Functional abnormalities associated with T lymphocytes from patients with chronic lymphocytic leukemia

Granulomatous interstitial nephritis secondary to chronic lymphocytic leukemia/small lymphocytic lymphoma

Granulomatous interstitial nephritis (GIN) is an uncommon pathologic lesion encountered in 0.5% to 5.9% of renal biopsies. Drugs, sarcoidosis, and infections are responsible for most cases of GIN. Malignancy is not an established cause of GIN. Here, we report a series of 5 patients with GIN secondary to chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL). Patients were mostly elderly white males with an established history of CLL/SLL who presented with severe renal impairment (median peak serum creatinine, 7.3 mg/dL), leukocyturia, and mild proteinuria. One had nephromegaly. In 2 patients, the development and relapse of renal insufficiency closely paralleled the level of lymphocytosis. Kidney biopsy in all patients showed GIN concomitant with CLL/SLL leukemic interstitial infiltration. Granulomas were nonnecrotizing and epithelioid and were associated with giant cells. One biopsy showed granulomatous arteritis. One patient had a granulomatous reaction in lymph nodes and skin. Steroids with/without CLL/SLL-directed chemotherapy led to partial improvement of kidney function in all patients except 1 who had advanced cortical scarring on biopsy. In conclusion, we report an association between CLL/SLL and GIN. Patients typically present with severe renal failure due to both GIN and leukemic interstitial infiltration, which tends to respond to steroids with/without CLL/SLL-directed chemotherapy. The pathogenesis of GIN in this clinical setting is unknown but may represent a local hypersensitivity reaction to the CLL/SLL tumor cells.

Abnormal T-cell function in B-cell chronic lymphocytic leukaemia

There is increasing evidence of T cell dysfunction in B cell chronic lymphocytic leukaemia (B-CLL) which may contribute to the aetiology and progress of the disease. An absolute CD8+ lymphocytosis correlates with disease progression and low expression of CD4 and CD8 (as found in autoimmune disease) is seen with abnormal expression of other surface molecules. Although the expression of T cell surface activation markers, CD25 and CD152, may be increased on culture in B-CLL serum, response to the common mitogens, PHA and PWM, is reduced. This and the excess of CD8 cells may explain partly the variable cooperation of T cells with B cell production of immunoglobulin in B-CLL. In the context of T cell cross-talk with antigen presenting cells, B-CLL B cells are poor antigen presenters. But the T cells themselves have significant abnormalities of expression of the many antigens and ligands necessary for this process. In particular, they exhibit variable expression of the low affinity and non-specific adhesion molecules LFA-1 and ICAM-1, variable, clonally restricted and skewed expression of the TCR repertoire (implying repeated antigenic stimulation possibly by CLL antigens), reduced CD28 and CD152 expression (implying impairment of ability to start or stop an immune response) and reduced IL2 and CD25 (IL2 R) expression (critical for positive feed-back in maintenance and expansion of the T cell response to antigen presentation). Although the production of IL2 and other cytokines by the T cell in B-CLL may be impaired, production of the anti-apoptotic cytokine IL4 is not and there may be a unique and expanded subset of CD8/CD30 cells capable of releasing IL4. The relationship of this T cell subset to the malignant B cell in vivo is unknown. However, T cells which are CD4+/CD152+/CCR4+ migrate selectively in vitro in response to the chemokine CCL22 (specific for the receptor CCR4) produced by the malignant B cells and are always seen amongst the malignant cells in bone marrow and lymph nodes from B-CLL patients. Other abnormalities of cytokine secretion are described. These findings suggest that the T cell in B-CLL may be unable to start, maintain and complete an immune response to the malignant B cell and other antigens and may be involved directly in sustaining the tumour. However, autologous tumour specific cytotoxicity has been shown in vitro and T cells which recognise tumour-derived heavy chain fragments circulate in vivo. If adoptive immunotherapy of any nature is to succeed in B-CLL, manipulation to optimise these CTL responses is needed to overcome the profound and variable T cell dysfunction in this disease.

Acquired CD40-ligand deficiency in chronic lymphocytic leukemia

Patients with B-cell chronic lymphocytic leukemia (CLL) acquire an immunodeficiency with many characteristics similar to those of persons with inherited defects in the gene encoding the CD40-ligand (CD154). We found that the blood and splenic CD4+ T cells of patients with CLL failed to express surface CD154 after CD3 ligation. However, using an enzyme-linked immunosorbent assay (ELISA)-based quantitative competitive polymerase chain reaction (PCR), we noted that CD3 ligation could induce such T cells to express CD154 messenger RNA at levels similar to that of CD3-activated T cells from normal donors. Moreover, addition of increasing numbers of CLL B cells to activated normal donor T cells rapidly resulted in progressively greater down-modulation of CD154. Such down-modulation of CD154 could be blocked by addition of CD40 monoclonal antibody to cultures in vitro. We propose that leukemia cell-mediated down-modulation of CD154 on activated T cells accounts for some of the acquired immune defects of patients with CLL.

T-lymphocyte response to cytokines in B-chronic lymphocytic leukemia

The mechanisms underlying abnormal T-cell function in B-chronic lymphocytic leukemia (B-CLL) are unknown. We have studied B-CLL T-cell activation pathways in the rigorous absence of leukemic cells and with controlled numbers of accessory cells present. The responsiveness to added recombinant IL-1 and IL-2 was assessed. We have found that under optimal culture conditions B-CLL T cells had a normal PHA-induced proliferative response in terms of incorporated 3H-thymidine per T cell. Also the capacity of mitomycin-C treated B-CLL monocytes to support autologous T-cell mitogenesis was normal. However, a subtle difference between normal and B-CLL T cells emerged with respect to cytokine responsiveness. While the PHA response of purified normal T cells in the absence of monocytes was augmented by rIL-1, this could not be demonstrated for B-CLL T cells. A much greater degree of augmentation occurred with added rIL-2 in the case of both normal and B-CLL T cells. In the presence of 20% autologous monocytes rIL-1 and rIL-2 had no effect on mitogenesis. We conclude that B-CLL T cells have an abnormal profile of cytokine responsiveness which is consistent with observed abnormalities of subset distribution, and which may contribute to the clinical immunodeficiency in B-CLL.

Impaired synthesis of immunoglobulin in patients with chronic lymphocytic leukemia

The cause of hypogammaglobulinemia in patients with chronic lymphocytic leukemia (CLL) is unknown. Experiments were performed to determine if sera, monocytes, or non-T cells from patients with CLL suppress the proliferative response and synthesis of immunoglobulin (Ig) following incubation with pokeweed mitogen (PWM) in cocultures with lymphocytes from normal individuals. The data indicate that sera and monocytes from patients with CLL did not suppress the proliferative response or synthesis of Ig normal non-T cells. When various numbers of normal non-T cells and CLL non-T cells were cocultured with a constant number of normal T cells, the proliferative response and the concentration of supernatant Ig decreased as the proportion of CLL non-T cells increased. Since similar results were obtained when irradiated non-T cells from normal individuals were substituted for non-T cells from patients with CLL, we believe that the decrease in proliferative response and diminished synthesis of Ig is not the result of the suppressor non-T cells but is related to the dilution of normal B cells by inert non-T cells. We conclude that these experiments serve as as in vitro model for patients with CLL and suggest that the hypogammaglobulinemia observed in this disease is related to the diluting out of normal B cells by the accumulation of neoplastic B cells in the peripheral blood, bone marrow, and lymphoid tissue of these patients.

The ultrastructural morphology of T lymphocytes in B-chronic lymphocytic leukaemia: a study with monoclonal antibodies and the immunogold technique

T-lymphocytes from five patients with B-cell chronic lymphocytic leukaemia (B-CLL) were analysed by light (LM) and electron microscopy (EM) by means of the immunogold technique with monoclonal antibodies combined with E rosettes. LM analysis confirmed the existence of a population of E+ lymphocytes unreactive with the OKT3 monoclonal antibody. The EM study showed that E+ lymphocytes from B-CLL can be distinguished morphologically from the leukaemic B-cells which were identified by their labelling with FMC4 (anti HLA-Dr). Within the E+ fraction two cell types were seen which differed both in reactivity with OKT3 and ultrastructural morphology. T3+ lymphocytes are similar to normal T3+, T4+ cells: they have high nucleocytoplasmic (N/C) ratio and few cytoplasmic organelles. Their reactivity with OKT3 is, however, considerably weaker than that of normal T3+ lymphocytes. T3- (E+) lymphocytes, on the other hand, are characterized by low N/C ratio, active Golgi, lysosomal granules and parallel tubular arrays. These cells resemble normal T gamma lymphocytes which comprise cells with the membrane phenotypes: T3+, T8+, M1- and T3-, T8-, M1+. These results provide further evidence for a T-cell imbalance in B-CLL and help define better the cellular basis for this abnormality.

Chromosomal translocation involving the immunoglobulin kappa-chain and heavy-chain loci in a child with chronic lymphocytic leukemia

Chronic lymphocytic leukemia is usually a monoclonal B-cell neoplasm that occurs almost exclusively in middle-aged and elderly adults. We observed a rapidly progressive case of the disease in a 10-year-old girl. The leukemic cells bore surface IgM and IgD immunoglobulins of the kappa-light-chain type. Karyotyping of the abnormal cells revealed an unusual translocation [t(2;14) (p13;q32)], with break points at or near the kappa-light-chain and heavy-chain gene loci. Translocations involving the immunoglobulin gene loci may be important in the pathogenesis of some cases of chronic lymphocytic leukemia, as they appear to be in Burkitt's lymphoma.

T lymphocytes in B-cell chronic lymphocytic leukemia: characterization by monoclonal antibodies and correlation with Fc receptors

In 35 patients with B-cell chronic lymphocytic leukemia (B-CLL), T lymphocytes were characterized by their ability to react with OKT-4 and OKT-8 monoclonal antibodies. These T-cell subsets were also compared with the expression of Fc receptors. An imbalance in the distribution of OKT-4 and OKT-8 lymphocyte subpopulations was observed, with an overall significant reduction in the OKT-4/OKT-8 ratio. When the patients were subdivided according to Rai's staging classification, the OKT-4/OKT-8 ratio was more severely impaired in stages III and IV than in stages 0, I, and II. The correlation between the expression of Fc receptors and monoclonal antibodies revealed in both systems an increase in cells bearing suppressor phenotypes (OKT-8+ and TG+ cells) and a decrease in cells bearing helper phenotypes (OKT-4+ and TM+). However, a strict correlation between cells defined by the two assays could not be found in individual cases. In some cases a proportion of T lymphocytes (E+ and OKT-3+) did not express the OKT-4 and OKT-8 determinants; possible implications of this finding are discussed. These data provide further evidence of the T-cell abnormality in B-CLL and emphasize the importance of T-cell subsets in this disease.

Chronic lymphocytic leukemia. Immunologic markers and functional properties of the leukemic cells

In 230 cases of chronic lymphocytic leukemia (CLL), marker analysis was performed with rosette techniques and a panel of xeno-antisera. A monoclonal B-cell proliferation was found in the majority of cases (94%). In most cases, the B-cells carried IgM, with or without IgD. Cytoplasmic immunoglobulin-inclusion bodies were seen in 7% of the cases of B-CLL. The number of patients with non-B/non-T-CLL was small (2%) in this series. In eight patients (4%), a proliferation of T-cells was established. These patients had a different clinical presentation and marker analysis of the lymphocytes, together with functional studies, showed that this group represented a mixture of different disease processes. Functional analysis of the B-CLL cells in 19 cases showed a poor or absent mitogen response and in nine cases the absence of the capacity to differentiate in vitro into plasma cells and/or to produce immunoglobulins.

B-cell function in patients with chronic lymphocytic leukemia

Using a reverse hemolytic protein A plaque assay, spontaneous and pokeweed mitogen (PWM)-induced immunoglobulin (Ig) secretion was determined in peripheral blood from 22 patients with B1-chronic lymphocytic leukemia (CLL), one patient with B2-CLL, and one patient with suppressor T-CLL. Diagnoses were established by cytological and histological criteria as well as several marker analyses. Lymphocytes from B1- and B2-CLL patients were unable to secrete Ig either spontaneously or after PWM stimulation. In T-CLL lymphocytes, spontaneous Ig secretion was suppressed very probably by the OKT-8-positive leukemic population, since, after cultivation with PWM, a normal Ig secretion could be demonstrated which was paralleled by a decrease in the OKT-8-positive cells. Cocultivation experiments with freshly isolated, unseparated lymphocytes from normal subjects and lymphocytes from patients were of no informational value, since isolated normal B-cells alone already showed a high rate of Ig secretion. However, coculture experiments with separated subpopulations after PWM stimulation revealed an intrinsic B-cell defect in lymphocytes from B1-CLL patients, whereas their T-lymphocytes were found to be normal helper cells.

T-cell function in chronic lymphocytic leukaemia

Fifteen patients with chronic lymphocytic leukaemia (CLL) were studied. The diagnosis was made by a combination of clinical findings, peripheral blood morphology and cell surface markers. The Rai clinical staging (Rai et al, 1975) was used to classify all patients. Serum immunoglobins, B and T cell lymphocytes, TG and TM cell populations were evaluated in all patients before commencing treatment. No correlation was found between clinical staging and the presence or absence of hypogammaglobulinaemia. The ratios of TG to TM cells were abnormal in all patients and this abnormality paralleled the stage of the disease. While there was significant difference in the proliferative responses of highly purified T cells from patients and controls at 1 micrograms and 2 micrograms/ml of Concanavalin A (Con A) (P values = P less than 0.005 and P less than 0.01 respectively). There was no significant difference at dose 5 micrograms/ml. The ability of T cells to suppress allogeneic PBMC responses to Con A was dependent on T cell purification procedures. The significance of the results and the possible role of T cells in the pathogenesis of CLL is discussed.

Unusual T-cell phenotype in advanced B-chronic lymphocytic leukaemia

T-lymphocytes isolated by E-rosetting from 22 patients with B-cell chronic lymphocytic leukaemia (B-CLL) showed membrane phenotype features distinct from those of normal T-lymphocytes. These changes were particularly marked in advanced disease (Rai stages II, III, IV and WBC over 100x10(9)/l). The most significant finding was the demonstration, in 10 cases, of a major population of E-rosette positive cells (40-80%) unreactive with the OKT monoclonal antibodies against mature or immature T-cells; 15-30% of the cells were unreactive in seven other cases. A significant reduction in OKT4 positive (helper) lymphocytes was seen in 18 cases. The proportion of OKT8 positive cells was increased in two and normal or low in the rest. Only four patients with early disease (stages 0 and I) had a normal T-cell phenotype. These findings could explain abnormalities previously described in the T-lymphocytes of B-CLL and provide new insights into the pathogenesis of the disease.