Ia antigens on indeterminate cells of the epidermis: immunoelectronmicroscopic studies of surface antigens

Indeterminate DC histiocytosis is distinct from LCH and often associated with other hematopoietic neoplasms

ABSTRACT

Indeterminate dendritic cell histiocytosis (IDCH) is a rare and poorly understood entity characterized by accumulation of CD1a+/S100+ histiocytes (as Langerhans cell histiocytosis [LCH]) but with reduced-absent expression of Langerin/CD207. We assembled 43 cases of IDCH (defined by CD1a+/CD207<20% immunophenotypic profile) examining the clinical, pathologic, and molecular landscape. Median age at presentation was 70 years (interquartile range, 44-80) with cutaneous (31/43; 72%) and nodal (11/43; 26%) involvement predominating. Eighteen (42%) individuals had an associated nonhistiocytic hematopoietic neoplasm ("secondary" IDCH) whereas 7 of 43 (16%) had a concurrent non-IDCH histiocytosis ("mixed" histiocytosis). Most cases exhibited morphology indistinguishable from LCH but with a CD1c+/CSF1R(CD115)- phenotype, mirroring the signature of normal indeterminate cells and conventional DC type 2. Mutational analysis revealed frequent KRAS (13/32; 41%) and BRAF p.V600E (11/36, 31%) mutations that were nearly mutually exclusive. RNA-sequencing analysis uncovered ETV3::NCOA2 fusion in 6 other patients presenting as a sole genetic alteration without any other concurrent histiocytic or hematopoietic neoplasm. BRAF and MAP2K1 alterations were significantly associated with partial/retained (1%-20%) Langerin expression (P = .005) and mixed histiocytosis (P = .002). Remarkably, myeloid alterations (DNMT3A, TET2, and SRSF2) co-occurred in IDCH tissues of several individuals. Paired sequencing of IDCH and concurrent non-IDCH hematopoietic neoplasm in 4 individuals revealed shared mutations. Age at diagnosis and any nodal involvement at diagnosis predicted inferior overall survival, but BRAF/RAS pathway alterations did not affect outcome. These data have implications for the diagnostic evaluation, classification, and therapeutic management of IDCH.

Indeterminate Dendritic Cell Tumor in Thoracic Spine: A Case Report

BACKGROUND

Indeterminate dendritic cell tumor (IDCT) is an extremely rare hematologic disorder with poorly understood pathogenesis. Occasionally encountered by hematologists, unusual presentations of IDCT have not been reported in the spine literature.

METHODS

We report a 51-year-old man who presented with a 3-month history of progressively worsening axial thoracic back pain radiating to his sides. Magnetic resonance imaging revealed a 3-cm enhancing mass at the T9 vertebral body with an exophytic component causing significant canal stenosis. Initial percutaneous biopsy revealed histiocytic sarcoma.

RESULTS

The patient underwent exploratory thoracotomy and en bloc resection of the lesion with T8-10 fusion. Final pathology results revealed IDCT with fibrosis. IDCT immunostaining was partially positive for Langerhans cell marker (positive for S100 and CD1a, but lacked Birbeck granules and Langerin stain) and partially positive for blastic plasmacytoid dendritic cell neoplasm. Additionally, it was positive for CD45, CD68, and CD163. Lymphadenopathy was absent in this patient.

CONCLUSIONS

Although first reported in the 1980s, IDCT has been omitted from most classifications owing to its rarity. Hematologists have debated the cell of origin; it is believed to comprise pre-Langerhans cells, as Birbeck granules are acquired after migration to the epidermis. IDCT remains of indeterminate origin. We report the first case of spinal IDCT. Familiarity with the histologic features is warranted to ensure accurate diagnosis and appropriate treatment.

Indeterminate cell histiocytosis: fact or fiction?

Indeterminate cell histiocytosis is a rare disorder, in which the predominant cells have the characteristics of both Langerhans cells and macrophages. We, in this study, describe 18 patients and compare them with those previously published. Most patients were adults with either solitary or multiple red-brown papules or nodules. While most lesions were confined to the skin, both conjunctival and bony involvement was seen. Histologically, the lesions showed patterns resembling those described for xanthogranulomas, with predominantly oncocytic (nine patients), spindled (five patients), scalloped (two patients) or vacuolated (two patients) macrophages. The accompanying infiltrate was mainly lymphocytic, although eosinophils and occasionally plasma cells were seen. All lesions were positive for macrophage markers, such as KP1 (CD68) and Ki-M1p, as well as for S-100 protein and showed variable reactivity for CD1a. No Birbeck granules were seen ultrastructurally in one patient. Some patients shared features with sinus histiocytosis with massive lymphadenopathy. It is unclear whether this disorder is a separate entity or represents various macrophage disorders identified at various time points in the inflammatory response. Ratzinger G, Burgdorf WHC, Metze D, Zelger BG, Zelger B. Indeterminate cell histiocytosis: fact or fiction? A clinicopathological series of 18 patients.

Cutaneous indeterminate cell histiocytosis: a new spindle cell variant resembling dendritic cell sarcoma

BACKGROUND

Cutaneous indeterminate cell histiocytosis is a rare neoplastic disorder. Its varied histological presentation and rarity have limited efforts to determine its pathogenic relationship with other histiocytic lesions and possibly, its recognition.

METHODS

We report on an unusual histologic pattern of indeterminate cell histiocytosis that resembled follicular dendritic sarcoma. A battery of immunohistochemical stains and electron microscopy were performed to elucidate the phenotype of the "histiocytic" cells. Based on a review of the literature, reported cases of indeterminate cell histiocytosis are presented and the diagnostic differential of spindle-cell lesions is discussed.

RESULTS

Spindling histiocytes were positive for S-100 and CD1a. The monocytic/macrophage marker, CD68, and the dendritic cell marker, CD21, were negative. Electron microscopy failed to reveal Birbeck granules.

CONCLUSIONS

Relatively few reports of indeterminate cell histiocytosis exist, some of which include discussion of potential overlaps with the non-X histiocytoses. Although the presence of prominent spindling in our case expanded the differential to include non-histiocytic disorders, the identified histiocytes unequivocally fulfilled the criteria of S-100 and CD1a positivity without demonstrable Birbeck granules.

Histiocytic disorders with spontaneous regression in infancy

The histiocytic disorders are uncommon, have a wide spectrum, and are poorly understood. We describe seven cases developing in infancy, seen during a period of 9 years at Asan Medical Center, Seoul, Korea. Clinically the patients had multiple papules over the face, trunk, and extremities that developed at birth or during infancy. Histopathologic examinations revealed an infiltrate of many histiocytic cells in the upper dermis with or without epidermotropism. Four cases were classified as congenital self-healing reticulohistiocytosis in that the histiocytes were identified as Langerhans cells by positive immunohistochemical staining for S-100 protein, ultrastructural studies showing many Birbeck granules, and spontaneous regression of the lesions within 1-4 months. One infant with a solitary lesion on the forehead was diagnosed as solitary, congenital, indeterminate cell histiocytoma because the histiocytic cells were S-100 protein positive, but meticulous ultrastructural studies did not detect Birbeck granules. The lesion was removed by shave excision. Two cases were classified as generalized eruptive histiocytoma. The histiocytic cells were S-100 protein negative and ultrastructurally Birbeck granules were absent. In one patient, eyeball- or popcornlike lysosomal structures were seen. The lesions regressed completely.

Langerhans cells in prurigo nodularis investigated by HLA-DR and S-100 immunofluorescence double staining

The Langerhans cell is one of the antigen-presenting cells in the immune system. To study the presence of cutaneous Langerhans cells in prurigo nodularis, age- and sex-matched prurigo nodularis patients and healthy volunteer skin biopsies were investigated by an HLA-DR and S-100 immunohistochemical double staining method. The results showed that the HLA-DR- and S-100-immunoreactive (IR) Langerhans cells were altered in prurigo nodularis epidermis and dermis. The number of epidermal Langerhans cells in the prurigo nodularis patients was decreased in five and increased in two cases. In the dermis, the HLA-DR- and S-100-IR cells were apparently more numerous than in the controls. In the involved skin there were also more S-100-IR coarse nerve fibres in the dermis as compared to controls. The results indicate that dermal Langerhans cells (HLA-DR and S-100 double-labeled) as well as other dermal HLA-DR- and S-100-IR dendritic cells, but most likely not epidermal Langerhans cells, may be critically involved in the development or persistence of prurigo nodularis.

Ultrastructural evidence for the participation of Langerhans cells in cutaneous photoaging processes: a quantitative comparative study

Langerhans cells were studied comparatively by electron microscopy in order to explore their possible participation in cutaneous photoaging processes in chronically photodamaged preauricular skin and in paired sun-protected postauricular sites of 25 Caucasian women aged 56-76 years. The characteristic ultrastructural features of Langerhans cells in photodamaged skin compared to those in sun-protected skin were as follows: (1) a significant decrease in the density of Langerhans cells and Birbeck granules, and an increase in the number of indeterminate cells, (2) an inversely proportional relationship between intraepidermal density of Langerhans cells and the severity of epidermal photodamage, (3) frequent apposition of Langerhans cells to vacuolar structures of photodamaged keratinocytes, (4) predominant distribution of Langerhans cells in the lower epidermis, (5) degenerative changes suggesting direct cellular damage, without evidence of apoptosis, (6) a strong correlation of the number of degenerated Langerhans cells with the degree of epidermal photodamage, (7) loss of dendritic processes, (8) direct contact of Langerhans cells with melanocytes suggesting interaction between these two types of cells, (9) juxtaposition of Langerhans cells and lymphocytes in the epidermis. These results suggest marked qualitative and quantitative ultrastructural differences in Langerhans cells between photodamaged and intrinsically aged skin and the positive involvement of Langerhans cells in the processes of cutaneous photoaging.

Electron microscopic studies of the early cellular events occurring in oral mucosa of rats affected by graft-versus-host disease (GVHD)

Previous histologic studies of tongue lesions in graft-versus-host disease (GVHD) in non-irradiated (Brown Norway x Lewis) F1 rats given parental spleen cells have demonstrated an increase in the number of MHC class II+ cells with dendritic shape in the lamina propria to be the earliest event in the development of the lesion. We studied this histologic finding by electron microscopy to increase understanding of the early cellular events occurring in the lesion. Electron microscopically, the most prominent cell type observed in the lamina propria was the cell with a dendritic shape. These dendritic cells possessed large nuclei that often showed irregular indentations and ample cytoplasm containing numerous filaments and mitochondria. A few lysosomal or phagocytic structures were also seen in the cytoplasm. No Birbeck granules were identified. These findings were very similar to those of indeterminate cells in the epidermis and dermis. Our data strongly support the hypothesis that MHC class II+ cells with dendritic shape present antigen during the induction of local immunological responses in the tongue of GVHD rats.

Tattooing increases the number of Langerhans cells in skin: an immunocytochemical study

Tattooing is an act of permanent marking of the skin with indelible patterns by pricking and inserting pigments. Langerhans cells (LCS) are dendritic cells normally present in suprabasal layers of the epidermis of the skin. To assess whether there were any effects caused by the tattooing on Langerhans cell population and cutaneous nerves, skin from affected areas (n = 15) was compared with controls (n = 10). Frozen sections were immunostained with antisera to S-100. No discernible change either in distribution or in number of Langerhans cells and nerves was seen upon comparison with control skin taken from different areas, but all of the specimens taken from affected areas had a significant increase in the number of Langerhans cells (p < 0.001) even after several years of tattooing with no change in the cutaneous nerves. Thus, the study shows persistent stimulation of Langerhans cell population in tattooed skin.

Turnover and kinetics of epidermal Langerhans cells and their dendritic precursor cells in experimental contact dermatitis. A correlated ultrastructural-morphometric and immunohistochemical evaluation

The numerical density of epidermal Langerhans cells (LCs) in contact sensitivity and toxic contact dermatitis is still a matter of controversy, mainly due to changes in the phenotypic markers of this antigen-presenting cell during the skin reactions. Since the electron microscopic detection of Birbeck granules is the most reliable marker for the identification of normal and pathologically altered LCs, we performed an ultrastructural-morphometric time-course analysis to evaluate their epidermal turnover in the earskin of BALB/c mice after painting the ears with the hapten 2,4-dinitrofluorobenzene and the irritant croton oil. The counts revealed degeneration and depletion of epidermal LCs in both allergic and toxic dermatitis. In contrast, a slightly increased number of activated epidermal LCs was found during contact sensitization. All experimental procedures resulted in an enhanced immigration of so-called indeterminate dendritic cells which also became ultrastructurally activated and often showed Birbeck granule-like formations at their cell membrane. Immunohistochemistry with the monoclonal antibody 4F7, a new marker for dendritic precursor cells of LCs, demonstrated a significant increase in these accessory cells in the epidermis. Our results indicate that contact sensitivity and toxic skin reactions are characterized by complex but distinct changes in the turnover, kinetics and cellular properties of epidermal LCs and their dendritic precursor cells.

Immunomorphological and ultrastructural characterization of Langerhans cells and a novel, inflammatory dendritic epidermal cell (IDEC) population in lesional skin of atopic eczema

We investigated epidermal cell suspensions prepared from lesional and nonlesional atopic eczema skin, other inflammatory skin conditions, and normal human skin for high-affinity IgE receptor (Fc epsilon RI) expression on dendritic CD1a cells by quantitative flow cytometric analysis. A single CD1a bright/CD1b neg/Fc epsilon RI dim/CD23 neg/CD32 dim/HLA-DR bright/CD36 neg population was found in normal skin. In contrast, lesional skin of atopic eczema and other inflammatory skin diseases harbored variable proportions of two distinct CD1a populations. Both populations exhibited typical ultrastructural features of Langerhans cells, but the second one lacked Birbeck granules and was unreactive to the Birbeck granule-specific LAG antibody. Both populations differed phenotypically: classical Langerhans cells were CD1a bright/CD1b neg/Fc epsilon RI dim/CD23 neg/CD32 dim/HLA-DR bright/CD36 dim, while the second population was CD1a dim/CD1b dim/Fc epsilon RI bright/CD23 dim/CD32 dim/HLA-DR bright/CD36 bright. The highest Fc epsilon RI expression was found on the second CD1a population in lesional atopic eczema skin. Furthermore, Fc epsilon RI expression on CD1a cells correlated significantly with the serum IgE level of the patients. Thus, a distinct population of CD1a inflammatory dendritic epidermal cells different from classical Langerhans cells appears in the epidermis of lesional skin and is subjected to specific signals leading to the upregulation of Fc epsilon RI in atopic eczema skin.

Histiocytic sarcomas

In this study a review of malignancies classified as histiocytic in the literature is given. The available data suggest that a distinction can be made between three main categories, i.e., follicular dendritic cell (FDC) sarcomas, Langerhans' cell/interdigiting reticulum cell (LC/IRC) sarcomas and histiocytic sarcomas (HS) which are unrelated to accessory cells. With the exception of FDC sarcomas these tumours are high-grade malignancies with an aggressive course and short survival times. The recognition of FDC sarcomas and LC/IRC sarcomas rests upon the identification of accessory cell related antigens (e.g., R4/23, CD1a, S-100) and/or the demonstration of desmosomes or Birbeck granules. The diagnosis of HS which are unrelated to accessory cells is more complex. These tumours are heterogenous with respect to morphology and phenotype and can only be recognized with the use of an extensive panel of antibodies supplemented when possible by analysis of T-cell receptor--or immunoglobulin genes.

The ELAM-1 ligand sialosyl-Le(X) is present on Langerhans cells isolated from stratified epithelium

In this study we show the expression of the newly identified carbohydrate ligand, sialosyl-Le(X) on Langerhans cells. The receptor for sialosyl-Le(X) is the endothelial leukocyte adhesion molecule-1 (ELAM-1) present on activated endothelial cells. Using flow cytometry, Langerhans cells were selected due to positivity for an antibody against CD1a and low orthogonal light scatter. The CD1a antigen stained by the OKT6 antibody is considered a maturational marker of Langerhans cells in agreement with the specific labeling of dendritic cells in the epithelium only. Double immunostaining (OKT6/anti-sialosyl-Le(X)) using flow cytometry and immunohistochemistry demonstrated that almost all OKT6-positive cells in normal stratified epithelium expressed sialosyl-Le(X). Conversely, by immunohistochemistry of oral epithelium with acute inflammation, additional dendritic cells negative for OKT6 were found to express sialosyl-Le(X). In addition, sialosyl-Le(X)-positive but not OKT6-positive dendritic cells were found in the submucosa. These findings indicate that the carbohydrate antigen sialosyl-Le(X) is expressed earlier than the CD1a antigen in the maturation of the Langerhans cell lineage. Future studies should aim at investigating the importance of adhesion between sialosyl Le(X) and ELAM-1 in epithelial recruitment of Langerhans cells.

Three-dimensional reconstruction and stereometric analysis of Langerhans cells in mouse epidermis

In the presented studies stereometric analysis and spatial reconstruction was performed on two Langerhans cell (LC) types. One was free of LC-I and the other contained LC-II Birbeck granules in the perinuclear space. The presented stereometric analysis demonstrated significant differences between the so-distinguished two cell types. Differences were observed not only in the number and distribution of Birbeck's granules but also in the areas of smooth and rough endoplasmic reticulum, in the area of vesicles surrounding Golgi apparatus, in the volume of cisterns of the apparatus, and in the ratio of cell nucleus area to its volume. Differences noted between the two cell types were of quantitative character. They might result from different stages of differentiation of the cells from their precursors in the epidermis or from distinct functional stages of the cells.

A novel monoclonal antibody to a distinct subset of cutaneous dendritic cells

A monoclonal antibody was generated by immunizing rats with Langerhans cell (LC)-enriched epidermal cells obtained from BALB/c mouse earskin after epicutaneous application of the contact sensitizer 2,4-dinitrofluorobenzene (DNFB). The antibody 4F7 detects in normal mouse skin, few dermal cells showing the morphologic, phenotypic, and functional properties of accessory dendritic cells, but lacking Birbeck granules. The capacity to stimulate allogenic T cells in the mixed leucocyte reaction resembles that of freshly isolated LCs. After DNFB application, an increased number of 4F7+ dendritic cells are found in the dermis and, in addition, some labeled dendritic cells occur in the epidermis. Some of the latter cells exhibit cytoplasmic Birbeck granules. Remarkably, there is no increase of the 4F7+ cells in the regional lymph nodes after DNFB treatment. These data suggest that the 4F7 antibody labels distinct dendritic cells of the mouse skin that are involved in the mediation of contact sensitization and probably represent immature LCs.

Dynamic nature and function of epidermal Langerhans cells in vivo and in vitro: a review, with emphasis on human Langerhans cells

Epidermal Langerhans cells (LC) are Birbeck granule-containing bone-marrow-derived cells, which are located mainly in the suprabasal layer of the epidermis. They can be readily identified by their strong expression of CD1a and MHC class II molecules. In addition to these 'classical' properties, an extensive phenotypic profile of normal human LC, summarized in this review, is now available. The powerful capacity of LC to activate T lymphocytes is clearly documented and, to date, LC are recognized as the prominent antigen-presenting cells of the skin immune system. They are generally believed to pick up antigens encountered in the epidermis and to migrate subsequently from the epidermis to the skin-draining lymph nodes. Upon arrival in the paracortex of lymph nodes, the antigen-laden LC transform into interdigitating cells and they present antigen to naive T lymphocytes in a MHC class II-restricted fashion; this results in the generation of antigen-specific immune responses. It has also been demonstrated that transformation of LC into interdigitating cells occurs when LC are cultured in vitro. Both in vivo and in vitro studies have indicated that properties of LC, such as phenotype, morphology and the stimulatory potential to activate T lymphocytes, are dependent on the local microenvironment in which the LC reside. The essential role of LC in the induction of contact allergic skin reactions and skin transplant rejection is well established.

Dendritic cells in the murine dermis in delayed-type contact hypersensitivity. An ultrastructural and immunocytochemical study

Dendritic cells within the dermis in the later stages of delayed-type contact hypersensitivity were examined ultrastructurally and immunohistochemically. The immunohistochemical observations were done using monoclonal antibody M1-8, which reacts specifically with murine Langerhans cells and interdigitating cells. Seventeen hours after challenge, infiltrating cells in the dermis included dendritic cells, possibly so-called indeterminate cells, monocytoid cells and Langerhans cells. Immunohistochemically, the indeterminate cells and some monocytoid cells were M1-8-positive. These findings suggest that indeterminate cells are intimately related to Langerhans cells, and that they belong to the mononuclear phagocyte system. M1-8 is a very useful marker for studies on the kinetics of Langerhans cells or indeterminate cells.

T-cell receptor gamma delta bearing cells in normal human skin

T-cell antigen receptors (TCR) are divided into common alpha beta and less common gamma delta types. In the murine skin, TCR gamma delta+ cells have been reported to form the great majority of epidermal T lymphocytes. We have examined the relative contribution of TCR alpha beta+ and TCR gamma delta+ cells to the T-cell population in normal human skin. Serial sections of freshly frozen skin specimens were acetone fixed, incubated with anti-CD3, beta F1 (anti-TCR alpha beta), anti-TCR gamma delta-1 and anti-TCR delta 1 (anti-TCR gamma delta) monoclonal antibodies (MoAb), and stained with a highly sensitive method. Over 90% of the T cells of normal human skin are localized around the postcapillary venules of the dermis, while less than 5% are present within the epidermis. In papillary dermis, TCR gamma delta+ cells formed on average 7% (anti-TCR gamma delta-1) or 9% (anti-TCR delta 1) of the total number of CD3+ cells, while TCR alpha beta+ cells constituted up to 80%. In epidermis, these percentages were 18% and 29% for TCR gamma delta+ cells, and up to 60% for TCR alpha beta+ cells. It is concluded that there is no preferential immigration or in situ expansion of TCR gamma delta+ T cells in normal human skin, because the relative percentages found for the TCR alpha beta+ and TCR gamma delta+ populations in skin are comparable to those found in lymphoid organs and peripheral blood. However, the percentage of TCR gamma delta+ cells in epidermis seemed on average higher than in papillary dermis. Therefore, there may still be a difference in migration patterns of TCR gamma delta+ v TCR alpha beta+ cells, but this does not result in their preferential localization in human epidermis. The hypothesis that TCR gamma delta+ T cells have a specialized function in immunosurveillance of epithelia may thus not be valid for human epidermis.

The human gingival indeterminate cell revisited

Electron microscopic examination of over 100 dendritic cells in human keratinized gingiva has shown that the indeterminate cells are not a separate cell type. This approach disclosed the sources of error which have led to the commonly held, but erroneous, view that there exist numerous indeterminate cells in this epithelium. Two interesting differences were found between gingival and epidermal Langerhans cells. The number of Birbeck granules in the former cells can be extremely low while they occur frequently in the epidermal cells, and granules in their formative stage are commonplace in the gingival cells but rare in the epidermal cells.

An immunohistochemical and immunoelectron microscopic study of the ontogeny of rat Langerhans cell lineage with anti-macrophage and anti-Ia monoclonal antibodies

An immunohistochemical study with anti-macrophage and anti-Ia monoclonal antibodies was performed to clarify the relationship between Langerhans cells (LC) and indeterminate cells (IC) in rat epidermis both in adulthood and in the fetal stage. On immunoelectron microscopy, a mouse anti-rat macrophage monoclonal antibody, TRPM-1, recently produced by us, reacted with IC and some LC in adult rat skin. Ontogenic study revealed that TRPM-1-positive cells first appeared in the epidermis of fetal rat heads on Day 17 of gestation and then spread caudally along the anterior-posterior axis. On Day 20 of gestation, when the distribution of the TRPM-1-positive cells over body surface became even, Ia-positive cells appeared in the epidermis and began to increase in number. Ia-positive cells with Birbeck granules were found on Day 21 of gestation. These results indicate that. TRPM-1-positive IC matured into Ia-expressing LC after being exposed to microenvironmental change during the perinatal period. The number of Ia-positive cells exceeded that of TRPM-1-positive cells at around 5 d after birth. Afterwards, there were more dendritic Ia-positive cells found in the interfollicular areas than TRPM-1-positive ones. However, local concentrations of the TRPM-1-positive IC in the follicular infundibula were frequently found in the fetal stage and occasionally in adulthood. These TRPM-1-positive cells in the follicular infundibula were thought to be a precursor pool in the epidermis for LC.

Adhesion molecules on the plasma membrane of epidermal cells. I. Human resting Langerhans cells express two members of the adherence-promoting CD11/CD18 family, namely, H-Mac-1 (CD11b/CD18) and gp 150,95 (CD11c/CD18)

The CD11/CD18 family of leukocyte adhesion-promoting proteins is comprised of three members, each composed of a shared beta subunit (CD18) noncovalently associated with unique alpha subunits (CD11a, CD11b and CD11c respectively). Such three heterodimers, named LFA-1 (CD11a/CD18), H-Mac-1 (CD11b/CD18) and gp150,95 (CD11c/CD18), are involved in mediating leukocyte adhesion in virtually all phases of the immune responses. Since Langerhans cells are regarded as cutaneous leukocytes, we investigated the expression of the members of the CD11/CD18 family on Langerhans cells. A vast series of immunostaining procedures was carried out, using monoclonal antibodies anti-CD11a, -CD11b, -CD11c, and -CD18. Normal skin frozen sections and epidermal sheets were investigated by immunohistology and immunofluorescence; suspended freshly isolated epidermal cells were processed using immunogold techniques, performed in both transmission and scanning electron microscopy, including double labeling procedures and semiquantitative analysis of the labeled cells. The results demonstrated the expression on the membrane of Langerhans cells of the CD11b, CD11c and CD18 antigens, thus indicating that at least both the H-Mac-1 (CD11b/CD18) and the gp150,95 (CD11c/CD18) members of the CD11/CD18 family are detectable on the cell surface of human resting Langerhans cells. Since both such moieties serve as adhesion molecules in (a) cell-cell interactions and in (b) leukocyte migration and localization, the present results suggest that H-Mac-1 and gp150,95 might display a key role (a) in promoting interactions between Langerhans cells and other cells, and (b) in guiding the migration and localization of Langerhans cells.

CD-1 (T6), HLA-DR-expressing cells, presumably Langerhans cells, in nasal mucosa

In the skin, epidermal Langerhans cells (LC) constitute a major population of antigen-presenting cells. These cells are characterized by the expression of both CD-1 (T6) and HLA-DR on the cell membrane. We wanted to know whether similar CD-1/HLA-DR-positive cells occur in the nasal mucosa of patients with an isolated grass pollen allergy and in non-allergic controls. CD-1/HLA-DR-positive dendritic cells were found in columnar and cuboidal epithelium and the lamina propria of the nasal mucosa. These CD-1/HLA-DR-positive cells presumably correspond with LC in the skin. We also found significantly more CD-1-positive cells in nasal biopsy samples of allergic than in those of the non-allergic controls. In the allergic patients some of the CD-1-positive cells were found to be surface IgE-positive, possibly due to passive adherence of IgE to Fc receptors.

Ontogeny of Langerhans cells in human embryonic and fetal skin: cell densities and phenotypic expression relative to epidermal growth

Langerhans cells (LCs) positive for HLA-DR antigens were present in developing human epidermis by at least 7 weeks estimated gestational age (EGA). Most were negative for CD1 (T6) until 12-13 weeks EGA when they underwent a dramatic increase in CD1 reactivity. To gain insight into the density of LCs during ontogeny and to assess whether their distribution was coordinated with epidermal growth, the number of cells positive for both HLA-DR and CD1 antigens was determined relative to surface area and to volume of developing, interfollicular epidermis. LCs differed in their phenotype, distribution (follicular vs. interfollicular), size, and shape between 7 and 21 weeks EGA; however, during this period they maintained a statistically equivalent (P greater than .25) density (65 cells/mm2 and 1,750/mm3) even though the epidermis increased in thickness and the fetus rapidly expanded its surface area. While LCs were evenly distributed within the epidermal sheets at all gestational ages, those in embryonic skin were much smaller and less dendritic than the older cells. The density, size, and shape of LCs in developing skin seemed to be independent of epidermal status (e.g., thickness of keratinization, and number of cell layers) but rather were correlated with gestational age. The number of fetal LCs, through at least 23 weeks EGA, was only 10-20% of the adult LC density. Thus, we can conclude that the increase in LC density to adult levels must occur either during the third trimester or after birth.

Ultrastructural changes in epidermal Langerhans cells and melanocytes in response to ultraviolet irradiation, in Australians of Aboriginal and Celtic descent

The effects of exposure to small doses of artificial ultraviolet radiation (UVR) on the ultrastructure of epidermal Langerhans cells (LC) and melanocytes were studied in two groups of Australian subjects, one of Aboriginal and the other of Celtic descent. UV exposure induced an apparent depletion of LC in the epidermis of both groups. However, LC depletion in the Aboriginal subjects was associated with apoptosis, whereas organelle and membrane disruption in the LC of Celtic subjects suggested a reduction by direct cellular damage. LC in Aboriginal epidermis tended to become relocated at more superficial levels following UV exposure, and their Birbeck granules became more numerous. LC in Celtic epidermis appeared to become relocated in a basal location and contained fewer Birbeck granules. The central lamina of the Birbeck granules in Aboriginal LC, which was more electron-dense than that in Celtic subjects prior to UV treatment, was temporarily lost following treatment, while the ultrastructure of Birbeck granules in Celtic LC was unchanged. LC and 'indeterminate cells' in intimate association with lymphocyte-like cells occurred in the basal layer of Celtic epidermis 5 days after exposure. These complexes were not observed in Aboriginal epidermis although isolated lymphocyte-like cells were observed in the same location. Melanocytes in Aboriginal epidermis contained greater numbers of melanosomes than those in Celtic epidermis throughout the experiment. Inactive epidermal melanocytes in Celtic subjects initially responded to UV exposure with a slight increase in melanosome content followed by a substantial further increase, whereas active melanocytes in the Aboriginal subjects showed the opposite response. The implications of the different responses of LC and melanocytes in the two groups, in relation to immunological function of the epidermis and the marked racial difference in the incidence of skin cancer, are discussed. Cancer of the skin, particularly basal and squamous cell carcinoma, occurs primarily in people with fair skin who burn easily following exposure to ultraviolet radiation (UVR). In contrast, the incidence of skin cancer in inherently dark-skinned people is low. Melanin is synthesized by melanocytes in response to UVR and is thought to protect epidermal cells against damage to their genetic material by absorbing UVR and thereby reducing its penetration into the skin. Thus darkly pigmented skin is more resistant to the effects of UVR.(ABSTRACT TRUNCATED AT 400 WORDS)

Distribution of Langerhans cells in clinically healthy human gingival epithelium with special emphasis on junctional epithelium

Twenty-one biopsies of clinically healthy marginal gingiva from children, who performed conventional oral hygiene but received no additional professional prophylaxis, were studied in order to obtain information on distribution and density of Langerhans cells (LC) in the oral gingival epithelium (OGE), the sulcular epithelium (SE) and the junctional epithelium (JE). A simple freeze-separation technique was found to create acceptable histomorphology of JE in specimens obtained adherent to teeth, while partially and non-adherent ones were rejected. The majority of LC in OGE were highly dendritic and stained intensively with OKT6 monoclonal antibodies. The distribution was network-like with a density of 21.0 +/- 3.2 LC/0.1 mm2 cross-sectional epithelial area. A similar although less dense distribution was found in SE (8.6 +/- 3.0 LC/0.1 mm2). These observations confirm previous findings. In JE 2 groups of LC were identified: 1) Weakly stained LC with very few and short dendrites distributed in a scattered way (2.8 +/- 1.4 LC/0.1 mm2) in the apical three-fourths of JE in most specimens. Present evidence suggests that these cells might be immature cells of Langerhans lineage. 2) Clusters of LC (9.4 +/- 2.9 LC/0.1 mm2) with dendrites of moderate lengths and numbers and a varied fluorescence intensity; they were found in a few specimens in the coronal one-fourth of JE and at the border zone to SE. Such clusters might represent genuine variation in the distribution of LC or reactions to initial/early plaque formation.

Role of epidermal Langerhans cells in viral infections

Langerhans cells function as highly potent antigen-presenting cells in the epidermis. In the last few years, their role in viral infections has been studied in various experimental systems. They have been shown to be involved in the pathogenesis of a number of infections of viral origin. These include vaccinia virus, human papilloma virus, herpes simplex virus, foot and mouth disease virus and human retrovirus infections. Studies on the effect of various factors, that are known to modulate the activity and density of Langerhans cell in the epidermis, may lead in the future to the development of new strategies aimed at inhibiting virus infections or even eradicating latent infection.

Human epidermal Langerhans cells cointernalize by receptor-mediated endocytosis "nonclassical" major histocompatibility complex class I molecules (T6 antigens) and class II molecules (HLA-DR antigens)

HLA-DR and T6 surface antigens are expressed only by Langerhans cells and indeterminate cells in normal human epidermis. We have previously demonstrated that T6 antigens are internalized in Langerhans cells and indeterminate cells by receptor-mediated endocytosis. This process is induced by the binding of BL6, a monoclonal antibody directed against T6 antigens. In the present study, using a monoclonal antibody directed against HLA-DR antigens, on human epidermal cells in suspension, we show that the surface HLA-DR antigens are also internalized by receptor-mediated endocytosis in Langerhans and indeterminate cells. Moreover, using immunogold double labeling, we demonstrate that T6 and HLA-DR antigens are internalized through common coated regions of the membrane of Langerhans or indeterminate cells. The receptor-mediated endocytosis that is induced involves coated pits and vesicles, receptosomes, lysosomes, and also, in Langerhans cells, the Birbeck granules. Thus, T6 antigens, which are considered to be "unusual" or "nonclassical" major histocompatibility complex class I molecules, and the major histocompatibility complex class II molecules, HLA-DR, are internalized in Langerhans and indeterminate cells through common receptor-mediated endocytosis organelles.

Multiple skin tumors of indeterminate cells in an adult

An adult patient with multiple unusual histiocytic tumors of the skin is described. As shown by immunohistologic study, electron microscopy, and immunoelectron microscopy, the tumors represent circumscribed proliferations of the Langerhans cell-related indeterminate dendritic cells of the skin. This distinct cutaneous histiocytosis may represent a paraneoplastic syndrome.

The ultrastructure of human gingival Langerhans cells in health and disease

There was a statistically significant shift towards increased proportions of type I Langerhans cells (containing many Langerhans-cell granules) and reduced proportions of both type II Langerhans cells (containing few granules) and indeterminate cells in diseased oral epithelium when compared to healthy oral epithelium. Langerhans cells and indeterminate cells were also seen in the sulcular epithelium of healthy and diseased specimens but never in junctional or pocket-lining epithelium.

Dendritic cells in the dermal infiltrate of Sézary syndrome

The dermal infiltrates of four patients with the Sézary syndrome were studied by electron microscopy and the data were evaluated quantitatively. The nuclear contour index of lymphocytes was calculated, and many tumour cells had an index greater than 6.5. Dendritic cells were found in all cases. The dendritic cells contained smooth and rough endoplasmic reticulum, moderately well-developed Golgi apparatus, scanty lysosomes and many thin and intermediate filaments; their surface was scalloped with numerous vesicles. Birbeck granules were not found in the cytoplasm of dendritic cells. Dendritic cells comprised 24% of infiltrating cells and were interspersed with lymphocytes; 75% of the lymphocytes were in contact with dendritic cells; 35% of the lymphocytes in contact with dendritic cells had a nuclear contour index higher than 6.5 and 76% had a nuclear contour index higher than 5. The data strongly suggest a functional relationship between lymphocytes and dendritic cells in the dermal infiltrate of Sézary syndrome. They are discussed in relation to the hypothesis that the disease is a consequence of chronic immune stimulation.

Immunoelectron microscopic investigation of HLA-DR-positive dendritic cells at the dermo-epidermal junction in skin disorders associated with the deposition of immune complexes

HLA-DR-positive dendritic cells present at the dermo-epidermal junction in skin disorders associated with the deposition of immunoglobulins and/or complement factors in the skin biopsy are investigated ultrastructurally. They demonstrate long, slender cytoplasmic processes, an indented nucleus, and strikingly dilated cisternae of the endoplasmic reticulum. HLA-DR antigen is present on the plasma membrane and within some of the dilated cisternae. These findings further support our previously formulated hypothesis that these cells represent a functionally active stage of antigen-presenting cells.

Immunohistochemical staining of Langerhans cells and macrophages in oral lichen planus

Twenty patients with clinically and microscopically confirmed lichen planus were studied immunohistochemically. Monoclonal antibody to HLA-DR antigens and polyclonal antisera to S-100 protein and muramidase were applied to paraffin-embedded sections for the purpose of elaborating on the pathogenesis of this disease. Trypsin incubation of sections was also done in order to determine its effect on immunostaining. Langerhans cells were identified with anti-S-100 and anti-HLA-DR, and macrophages were identified with antimuramidase and anti-HLA-DR. Keratinocytes also expressed HLA-DR membrane activity in lichen planus tissue. Trypsinization significantly improved the expression of S-100 protein and muramidase antigens. It was concluded that Langerhans cells, macrophages, and keratinocytes play important roles in antigen processing and/or phagocytosis during the natural history of this disease.

Human epidermal cells are more potent than peripheral blood mononuclear cells for the detection of weak allogeneic or virus-specific primary responses in vitro

Human epidermal cells (EC) and peripheral blood mononuclear cells (PBMC) have been used as antigen-presenting cells in allogeneic reactions or in self-restricted antiviral responses. Comparison of results from both cell types indicates that: (1) EC were better stimulators of primary proliferative responses in all the antigenic systems tested. (2) In secondary reactions, EC and PBMC functioned similarly for allogeneic responses, while a weak but significant difference could be observed in both (HSV1 or influenza A) virus-specific reactions. (3) By comparing pairs of HLA-identical mixed lymphocyte reaction (MLR)-negative siblings, positive responses were observed in several different families when lymphocytes of potential bone marrow donors were stimulated by EC of the recipient. This suggests that EC might be useful in detecting relatively weak proliferative responses in a number of antigenic systems, but especially in primary reactions against viral or putative minor histocompatibility antigens. (4) Despite this stronger antigen-presenting capacity in proliferative responses, EC induced lower levels of cytotoxic T lymphocyte (CTL) reactions than PBMC, not only in allogeneic responses but also in virus-specific self-restricted reactions.

Recent advances of ultrastructural immunocytochemistry of epidermal Langerhans cells

Using electron microscopy, the immunological visualization of the membrane antigens of Langerhans cells (LC) can be performed by immunoperoxidase and immunogold techniques. The immunoperoxidase labelling permits the identification of only one antigen and the observation of qualitative variations of surface antigens. The immunogold method allows the identification of one antigen or simultaneously two or three surface antigens using gold particles of various sizes. This technique can be used to quantify the surface density of antigens on the cell membrane. The simultaneous identification of different surface antigens can be correlated with the ultrastructural characteristics of the cells. Using this technique we have recently demonstrated the existence of LC subsets in normal epidermis, and the presence of circulating T6-positive cells in normal subjects. In addition, a very low density of T4 antigenic sites on the LC membrane surface was observed. Several problems of a double-labelling immunogold technique related to steric hindrance and current artifacts are discussed.

Langerhans cell surface densities in rat oral mucosa and human buccal mucosa

We determined surface densities of Langerhans cells (LCs) in rat oral mucosa and human buccal mucosa by enumerating ATPase-positive dendritic cells in epithelial whole mounts. For the rat, mean surface densities per mm2 were 160 in anterior buccal mucosa, 640 in posterior buccal mucosa, 430 in the palate and 340 in the tongue. Human buccal mucosa showed a density of 890 cells per mm2. We conclude that LC densities in oral mucosa approximate those of external body sites, making them available in numbers sufficient to accomplish their postulated antigen-presenting functions.

Heterogeneity of dermal OKT6+ cells in inflammatory and neoplastic skin diseases

This immunopathologic study of both normal and pathologic skin specimens (contact dermatitis [CD], lichen planus [LP], cutaneous T cells lymphoma [CTCL], and histiocytosis X [HX]) allowed as to differentiate four types of dermal OKT6+ cells: (1) cells with the same morphologic features as epidermal Langerhans cells (LCs), rarely found in either normal or pathologic dermis; (2) cells structurally similar to LCs but lacking Birbeck granules (BGs), found mainly in CD and LP; (3) larger cells rich in cytoplasmic organelles, only 5% of which contained BGs. They were especially common CTCL; and (4) cells typical of HX.