Auto-immunity in man and homologous disease in mice in relation to the malignant lymphomas

Sjögren syndrome: advances in the pathogenesis from animal models

Sjögren syndrome is an autoimmune disease characterized by hyposecretion of the lacrimal and salivary glands, resulting in dryness of the eyes and mouth. Individuals may experience primary Sjögren syndrome or a secondary form accompanying another rheumatic autoimmune disease, such as rheumatoid arthritis or systemic lupus erythematosus. The pathogenic mechanisms of Sjögren syndrome remain largely unknown, in part a consequence of the heterogeneity of the disease. Animal models have shed light on the connections between specific pathways and symptoms, but an ideal system is wanting. Improved disease models will enable a better understanding of Sjögren syndrome, including how immune tolerance is lost and potential therapeutic interventions. Most importantly, an optimal model will enable detection of disease biomarkers, since injury to the salivary glands may precede lymphocytic infiltration. This review aims to characterize available mice models of Sjögren syndrome, including advantages and disadvantages, from the researcher's perspective.

Histogenesis of Hodgkin's disease: possible insights from a comparison with lymphomatoid papulosis

Comparison of LyP and HD suggests that these are closely related lymphoproliferative disorders that may occur in the same patient, share similar histologic features, and have the same immunologic phenotype. Recent studies of the molecular biology of both disorders confirm a similar distribution of T-cell receptor gene rearrangement patterns. The study of LyP, although a rare and benign disorder, has improved our understanding of HD, which appears, in some cases, to be a proliferation of malignant activated T lymphocytes. Further analysis of LyP may lead to a better understanding of the spontaneous regression of this disorder and result in new methods for treatment of HD.

Common activated helper-T-cell origin for lymphomatoid papulosis, mycosis fungoides, and some types of Hodgkin's disease

A hypothesis is proposed to explain the nature of the Reed-Sternberg (RS) cell and the unexpectedly common clinical associations between lymphomatoid papulosis, mycosis fungoides, and some types of Hodgkin's disease. The RS cell appears to be a lymphoblast arising from activated helper T cells. In lymphomatoid papulosis, a cutaneous eruption with histological features of Hodgkin's disease, there is a spectrum of activated helper T cells, including cerebriform cells and large transformed RS-like cells. Clonal expansion of cerebriform cells in lymphomatoid papulosis leads to mycosis fungoides. Similar expansion of large transformed cells results in Hodgkin's disease. Progressive transformation of T4-positive cerebriform cells to Ki-1-positive RS cells accounts for rare cases of coexistent mycosis fungoides and Hodgkin's disease. Confirmation of this hypothesis should focus attention on the family of human T-cell leukaemia/lymphoma viruses as possible aetiological agents in these helper-T-cell disorders.

B- and T-lymphocytes in Hodgkin's disease. An immunohistochemical study utilizing heterologous and monoclonal antibodies

Immunohistologic techniques utilizing monoclonal antibodies have made possible the identification of leukocytes by their phenotypic characteristics rather than by morphologic features alone. A panel of antibodies for T-lymphocyte, B-lymphocyte, and monocyte/histiocyte markers has been applied to frozen sections of nodular sclerosing and mixed cellularity Hodgkin's disease to identify more precisely the various cell types present in tissues involved in Hodgkin's disease. The majority of lymphocytes expressed detectable T-cell phenotypic markers, with a predominance of the "helper" phenotype (Leu 3/OKT4) in most cases. Lymphocytes reacting with anti-B-cell antibodies were also demonstrated; their distribution is described here and has not previously been reported. The anti-B- and anti-T-cell antibodies used in this study failed to give positive reactivity with Reed-Sternberg cells. However, one of the anti-monocyte antibodies (Leu-M1) reacted with diagnostic Reed-Sternberg cells in some cases. The patterns of staining observed varied widely within the two histologic types of Hodgkin's disease, leading to a conclusion that this disease may be more heterogeneous than is currently suspected.

Isolation of activated ras transforming genes from two patients with Hodgkin's disease

Despite impressive advances in the clinical management of Hodgkin's disease, little is known about its cellular origin or the mechanism(s) of "Hodgkinogenesis." Recent findings that certain human cellular oncogenes can cause malignant transformation suggest that aberrant activation of these genes may play a role in carcinogenesis. To determine if such genes are operative in Hodgkin's cells, we isolated DNA from splenic nodules of three patients with nodular sclerosis Hodgkin's disease and tested its ability to transform mouse NIH 3T3 cells, the standard assay for oncogene-mediated malignant transformation. Transformed cells containing human DNA were obtained from two patients. DNA from these primary transformants yielded secondary transformants of NIH 3T3 fibroblasts; one also transformed normal mouse bone marrow macrophages, a cell type probably related to the Hodgkin's cell. When analyzed by Southern blot methods for homology with closed oncogene probes, the transforming genes from both patients had homology with N-ras. The homology and size of the restriction fragments were similar to those of transforming genes isolated from patients with acute nonlymphocytic leukemias. The presence of the same activated oncogene in tumor tissue from two different patients suggests that it may play an important role in Hodgkinogenesis.

P-cell stimulating factor: characterization, action on multiple lineages of bone-marrow-derived cells and role in oncogenesis

T-cell hybridomas have allowed us to define unequivocally a group of 3 distinct molecules, TCGF, T-cell GM-CSF, and PSF, as the products of the activated T-cell. It is becoming increasingly evident that these T-cell-derived molecules, together with a fourth, interferon-gamma, (Wong et al. 1982, 1983), affect a wide range of cell-types. The molecule which we have studied in greatest detail, PSF, probably effects every lineage of non-lymphoid bone-marrow-derived cells. We have evidence that PSF acts in vivo as an important mediator in a pleotropic defence and repair response to antigens that involves all the non-lymphoid elements of the blood. Finally, there is evidence that PSF-dependent cells can become immortal, and that activation and functional expression of the PSF gene can occur in such cells and result in autonomy and tumorigenesis. Clonal sources of T-cell lymphokines and clonal targets for lymphokine assays, formed the basis of recent progress in defining the number and nature of non-antigen-specific T cell products; cloning of the genes coding for these lymphokines should result in a similar impetus to the investigation of the physiology and possible therapeutic role of T-cell lymphokines, and lead to new insights into the control of gene expression and the role of these factors in oncogenesis.

Impaired autologous mixed lymphocyte reactivity in Hodgkin's disease

In patients with Hodgkin's disease, the impaired immune reactivity, especially of the thymus dependent system, is well established. This decreased immune response of the lymphocytes from the peripheral blood contrast to an increased lymphocytopoiesis in the the lymphatic organs with a hyperplasia of these tissues. We studied the reactivity of peripheral T lymphocytes from 20 patients with Hodgkin's disease and 26 healthy control persons against autologous and allogeneic non T cells respectively in the mixed lymphocyte culture (MLC). Our experiments show an extremely depressed autologous mixed lymphocyte reactivity (MLR) of T lymphocytes from patients with Hodgkin's disease compared to those from normal donors. In the allogeneic MLC, the proliferation of the patients' T cells was stronger than in the autologous MLC, but significant lower than the proliferation of normal T lymphocytes when stimulated by normal non T cells. Patients' non T cells stimulated T lymphocytes from healthy donors as well as non T lymphocytes from normals did. Finally, the autologous MLR of normal lymphocytes was significantly suppressed by 18 of 23 sera from Hodgkin's patients when these sera were substituted for normal AB serum in the cultures. These results demonstrate an impaired function of T lymphocytes from patients with Hodgkin's disease in the autologous MLC and the presence of one or more factors in their serum which inhibit the proliferation of normal lymphocytes in the autologous MLC. The role of suppressor cells and their factors will be discussed.

Hodgkin's disease: pathology and pathogenesis

The pathogenesis of Hodgkin's disease has been the subject of intensive investigation for nearly a century. Numerous lines of inquiry have been pursued and the resulting quantity of literature on the subject attests to the enigmatic nature of the disease. Periodically, it becomes prudent to review progress in the study of a disease such as this, in light of recent methodologic and conceptual advances. By so doing, a more integrated view of the disease process may emerge, thereby guiding future research endeavors. The present report is undertaken to explore, in depth, recent advances in the study of the pathology and pathogenesis of Hodgkin's disease. Contemporary classifications, clinicopathologic and epidemiologic studies, cellular and humoral derangements, and the controversial nature of the Reed-Sternberg cell are considered.

Hodgkin's disease: unfolding concepts concerning its nature, management and prognosis

The evolution of our concepts concerning the fundamental nature and natural history of Hodgkin's disease is reviewed. Recent evidence establishes that it is indeed a malignant neoplasm, albeit a curious one, the giant cells of which display aneuploid karyotypes, often with marker chromosomes indicating their clonal derivation, and the functional and surface marker properties of cells of the mononuclear phagocyte series. The disease tends initially to spread by contiguity from one lymph node chain to others with which direct lymphatic channel communications exist. Essentially all patients, even those with limited disease, have some degree of impairment of cell-mediated immunity, apparently due to inhibition of T-lymphocyte function. Lymphangiography, computed tomography, and laparotomy with splenectomy have greatly improved the accuracy of clinical staging. Total lymphoid megavoltage radiotherapy and/or multidrug combination chemotherapy now permit the eradiction of disease of all stages, resulting in a dramatic improvement in prognosis and an increasing frequency of permanent cure of this once inevitably fatal condition.

Pathophysiological aspects of Hodgkin's disease

Hodgkin's disease is characterized by unique features setting it apart from other malignancies. Clinically, systemic symptoms are often prominent and spontaneous remissions may be seen. As major immunological aberrations, a reactive humoral response with hypergammaglobulinemia and a depression of cell-mediated immunity are observed. Pathologically, the diagnosis is based on the presence of pleomorphic morphology; this consists of an infiltrate of reactive inflammatory cells sometimes forming granulomatous lesions with or without varying numbers of the cells presumed to be malignant. The nature of these malignant cells remains undefined, with data supporting mainly B-cell, but also macrophage origin. Clear-cut evidence for monoclonality is available only in prognostically unfavourable histological forms.

Hodgkin's disease and anergy

The clinical, pathologic, and immunologic features unique to Hodgkin's disease can be explained by the following hypothesis. A viral transformation of a lymph node cell leads to proliferation of tumor cells and the generation of an immune response consisting of lymphokine production, B cell activation and concomitant suppression of further T cell activation, but ineffective cellular cytotoxicity against the tumor cells. The result of this interaction would be chronic infiltration around the transformed cells, increased immunoglobulin synthesis, and anergy. Failure to destroy the target cells would result in chronicity of these features and progressive disease.

Epidemiology of hodgkin's disease in the young

Many features of Hodgkin's disease (HD) among adolescents and young adults suggest that it has an infectious etiology. However, the proposal that HD is a contagious disease which can be transmitted by patients or their close contacts has not been substantiated. An alternative infectious disease model is suggested by analogy with paralytic poliomyelitis (PP). For both diseases, the peak age of incidence is delayed as living conditions improve. For both, increased risk is associated with higher social class and small family size. Like PP, HD may be a rare manifestation of a common infection with the probability of disease development increasing as age at infection is delayed. This analogy is supported by the report that the risk of HD is higher for persons who had a low frequency of childhood infectious diseases. If this model is valid, HD patients represent no hazard to their contacts. However, the incidence of HD among young adults may increase in the coming decade because of the current high standard of living and small family size.

Angio-immunoblastic lymphadenopathy terminating as Hodgkin's disease

The clinical course of a 33-year-old man with generalized lymphadenopathy bearing all physical, laboratory and histologic characteristics of "angio-immunoblastic lymphadenopathy with dysproteinemia" (AILD) is described. Therapy was without significant benefit and the patient died 22 months after initial diagnosis. At autopsy in addition to the characteristic cellular polymorphism of AILD, numerous Hodgkin's cells and Sternberg-Reed cells were identified in the lymph nodes and spleen. Pleomorphic cellular infiltrates containing an increased number of immunoblasts and some giant cells were found also in the portal spaces of the liver. The evolution of Hodgkin's disease (H.D.) from AILD suggests that the latter may have represented a reaction to the agent which causes H.D..