent signaling in the adult by T cell-independent antigens. We studied the ability of cord blood human B cells to become activated after ligation of their surface Ig by unconjugated anti-Ig, dextran-conjugated anti-Ig, and Staphylococcus aureus Cowan A1, and compared their response with that of adult B cells. After the addition of nanogram concentrations of anti-Ig-dextran, neonatal cord blood B cells proliferated at levels comparable to that observed with adult B cells. The majority of cord blood B cells showed a marked rise in intracellular calcium, increased surface expression of human leukocyte antigen DR, and an increase in cell size. Direct activation of protein kinase C by phorbol esters in neonatal B cells led to cellular proliferation, and when combined with anti-Ig, a synergistic effect on proliferation was observed. These data suggest that the unresponsiveness of human neonates to polysaccharide antigens does not represent an inability of these antigens to induce early activation events in circulating B cells.

T cell receptor repertoire diversity and clonal expansion in human neonates

Newborn human infants, particularly those born prematurely, are susceptible to infection with a variety of microorganisms. We questioned whether limitations in the T cell repertoire contribute to the neonatal immunocompromised state. To describe developmental changes of the T cell repertoire, cDNA segments corresponding to third complementarity regions (CDR3) of human umbilical cord blood T cell receptors (TCR) from 24-41-wk gestational age were amplified with TCR family-specific probes. The resulting amplified CDRs were visualized by fingerprinting and single strand conformation polymorphism (SSCP) analysis. At 24-wk gestation there were no limitations in TCRBV family usage, and the degree of CDR3 size heterogeneity was not different from the adult. However, earlier in gestation, CDR3s were shorter for all families and gradually increased in size until term. The extent of oligoclonal expansion observed in cord blood was greater than in adult peripheral blood (p = 0.03). T cell oligoclonal expansion was greatest at 29-33-wk gestation and declined toward term. Expansions were detectable in both CD4+ and CD8+ subpopulations. Our findings indicate that the genetic mechanisms of repertoire diversification appear intact as early as 24 wk of gestation, but repertoire diversity is limited as a result of smaller CDR3 sizes. In addition, there was a developmentally regulated progression of oligoclonally expanded T cells. These differences in the TCRBV repertoire add to the body of evidence demonstrating immaturity of the neonatal immune system. However, the role that these subtle differences are likely to play in the relative immunodeficiency of the neonate remains to be determined.

Umbilical cord blood lacks circulating B lymphocytes expressing surface IgG or IgA

In vitro umbilical cord blood B lymphocytes fail to form IgG and IgA secreting plasma cells when stimulated with Pokeweed mitogen. Since previous investigators have found percentages of B lymphocytes expressing surface IgG or surface IgA comparable to those seen in adults, this implies a defect in umbilical cord blood B-lymphocyte function. We have examined surface Ig expression on umbilical cord blood B lymphocytes by flow cytometry under conditions in which serum derived Ig are rigorously excluded. Under these conditions no B lymphocytes expressing surface IgG or IgA, which should serve as precursors for IgG and IgA secreting plasma cells, were observed. This finding was confirmed by comparing the ratio of mRNA levels for immunoglobulin gamma-chain to mu-chain in mononuclear cells by quantitative mRNA-based PCR. The ratio in umbilical cord mononuclear cells was 10-fold less than that seen in adult cells. The inability of newborn peripheral blood to form IgG and IgA plasma cells may result from an absence of appropriate precursor cells and not a defect in B lymphocyte maturation.

Antibody activity before and after pneumococcal vaccination of otitis-prone and non-otitis-prone children

The antibody activity of the IgM class and subclasses of IgG and IgA against pneumococcal bacteria of types 3, 6A and 19F was studied before and after administration of a pneumococcal vaccine (Pneumovax) in a group of children with recurrent acute otitis media (rAOM) and in groups of non-otitis-prone children. Only occasionally was there a significant rise in antibody activity after vaccination in any of the groups. There was no difference in the response to vaccination between rAOM children and healthy children. However, rAOM children exhibited lower antibody activities in most Ig subclasses against pneumococcus type 6A--a common causative agent in AOM--before as well as after vaccination compared with the healthy children. The results indicate that the response to vaccination is equally poor in all children, irrespective of whether they have a history of frequent attacks of acute otitis media, but, in contrast to healthy children, the rAOM children seem to have an inability to mobilize antibodies in response to infections with some pneumococcal types.

Monocyte-regulated hyporesponsiveness of human cord blood lymphocytes to OKT3-monoclonal-antibody-induced mitogenesis

OKT3 monoclonal antibody recognizes surface antigenic structures present on all human mature T lymphocytes and is mitogenic for resting peripheral T cells. Recent reports suggest that these structures are linked to the specific antigen receptor of the T cells and play an important role in T-cell activation. We have tested the mitogenic action of OKT3 on resting lymphocytes from human newborns, their mothers, and unrelated adults. We found that the proliferative response of cord T cells to OKT3 is significantly lower than the response of maternal and adult cells at all doses of the antibody tested (5-1000 ng/ml). This difference was not dependent on culture conditions (source of serum, kinetics induced by the OKT3 antibody, or different proportions of adherent cells in peripheral blood mononuclear leukocytes), and could only to some extent be accounted for by differences in the proportions of OKT3-binding cells between these populations. Removal of adherent monocytes largely diminished the OKT3-induced proliferation of maternal and adult cells, by an average of 70-80%. In contrast, it significantly enhanced the proliferation of cord cells. The proliferative response of cord T lymphocytes to the two polyclonal T-cell activators phytohaemagglutinin and concanavalin A was similar to or greater than that of mothers and other adults.

Human fetal/neonatal suppressor activity: relation between OKT phenotypes and sensitivity to prostaglandin E2 in maternal and neonatal lymphocytes

T lymphocytes from human fetuses and newborns strongly and spontaneously suppress various adult cell functions (i.e. T-cell proliferation, B-cell differentiation, and Ig synthesis). The precise phenotype of the suppressor cell is controversial. In this investigation we use cord T-cell subsets negatively selected by the panning technique or by complement-mediated lysis using the monoclonal antibodies OKT4 and OKT8. Cord T cells deprived of the OKT4+ subpopulation exerted only a marginal suppressor activity (12 +/- 7 as compared to 73 +/- 4% of unfractionated T cells) on the proliferation of maternal cells in our PHA-stimulated co-culture assay using sex chromosomes as markers for dividing cord (male) and maternal cells. The suppressive effect was direct, i.e. not mediated by induction of maternal OKT8+ suppressor effector cells. Cord and maternal T-cell subsets were also tested for their sensitivity to exogenous prostaglandin E2 (PGE2) at doses varying between 1.4 X 10(5) and 1.4 X 10(9) M. Both maternal OKT4- and OKT8- T-cell subsets were highly sensitive to suppression by PGE2. In contrast, cord OKT8- T cells were essentially nonsensitive at all doses of PGE2 used, whereas cord OKT4- T cells were significantly suppressed at four out of five concentrations tested (1.4 X 10(6) through 1.4 X 10 (9). Our results suggest a direct correlation between the phenotypes of the cord-suppressor and maternal-target T cells and their sensitivity to PGE2.

Immunoglobulin synthesis in a patient with C4 deficiency: functional immaturity of peripheral blood lymphocytes

Peripheral blood lymphocytes from a systemic lupus erythematosus patient with homozygous C4 deficiency were stimulated in vitro. Although T cell independent stimulation (Epstein-Barr virus) induced normal proportions of IgM secreting cells. IgG and IgA secreting cells were almost absent. Virtually no immunoglobulin secretion was obtained after T cell dependent stimulation (pokeweed mitogen). Cell fractionation experiments indicated that the low pokeweed mitogen response, at least with regard to IgG and IgA production, was mainly due to impaired B-lymphocyte function. The serum IgG subclass distribution pattern of specific antibodies against certain carbohydrate antigens demonstrated a relative lack of IgG2 antibodies. The findings were consistent with functional immaturity of B lymphocytes in the patient.

The effects of indomethacin administration during pregnancy on women's and newborns' T-suppressor lymphocyte activity and on HLA class II expression by newborns' leukocytes

It has been previously shown that T lymphocytes from human newborns and pregnant women exert a suppressive activity when assayed on the PWM-induced B cell maturation. The mechanisms of the suppression have remained entirely unknown. Prostaglandin E2, known to trigger T-cell mediated suppressive activity, may be involved. We took advantage of the treatment of pregnant women with indomethacin, because of premature labor or hydramnios, to investigate the role of prostaglandins in the activation of T suppressor (TS) activity. Administration of indomethacin (250 mg/day for 1-7 weeks, then 150 mg/day for 3-12 weeks) during the third trimester of pregnancy, abrogated the TS activity in the nine women and the three newborns tested. Abrogation of TS activity by indomethacin therapy led to normal PWM-induced B cell maturation in pregnant women but not in newborns. Moreover, the low expression of HLA class II antigens observed on normal newborn B lymphocytes and monocytes was corrected in newborns from indomethacin-treated mothers. Our results strongly suggest that prostaglandins may play a role in induction of TS activity observed in normal pregnant women and newborns and in the decreased expression of HLA class II antigens on newborns' leucocytes. Both phenomena could play a role in immunological interactions between mother and fetus.

Human T cells in cord blood: abnormalities in IA antigens induction by phytohemagglutinin and in autologous mixed lymphocyte reactions

About 25% of human T cells isolated from cord blood acquired la antigens, following stimulation with phytohemagglutinin (PHA) for 72 hr. This percentage is markedly lower than that found in PHA-activated T-cell populations (PHA-T cells) isolated from peripheral blood of adults. The low expression of la antigens by human T cells from cord blood does not reflect abnormalities in the sensitivity to PHA stimulation and/or in the kinetics of induction of la antigens. PHA-T cells from cord blood display a low stimulatory activity in autologous mixed lymphocyte reactions (MLR). The defect does not reflect a nonspecific abnormality in the stimulatory activity of PHA-T cells from cord blood, since the latter do not differ from PHA-T cells from adults in their ability to stimulate allogeneic T cells from adults. Furthermore the defect does not reflect a nonspecific abnormality in the proliferative response of T cells from cord blood, since the latter display a normal proliferative response to PHA-T cells from adults. The defect in the proliferative response is not restricted to the autologous MLR with PHA-T cells, since it was found also in autologous MLR with non-T cells as stimulators. Correlation of the temporal evolution of the abnormalities of human T cells with the maturation of the immune system may contribute to our understanding of the role of la antigens in cell-cell interactions and of the biological significance of abnormalities of autologous MLR.

Immunoregulatory function of human cord blood lymphocytes on immunoglobulin production

The functional maturity of human umbilical cord blood B lymphocytes and the immunoregulatory activity of cord T lymphocytes were assessed by measuring the in vitro immunoglobulin production by B cells from either cord or adult blood. Supernatants from 48-hr pokeweed-mitogen (PWM) stimulated cord or adult lymphocyte cultures were added to cord or adult B cell cultures in the presence of PWM; a significant amount of immunoglobulin was produced in adult B cell cultures only. Adult B or T cells were then cocultured with cord T or B cells; a significant amount of immunoglobulin was again found only in adult B cell cultures. These results indicated that cord B cells were functionally immature and that cord helper T cell function was adequate but masked by excessive suppressor activity. Indeed, addition of cord T cells but not of allogeneic adult T cells to PWM stimulated adult lymphocyte cultures inhibited their immunoglobulin production; this confirmed cord T cells' increased suppressor activity. Cord T cells were not intrinsically suppressive since they failed to suppress immunoglobulin production by Epstein-Barr Virus (EBV) transformed B cells. They could be activated, however, by PWM or allogeneic cells (in mixed lymphocyte cultures) and their effect was mediated via soluble factor(s) as demonstrated by the suppressor effect of these culture supernatants on immunoglobulin production by unfractionated adult lymphocytes. In contrast, when these supernatants were added to T cell-depleted adult lymphocyte cultures, enhancement rather than suppression was observed. These results indicated that the soluble factor(s) released by Cord T lymphocytes was not suppressing per se but induced suppression through activation of suppressor cells.

Frequencies of the separate human B cell subsets activatable to Ig secretion by Epstein-Barr virus and pokeweed mitogen

We have developed a microculture system suitable for limiting dilution analysis of Epstein-Barr virus (EBV)- and pokeweed mitogen (PWM)-induced activation of immunoglobulin secretion by human B cells. It was found that exogenous filler cells were not required to obtain optimal EBV-induced B cell precursor frequency (PF) estimates, although filler T cells were required for optimal PWM activation. In fact, when autologous T cells were used as filler cells, a marked decrease in the EBV-induced IgM PF was noted. Treatment of the T cells with cyclosporin A partially eliminated, and irradiation of the T cells completely eliminated, this decrease. The calculated PF of B cells activated by EBV was from 1/290 to 1/3,700 for IgM, and from 1/920 to 1/3,250 for IgG secretion. PWM activated from 1/140 to 1/3,200 B cells to IgM secretion. The results of experiments in which EBV and PWM were mixed, indicated that these two polyclonal activators operated on different B cell subpopulations. Therefore, both these agents seem to activate small, discrete subpopulations of human peripheral blood B cells to Ig secretion.

Antigen-specific plaque-forming cell response of human cord blood lymphocytes after in vitro stimulation by T cell-dependent antigens

Mononuclear cells isolated from human cord blood (CBL) of full-term neonates were stimulated in vitro with a dose range of T cell-dependent antigens, i.e. ovalbumin or sheep erythrocytes, and tested for the capacity to mount an antigen-specific plaque-forming cell (PFC) response. Both of the antigens used induced in CBL a PFC response with the same kinetics of PFC formation and of the same magnitude as found in cultures of adult peripheral blood lymphocytes (PBL). However, optimal PFC responses in CBL were obtained at a hundredfold lower concentration of the antigens compared with the optimal antigen doses for the induction of a PFC response in adult PBL. This phenomenon was further investigated with respect to the antigen dose dependency of the activation of neonatal B cells and neonatal regulatory T cells. The induction of a PFC response in CBL at antigen concentrations that were suboptimal for adult PBL showed a correlation with the particular antigen dose requirements for the activation of B cells and T helper cells in neonates. Furthermore, the findings suggest that the decrease of the PFC response in CBL stimulated with supraoptimal doses of antigen was not caused by the induction of unresponsiveness at the B cell level or by interference of pregnancy-associated substances with the PFC response, but was rather the result of the activation of antigen-specific T suppressor cells. Neonatal T suppressor cells were activated at antigen concentrations that generated T helper activity in the adult. Thus, although neonatal B cells possess the intrinsic capacity to mature into antigen-specific PFC, the conditions for effective activation of neonatal T cells regulating the B cell response differ from those for the activation of adult regulatory T cells.

Suppression of B lymphocytes in mature newborn infants

The ability of cord blood lymphocytes to secrete immunoglobulins during in vitro culture was investigated by means of a reverse hemolytic plaque forming cell (PFC) assay. Mononuclear cord blood cells did not differentiate into immunoglobulin-secreting cells after stimulation with the polyclonal B lymphocyte activator pokeweed mitogen (PWM), contrary to the findings in normal adults. Mononuclear cord blood cells were then separated into T-enriched and T-depleted blood lymphocyte subsets. When these were co-cultured, the PWM-induced immunoglobulin secretion was still low; following irradiation of the T-enriched cells, the numbers of IgM-PFC but not of IgG- or IgA-PFC increased considerably. The effect of irradiation of the T-enriched cells on the PWM-induced IgM response was dose-dependent, with maximal effect at 2500 rad. It is concluded that the low PWM responses obtained using cord blood lymphocytes are in part due to suppression by radiosensitive T suppressor cells. Following removal of this suppression by means of irradiation, B lymphocytes can be induced to secrete IgM, but not IgG or IgA.

Immature B cells in fetal development and immunodeficiency: studies of IgM, IgG, IgA and IgD production in vitro using Epstein-Barr virus activation

Epstein-Barr virus has been used as a B cell mitogen to explore the parallels between the B cells found in patients with hypogammaglobulinemia and the immature B cells in fetal tissues. Peripheral blood lymphocytes from 29 cases of late onset hypogammaglobulinemia (common variable immunodeficiency) and from 10 cases of X-linked hypogammaglobulinemia were depleted of T lymphocytes and stimulated with virus in vitro. Immunoglobulin production was measured over a 4-week culture period using inhibition radioimmunoassays for IgM, IgG, IgA and IgD. The results were compared with those seen with fetal liver cells, cord blood lymphocytes and adult lymphocytes. Virus-stimulated cells from fetal sources produced small amounts of IgG and IgA relative to IgM, the ratio of IgM to IgG in the second week being in all cases greater than 10. Similar patterns were seen in 25/29 cases of late onset hypogammaglobulinemia, and in the eight cases of X-linked hypogammaglobulinemia that responded in vitro. In contrast, the ratio of IgM to IgG was always less than 8 in cultures of normal adult peripheral blood or bone marrow lymphocytes, and also in cultures from four cases of hypogammaglobulinemia known independently to have abnormal circulating suppressor cells. Eight cases of selective IgA deficiency showed reduced IgA production; six of these showed a normal ratio of IgM to IgG production. Thus, the B lymphocytes which circulate in many patients with hypogammaglobulinemia are functionally immature.

The mucosal immune response in the neonate

Human infants are relatively deficient in the IgA system defending mucosal membranes, but are provided via the maternal milk with considerable amounts of SIgA directed against microbes and food antigens to which both mother and infant are exposed. It is possible that serum antibodies may support the mucosal defense as do the lactoferrin, lysozyme and other defense factors present in the milk.

A sequential study of human B lymphocyte function from birth to two years of age

The immunoglobulin synthesizing capacity of individual lymphocytes from newborns and infants aged 2, 6, 12 and 24 months respectively has been studied. The technique has been to expose purified lymphocytes to a T lymphocyte dependent (pokeweed mitogen) or a T lymphocyte independent (Epstein-Barr virus) activator of B lymphocytes. Activation has been measured as immunoglobulin secretion of individual B lymphocytes using a hemolytic plaque assay. B lymphocytes from newborns can be made to synthesize IgM at adult levels, but not IgG and IgA. Within 24 months from birth the secretion of IgG has reached adult capacity whereas IgA formation is still diminished. Lymphocytes synthesizing IgG subclasses appear at different times insofar as IgG1 and IgG3 are well demonstrable within 12 months from birth whereas IgG2 and IgG4 has not at all reached adult levels even 24 months after birth. The T lymphocyte dependent activator (pokeweed mitogen) fails to induce immunoglobulin synthesis in peripheral blood lymphocytes from newborns because of a defect helper T cell function. Such T cell capacity appears at the age of 6 months. The data unequivocally demonstrate restricted but definite B lymphocyte functional capacity already at birth and a gradual but partial acquisition of adult competence until the age of 2 years.

Induction of lymphoid cell chimerism in noninbred, histocompatible rabbits. A new model for studying allotype suppression in the rabbit

Noninbred rabbits, matched with regard to the major histocompatibility complex (RLA-A and RLA-D loci) but mismatched for Ig allotypes, served as donors (adult) and recipients (newborn) of lymphoid cells. Lasting chimerism regularly followed the transfer of 1 x 10(8)-3 x 10(8) spleen, lymph node, or bone marrow cells, as indicated by the continued production of Ig with allotypic determinants of both donor and recipient. Typically, Ig of donor allotype accounted for 25-50% of total allotypic Ig at 4 wk of age and the amount of donor Ig produced remained stable for up to 20 mo. Total allotypic Ig levels remained normal in the chimeric rabbits. "Chimeric drift" or a gradual diminution of donor products over a period of several months, occurred in some individuals. Transfer of lymphoid cells from allotype-suppressed adult donors to newborns of appropriate allotypes did not result in specific suppression of the target allotype in the recipients. Other experiments showed that lymphoid cells from suppressed donors adoptively transferred to histocompatible recipients continued to synthesize Ig of the nonsuppressed type only. The suitability of using an outbred population of histocompatible but allotype-mismatched rabbits for analyzing allotype suppression and other immunoregulatory phenomena is demonstrated by the results presented here.

Characteristics of Epstein-Barr virus activation of human B lymphocytes

Epstein-Barr virus (EBV) will infect at least every third cell if exposed in vitro to an extensively purified B cell population from human peripheral blood. About 10% of such infected cells will be driven into immunoglobulin synthesis and secretion, as judged by the indirect protein A plaque assay. The appearance of EB nuclear antigen, de novo DNA synthesis, and immunoglobulin secretion are linked phenomena accompanying infection as judged by viral dilution experiments, which yield kinetics of a one-hit order. Induction of immunoglobulin secretion in B cells by EBV requires de novo synthesis of DNA, and consequently, nontransforming EBV (P3HR1) will not induce immunoglobulin secretion and will also specifically block such induction from subsequently added EBV. The termination of immunoglobulin induction by EBV in short-term cultures appears to be T cell dependent.