Selective defect of a T helper subpopulation in severe combined immunodeficiency

Editorial to the Special Issue "Clinical Immunology in Italy, with Special Emphasis to Primary and Acquired Immunodeficiencies: A Commemorative Issue in Honor of Prof. Fernando Aiuti"

Fernando Aiuti (Figure 1), born in Urbino on 8 June 1935, suddenly died on 9 January 2019, leaving a great void not only among his family members and those who knew him and appreciated his great humanity and acute intelligence, but in the entire immunological scientific community [...].

Immune function in growth hormone-deficient children treated with biosynthetic growth hormone

Conflicting data regarding the immune function in growth hormone (GH) -deficient children or changes in immune parameters during substitutive GH therapy have been reported. We have studied the immune function in 13 patients with GH deficiency before and during treatment with biosynthetic GH (12 IU/m2 body surface/week) after 6 and 12 months of therapy. We found that the absolute number of total T lymphocytes and T-cell subsets (using monoclonal Ab as markers), Natural Killer cell activity (target K562) and response of lymphocytes to polyclonal mitogens (PHA, ConA, PWM) were all in the normal range and remained so after 6 and 12 months of therapy. The absolute number of B lymphocytes was in the normal range before treatment and after 6 months of therapy but dropped significantly after 12 months of treatment. Serum immunoglobulins (IgG, IgA, IgM) did not show a parallel drop and remained normal throughout the whole study. Our GH-deficient patients did not show any undue susceptibility to infections and our data thus seem to confirm that the immune function is basically intact in these children and that it is not suppressed by GH treatment. Although a drop in B lymphocytes was observed, the normal level of immunoglobulins and the normal functional response to PWM seem to demonstrate the maintenance of a normal humoral immune response.

Severe combined immunodeficiency with T lymphocytes retaining functional activity

Two cases of severe combined immunodeficiency (SCID) with normal numbers of T cells are reported. Studies of T-cell subsets showed an absence of TQ1+ lymphocytes and a very low percentage of CD4+ cells in Patient 2. Functional studies of T cells from this patient showed a normal suppressor activity. Patient 1 had normal percentages of T-cell subsets and his lymphocytes showed helper and suppressor activities but to a lesser degree than normal controls. Both cases stressed the heterogeneity of SCID in which T cells could be present and retain some of their functional activities.

Immunological studies in patients with central nervous system tumors

Impairment of cell-mediated immunity in patients with primary central nervous system (CNS) tumors has repeatedly been reported but data to demonstrate the underlying immunological defect are not univocal. This report concerns a series of 31 patients harboring a glioma in which we studied: peripheral blood T-lymphocyte subpopulations by monoclonal antibody analysis; cellular responsiveness to mitogens; serum immunoglobulin values. The same parameters were also evaluated in 7 cases of intracranial meningioma and in 8 patients affected by non-proliferative, non-inflammatory CNS diseases. Thirty age-matched healthy volunteers formed the control group. Neither impairment of T-cells as regard to number, responsiveness and subsets, nor abnormal Ig values were found in these groups. However two patients, harboring respectively a third ventricle low grade astrocytoma and an anterior callosal glioblastoma, presented a striking T-cells impairment. These findings might suggest a correlation between hypothalamus and immune system, as already postulated by several previous experimental and clinical studies.

Defective expression of T cell-associated glycoprotein in severe combined immunodeficiency

A T cell surface membrane-associated glycoprotein, Tp40 (40,000 mol wt), also designated as CD-7, was not expressed by the T cells of a patient with severe combined immunodeficiency. In addition to this abnormality, T cell proliferative responses to mitogens were defective and the IL-2 receptor expression was deficient on the patient's T lymphocytes. However, his T cells were found to provide help for the differentiation of normal B cells to Ig-secreting cells. Abundant circulating B cells were detected. These B cells proliferated normally in the presence of anti-mu antibodies and B cell growth factors, but did not differentiate into antibody-secreting cells when provided with the help of normal T cells. In addition, his activated B cells did not proliferate to IL-2 even though IL-2 receptors were expressed. A successful allogeneic histocompatible bone marrow transplantation resulting in T cell engraftment corrected both the T and B cell immunodeficiencies. These findings support the hypothesis that the Tp40 deficiency present in this patient is related to a defect of the T cell precursors, and that Tp40 plays important roles not only essential to T cell interactions but also to certain aspects of T-B cell interaction during the early lymphoid development.

Analysis of false negative results in the immunoassay for anti-acetylcholine receptor antibodies in myasthenia gravis

Possible causes for the failure of immunoassays to detect anti-acetylcholine receptor activity in serum from confirmed myasthenia gravis (MG) patients were investigated. A more sensitive assay, using Protein A to trap immune complexes (ARIA), was applied to 65 MG sera which were negative in the usual assay and to 42 normal human sera. Normal and negative MG sera had antibody (Ab) activity in the same range (50-70 pM). Titers present in 70% of normal sera appeared to be specific antireceptor antibodies as defined by tests for antigen specificity. Thus, higher sensitivity assays did not improve discrimination of MG from normals. In a second group of 108 MG sera studied, 48 were negative by the usual assay criteria in a rat acetylcholine receptor immunoassay. Further detailed analysis of this negative group showed that 3/48 had IgG3 antibody not detectable in the test, 14/48 had Ab's recognizing human receptor determinants exclusively, 29/48 had toxin blocking Ab's not determined by immunoassays, and 6/48 were negative in all tests. The results indicate that the exclusive occurrence of toxin-blocking antibodies in MG subjects is a major factor contributing to false negatives in the ARIA test. Estimates of the amount of Ab's with this functionality indicated that they are present in very much smaller amounts than other classes of anti-receptor Ab's. Degree of blocking activity in patient serum showed a fair correlation with severity of disease. Thus, blocking antibodies appear capable of causing all degrees of disease severity in the absence of other types of antireceptor Ab's. The development of a sensitive and quantitative in vitro assay for blocking antibodies combined with the usual immunoassay would be a major improvement for a MG diagnostic test, with greater than 94% positivity predicted.

Thymopentin (TP-5) potency in vivo is enhanced by slow infusion

The in vivo activity of thymopentin in guinea pigs was assessed electromyographically 18 h after intravenous or subcutaneous injections or infusions ranging over varying periods of time. The lowest threshold dose required to establish a positive effect was obtained with a 30-60 min i.v. infusion (0.38-0.75 micrograms/kg) and we found that we needed X 5 times this dose with 30 min s.c. infusion, X 10 this dose with 10 min i.v. or s.c. infusion, X 200 this dose with bolus IV injection and X 400 this dose with bolus s.c. injection. The marked increase of potency of thymopentin with infusion should be considered in designing clinical regimens.

Comparative efficacy of various routes of administration of thymopentin (TP-5) with consideration of degradative mechanisms

Thymopoietin (originally termed TP-5 and now called thymopentin) is a synthetic pentapeptide that can reproduce the biological activity of the 49 amino acid thymic hormone thymopoietin. The efficacy of various routes of administration of thymopentin was studied in mice and guinea pigs using an electromyographic assay as an end point to determine biological activity. In mice, the threshold dose necessary for a significant response when compared to controls was 0.03 mg/kg (mpk) for i.v. (intravenous) injection and 0.3 mpk for both i.p. (intraperitoneal) and s.c. (subcutaneous) injection. For the guinea pig, 0.03 mpk produced a significant response when compared to controls when injected either i.v. or s.c.; 0.3 mpk was required for a significant response for i.n. (intranasal) administration and 0.6 mpk for i.p. injection. When saline or plasma was injected, it produced no change in the electromyographic response. In plasma the pentapeptide is rapidly degraded by proteolytic enzymes. Treatment of plasma with specific enzyme inhibitors followed by incubation with thymopentin or thymopoietin confirmed that serine protease and aminopeptidase M-like enzymes are responsible for the rapid inactivation of thymopentin in plasma, as measured by the electromyographic response.