Blood lymphocyte subpopulations show characteristic changes during ACTH therapy in acute exacerbations of multiple sclerosis

The behaviour of OKT3-, OKT4- and OKT8-positive cells during phases of elevated spontaneous chemiluminescence activity (CL-A) in multiple sclerosis patients. A serial study

The chemiluminescence activity (CL-A; synonym = burst activity, BA) and the percentage of OKT3-, OKT4- and OKT8-positive peripheral blood cells were serially examined in four control persons and in eight patients with multiple sclerosis. When the OKT values obtained in phases of increased CL-A (clinical remission) were compared with those of the control group, the percentage of OKT3-positive cells was reduced (P = 0.014), and that of OKT4-positive cells increased (P = 0.014); there were no significant changes in the percentage of OKT8-positive cells (P = 0.171). After the CL-A had returned to normal values, the OKT4-positive cells remained elevated (P = 0.029), whereas the OKT3- (P = 0.342) and OKT8-positive cells (P = 0.443) showed no significant changes. When in the same patients, phases of increased CL-A were compared with phases in which values were not elevated, a reduced percentage of OKT3-positive cells was found in phases with increased CL-A (P = 0.031); however, the OKT4-positive and OKT8-positive cells did not differ significantly (P = 0.156 and 0.281).

Indications of the occurrence of inflammatory reactions in the clinical improvement phase in multiple sclerosis patients

In patients with multiple sclerosis (MS) the spontaneous burst activity (BA) of peripheral blood mononuclear cells was related to the clinical course of the disease. In five patients clinical improvement was found while the BA was significantly increased (more than 300% of the controls). During the appearance of new or deteriorating signs and in the period without clinical changes, the BA was not at all or not markedly increased. In two patients without clinical improvement the BA did not reach levels above 300% of the controls. Our findings suggest that inflammatory reactions represented by the BA occur in the phase of clinical improvement. Since burst-stimulating activity was found in the serum of MS patients, cytokines produced by activated immuno-competent cells are assumed to cause the increased BA. A possible role of prednisone and ACTH on the BA of peripheral mononuclear leucocytes is discussed.

The influence of disease activity on the number of blood cells of multiple sclerosis patients

The influence of disease activity on blood cell counts was studied in over 100 multiple sclerosis patients examined at regular intervals of 4-8 weeks over an 18-month period. T-lymphocytes were assessed by the cytochemical alpha-naphthyl-acetate-esterase (ANAE) stain in addition to conventional differentials. In all patients as a group as well as in individual patients studied sequentially, an exacerbation was marked by a striking reduction in both the relative and absolute numbers of ANAE-positive cells. Simultaneously, a strong increase in granulocytes and a slight augmentation of ANAE-negative cells occurred. Similar changes related to disease activity in leucocytes and lymphocytes were also detected in conventional blood smears. Fluctuations in the number of blood cells with disease activity persisted under therapy with corticosteroids and to a lesser degree also with azathioprine.

Lymphocyte blast transformation responses to mitogens and specific antigens in different clinical phases of multiple sclerosis: a follow-up study

28 MS patients were studied at least 5 times for lymphocyte blast transformation responses to several mitogens (PHA, Con, PWM) and specific antigens (PPD, herpes simplex, measles, mumps, rubella), the mean duration of the follow-up being 15.3 months. Comparison of responses during remissions, exacerbations and ACTH treatment revealed no straight-forward association between the strength of response and clinical disease activity. Mitogen responses did not differ among various disease phases, but the PPD response was significantly lower during exacerbations than during remissions and still lower during ACTH treatment (P less than 0.05, Wilcoxon paired test). In responses to viral antigens, there was the same trend as in the PPD response. However, there were great individual differences in the behaviour of all antigen and mitogen induced lymphocyte responses. As a group, MS patients also showed more changes in their PHA mitogen responses during the follow-up than 8 control subjects followed similarly (P less than 0.005, F-test). The variation coefficient of the PHA response was also correlated with the maximal difference in the Fog neurologic deficit scale during the follow-up time (r = 0.460, P less than 0.05). However, patients with greatest clinical changes most often also received ACTH treatment, which may affect the results. The follow-up results of individual patients revealed that some had quite regular patterns of decreasing responses during disease relapses, whereas others had more irregular wide fluctuations of responses.

[Lymphocyte subpopulations in the normal cerebrospinal fluid: I. Major reports in the literature]

Data concerning the characterization of lymphocytes in the cerebrospinal fluid are reviewed, markedly those on T and B subpopulations. Special attention is given to T-lymphocyte subpopulations actually related to the immune response and to the immune regulation within the central nervous system.

Autologous lymphocyte proliferation in multiple sclerosis and the effect of intravenous ACTH

The proliferative response of peripheral blood T cells to autologous non-T cells, a reaction called the autologous mixed lymphocyte reaction (MLR), was significantly increased in 17 patients with active multiple sclerosis (MS) compared to age- and sex-matched individuals with other neurological diseases (OND). Following a 10-day course of intravenous adrenocorticotropic hormone (ACTH) therapy the values were reduced to control levels. No differences were noted between MS patients and controls in their response to alloantigens. The increased autologous MLR in patients with active MS appeared to result from an increased stimulatory capacity of non-T cells rather than from an intrinsically greater T cell proliferative potential. ACTH appeared to induce a change in the populations of circulating non-T cells such that these cells had a decreased stimulatory capacity in both autologous and allogeneic MLR. The decrease in stimulatory capacity in autologous MLR was, however, significantly greater than the decrease in allogeneic stimulatory capacity, suggesting a functional decrease of specific non-T cell-enriched subpopulations. No significant changes in the numbers of myeloperoxidase-positive (MP+) cells were noted in the blood of MS patients before and after ACTH therapy. Since the autologous MLR results in generation of cells that regulate immune responsiveness, the changes noted provide additional evidence for abnormal immune regulation in MS.