Suppressor cells assayed by three different methods in patients with chronic active hepatitis and systemic lupus erythematosus

Dual colour fluorescein analysis of peripheral blood T cells in auto-immune chronic active hepatitis

Both CD4 and CD8 T cells are subdivided into two phenotypically distinct sublineages via another two T cell markers, Leu-8 and CD11b antigens. The proportions of these four T cell subsets, CD4+Leu8+, CD4+Leu8-, CD8+11b+ and CD8+11b-, were studied in patients with auto-immune chronic active hepatitis (CAH) and compared with disease controls (hepatitis B surface antigen positive chronic active hepatitis) and healthy controls. We found that the proportion of CD4+Leu8+ cells was significantly reduced compared with controls (P less than 0.01), whereas those of the other cells were almost identical in all 3 groups. The absolute number of these CD4+Leu8+ cells was also lower than that of controls (P less than 0.01). Thus, the present study suggests that a reduced number of CD4+Leu8+ cells is associated with the aberrant immune response in auto-immune CAH.

Cell-mediated immunity in liver disease

Four liver diseases in which cell-mediated immunity seems to be of major importance but in which the exact pathogenic event has been not fully clarified have been briefly discussed. More precise delineation of the phenotypes of mononuclear cells and the advent of in vitro techniques for the study of lymphocyte function and cytotoxicity have led to better understanding of the importance of cell-mediated immunity in some liver diseases. It seems that the liver itself may be variously affected by different immunologic reactions, not only in various diseases but also in different locations in the same disease.

HLA A1-B8-DR3 and suppressor cell function in first-degree relatives of patients with autoimmune chronic active hepatitis

The relationship between suppressor T cell function and the inheritance of the A1, B8, DR3 haplotype was studied in 17 healthy, first-degree relatives of patients with autoimmune chronic active hepatitis. A marked defect in suppressor cell function was found significantly more often in A1, B8, DR3-positive relatives (5 of 7) compared with those who were A1, B8, DR3-negative (1 of 10; P = 0.017). Less marked abnormalities were also found in the A1, B8, DR3-negative relatives compared with A1, B8, DR3-negative control subjects. The results indicate that the defects in suppressor cell function in patients with untreated chronic active hepatitis result from the inheritance of genetic factors linked to the major histocompatibility complex and other gene loci and are not secondary to hepatic inflammation.

Decrease in suppressor/cytotoxic T-cells with histamine receptors in patients with chronic active hepatitis

A fluorescence assay was employed to measure the levels of circulating suppressor/cytotoxic T cells with membrane receptors for histamine (H+T cells) in 33 patients with chronic active hepatitis, in seven patients with metabolic and vascular liver disorders and in 25 healthy individuals. The H+T cells were decreased in patients with CAH (4.6 +/- 2.2 cells/mm3 vs 16 +/- 3.9 cells/mm3; p less than 0.001), but were normal in patients with metabolic or vascular liver diseases (17.6 +/- 6 cells/mm3 vs 16 +/- 3.9 cells/mm3; NS). Patients with HBsAg-negative CAH had fewer circulating H+T cells than those with HBsAg-positive CAH (p less than 0.05). The same was true for patients with cirrhosis as compared to those without. The lymphocyte alterations were independent of the nature and course of CAH, but correlated inversely with the serum levels of gammaglobulins and with the histological features of hepatic inflammation (p less than 0.05). Like other sets of lymphocytes, the H+T cells in CAH may have locally either immunomodulatory or cytotoxic effects. In analogy with other immune disorders (histiocytosis X, atopic dermatitis), one might speculate that the alterations in H+T cells in CAH represent derangement of the immunoregulatory cell network. The absence of systemic features of autoimmunity in viral CAH correlates with the demonstration that H + T cells exert their immunoregulatory effects at the sites of inflammation where histamine is being released.

Increased immunoglobulin production in vitro in healthy HLA-B8-positive persons

The histocompatibility antigens B8 and DR3 are associated with several autoimmune diseases, and immune hyper-responsiveness has been believed to be one factor in the pathogenesis of these diseases. In the present study we compared the in vitro immunoglobulin production of healthy HLA-B8-positive individuals with that of HLA-B8-negative individuals. In HLA-B8-positive persons a higher number of pokeweed mitogen (PWM)-stimulated Ig-secreting cells was obtained. When the cells were stimulated with PWM in the presence of a physiological concentration of hydrocortisone (HC), the secretion of IgG was significantly higher in HLA-B8-positive individuals. This finding indicates that the PWM-stimulated IgG secretion in healthy HLA-B8-positive individuals is more sensitive for the enhancing action of HC.

Immunoregulatory function of human intestinal mucosa lymphoid cells: evidence for enhanced suppressor cell activity in inflammatory bowel disease

Abnormalities in immune regulation at the gut level may be relevant to the pathogenesis of inflammatory bowel disease, but little is known about the immunoregulatory properties of intestinal mononuclear cells. Therefore, we wished to see if lymphoid cells derived from the lamina propria of surgically resected bowel specimens have any modulatory effect upon the immune response of peripheral blood mononuclear cells from patients with ulcerative colitis or Crohn's disease. When autologous peripheral blood and intestinal lamina propria lymphoid cells were mixed at different ratios and cultured in the presence of phytohaemagglutinin, we were able to show that intestinal mononuclear cells had the capacity to modify the mitogenic response of the cultured cells. These intestinal immunoregulatory cells, when obtained from mucosa affected by inflammatory bowel disease, express a significantly enhanced suppressor cell activity as compared with those from non-inflamed control mucosa. Such suppressor cell activity varies with cell concentration and requires cell proliferation, but it is independent of anatomical origin (small vs large bowel), type of inflammatory bowel disease (ulcerative colitis vs Crohn's disease) or immunosuppressive therapy. These findings point to an important functional difference between inflammatory bowel disease and control intestinal mucosa mononuclear cells. The enhanced suppressor activity of lamina propria mononuclear cells may be associated with impairment of cell-mediated immunity at the gut level. This may be related to the pathogenesis of inflammatory bowel disease by leading to defective intestinal immune regulatory events, which may not be detectable at the peripheral level.

Suppressor cell function and T lymphocyte subpopulations in peripheral blood of patients with progressive systemic sclerosis

Three different in vitro assays--immunofluorescence with monoclonal anti-T cell reagents, enumeration of T gamma cells, and nonspecific suppressor cell function--were used for the analysis of suppressor lymphocytes in the circulation of 28 patients with progressive systemic sclerosis (PSS, scleroderma) and 20 normal individuals. Both OKT8+ and T gamma lymphocytes were significantly reduced (P less than 0.001 and P less than 0.02, respectively) in patients with PSS compared with controls. The OKT4/OKT8 ratio was increased (P less than 0.02). However, the mean suppressor cell index (SCI) of 1.9 (range 0.4-6.6) for patients with PSS was not significantly different (P greater than 0.05) from the SCI of 2.9 (range 1.2-14) for controls. Eleven of the patients had depressed suppressor cell function as indicated by the index value of less than 1.2. In only 5 of these patients, simultaneously measured T gamma and OKT8+ cells were reduced and OKT4+ lymphocytes were concomitantly increased. There were no significant correlations between the numbers of T gamma or OKT8+ cells and the SCI in patients and controls. Neither depressed suppressor cell function nor the OKT4+/OKT8+ ratio greater than 4.2 (greater than 2 SD of normal) in the patients could be related to other immunologic findings, to disease duration and severity, or to involvement of internal organs. These results suggest that depressed suppressor cell activity and immunoregulatory T cell imbalance in PSS may not be directly related to the pathogenesis of the disease.

Immunoregulatory T cells in HBV-induced chronic liver disease as defined by monoclonal antibodies

Peripheral blood T lymphocytes and T-cell subsets were analyzed in 19 patients with HBV-associated chronic liver disease, in 9 "autoimmune" chronic active hepatitis patients, and in three patients with HBV acute hepatitis. The percentages of the different T-cell subpopulations were defined by indirect immunofluorescence using monoclonal antibodies against all peripheral blood T cells (OKT3), T helper cells (OKT4), T suppressor cytotoxic cells (OKT8), and Ia antigens (OKIa1). The OKT4/OKT8 ratio was significantly lower in HBsAg+ chronic liver disease patients as compared with controls (P less than 0.001), with both decreases of T helper cells and increases of T suppressor cells, while "autoimmune" chronic active hepatitis patients showed a significantly increased ratio (P less than 0.001). Acute HBV infection was associated with a reversal in the normal ratio of helper to suppressor T lymphocytes. During convalescence helper T lymphocytes increased and suppressor T lymphocytes decreased.

Intrahepatic synthesis of immunoglobulin in liver disease

Patterns of intrahepatic immunoglobulin production were investigated by an in vitro biosynthetic labelling technique which measured the rate of Ig production in liver biopsy fragments. This technique depends on the incorporation of 3H-leucine into proteins synthesized by cells in the biopsy fragment and subsequently released into the culture medium, and precipitation of Ig with monospecific antisera. Intrahepatic Ig production was expressed as counts of radioactivity precipitated/g of liver tissue/24 h. Mean values were high in various inflammatory diseases of the liver, including alcoholic hepatitis (AH) (17 cases), IgG, 87.8, IgA, 105.6 and IgM, 14.7, chronic active hepatitis (CAH) (19 cases), IgG, 86.0, IgA, 56.1 and IgM, 12.6, and acute viral hepatitis (3 cases), IgG, 116.0, IgA, 61.0 and IgM, 32.0, but low in histologically normal livers (6 cases), IgG, 4.5, IgA, 4.8 and IgM, 4.7, alcoholic fatty liver (11 cases), IgG, 9.4, IgA, 11.4 and IgM, 7.1, and miscellaneous non-inflammatory conditions (10 cases), IgG, 8.7, IgA, 11.1 and IgM, 5.0. Photomicrographs were used to measure the density of plasma cells, expressed as cells/mm2 of liver biopsy tissue: mean counts were for AH 5.1, CAH 16.2 and normal liver 0.0. Intrahepatic Ig production in vitro did not correlate with the density of plasma cells in biopsy samples from cases of AH or CAH, nor with serum Ig levels.

Normal suppressor-cell activity in systemic lupus erythematosus. A study on 26 cases

Suppressor-cell activity of 26 SLE patients suffering from active disease was compared to that of 15 healthy controls. ConA-induced and spontaneous suppression was evaluated. The mitogen-driven proliferation of normal allogeneic cells was significantly impaired by ConA-induced as well as spontaneous suppressor cells. However, no difference in suppressor-cell activity could be demonstrated between SLE patients and controls.

Suppressor cells assayed by numerical and functional tests in chronic renal failure

Suppressor cells were assayed by numerical and functional tests in adults on chronic hemodialysis. Peripheral blood mononuclears (PBM) were classified as total T-cells by E-rosettes and by the monoclonal antibody OKT3, as T-cell subsets by OKT4 (inducer/helper T-cells) and OKT8 (cytotoxic/suppressor T-cells) and as B-cells by the presence of surface immunoglobulin. The suppressive effect of PBM pretreated with either Concanavalin A (Con A), sodium periodate, or serum rich in immune complexes, on normal homologous phytohemagglutinin (PHA) lymphocyte transformation, was determined. Usual tests of T-cell function were not done. T lymphopenia was due to significant diminution (P less than 0.002) in numbers of OKT4+ cells in patients (516 +/- 44 cells/mm3, mean +/- sem) as compared to controls (906 +/- 96 cells/mm3). The number of OKT8+ cells in patients was not different from normal although their percentage (45 +/- 4%) was slightly higher than controls (36 +/- 5%) (P less than 0.10). Suppressor activity using only a suboptimal dose of Con A (5 micrograms/ml), was significantly lower (P less than 0.002) in uremic patients (36 +/- 12%) than in controls (67 +/- 7%). An important finding was that no significant correlations were detected between the numerical and functional assays of suppression used or between any of these immunological tests and biochemical parameters studied. The implications of these results for immunoparesis in uremia are discussed with particular reference to the discordance between marker and functional assays of suppressor cells.

Immune regulation and HLA types in chronic hepatitis

Studies were undertaken in 32 patients with hepatitis B-negative or -positive chronic active hepatitis or chronic persistent hepatitis to define the relationship between immunoregulatory activity and the HLA-B8 and B12 phenotypes. Suppressor T-cell activity measured by a concanavalin A-induced suppressor system using allogeneic responder cells was dependent on which individual was selected as a source of responder cells. No differences were noted using isogeneic cells as responders. Suppressor T-cell activity measured by the effect of a noninduced suppressor cell on a mixed leukocyte culture was not different from controls. Increased prostaglandin-producing suppressor cell activity was found in patients with hepatitis B-negative (p less than 0.005) and hepatitis B-positive (p less than 0.05) chronic active activity hepatitis. When results of the suppressor activities were compared among patients with chronic hepatitis dependent on the presence of HLA-B8, B12, or neither of these phenotypes, no significant differences were present. These results provide further evidence of altered immunoregulatory function in patients with chronic active hepatitis, which may reflect increased suppression by a population of prostaglandin-producing suppressor cells. The results do not, however, suggest that a gene coding for altered immune regulation is linked to HLA-B8 or B12.