Interrelations of lymphocyte subset values, human immunodeficiency virus antibodies, and HIV antigen levels of homosexual males in San Francisco.

Serum and leukocytes from a cohort of homosexual males were analyzed to determine the interrelationships of antibodies to human immunodeficiency virus (HIV), serum HIV antigen levels, and phenotypical differences in lymphocyte subpopulations of HIV antibody-positive (HIV Ab+) and HIV antibody-negative (HIV Ab-) homosexual males. Significant reductions were observed in the percentages of B lymphocytes, CD4+ and CD4+ kappa lambda- T lymphocytes and the CD4+/CD8+ ratios of HIV Ab+ homosexual males in comparison to HIV Ab- homosexual males. Significant increases were observed in the percentages of CD8+, CD8+ CD11b-, CD8+ kappa lambda-, CD8+ DR+, CD8+Leu7+, and Leu7+ lymphocytes of HIV Ab+ study subjects. Statistical analysis revealed that among the immunological variables tested, decreases in the CD4+/CD8+ ratio and in the percentage of CD4+ kappa lambda- lymphocytes showed the strongest associations with HIV-sero-positivity in asymptomatic homosexual males. Only 44 (16.5%) of 267 HIV Ab+ homosexual males had detectable levels of HIV antigen (HIV Ag) in their serum. The percentages of CD4+ or CD4+ kappa lambda- lymphocytes and the CD4+/CD8+ ratios of HIV Ab+ males differed significantly between HIV Ag-positive (HIV Ag+) and--negative (HIV Ag-) homosexual males. These variables, however, did not correlate well with HIV Ag levels,indicating that no clear associations can be drawn between levels of HIV antigen and lymphocyte subset abnormalities of HIV-infected individuals.

Detection of the human erythrocyte surface antigen gerbich by flow cytometry using human antibodies and phycoerythrin for extreme immunofluorescence sensitivity.

We used indirect immunofluorescence and flow cytometry to detect the human erythrocyte surface antigen Gerbich. The procedure consisted of sequential erythrocyte-labeling with human antibody to Gerbich, biotinylated goat anti-human IgG and finally phycoerythrin-conjugated streptavidin. With maximal excitation of phycoerythrin at 546 nm, an increase in the fluorescence sensitivity was achieved. All erythrocytes from normal controls had detectable Gerbich antigen with little variation in antigen density between individuals. Six Gerbich-negative patients had no detectable antigen. By diluting the erythrocytes, as few as 0.1% antigen-positive cells in an antigen-negative population could be detected. These studies indicate that flow cytometry is a useful technique for the detection of erythrocyte surface antigens.

Flow cytometric detection and quantitation of immune complexes using human C1q-coated microspheres.

A solid phase human C1q-binding fluorescent immunoassay for the measurement of immune complexes in human serum was developed. The solid phase used was 5 micron diameter polystyrene microspheres. Serum immune complexes bound to the C1q-coated microspheres were measured by flow cytometry using fluoresceinated anti-human IgG, and heat-aggregated human IgG as a standard. Patient samples were assayed and results compared to a standard fluoroimmunometric C1q-binding immune complex assay. Greater differences in circulating immune complexes were observed between the healthy control group mean and the mean of the patient values in the microsphere-flow cytometric method than were seen in the standard assay. In the microsphere-flow cytometric assay, the mean patient value was 7.5 times greater than the control mean, whereas in the standard assay the mean patient value was 2.8 times the control mean. Preliminary results suggest greater sensitivity of the microsphere-flow cytometric method over the other method.

Flow cytometric analysis of lymphocyte phenotypes in AIDS using monoclonal antibodies and simultaneous dual immunofluorescence.

Simultaneous dual immunofluorescence and flow cytometry was used to study sixteen lymphocyte phenotypes in 209 men including: healthy homosexuals, lymphadenopathy patients (LAN), and AIDS patients. Significant differences between the distribution of lymphocytes in healthy homosexuals and healthy heterosexuals were decreased percentages of helper/inducer T cells (Leu 3), increased cytotoxic/suppressor T cells (Leu 2), and consequently a decreased Leu 3/Leu 2 ratio. The increased Leu 2 cells were identified as functionally cytotoxic subset Leu 2+ 15- phenotype rather than suppressor cells which are Leu 15+. Leu 2 and Leu 3 bearing cells exhibited an excess of membrane-bound immunoglobulins which were easily elutable at 37 degrees C. An increased percentage of an HLA-DR framework determinant bearing T cells were also detected. Within the NK cell family, Leu 7 cells were moderately increased and the functionally unidentified Leu 2+ 7+ population was strikingly elevated. LAN or AIDS patients were compared to healthy homosexual controls. Lower percentages of Leu 3 cells and higher percentages of Leu 2 cells were evident in LAN patients. These subsets were similar in LAN and AIDS patients. The increase in Leu 2+ cells was due to the Leu 2+ 15- cytotoxic subset. Fewer T cells had immunoglobulin in LAN and AIDS. A definite increase in Leu 2+ DR+ cells but not Leu 3+ DR+ cells occurred in AIDS compared to LAN or healthy controls. NK cell changes already present in healthy homosexuals persisted in LAN and AIDS patients. No differences in the distribution of B cells was detected in any intergroup comparisons. Changes in monocytes or pan-T cells were relatively insensitive measures of immunologic alterations among any of the groups. These results indicate many of the changes in lymphocyte subsets seen in AIDS and LAN subjects are already present in a carefully screened population of healthy homosexuals in San Francisco. Many of the changes in Leu 2 and NK family of cells suggest a possible adaptive response to viral or neoplastic challenge. Whether these interesting phenotypic alterations relate to functional changes in response to such challenge of the identified subsets waits further investigation.

Evaluation of the indirect immunofluorescence assay as a confirmatory test for detecting antibodies to the human immunodeficiency virus.

One hundred and eighty-four serum specimens were assayed for antibodies to the human immunodeficiency virus. All specimens were screened with a commercial enzyme immunoassay and confirmed by two indirect immunofluorescence assays. Sera were also assayed by Western blot. Results from sera of 48 healthy heterosexual volunteers were all negative by EIA, IFA, and Western blot. Sera from 50 healthy homosexual men negative by EIA were also negative by IFA and Western blot. Sixty-two patients with persistent generalized lymphadenopathy or newly diagnosed AIDS all were positive by EIA, IFA, and Western blot. Of 24 sera from patients with autoantibodies, with no evidence of AIDS-related diseases, five appeared to be false-positive by EIA, since they were nonreactive by IFA and Western blot. In addition, three other samples contained both autoantibodies and human immunodeficiency virus antibodies. False-positive results were observed in both the EIA and IFA with monoclonal antibodies directed toward the MHC class II antigens DQ and DR. The reactivity of these antibodies could not be distinguished from positive patients' sera, in either EIA or IFA. We conclude that in general indirect immunofluorescence performed well as a confirmatory test after screening by enzyme immunoassay for human immunodeficiency virus antibodies.

Comparison of six methods for the detection of antibody to cytomegalovirus.

Five commercial assays were compared to a standardized complement fixation (CF) test for the detection of antibody to cytomegalovirus. Two hundred and thirty serum specimens were analyzed. In addition, nine pairs of acute- and convalescent-phase sera were tested by two of the commercial assays. The assays were compared as to sensitivity, specificity, and positive and negative predictive value, as well as incidence of false-positive and -negative results. Samples which did not agree in all the assays were retested and tested with an indirect fluorescent-antibody assay. Of 228 specimens, 103 (45.2%) were positive by CF. Of the 230 samples, 2 (0.9%) were inconclusive by CF and readable in the other assays. Of the 230 specimens, 97 (42.2%) were positive by an enzyme immunoassay (EIA; Litton Bionetics), 100 (43.5%) were positive by a second EIA (Abbott Laboratories), 104 (45.2%) were positive by a third EIA (M. A. Bioproducts). One hundred and eight (47.0%) were positive by indirect hemagglutination (IHA; Cetus Corporation), and 110 (47.8%) were positive by latex agglutination (LA; Hynson, Westcott and Dunning). Sensitivity and specificity were similar with all the assays (93 to 100%). The greater numbers of positive results by IHA and LA were confirmed by repeat CF testing at less than 1:8 dilution, and by indirect fluorescent-antibody assay. Acute- and convalescent-phase serum pairs showed a significant rise in antibody titer when tested by anticomplement immunofluorescence, IHA, and LA. There was good agreement among the assays, with LA having the highest sensitivity.

Long-term cultivation of T-cell subsets from patients with acquired immune deficiency syndrome.

Peripheral blood mononuclear cells from patients with acquired immune deficiency syndrome (AIDS) and from healthy controls have been cultured in vitro in the presence of phytohemagglutinin (PHA) and interleukin 2 (IL-2). The T-cell subsets that grew were of both helper and suppressor type within the first week, but after 1-3 months, T cells with a suppressor/cytotoxic phenotype predominated. The lymphocytes from AIDS patients responded less effectively to the culture conditions employed. These results indicate that IL-2 can be used to maintain both major subsets of T cells from AIDS patients as well as healthy controls for short periods. However, in both situations, the helper phenotype is selectively reduced after one month in culture.

Comparison of the expression of terminal deoxynucleotidyl transferase and common acute lymphoblastic leukemia antigen in selected hematologic malignancies.

Assays were performed on cells from 38 consecutive malignancies for both terminal deoxynucleotidyl transferase (TdT) and common acute lymphoblastic leukemia antigen (CALLA). TdT and CALLA occurred together only on lymphoblasts from some cases of acute lymphoblastic leukemia (ALL). In other cases of ALL, chronic myelogenous leukemia (CML) in blast crisis, and acute undifferentiated leukemia (AUL), TdT was expressed, but CALLA was absent. TdT was present predominantly on cells from the lymphoid lineage as proven by special histologic stains, and CALLA marked a population with a favorable prognosis. Significant discrepancies in the expression of these two markers and the unique properties of each suggest that both markers are useful for the full characterization of specific hematologic malignancies.

Solid-phase Clq-binding fluorescence immunoassay for detection of circulating immune complexes.

A fluorescence immunoassay for detection of immune complexes bound to solid-phase C1q was developed. The method was standardized by using human aggregated immunoglobulin G (IgG) to simulate immune complexes. A linear relationship existed between the concentrations of the aggregated IgG standards and the resulting fluorescent intensity. The method was found to be reproducible and capable of detecting as little as 10 micrograms of aggregated IgG per ml of heat-inactivated human serum. Antigen-antibody complexes prepared in vitro were detectable from equivalence to moderate antigen excess. Endogenous serum C1q inhibited the binding of aggregated IgG to solid-phase C1q. Pretreatment of test sera with EDTA was ineffective in eliminating this competitive effect. Heating the sera at 56 degrees C alleviated, but did not abolish, interference of endogenous C1q. Elevated levels of immune complexes were detectable in sera fro seven of nine patients wit systemic lupus erythematosus, provided the samples were heat inactivated before testing. Heparin and DNA were also found to interfere with the detection of aggregated IgG added to human serum. Assay values were falsely decreased due to competitive inhibition by these anions. Lipopolysaccharides from a variety of bacterial preparations produced no detectable interference. A comparative study was conducted on samples that had previously been tested by fluid-phase C1q-binding radioimmunoassay. The two methods were concordant in assigning normal or elevated levels of immune complexes in 70% of the samples tested. This solid-phase fluorescence immunoassay is proposed as a possible alternative to radioimmunoassay for the detection of circulating immune complexes.

Comparison of a semiautomated fluorescent immunoassay system and indirect immunofluorescence for detection of antinuclear antibodies in human serum.

A semiautomated fluorescent immunoassay system (FIAX) for detecting anti-nuclear antibodies (ANAs) in human serum was compared with conventional indirect immunofluorescence using microscope slides (Meloy Laboratories) coated with mouse fibroblasts. The FIAX system uses quantitative indirect immunofluorescence to measure the specific binding of ANA to a sampler coated with human epithelial cells. A total of 101 serum samples were examined for the presence of ANAs by employing both methods. At an initial 1:10 screening dilution, 23 samples were negative for ANAs by the slide method, whereas 21 samples were negative with the FIAX system. Using 2+, 3+, and 4+ subjective brightness, 68 (100%) samples were positive by the slide method, whereas 67 (98.5%) were positive with the FIAX system. ANA-positive samples were diluted twofold from 1:10 to 1:640, and positive titers were determined by both methods. Sixty (77%) of 78 positive samples titrated by FIAX came within +/-1 dilution of the titers determined by the slide method, and 75 (96%) of the samples fell within +/-2 dilutions. Results indicate good correlation between the FIAX system and indirect immunofluorescence for the detection of ANAs in human serum. The FIAX system has the advantage of speed, reproducibility, and the elimination of subjective microscopic assessment of ANA titers.

Host response to Treponema pallidum infection. III. Demonstration of autoantibodies to heart in sera from infected rabbits.

Sera from rabbits infected intratesticularly with Treponema pallidum but not from animals injected intratesticularly with other bacteria or with extract of normal rabbit testes demonstrated autoantibody to heart tissue. The antibody was organ-specific with cross-reactivity to skeletal muscle but was not species-specific. It could not be absorbed by T. pallidum, T. reiteri, Veneral Disease Research Laboratory reagent or rabbit mitochondrial preparation. The antibody had a transitional pattern of appearance; it could be demonstrated between 30 and 60 days after infection but it decreased or disappeared thereafter. In many instances, it could be shown between 2 and 3 years after infection. The finding of the heart-reacting antibody strongly suggests an autoimmune phenomenon associated with T. pallidum infection.

The induction of delayed hypersensitivity in guinea pigs to poly U and poly A:U.

Guinea pigs were sensitized to poly U and poly A:U so that subsequent stimulation of spleen cells from these immunized animals with poly U and poly A:U resulted in the production of migration inhibitory factor (MIF). MIF was also produced when spleen cells from animals immunized with poly A:U were cultured in the presence of mycobacterial RNA or whole viable H37 Ra cells. Negative dermal reactions were observed when guinea pigs immunized with poly A, poly A:U were skin tested wtih these same synthetic nucleotides.

The adjuvant activity of mycobacterial RNA preparations and synthetic polynucleotides for induction of delayed hypersensitivity to purified protein derivative in guinea pigs.

The adjuvant activity of mycobacterial RNA and synthetic polynucleotides for the induction of delayed hypersensitivity to PPD was determined. It was shown that when mycobacterial RNA or synthetic polynucleotides are injected together with purified protein derivative (PPD), delayed hypersensitivity to PPD developed as compared to no detectable delayed response when PPD was administered alone without adjuvant into guinea pigs. Four different criteria were employed to detect delayed hypersensitivity responses. These were the time, appearance, and magnitude of dermal reactions, histologic examination of dermal sections, passive transfer of sensitivity with sensitized spleen cells and the elaboration of migration inhibitory factor (MIF) by sensitized spleen cells. When synthetic polynucleotides were used as adjuvants and were injected into guinea pigs in combination with PPD, dermal reactions as well ad MIF assays gave evidence that these animals exhibited delayed-type hypersensitivity. Poly U alone exhibited adjuvant activity for induction of delayed hypersensitivity to PPD. Trypsin and pronase treatment did not affect the adjuvant activity of mycobacterial RNA whereas KOH treatment completely abolished any adjuvant effect, suggesting that ribosomal protein did not contribute to the adjuvant characteristics of mycobacterial RNA. Titration experiments indicated that the adjuvant activity of mycobacterial RNA was greater than that of poly A:U.