Development of lymphocyte responses and interactions in the human fetus and newborn

Intrauterine desensitization enables long term survival of human oligodendrocyte progenitor cells without immunosuppression

Immune rejection can be reduced using immunosuppressants which are not viable for premature infants. However, desensitization can induce immune tolerance for premature infants because of underdeveloped immune system. The fetuses of Wistar rats at 15-17 days gestation were injected via hOPCs-1 into brain, muscles, and abdomen ex utero and then returned while the fetuses of control without injection. After 6 weeks of desensitization, the brain and muscles were transplanted with hOPCs-1, hNSCs-1, and hOPCs-2. After 10 and 34 weeks of desensitization, hOPCs-1 and hNSCs-1 in desensitized groups was higher than that in the control group while hOPCs-2 were rejected. Treg, CD4CD28, CD8CD28, and CD45RC between the desensitization and the control group differed significantly. Inflammatory cells in group with hOPCs-1 and hNSCs-1 was lower than that in the control group. hOPCs-1 can differentiate into myelin in desensitized groups. Wistar rats with desensitization developed immune tolerance to desensitized and transplanted cells.

Effect of age on the frequency, cell cycle, and lineage maturation of rhesus monkey (Macaca mulatta) CD34+ and hematopoietic progenitor cells

The effects of maturation and aging on hematopoietic progenitor cells, blood and bone marrow from second- and third-trimester fetal, newborn, infant, adult, and aged rhesus monkeys (Macaca mulatta) were analyzed. CD34(+) cells were immunoselected and stained with propidium iodide for cell cycle analysis. Blood and bone marrow mononuclear cells were plated in methylcellulose, and erythroid and myeloid progenitors were grown and counted. A higher frequency of circulating CD34(+)CD38(-) and CD34(+)DR(-) cells was observed in second-trimester fetuses compared with the other age groups. The frequency of bone marrow CD34(+)CD38(-) and CD34(+)DR(-) cells declined in adult and aged animals when compared with the younger age groups. Cell-cycle analysis showed 4.5% second-trimester fetal bone marrow CD34(+) cells entering the G(2)/M phase, compared with 1.7% CD34(+) cells in aged animals. More than 95% of circulating CD34(+) cells remained quiescent for most age groups, except for second-trimester fetuses. Adult marrow myeloid progenitors were found in a lower quantity when compared with third-trimester fetuses, whereas erythroid progenitors were greatest in early-gestation fetuses and adults. The results of these studies suggest that 1) the greatest quantity of CD34(+)CD38(-) and CD34(+)DR(-) cells was found in fetal and infant bone marrow, 2) the frequency of cycling CD34(+) cells declines with maturation and aging, and 3) an age-dependent difference in lineage commitment occurs.

Functional and morphological development of lymphoid tissues and immune regulatory and effector function in rhesus monkeys: cytokine-secreting cells, immunoglobulin-secreting cells, and CD5(+) B-1 cells appear early in fetal development

Little is known regarding the timing of immune ontogeny and effector function in fetal humans and nonhuman primates. We studied the organization of lymphocyte and antigen-presenting cell populations in developing lymphoid tissues of rhesus monkey fetuses during the second and third trimesters (65 to 145 days of gestation; term = 165 days). Immunoglobulin-secreting and cytokine-secreting cells were detected at day 80. The thymus, spleen, lymph nodes, and intestinal mucosa were examined for cells expressing CD3, CD5, CD20, CD68, p55, and HLA-DR. In the spleens of 65-day-old fetuses (early second trimester), the overwhelming majority of total lymphocytes were CD5(+) CD20(+) B-1 cells. The remaining lymphocytes were CD3(+) T cells. By day 80, splenic B and T cells were equal in number. Intraepithelial CD3(+) CD5(-) T cells and lamina propria CD20(+) CD5(+) B cells were present in the intestines of 65-day-old fetuses. By day 80, numerous CD20(+) CD5(+) B cells were present in the jejunums and colons and early lymphocyte aggregate formation was evident. The spleens of 80- to 145-day-old fetuses contained immunoglobulin M (IgM)-secreting cells, while IgA-, IgG-, interleukin-6-, and gamma interferon-secreting cells were numerous in the spleens and colons. Thus, by the second trimester, the lymphoid tissues of the rhesus monkey fetus have a complete repertoire of properly organized antigen-presenting cells, T cells, and B cells.

Primary sensitization in infants

OBJECTIVE

It has become increasingly clear that the mechanisms by which an allergic immune response is generated are complex and may begin even before a baby is born. Genetic, environmental, nutritional, and immunologic factors acting during pregnancy all play a role in determining whether or not a baby is born with a propensity to develop allergic sensitization and subsequent allergic disease. The objective of the research described in this article is to determine whether manipulation of any or all of these could lead to prevention of disease.

DATA SOURCES

The database used was Medline up to and including 1997. The Conference Proceedings of the XVth World Congress of Asthmology in Montpellier 1996 are quoted. Many of the research hypotheses are generated from work performed in our own laboratories.

STUDY SELECTION

The criteria used to select studies for review centered around a necessity for the data to have been collected in very early life with, if possible, a follow-up period to determine disease progression, or for the data to have been collected during pregnancy to elucidate primary mechanisms.

RESULTS

It has been shown that a fetus is able to mount a proliferative response to a common allergic trigger (beta-lactoglobulin, house dust mite, etc) as early as 22 weeks of pregnancy. Maternal exposure to allergens influences her own IgG production which modulates the allergen exposure of the fetus resulting in either primary sensitization of T cells or "tolerance" to the allergen. Atopic mothers create a more Th2-orientated environment for the developing fetus than non-atopic mothers.

CONCLUSIONS

Manipulation of the maternal immune response during pregnancy, either by altering her environment or controlling her allergic reactions, may be a method of preventing the development of allergic disease in infants.

Mononuclear cell subpopulations in preterm and full-term neonates: independent effects of gestational age, neonatal infection, maternal pre-eclampsia, maternal betamethason therapy, and mode of delivery

Blood samples from 29 preterm (24-32 weeks of gestation) and 21 full-term (37-42 weeks of gestation) neonates were analysed for surface markers of lymphocyte subtypes and macrophages, and the effects of gestational age, neonatal infection, maternal pre-eclampsia, maternal betamethason therapy and mode of delivery were assessed with multiple regression analysis. Gestational age alone had few independent effects (increase in CD3+, CD8+CD45RA+, and CD11alpha+ cells, and decrease in CD14+, HLA-DR- cells) during the third trimester on the proportions of the immune cell subtypes studied. Neonatal infection and mother's pre-eclampsia had the broadest and very opposite kinds of effects on the profile of immune cells in the blood. Infection of the neonate increased the proportions of several 'immature' cells (CD11alpha-CD20+, CD40+CD19-, and CD14+HLA-DR-), whereas mother's pre-eclampsia decreased the proportions of naive cell types (CD4+CD8+, CD5+CD19+). In addition, neonatal infection increased the proportion of T cells (CD3+, CD3+CD25+, and CD4+/CD8+ ratio, and CD45RA+ cells), while maternal pre-eclampsia had a decreasing effect on the proportion of CD4+ cells, CD4+/CD8+ ratio, and proportions of CD11alpha+, CD14+ and CD14+HLA-DR+ cells. Maternal betamethason therapy increased the proportion of T cells (CD3+) and macrophages (CD14+, CD14+HLA-DR+), but decreased the proportion of natural killer (NK) cells. Caesarean section was associated with a decrease in the proportion of CD14+ cells. We conclude that the 'normal range' of proportions of different mononuclear cells is wide during the last trimester; further, the effect of gestational age on these proportions is more limited than the effects of other neonatal and even maternal factors.

Umbilical cord blood lacks circulating B lymphocytes expressing surface IgG or IgA

In vitro umbilical cord blood B lymphocytes fail to form IgG and IgA secreting plasma cells when stimulated with Pokeweed mitogen. Since previous investigators have found percentages of B lymphocytes expressing surface IgG or surface IgA comparable to those seen in adults, this implies a defect in umbilical cord blood B-lymphocyte function. We have examined surface Ig expression on umbilical cord blood B lymphocytes by flow cytometry under conditions in which serum derived Ig are rigorously excluded. Under these conditions no B lymphocytes expressing surface IgG or IgA, which should serve as precursors for IgG and IgA secreting plasma cells, were observed. This finding was confirmed by comparing the ratio of mRNA levels for immunoglobulin gamma-chain to mu-chain in mononuclear cells by quantitative mRNA-based PCR. The ratio in umbilical cord mononuclear cells was 10-fold less than that seen in adult cells. The inability of newborn peripheral blood to form IgG and IgA plasma cells may result from an absence of appropriate precursor cells and not a defect in B lymphocyte maturation.

Prenatal origins of asthma and allergy

The prevalence of asthma and related allergic disorders has increased considerably over the last 25 years. Genetic stock has not changed, so environmental factors must have influenced the phenotype. Infants who develop allergy already have an altered immune response at birth. We have investigated the development of immune responses during gestation and the effect of maternal allergen exposure during pregnancy and infant exposure in the first month of life on the development of allergy and disease. There was higher specific peripheral blood mononuclear cell proliferation to house dust mite (P = 0.01) and birch pollen (P = 0.004) in the third trimester compared with the second trimester, with the first positive responses seen at 22 weeks gestation. Maternal exposure to birch pollen after 22 weeks resulted in higher (P = 0.005) infant peripheral blood mononuclear cell responses to birch pollen at birth. Infants born at term, with at least one atopic, asthmatic parent, who developed allergic symptoms and positive skin prick test by one year of age had raised proliferative responses to house dust mites at birth compared to those with no symptoms (P = 0.01). In genetically predisposed individuals, antenatal factors, including maternal and thereby fetal exposure to allergens and maternoplacental-fetal immunological interactions, are active in determining whether an allergic predisposition is manifested as disease.

Prenatal contact with inhalant allergens

Pollen contact in early infancy may enhance the risk for subsequent pollen allergy. In this study likelihood of a prenatal antigen contact, as a result of inhalation of pollen allergens by the mother, was investigated. Due to the seasonal occurrence of allergens studied, the date of priming can be estimated, and this can supply data about the maturation of the fetal immune system. Proliferative responses of umbilical cord blood mononuclear cells (UCB MNCs) to the recombinant major allergens of birch (rBet v 1) and timothy grass (rPhl p 1) were analyzed throughout the whole year. A positive proliferative response was regarded as the criterion for a prenatal contact of the immune system with the allergen. Prenatal priming with both allergens was observed. Timothy grass pollen displayed considerably higher antigenicity than did birch pollen. The susceptibility of the fetal immune system to be primed by these allergens varies during the gestation period. The majority of positive responses to rPhl p 1 and rBet v 1 were found in UCB samples in which antigen contact (the respective pollen season) took place in the first 6 mo of pregnancy. Our results offer indirect evidence that, shortly after migration of T cell precursors to the epithelial thymus, T cells are mature enough for priming with antigens. No relationship was found between the susceptibility of the fetal immune system to be primed by these allergens and the clinical history of the family concerning type I allergy.

Fetal peripheral blood mononuclear cell proliferative responses to mitogenic and allergenic stimuli during gestation

Blood samples were obtained from fetuses and premature babies (n = 51) (15-34 weeks gestation) to determine at what stage the fetal immune system was able to produce a positive proliferative response to common allergens. Peripheral blood mononuclear cells (PBMC) were stimulated with the mitogen, phytohaemagglutinin (PHA), and the allergens, house dust mite, cat fur, birch tree pollen, beta-lactoglobulin, ovalbumin and bee venom (mellitin). Results were expressed as ratios of stimulated to unstimulated 3H thymidine incorporation, and as percent positive responders. There was an increase in proliferation ratio which correlated with increasing gestational age for PHA (p < 0.0001), cat fur (p = 0.042), birch pollen (p = 0.022) and beta-lactoglobulin (p = 0.006). The point in gestation when cells from some individuals began responding to the allergens with a ratio of 2.0 was at approximately 22 weeks. PBMC proliferative response ratios were higher from samples from babies > 22 weeks gestation compared to < 22 weeks for the mitogen and all allergens, except mellitin. There was also a greater proportion of positive responders from samples > 22 weeks compared to < 22 weeks for the mitogen and all allergens, except mellitin. Maternal exposure to birch pollen, which has a discrete season, was assessed to determine whether exposure had occurred at 22 weeks gestation or beyond. Results showed a higher proliferative response in infant cells stimulated with birch pollen (p = 0.005) and higher proportion of positive responders (p = 0.01) in the group of babies whose mothers had been exposed to birch pollen beyond 22 weeks, compared to those whose mothers had not been so exposed. These results suggest that in utero fetal exposure to an allergen from around 22 weeks gestation may result in primary sensitisation to that allergen, leading to positive proliferative responses, at birth.

The humanized severe combined immunodeficient mouse as a model for primary human humoral response against HIV1 peptides

Adequate animal models for the study of human immunodeficiency virus (HIV) infection are important for the analysis of specific cellular and humoral immune responses. Humanized severe combined immunodeficiency (SCID) mice can be constructed either by injecting human peripheral blood lymphocytes (hu-PBL-SCID) or by transplanting human fetal tissues--liver, thymus and bone fragments--(SCID-hu) into these mice. Such animals can produce human immunoglobulins and SCID-hu mice exhibit circulating T and B lymphocytes of human origin. These humanized mice were injected with immunogenic HIV peptides and the specific humoral response was studied. A human antibody response was obtained after de novo contact with HIV1 peptides p583 and p642, from gp41. In SCID-hu mice, a primary, then a secondary response were demonstrated to occur with 225 mg/l of human immunoglobulin (Ig)M and 300-1860 mg/l human IgG. When tested in ELISA, these human antibodies recognized specifically both the immunization peptides and the HIV1 antigens. The antibody response was obviously of a primary nature since the human cells derived from naive fetal cells. When SCID mice received intraperitoneal injections of human peripheral blood lymphocytes pre-incubated in vitro with peptide p583 for 1 week, and when the resulting hu-PBL-SCID mice were injected with the same peptide, only IgM anti-HIV antibodies were produced (372-424 mg/l) and the switch to IgG antibodies did not occur. This model may provide a means to produce human monoclonal antibodies to HIV and to check candidate HIV vaccines.

Altered T lymphocyte phenotype at birth in babies born to atopic parents

Flow cytometry was used to analyse the cord blood T cells of 33 babies at high risk 'HR' for developing allergy (born to at least one atopic, asthmatic parent), and 10 low risk 'LR' babies (born to non-atopic parents), following normal term deliveries. Significantly lower numbers of CD25+, (activated) T cells (p < 0.005) were seen in the cord blood of the HR babies who had developed both allergic symptoms and positive skin prick tests by one year of age when compared with the LR group. CD45RO+ (memory) T cells were detected in both HR and LR babies with a trend for lower numbers of memory cells to be detected in HR infants who later developed allergic symptoms and/or positive skin prick tests. Significantly lower numbers of CD4+/CD45RO+ were seen in the cord blood of HR babies who developed allergic symptoms compared to HR babies who showed no sign of allergy by one year and to the LR babies (p < 0.05 and p < 0.005). The presence of activated and memory T cells at birth implies intra-uterine priming. The significantly lower numbers of memory T cells in the HR babies suggests a suppression of T cell activation or lack of antigenic priming in this group. This prenatal influence on babies born to atopic parents may have important implications with regard to the mechanisms underlying atopic sensitisation.

BY55 monoclonal antibody delineates within human cord blood and bone marrow lymphocytes distinct cell subsets mediating cytotoxic activity

We had previously reported, using BY55 monoclonal antibody, a cell surface 80-kDa protein restricted to human functional peripheral blood cytotoxic lymphocytes with either natural killer CD3- or cytotoxic T lymphocyte CD3+CD8+ phenotype. In the present report, we studied the cytotoxic lymphocytes in adult bone marrow and newborn cord blood as these organs are commonly used as sources of hematological stem cells for allogeneic transplantation. Our results showed that BY55 mAb labeled only 5-10% of the bone marrow lymphocytes, which included a major proportion of CD3+ CD8+ cytotoxic T lymphocytes. Interestingly, within cord blood cells, BY55+ lymphocytes represented 20-35% of the lymphocytes corresponding exclusively to a CD3- cell subset. Furthermore, we detected in cord blood no cytotoxic T lymphocyte activity but we demonstrated that the CD3-BY55+ cell subset contained the whole natural killer activity.

Relative immunocompetence of the newborn harbour seal, Phoca vitulina

The immune system of many mammalian species is not fully developed at birth, with newborns obtaining temporary immunological protection from maternal antibodies. Little is known of the immune system of the harbour seal, and developmental aspects of its immune system have not been systematically studied. We collected blood and milk samples from nine free-ranging mother-pup pairs throughout the lactation period on Sable Island, Canada, in an effort to characterise developmental aspects of the immune system of this newborn pinniped. Pup lymphocytes responded stronger to the mitogens concanavalin A, phytohaemagglutinin, and pokeweed mitogen than the lymphocytes of their mothers. In contrast to newborn cats and dogs, newborn seal pups developed high specific antibody responses after immunisation with an inactivated rabies vaccine. Circulating levels of total IgG in newborn pups were low (3% of maternal levels), but increased rapidly after colostrum intake (to 65% of maternal levels after 15 days). A similar pattern of increase in pup serum was observed for phocine distemper virus specific antibodies which had been detected in the serum and milk of mothers, suggesting that the transfer of colostral antibodies is an important feature of temporary protection for the pup. We speculate that the relative immunocompetence of the harbour seal at birth reflects an adaptation to its relatively short nursing period and limited maternal care.

The development of anti-HLA antibodies in multiply transfused preterm infants

The development of antihuman leucocyte antigen antibodies (aHLAA) in response to multiple transfusions in preterm infants was studied prospectively. Fifty seven infants requiring a minimum of two blood transfusions were recruited after obtaining informed written parental consent. They were randomised to receive either whole blood or blood that had been passed through a leucocyte filter. Anti-HLAA were sought in maternal and cord blood so as to ensure that any aHLAA detected after transfusion had not been passively transferred antenatally, and in 1 ml samples drawn monthly from the baby, at least 10 days from a previous transfusion, until discharge from hospital. Anti-HLAA were detected by microlymphocytotoxicity assay. Results were obtained in 42 babies, 19 in the filter and 23 in the no filter group. Fifteen babies had to be excluded because of protocol violation or because they died. None of the babies receiving filtered blood developed aHLAA, but seven babies in the no filter group developed aHLAA. In conclusion, multiply transfused preterm infants have the ability to elaborate antibodies to HLA and leucocyte filters may prevent this.

Regional development of Langerhans cells and formation of Birbeck granules in human embryonic and fetal skin

The regional development of Langerhans cells (LC) and the formation of Birbeck granules (BG) were examined in human embryonic and fetal skin. Samples were obtained from multiple anatomic sites and stained with anti-CD36, anti-CD1a, and anti-HLA-DR antibody as well as Lag antibody specifically reactive to BG and some vacuoles of human LC. In the first trimester, CD36+ dendritic epidermal cells were identified before the appearance of CD1a+ cells and Lag+ cells. Some of the former co-expressed HLA-DR antigens but not CD1a antigens. In the second trimester, regional variations in LC development were observed. Epidermal LC of palms and soles reached a peak in number in the first trimester but were rarely detected after 18 weeks estimated gestation age (EGA), whereas, in other regions, their number increased with age. In the second trimester, CD1a+ cells and Lag+ cells were also identified in the epidermis, although Lag+ cells appeared later than CD1a+ cells. The Lag+ cells until 17 weeks EGA showed a variety of staining intensities and immunoelectron microscopy revealed that they contained various amounts of Lag-reactive BG. Flow cytometric analysis showed that relative amounts of Lag antigens in LC increased during the second trimester and that fetal LC of 18 weeks EGA expressed the same amounts of HLA-DR, CD1a, and Lag antigens as did adult human LC. In the dermis, in the second trimester, numerous CD36+ cells and HLA-DR+ cells were found, whereas CD1a+ cells and Lag+ cells were rarely detected. Taken together, it is suggested that HLA-DR+ dendritic cells acquire CD1a+ antigens first and then form BG after migration to the epidermis and that fetal LC are phenotypically mature in the second trimester.

In vitro autoantibody production by normal adult and cord blood B cells

To investigate the repertoire of autoantibodies in humans, anti-DNA and rheumatoid factor (RF) production in vitro was assessed in cultures of adult peripheral blood B cells and neonatal umbilical venous blood B cells. B cells were stimulated under various culture conditions, using an immobilized monoclonal anti-CD3 antibody and adult T cells or Staphylococcus aureus (SA) in the presence or absence of adult T cells or factors derived from mitogen-stimulated adult T cells as polyclonal B cell activators. Total IgM, as well as IgM anti-DNA and RF, were assessed by ELISA. Total IgM production was induced from adult and neonatal B cells with SA plus T cell factors, as well as anti-CD3-stimulated T cells. RF was induced from adult and cord blood B cells by either mode of stimulation, whereas significant anti-DNA production was observed only when B cells were stimulated with anti-CD3-activated T cells. These results confirm the presence of B cell precursors for autoantibodies in the preimmune as well as normal adult repertoire, and indicate that the production of anti-DNA and RF appears to be regulated independently.

Immune modulation exerted by thymic humoral factor (THF-gamma 2), on T-cell subsets and IL-2 production of umbilical cord blood lymphocytes

The effect of a synthetic thymic humoral factor, THF-gamma 2, on the immune competence of T-cells was investigated in vitro on lymphocytes from human cord blood (UCBL). It was found that preincubation of UCBL with THF-gamma 2 caused an increase in the percentage of cells expressing the CD4 or the CD8 differentiation antigens, but did not affect the percentage of CD3 cells. The effect of THF-gamma 2 on PHA-induced IL-2 secretion was also studied and found that a 3hr preincubation with THF-gamma 2, prior to suboptimal PHA stimulation caused an increase in the IL-2 activity of the treated UCBL cultures. This effect was THF-gamma 2 dose dependent with an optimum in the range of 300-600 ng/ml and was not influenced by irradiation of the UCBL. These results indicate that THF-gamma 2, a synthetic octapeptide, modulates the immune state and response of human umbilical cord blood lymphocytes.

Experimental approach to the study of immune function in children with possible human immunodeficiency virus infection

The clinical immunology laboratory is often called on to assess risk in pediatric patients with clinical evidence of immunodeficiency and possible human immunodeficiency virus (HIV) exposure while antibody tests are being considered or are underway. Since non-HIV-related conditions including neoplasia, certain viruses, and primary immunodeficiency can potentially produce lymphocyte subset imbalance and functional impairment, there is need for a laboratory approach to differential analysis of pediatric immunodeficiency. In addition, laboratory methods may also influence the results obtained. In order to investigate these issues, we screened pediatric patients with and without HIV exposure. Altered lymphocyte subset expression and function were found among non-HIV-infected pediatric patients. The use of percentage and absolute lymphocyte numbers was found to affect the results obtained in a significant manner. Some patients who were chronic blood transfusion recipients were found to have blocking factors, presumably alloantibodies, in serum, which affected detection of lymphocyte surface antigens. In this population, age at seroconversion was a factor influencing subsequent levels of CD4+ T lymphocytes. Significant differences in CD4+ T lymphocyte percentages were also observed in children congenitally exposed to HIV compared with controls, even among those children with CD4/CD8 ratios greater than 1.0, who therefore had possibly escaped infection. Immune changes in children should be interpreted with caution.

Predominance of T cells that express CD45R in the CD4+ helper/inducer lymphocyte subset of neonates

Neonates have an increased risk of severe infections. For several in vitro and in vivo immune responses, neonates have been shown to have significant differences when compared to normal adults. To indirectly study immune cellular defects, we compared cell surface markers on cord blood lymphocytes (CBL) from 58 term infants to peripheral blood lymphocytes (PBL) from 17 healthy adults using flow cytometry with standard as well as newly defined monoclonal antibodies (Mab) that distinguish regulatory T cells. CBL had significantly smaller percentages of lymphocytes that express the CD2 and CD8 markers (total T cells, and suppressor/cytotoxic T cells, respectively), although absolute numbers of CD2+ and CD8+ cells were comparable in neonates and adults. CBL and PBL were similar in terms of the percentage of CD4+ cells (helper/inducer T cells), although the absolute numbers of CD4+ cells were higher in CBL than in PBL. The CD4+ population was subdivided into cells bearing the virgin and memory T cell phenotypes using anti-2H4 and anti-4B4 Mab and dual parameter analysis with anti-CD4. Neonates were deficient in the percentage of CD4+, 4B4+ (3.8 +/- 2.8 vs 13.4 +/- 7.5, P less than 0.001), but equivalent to adults in the percentage of CD4+, 2H4+ T cells (21.4 +/- 9.8 vs 18.8 +/- 12.8). In absolute numbers, neonates had fewer CD4+, 4B4+ cells (178 +/- 173 vs 344 +/- 152 cells/microliters, P less than 0.001), but more CD4+,2H4+ cells (978 +/- 572 vs 542 +/- 518 cells/microliters, P less than 0.01) than adults. The predominance of 2H4+ virgin T cells in the CD4 population whose function is associated with that of the induction of suppression rather than the up-regulation of immune responses may contribute to the observed susceptibility of neonates to infection.

Autologous mixed lymphocyte reaction in human neonatal lymphocytes

Human neonatal mononuclear cells were examined to determine their ability to participate in an autologous mixed lymphocyte reaction (AMLR). Stimulator cells were isolated by plastic adherence and nylon wool adherence. The nylon wool-nonadherent cells were used as responder cells. In 10 of 10 neonatal samples and 6 of 7 adult samples, a significant AMLR was present when plastic-adherent cells were used as stimulators. Neonatal blood showed a mean increase in proliferation of 7.6 (3.6-14.9), while adult cultures showed a mean stimulation index of 11.8 (1.0-39.0). When nylon wool-adherent cells were used as stimulator cells, only 2 of 7 neonatal blood samples and 1 of 5 adult blood samples showed a significant AMLR. When recombinant interleukin 2 (IL-2) was added to AMLR cultures of plastic-adherent cells and nylon wool-nonadherent cells, a mean augmentation of 12.0 was seen in the neonatal AMLR, while the adult cultures were augmented by a mean response of 4.1. Addition of IL-2 to nylon wool-nonadherent cells alone produced a 5.9-fold increase in adult cells, while neonatal cells showed an 85.8-fold mean increase in proliferation. The results suggest that autoreactive T cells are present in neonatal blood and that these cells can be activated by plastic-adherent autologous cells. However, neonatal and adult nylon wool-adherent cells do not consistently activate autoreactive T cells.

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.

Developmental expression of C3 receptor on murine epidermal Langerhans cells during ontogeny

The developmental expression of C3 receptor, an important surface marker of murine epidermal Langerhans cells (LCs), was quantitatively studied using an immunohistochemical technique on epidermal sheets and then compared with developmental expression of Ia antigen and membrane ATPase. Anti-Mac-1 monoclonal antibody associated with CR3 was used for detecting C3 receptor and proved positive for LCs by immunoelectron microscopy. Mac-1 positive (Mac-1+) cells showed quite a different distribution from those of ATPase+ and Ia+ cells. Almost the same number of Mac-1+ and ATPase+ cells were present during the embryonic period. The number of Mac-1+ cells gradually decreased from day 1 to day 5 of postnatal life, after which they increased again. Using the double-labeling technique on epidermal sheets at day 1 of postnatal life, it was shown that Ia+ cells possessed membrane ATPase activity and some Mac-1+ cells expressed Ia antigen. On days 4 and 7 of postnatal life all Mac-1+ cells expressed Ia antigen. These findings suggest that Mac-1 antigen observed during the embryonic period gradually fades after birth and is re-expressed after day 5 of postnatal life.

Epidermal Langerhans' cells and dermal dendritic cells in human fetal and neonatal skin: an immunohistochemical study

The dendritic cells in skin biopsies from 36 fetuses (from 16 weeks' gestational age on) and neonatal infants of different ages were investigated using a number of markers for various cells of the immune system and immunohistochemistry. Epidermal Langerhans' cells were found in all cases in a predominantly basal localization. The number of OKT6-positive Langerhans' cells and the development of their dendritic processes gradually increased with age. Dermal dendritic cells were present as well. Both HLA-DR-positive and Leu-10-positive dermal dendritic cells were found in the superficial and deep dermis, often in a perivascular distribution. The OKT6-positive dermal dendritic cells were few in number and occurred only in the upper dermis.

Interleukin 2 induces proliferation of normal "resting" human T cells in the absence of other known external stimulation

Interleukin 2(IL-2) is known to stimulate the progression of activated T cells from G1 through the rest of the cell cycle. We have demonstrated that addition of purified recombinant human IL-2 (rIL-2) to fresh normal human peripheral blood mononuclear cells (PBM), which were IL-2 receptor (Tac) negative by FACS analysis, stimulated marked proliferation of the PBM. IL-2-induced proliferation was also observed with umbilical cord blood mononuclear cells. Monocyte depletion of PBM resulted in a marked reduction of rIL-2-induced proliferative response which could be restored by adding back autologous irradiated monocytes but not by interleukin 1. The T cells preincubated with rIL-2 showed a five to six times enhanced autologous mixed-lymphocyte reaction (AMLR) compared to controls. The rIL-2-induced proliferative response of PBM was inhibited in a concentration-dependent fashion by preincubation of PBM with an anti-HLA-DR framework monoclonal antibody. The proliferating cells were shown by two-color flow cytometric analysis to be primarily Leu-1+ and Leu-4+ T cells (both leu-3+ and Leu-2+ subsets); however, 6 to 19% of responding cells had surface markers for B cells or NK cells. The data demonstrate that rIL-2 can induce proliferation of "resting" human T cells. The phenomenon may be related to a monocyte-dependent AMLR which induces IL-2 receptors and IL-2 responsiveness in a subset of T cells.

The differentiation antigens of macrophages in human fetal liver

Macrophage populations from human fetal liver were examined for the sequential appearance of different antigenic determinant during maturation. Frozen sections of liver, from 12 to 21 weeks gestation were analyzed using a series of four monoclonal antibodies with known specificity. The macrophage monoclonal antibodies used were OKM-1, which defines monocytes, macrophages, and granulocytes; Leu M-3 and MO-2, which identify monocytes and macrophages; and 6B8, a new macrophage monoclonal antibody which binds to tissue macrophages. The staining pattern described by each of these monoclonal reagents was compared with the distribution of morphologically distinguishable tissue macrophages in fetal liver, based on the expression of surface and/or cytoplasmic antigens. The data indicate that the antigens defined by OKM-1 and 6B8 are present on large numbers of cells as early as 12 weeks gestation. In contrast, the antigenic determinants identified by Leu M-3 and MO-2 are present only on cells in 15 to 21 weeks of gestation; thus these antigens are mature differentiation antigens. Furthermore, double-staining studies confirmed that with the increase in fetal age unique macrophage populations can be identified based on the matrix of antigenic determinants. Thus, macrophage heterogeneity in the fetal liver may be a function of maturation.

Immunotherapy of neonatal septicemia

This chapter has reviewed the deficiencies in immune defense that place the neonate, particularly the premature infant, at increased risk of invasive bacterial disease. We also have reviewed the literature on the rationale for exchange transfusion, granulocyte transfusion, intravenous immunoglobulin, and fibronectin administration as immunotherapeutic agents in infected infants. There have been no randomized controlled trials of exchange transfusion, immunoglobulin, or fibronectin administration in human infants with infection. Granulocyte transfusion in the infected newborn infant has been studied in a controlled fashion, but the results of clinical trials are conflicting. Thus, all of these interventions appear to need further evaluation. We therefore recommend that in the septic newborn infant with neutropenia and an I/T ratio greater than or equal to 0.8, who fails to demonstrate a favorable response to conventional antibacterial chemotherapy and cardiopulmonary support, the administration of approximately 1 X 10(9) irradiated granulocytes per kg may be beneficial. In the absence of equipment to isolate the granulocytes, a double-volume exchange transfusion with fresh heparinized whole blood will provide a similar quantity of functional phagocytes.

Impaired T8 lymphocyte-mediated suppressive activity in patients with partial Di George syndrome

We have studied the in vitro B-cell maturation induced by pokeweed mitogen of lymphocytes from seventeen patients with partial Di George syndrome. These patients were characterized by a low number of T8(+) lymphocytes. They had normal immune functions with an increased level of serum IgE for most of them. These patients were investigated before the age of 1 month. In contrast to age-matched subjects, their lymphocytes were able to produce in vitro immunoglobulins, although the level of immunoglobulin production was lower than in adults. These data were explained by a lack of T-cell mediated suppressor activity normally found in newborns. There was a strong correlation between the low number of T8(+) lymphocytes and the magnitude of the in vitro immunoglobulin production by patients' cells. This was further demonstrated by the ability of residual T8(+) lymphocytes isolated from patients to normally suppress the PWM driven B cell maturation on a per cell basis. The defective T-cell mediated suppression progressively disappears within 5 months. It is possible that this phenomenon is secondary to a delayed differentiation of suppressor T-cells in patients with partial Di George syndrome.

Evaluation of the functional maturity of newborn T8+ suppressor cells and the resistance of newborn lymphocytes to suppression

Concanavalin A (Con A) was used to study the suppressor function of human umbilical cord blood T cells. The suppressor activity and the phenotype of Con A-activated adult and cord T cells were compared using allogeneic adult mononuclear cell (MNC) response to pokeweed mitogen (PWM), phytohemagglutinin (PHA), and alloantigen as indicator culture systems. It was found that Con A-activated adult suppressor T cells were predominantly T8+ cells and suppressed PWM-induced IgG production by adult lymphocytes, as well as PHA- and alloantigen-induced proliferation of allogeneic adult MNC. Con A-activated cord T cells, however, exhibited no significant suppression in any of the three indicator systems. Furthermore, using Con A-activated adult T8+ cells as a source of suppression, the proliferative response of cord lymphocytes to PHA and alloantigen were as susceptible to suppression as those of adult lymphocytes. These results, together with previous findings that PWM-induced cord suppressor T cells were predominantly T4+ cell-mediated suppression, suggest that fetus/newborn lymphocytes achieved their selective inhibition on adult lymphocytes through the T4+ suppressor cell circuit.

Ontogeny of Langerhans cells in human embryonic and fetal skin: expression of HLA-DR and OKT-6 determinants

Langerhans cells (LCs) have been identified in human skin by 10 weeks estimated gestational age (EGA), but it was not known when they first enter the epidermis or acquire HLA-DR, OKT-6, and ATPase reactivity. We assayed for LCs in human embryonic and fetal skin by using immunolabeling and histochemical techniques on epidermal sheets. HLA-DR+ and ATPase+ LCs were present in the epidermis by 6-7 weeks EGA, the youngest tissue examined. Most LCs were OKT-6- until about 12 weeks EGA when they underwent a dramatic increase in OKT-6 reactivity. Although LC densities between 50-100 days were statistically similar (100 cells/mm2 of epidermis), LCs early in development were smaller, less dendritic, and phenotypically heterogeneous. We conclude that LCs migrate into the epidermis during the first trimester and resemble the adult phenotype by the second trimester, long before the immune system is fully activated.

Human cord blood suppressor T lymphocytes: I. Phenotype and target of the inducer of suppressor cell factor

The present study examines the characteristics of the cord suppressor T cells and their targets. When an inducer of suppressor T cell factor (TisF) from culture supernatant of alloantigen-activated cord lymphocytes was used as a source of suppression, adult lymphocyte response to soluble antigen candidin, alloantigens, and pokeweed mitogen were all suppressed. These results suggest that TisF acts primarily on T cells in an antigen-nonspecific fashion. Furthermore, preculture T cell irradiation, but not T8+ cell depletion, of adult lymphocytes abrogated the suppressive effect of TisF on the PWM-stimulated IgG production, suggesting that the target of TisF belongs to the radiosensitive T8-(T4+) T cell subset. When different cord T cell subsets were tested for suppressor activity, only radiosensitive T4+ cells were capable of suppressing IgG production by adult lymphocytes. Neither preculture T8+ cell depletion nor irradiation of adult T cells affected the suppression. Taken together, these results suggest that the suppressor activity of cord T cells originated from an inducer of suppressor cells that activates radiosensitive T4+ suppressor effector cells through TisF. In turn, these effector cells act on either radioresistant T4+ helper T cells or B cells or both.

Ontogeny of human T and B lymphocytes during stressed and normal gestation: phenotypic analysis of umbilical cord lymphocytes from term and preterm infants

Cord blood lymphocytes from premature and stressed term infants were phenotyped and contrasted with T and B lymphocytes from healthy newborns at term. Cytofluorometric analysis shows that in the early third trimester, 80-85% of fetal T cells belong to the T4+ inducer population, and 10% to the T8+ suppressor/cytotoxic subset. As gestation progresses, the T4:T8 ratio shifts toward adult values and there is an increase in expression of the mature antigen, T12. The B-cell-differentiation antigens B1, B2, and B4 do not appear to change during gestation in healthy infants. Antenatal stress which threatens fetal survival, however, leads to circulating cells of both lineages which are phenotypically less mature than expected for gestational age. Most notably, in response to severe antenatal hypoxic stress, cells expressing the very early B-cell markers B2 and B4 increase and exceed the numbers of more mature B1+ cells in cord blood.

The effects of indomethacin administration during pregnancy on women's and newborns' T-suppressor lymphocyte activity and on HLA class II expression by newborns' leukocytes

It has been previously shown that T lymphocytes from human newborns and pregnant women exert a suppressive activity when assayed on the PWM-induced B cell maturation. The mechanisms of the suppression have remained entirely unknown. Prostaglandin E2, known to trigger T-cell mediated suppressive activity, may be involved. We took advantage of the treatment of pregnant women with indomethacin, because of premature labor or hydramnios, to investigate the role of prostaglandins in the activation of T suppressor (TS) activity. Administration of indomethacin (250 mg/day for 1-7 weeks, then 150 mg/day for 3-12 weeks) during the third trimester of pregnancy, abrogated the TS activity in the nine women and the three newborns tested. Abrogation of TS activity by indomethacin therapy led to normal PWM-induced B cell maturation in pregnant women but not in newborns. Moreover, the low expression of HLA class II antigens observed on normal newborn B lymphocytes and monocytes was corrected in newborns from indomethacin-treated mothers. Our results strongly suggest that prostaglandins may play a role in induction of TS activity observed in normal pregnant women and newborns and in the decreased expression of HLA class II antigens on newborns' leucocytes. Both phenomena could play a role in immunological interactions between mother and fetus.

In utero immunization of the fetus to tetanus by maternal vaccination during pregnancy

We tested 36 pairs of umbilical cord blood and maternal sera collected at the time of delivery by radioimmunoassay and by Western blot analysis for IgG or IgM antitetanus antibodies (anti-TT). Twenty-one participants had received a recall injection of tetanus toxoid at various periods during pregnancy. Maternal vaccination in the last trimester of pregnancy was associated with the presence of IgM anti-TT in the cord blood sera; these were not detected in neonatal sera from mothers who were not vaccinated during pregnancy or who received the booster injection during the first two trimesters of gestation. The results could not be ascribed to artifacts such as the contamination of neonatal sera by maternal blood, the contamination of the anti-IgM antisera by antiidiotypes, or by the presence of neonatal IgM rheumatoid factor binding to immune complexes made of maternal IgG anti-TT and radiolabelled TT. Hence, it is concluded that maternal vaccination during the last trimester of pregnancy may induce in utero active immunization of the fetus.

Typing of human fetal organs for the histocompatibility antigens A, B and DR

In the transplantation of human fetal pancreatic explants into diabetic man, the importance of matching the histocompatibility antigens of donor and recipient to decrease the chances of rejection is unknown. Before this question can be answered human fetuses must be tissue typed. We have shown that lymphocytes harvested from fetal liver, thymus, bone marrow and spleen can be successfully HLA DR typed in 64% and A and B typed in 57% of 58 fetuses aged 15 wk or more. Typing should ideally be carried out on unseparated T and B cells. Best results were achieved if all four of the above organs were available and more than one million viable cells were able to be harvested for typing. Whilst the DR antigens could be typed from all tissues, the A and B antigens could be typed, with few exceptions only from thymus, spleen and bone marrow. The efficacy of matching the histocompatibility antigens of recipient and donor fetuses, especially the DR antigens can now be tested in the human diabetic being transplanted with pancreatic explants.

Immature T lymphocytes in human cord blood identified by monoclonal antibodies: a model for the study of the differentiation pathway of T cells in humans

The reactivity of human cord blood lymphocytes was assessed against a panel of monoclonal antibodies (MoAb). The mean proportion of OKT3+ cells (pan-T) was significantly lower in cord blood (52 +/- 13.8%; mean +/- SD) compared with that of adult blood (75 +/- 8.9%) and paralleled well with the E-rosette-forming capacity (50 +/- 16.3%). Both the proportions of OKT4+ cells (helper/inducer phenotype) and of OKT8+ cells (suppressor/cytotoxic phenotype) were significantly reduced in cord blood (43 +/- 11.8% vs 50.3 +/- 7.4% and 20 +/- 10.3% vs 25.6 +/- 6.0%, respectively), while the overall OKT4/OKT8 ratio was increased compared with adult blood (2.87 +/- 1.83 vs 2.04 +/- 0.61). Unlike adult blood, in 30 of the 35 samples of cord blood an overlap was observed between the total proportion of OKT4+ and OKT8+ cells (65 +/- 15.2%) and that of OKT3+ cells (52 +/- 14.3%). Although small numbers of cells coexpressing both antigens were occasionally found, double-staining analysis showed that the overlap in cord blood was mostly due to an expanded proportion of OKT3 (Leu-4)-/OKT8 (Leu-2)+ cells. Relevant proportions of OKT6+ (common thymocyte antigen) and OKT10+ (thymocytes, activated T cells, precursor cells) cells were found in cord blood as opposed to adult blood (10.8 +/- 8.6% vs 0.6 +/- 0.6% and 67 +/- 18.0% vs 8 +/- 2.1%, respectively), while terminal deoxynucleotidyl transferase-positive cells were observed only in two samples of cord blood. A small proportion of T cells (E-rosette+) reacted with the MoAb OKIa1 (HLA-DR). Finally, the proportion of cord blood cells recognized by the MoAb Leu-7 (HNK-1 clone) was almost negligible compared with adult blood (2.8 +/- 2.4% vs 15 +/- 7.5%). These data confirm the immaturity and heterogeneity of cord blood lymphocytes and demonstrate the presence at birth of circulating lymphocytes which express a surface phenotype reminiscent of that found in the late stages of intrathymic differentiation and in some human T-cell leukemias. Human cord blood may thus represent a suitable model for the study of the differentiation pathway of normal and pathological T-cells in humans.

A mature thymocyte-like phenotypic pattern on human cord circulating T-lymphoid cells

Cord blood samples from healthy full-term newborns were tested with antimature and antiimmature lymphoid-cell monoclonal antibodies, as well as more traditional markers, in order to identify the phenotype of circulating precursor cells. The results demonstrated that human cord blood contains a lower number of OKT3+, E-rosetting mature T cells than adult blood, very high levels of OKT10+ cells, and few OKT9+, OKT8+ OKT3-, and OKT4+ OKT3- cells. Although the finding of OKT9+ and OKT10+ cord circulating cells could be indicative of cell activation, double marker studies in newborn blood pointed to phenotypically immature lymphoid subsets at different stages of maturation, according to Reinherz's hypothesis. In addition, the absence of nuclear Tdt-positive and hot-rosetting cells, together with the fact that most of these are OKT3+, OKT10+, OKT4+, or OKT8+ cells, suggests that the surface phenotype of newborn lymphocytes is similar to that of mature thymocytes.