Lysis of colonic epithelial cells by allogeneic mononuclear and lymphokine activated killer cells derived from peripheral blood and intestinal mucosa: evidence against a pathogenic role in inflammatory bowel disease

Overview of inflammatory bowel disease in Australia in the last 50 years

Inflammatory diseases of the intestine, including Crohn's disease, ulcerative colitis, and celiac disease are now very common in Australia and remain major challenges for clinicians. Australian (and New Zealand) clinicians and scientists have made considerable contributions to our current understanding of these diseases over the last 50 years, including pathogenesis (such as the 'butyrate hypothesis', 'endoplasmic reticulum (ER) stress', and the identification of the peptide sequences that incite celiac disease), true population epidemiology (albeit in New Zealand), precise clinical observation, new investigative tools, innovative new potential therapies, influential clinical drug trials (such as triple antibiotics for Crohn's disease), and a dietary approach with efficacy for functional gut symptoms (the low FODMAP diet). Underpinning the success has been clinical excellence and adaptation of clinicians to the changing landscape of disease severity and therapeutic options. The future is indeed bright if such trends continue.

Expression of apoptotic epithelial cells within lamina propria beneath the basement membrane triggers dextran sulfate sodium-induced colitis

We postulated that nuclear dust within the lamina propria beneath the basement membrane of the epithelium in colonic mucosa is a form of apoptotic epithelial cells and that its expression triggers dextran sulfate sodium-induced colitis. The aim was to determine the origin of nuclear dust and to explore the correlation between nuclear dust expression and clinicopathologic parameters of colitis. Rats were treated with 3% dextran sulfate sodium. Cells showing double positive staining with cytokeratin and TdT-mediated uUTP-biotin nick-end labeling technique were apoptotic cells derived from epithelial cells. Nuclear dust expression on day 5 correlated with bloody stools and a decrease of mitotic colonic cells just before ulceration. Examination of cultures under light and fluorescent microscopy showed that dextran sulfate sodium caused early apoptosis and late apoptosis or necrosis. Our results suggest that interventions directed toward the apoptotic process may be beneficial in the treatment of ulcerative colitis.

Circulating soluble factor-inhibiting natural killer (NK) activity of fresh peripheral blood mononuclear cells (PBMC) from inflammatory bowel disease (IBD) patients

This study was performed in order to assess the cytotoxic activity, both natural (NK) and antibody-dependent (ADCC), of PBMC from 38 IBD patients and correlate it with their clinical features. Cytotoxicity assays were performed using sensitive target cells for NK and ADCC activities. In some experiments, highly purified NK cells, obtained both by Percoll density gradient and by co-culturing non-adherent PBMC with RPMI 8866 feeder cells, were used as effector cells. Furthermore, we evaluated NK cell parameters such as number, surface expression of adhesion molecules (CD11a/CD18, CD49d and CD54) and response to different stimuli. We observed a decreased NK cytotoxicity of PBMC from IBD patients, both in ulcerative colitis (UC) and Crohn's disease (CD), independently of the clinical activity of disease. In contrast, the ADCC lytic activity was within normal range. The lower NK cytotoxic activity observed in our IBD patients cannot be related to a decreased number of NK cells, surface expression of adhesion molecules, defective response to IL-2 and maturative defect. Decreased NK activity was induced in PBMC of controls when serum of patients was added and this was unrelated to monocyte-derived modulating factor(s). Our data show a decreased natural killing by fresh PBMC from IBD patients. This lower activity seems to be unrelated to a primary NK cell defect, since purified NK cells exhibited normal levels of killing. It might be hypothesized that serum factors, possibly derived from lymphocytes, with inhibitory properties on NK activity, might be functionally active in the blood of IBD patients, thus modulating NK activity.

Ulcerative colitis: an immunological disease?

Ulcerative colitis is an inflammatory disease of the large intestine of unknown aetiology. The nature of the inflammatory infiltrate together with the response to corticosteroids suggests that an abnormal immune response is at work. The key question of whether the immune system is responding to an abnormal breach in the mucosa due to another primary abnormality or whether the primary defect lies within the immune response itself has not been answered. Thus far, it is clear that both T and B cell compartments are involved in the persistence of inflammation but the initial interactions that take place in the mucosa in terms of antigen processing and presentation have not been adequately investigated. Those critical steps and potential defects that push T cells and B cells into a heightened state of activation need to be identified.

Elevation of interleukin-6 in inflammatory bowel disease is macrophage- and epithelial cell-dependent

Local interleukin-6 (IL-6) activity was studied using colonic mucosal tissues in inflammatory bowel disease (IBD) and inflammatory control patients. Active IBD specimens exhibited significantly higher IL-6 activity than control specimens in both cultures of isolated lamina propria mononuclear cells (LPMC) and mucosal tissues with an increased number of IL-6-producing cells. However, the activity in inactive IBD or inflammatory controls did not differ from controls. Northern blot analysis demonstrated IL-6 messenger RNA in LPMC and colonic epithelial cells isolated from active IBD specimens but not in control cells. Furthermore, immunofluorescent microscopic study of active IBD specimens showed more conspicuous staining of IL-6 in infiltrating LPMC (mostly CD68+ cells) and colonic epithelial cells. These results suggest that elevation of local IL-6 activity may be a characteristic feature of active IBD and both macrophages and colonic epithelial cells are the major cell types responsible for this phenomenon.

Phenotypic and functional characterization of T-cell lines generated from colonoscopic biopsy specimens in patients with ulcerative colitis

Intestinal T-cell lines were generated from lamina propria mononuclear cells isolated from colonoscopic biopsies in ulcerative colitis patients and controls. In both ulcerative colitis and controls, expanded cells were constituted largely by T-cell receptor alpha beta+, CD4+, CD45RA- (helper), and CD8+, CD11b- (cytotoxic) phenotypes. T-cell receptor V beta gene usage was not significantly changed after cell expansion and no difference was observed between ulcerative colitis and controls. Ulcerative colitis cells, especially those derived from the patients with long-standing disease, showed significantly higher levels of cytotoxicity against the target cells, including those of colonic epithelial origin, and enhanced production of tumor necrosis factor-alpha and interferon-gamma after short incubation with anti-CD3 antibody. Generation of T-cell lines from colonoscopic biopsy specimens may be useful for detailed functional characterization of locally infiltrating T cells in ulcerative colitis patients.

T cell cytotoxicity of autologous and allogeneic lymphocytes in a patient with Crohn's disease

We report a 27-year-old male with Crohn's disease (CD) of the small and large intestine, whose peripheral blood lymphocytes (PBL) showed increased cell-mediated cytotoxicity (CTL). Autologous and allogeneic effector cells from PBL and intestinal lymph nodes (LN) were isolated on a Ficoll-Hypaque gradient. Colonic cells were prepared as the target and were incubated for 6h with effector cells, after being labeled with Na(2)51CrO4. The CTL activity [effector/target (E/T) ratio, 100:1] of PBL for autologous targets was increased by 38% compared with that in normal subjects (< 10%), while that shown by LN was not increased (14%). The CTL activity of allogeneic PBL prepared from three of four other CD patients was also increased. Anti-major histocompatibility (MHC) class I and II and CD4 and CD8 monoclonal antibodies (50 micrograms/ml) significantly inhibited CTL activity. Complement-mediated depletion of CD2+ cells significantly reduced CTL activity. These results suggest that MHC-restricted CTL may play a role in mucosal damage in some patients with Crohn's disease.

Major histocompatibility antigen-restricted cytotoxicity in inflammatory bowel disease

BACKGROUND

The role of cytotoxicity mediated by peripheral blood mononuclear cells for colonic epithelial cells in inflammatory bowel disease (IBD) is still controversial. To clarify it, we studied major histocompatibility antigen (MHC)-restricted T cell-mediated cytotoxicity (CTL).

METHODS

Cytotoxicity was measured by 51Cr release from colonic cells after the 6-hour incubation with peripheral blood mononuclear cells in 11 IBD patients (6 with Crohn's disease and 5 with ulcerative colitis).

RESULTS

CTL activity (E/T ratio = 200:1 or 100:1) for autologous target cells was significantly increased (22%-40%) in 5 of 6 CD and 4 of 5 UC patients (22%-64%) compared with that for allogeneic target cells. The increase in CTL activity was mainly inhibited by anti-MHC class I and CD8 monoclonal antibodies (50 micrograms/mL), while it was partially inhibited by anti-MHC class II or CD4 antibodies in some patients. Complement-mediated depletion of CD2+ cells also significantly decreased CTL activity.

CONCLUSIONS

The results indicate that MHC-restricted T cell cytotoxicity may play a role in mucosal damage in some patients of IBD.

Normal inflammatory bowel disease mucosa conceals alterations in natural killer cell activity

Non-major histocompatibility complex-restricted cytotoxicity or natural killer (NK) activity could be detected in all intestinal lamina propria mononuclear cell preparations of histologically normal mucosa from 57 patients with gastrointestinal disease. Similar levels of NK activity were detected among the different disease groups. Within the inflammatory bowel disease patient group, however, Crohn's disease patients showed a threefold higher level of NK activity than detected in ulcerative colitis patients. Cytotoxicity levels in Crohn's disease patients were also higher than in the control carcinoma patients, whereas ulcerative colitis patients had considerably lower cytotoxicity levels than the carcinoma patients. Thus, unaffected normal inflammatory bowel disease mucosa conceals alterations in NK activity which might occur before the inflammation. The colon adenocarcinoma cell line Caco-2 was found to be a representative target for detecting individual differences in NK activity of lamina propria mononuclear cells compared with standard K-562 targets. The latter can be of relevance when studying mucosal immunoregulatory mechanisms in intestinal disease.

Intestinal lymphokine-activated killer cells in inflammatory bowel disease

The role of non-specific cytotoxicity in the pathogenesis of inflammatory bowel disease (IBD) was investigated by assaying the natural killer (NK) and lymphokine-activated killer (LAK) cell activity of lamina propria mononuclear cells (LPMC) from 22 specimens of intestinal mucosa affected by IBD. Only minimal levels of NK activity were detected against K562 cells, as well as colon carcinoma cells, adenoma cells and fibroblasts freshly isolated from the intestinal mucosa. Culture of LPMC from IBD in the presence of interleukin-2 (IL-2) generated LAK cells that mediated high levels of activity against K562 cells and against neoplastic epithelial cells and fibroblasts derived from the intestinal mucosa. A group of 20 histologically normal specimens of intestinal mucosa showed similar levels of LAK activity against the K562 and intestinal cell targets. The minimal mucosal NK activity in IBD suggests that the cytotoxic properties of NK cells are not important in the pathogenesis of IBD. The presence of LAK precursor cells in the inflamed mucosa of IBD and their ability to lyse biologically relevant targets in vitro suggests that LAK cells have the potential to contribute to intestinal mucosal injury in IBD.

Cell associated urokinase activity and colonic epithelial cells in health and disease

It is not known if urokinase-type plasminogen activator (uPA) is associated with normal colonic epithelial cells. The aims of this study were to determine if normal colonic epithelial cells have uPA activity and whether this is concentrated at the cell membrane. In addition, the contribution of colonic epithelial cell associated uPA activity to disease related pertubations of mucosal uPA activity were examined. A highly enriched population of colonic epithelial cells was isolated from resected colon or biopsy specimens by an enzymatic technique. uPA activity was measured in cell homogenates by a specific and sensitive colorimetric method and expressed relative to cellular DNA. In two experiments subcellular fractionation of colonic epithelial cells was performed by nitrogen cavitation followed by ultracentrifugation over a linear sucrose gradient. The fractions collected were analysed for uPA and organelle-specific enzyme activities. Normal colonic epithelial cells have cell associated uPA activity (mean (SEM) 5.6 (1.1) IU/mg, n = 18). This colocalised with fractions enriched for leucine-beta-naphthylamidase and 5'-nucleotidase, markers of plasma membrane. uPA activities in epithelial cells from cancerous colons (9.8 (3.1) n = 7) or from mucosa affected by inflammatory bowel disease (3.8 (0.7) n = 15) were not significantly different from normal (paired t test), while that in epithelial cells from greatly inflamed mucosa was similar to that from autologous normal or mildly inflamed areas (4.4 (1.2) v 5.9 (3.6), n = 9). Thus normal colonic epithelial cells have cell associated uPA activity which is concentrated on the plasma membranes, suggesting the presence of uPA receptors. Increased mucosal levels of uPA previously reported in patients with inflammatory bowel disease are not due to increased colonic epithelial cell associated uPA.

Autoantibodies to colonic cells and subcellular fractions in inflammatory bowel disease: do they exist?

Previous observations have purported to demonstrate circulating antibodies which bind to colon epithelial cells. However, the significance and reproducibility of such observations has been difficult and the data often phenomenological. To further our understanding of such autoreactivity, we studied sera and purified serum immunoglobulins from patients with ulcerative colitis, Crohn's colitis and other inflammatory diseases, as well as normal volunteers using as a target, well-defined epithelial cell preparations from normal and diseased colon and small bowel including crude suspensions of homogenized cells, purified and characterized brush border membranes, basolateral membranes and a DEAE cellulose column purified protein fraction. Homogenates of normal liver, lung, kidney, thymus, pancreas, stomach and small and large intestine, obtained at surgery, were also included. The purified preparations were characterized by enzyme activity and were electrophoresed on SDS-polyacrylamide gels for immunoblotting. Additional studies were carried out comparing these findings with those of a previously published and described 'positive' colon target preparation and polyclonal antibody. There was no convincing demonstration of circulating autoantibodies in patients with ulcerative colitis. Our data, using well-defined and characterized tissue preparations, raises doubts regarding the presumptive demonstration of autoantibodies in ulcerative colitis.

Isolation of colonic crypts that maintain structural and metabolic viability in vitro

The aim of this study was to develop a method by which colonic epithelial cells can be isolated from resected mucosa or colonoscopic biopsy specimens and viability maintained in the short term. The principles of the technique are to digest the lamina propria from the epithelium with Dispase and collagenase, to disrupt the epithelium by trituration, and to purify the epithelial cells by seiving and differential sedimentation. Whole and partial crypts were isolated with consistently high purity of 93.5% +/- 1.2% (excluding red cells). Structural integrity was confirmed by light and electron microscopy, exclusion of trypan blue, minimal leakage of lactic dehydrogenase over 5 h (4.1% +/- 1.7%), and 51Cr leakage of less than 2% per hour over 16 h. Functional integrity was supported by continued deoxyribonucleic acid synthesis [( 3H]thymidine uptake) over 16 h and the formation of epithelial monolayer cultures on plastic. Thus, this simple method yields a highly enriched cell population that maintains high viability in vitro for at least 16 h. Such cells may be useful for the study of the biology of colonic epithelial cells.