In vivo production of cytokines and beta (C-C) chemokines in human recurrent herpes simplex lesions--do herpes simplex virus-infected keratinocytes contribute to their production?

Recurrent human herpes simplex lesions are infiltrated by macrophages and CD4 and CD8 lymphocytes, which secrete cytokines and chemokines. Vesicle fluid was examined by ELISA for the presence of cytokines and beta (C-C) chemokines. On the first day of the lesion, high concentrations of interleukin (IL)-1beta, and IL-6, moderate concentrations of IL-1alpha and IL-10, and low concentrations of IL-12 and beta chemokines were found; levels of macrophage inflammatory protein (MIP)-1beta were significantly higher than levels of MIP-1alpha and RANTES. At day 3, the concentrations of IL-1beta, IL-6, and MIP-1beta were lower, whereas the levels of IL-10, IL-12, and MIP-1alpha remained similar, and the level of tumor necrosis factor-alpha was now detectable. Herpes simplex virus infection of keratinocytes in vitro stimulated production of beta chemokines followed by IL-12 and then IL-10, IL-1alpha, IL-1beta, and IL-6, indicating a potential role for these events in early recruitment, activation, and interferon-gamma production of CD4 cells in herpetic lesions.

Increased frequency of the uncommon allele of a tumour necrosis factor alpha gene polymorphism in rheumatoid arthritis and systemic lupus erythematosus.

The frequency of the uncommon allele (TNF2) of a polymorphism in the promoter region of the tumour necrosis factor alpha (TNF alpha) gene in patients with rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) was found to be 3 times that of the normal anglo-saxon population. In SLE patients, this allele was strongly associated with HLA-DR3 expression and was also more frequent in patients who did not have malar rash. Functional studies of normal monocyte cytokine production in vitro showed that this genotype was associated with increased IL-1 alpha protein production but there were no differences in the production of TNF alpha protein.

Lack of association between an interleukin-1 receptor antagonist gene polymorphism and systemic lupus erythematosus.

Non-MHC linked genes may contribute to genetic predisposition to the development of systemic lupus erythematosus. The possibility that cytokine genes may be involved was raised by the observation of increased frequency in expression of an uncommon allele of an interleukin-1 receptor antagonist gene polymorphism and SLE in a recent U.K. study. We have not been able to show any significant differences in expression of this allele in SLE patients as a whole or in any patient subgroups. Our results actually show a slight decrease in the expression of this allele in SLE patients compared with healthy controls and in SLE patients with malar rash compared with SLE patients without malar rash.

Cytokine production by normal human monocytes: inter-subject variation and relationship to an IL-1 receptor antagonist (IL-1Ra) gene polymorphism.

Monocytes from different individuals show variable cytokine production in response to a variety of stimuli. We wished to determine the sets of conditions (cytokine combinations) that would enable us to demonstrate stable inter-individual differences in the production of IL-1 alpha, IL-1 beta, IL-1Ra, on-6 and tumour necrosis factor-alpha (TNF-alpha) by monocytes. We assessed the ability of a number of recombinant human cytokines (granulocyte-macrophage colony-stimulating factor (GM-CSF), interferon-gamma (IFN-gamma), TNF-alpha, IL-4, IL-6, transforming growth factor-beta (TGF-beta), IL-10 and IL-1Ra)) to stimulate or inhibit the production of one or more of these monocyte products. GM-CSF was found to stimulate the production of all five of these cytokines in a highly reproducible manner. TNF-alpha also up-regulated production of IL-1 alpha, IL-1 beta, IL-1Ra and IL-6 by monocytes, but the variability in the results of cells cultured from the same individuals on different occasions was greater. Other cytokines either stimulated production of only some of the five cytokine products tested, or stimulated the production of some cytokine products while inhibiting production of others. This was especially evident when cytokines were used in combination with GM-CSF: IFN-gamma down-regulated production of IL-1Ra while up-regulating the production of IL-1 alpha/beta, IL-6 and TNF-alpha, while IL-4 had the exact opposite effect. Polymorphisms in regions of cytokine genes that affect transcription may account for some of the interindividual variation in cytokine production. We have shown that a stable estimate of cytokine production phenotype can be obtained when monocytes collected on at least two separate occasions are stimulated by GM-CSF in vitro. We have looked for a relationship between IL-1 production and an 86-bp variable repeat polymorphism in intron 2 of the IL-1Ra gene. A less common allele of this polymorphism (allele 2) was associated with increased production of IL-1Ra protein, and also reduced production of IL-1 alpha protein by monocytes.

Effect of gonadal steroids on the production of IL-1 and IL-6 by blood mononuclear cells in vitro.

Sex hormones have profound effects on immune responses and may influence the outcome of autoimmune diseases such as rheumatoid arthritis (RA). We investigated the effect of gonadal steroids on the production of interleukin-1 (IL-1) and IL-6, cytokines believed to be important in the pathogenesis of RA. Peripheral blood mononuclear cells (PBMCs) were isolated from healthy male donors and male patients with RA, and were stimulated with lipopolysaccharide (LPS) in the presence of different concentrations of 17-beta-estradiol, progesterone or testosterone. In studies of cells from normal male donors, 17-beta-estradiol at pharmacological concentrations (> or = 10(-6) M) enhanced IL-1 and IL-6 secretion as well as the production of cell-associated IL-1. Progesterone and testosterone at similar concentrations inhibited IL-1 secretion but had no significant effect on IL-6 secretion or on the production of cell-associated IL-1. In studies of male RA donors, 17-beta-estradiol failed to enhance IL-1 or IL-6 secretion and progesterone failed to inhibit IL-1 secretion. The inhibitory effects of testosterone, however, appeared to be similar to that in normal donors. It is suggested that 17-beta-estradiol may promote IL-1 and IL-6 production and release, while gestation hormone, progesterone, and testosterone may inhibit IL-1 release in vivo. These data may partly explain the gender and age differences in the incidence of RA and the development of the disease in men with low and androgen levels.

Interleukin-1 production and cell-activation response to cytomegalovirus infection of vascular endothelial cells.

Human cytomegalovirus (HCMV) is a source of major complications in immunosuppressed individuals, and endothelial involvement in HCMV infection is well documented. Traditionally laboratory strains of HCMV have been used in experimental investigations in vitro; however the continuous propagation of these strains in fibroblasts have attenuated the virus making it unsuitable for infecting other cell systems such as endothelial cells. In this study a recent clinical isolate of HCMV was propagated through several passages in endothelial cells and was used to investigate the effect of HCMV infection of human umbilical vein endothelial cells (HUVEC) on IL-1 production and cell proliferation. Infection of HUVEC with the clinical isolate of HCMV (at multiplicity of infection 5:1) suppressed the production of IL-1 alpha (82%) and IL-1 beta (99%) at 5 h post infection; the levels returned to that of the control within 24h post infection. Ultraviolet inactivated (but not heat killed) virus produced similar suppression confirming that a thermolabile viral structural protein or intact virion were responsible for this suppression. Infection of HUVEC with the clinical isolate increased the number of these cells and the rate of their proliferation. An increase of infected HUVEC number under quiescent growth conditions continued as the infection progressed (6-10 days post infection), exhibiting, at 3 days post infection, 5 times the number of uninfected HUVEC (control) which did not tolerate the quiescent culture conditions for more than 4 days. Live virus is responsible for this increase because UV-inactivated virus did not maintain the proliferation of HUVEC. These studies suggest that while infection of HUVEC with a recent clinical isolate of HCMV suppressed the production of IL-1 at early hours after infection, it increased the proliferation of these cells at later stages of infection.

Circulating cytokine levels in patients with rheumatoid arthritis: results of a double blind trial with sulphasalazine.

Interleukin 1 (IL-1), IL-6, and tumour necrosis factor (TNF) alpha are pleiotropic cytokines produced predominantly by macrophages which have been implicated in the pathogenesis of rheumatoid arthritis (RA). Sulphasalazine has been shown to have disease modifying properties and to inhibit the production of cytokines in vitro. To evaluate the effect of sulphasalazine on cytokine production in vivo, serum cytokine levels were measured in a group of patients with RA entered into a randomised controlled trial. Serum levels of IL-1 alpha, IL-1 beta, IL-6, and TNF alpha were measured at baseline and at two monthly intervals for six months in 17 patients receiving sulphasalazine and in 22 patients treated with placebo. The two groups of patients had a similar age and sex distribution, had had RA for less than a year, had no joint erosions, and had not been treated previously with any other disease modifying drugs. In the 39 patients studied IL-1 alpha was detected (> 0.1 ng/ml) at baseline in 14 patients (median 0.24 ng/ml), IL-1 beta in 25 patients (median 1.0 ng/ml), TNF alpha in 27 patients (median 1.2 ng/ml), and IL-6 in 33 patients (median 0.44 ng/ml). In the group treated with sulphasalazine there was a progressive and significant decline in serum IL-1 alpha, IL-1 beta, and TNF alpha levels over the six month period (median levels at six months were < 0.1, 0.12, and 0.44 ng/ml respectively). Interleukin 6 levels were significantly reduced only at the four month time point (median level of 0.23 ng/ml). These reductions were associated with improvements in clinical and laboratory measures of disease activity. In contrast patients receiving the placebo showed no changes in serum cytokine levels and no improvement in clinical and laboratory indices of disease activity. These results suggest that sulphasalazine may exert its disease modifying effect partly by suppressing cytokine production in vivo.

Effects of granulocyte-macrophage colony-stimulating factor (GM-CSF), IL-2, interferon-gamma (IFN-gamma), tumour necrosis factor-alpha (TNF-alpha) and IL-6 on the production of immunoreactive IL-1 and TNF-alpha by human monocytes.

The effects of GM-CSF, IL-2, IFN-gamma, TNF-alpha and IL-6 on the production of IL-1 (both secreted and cell associated) and TNF-alpha by peripheral blood monocytes were studied. Monocytes were cultured for 20 h in suspension and in serum-free conditions which minimized background stimulation of monokine production. GM-CSF, IL-2 and TNF-alpha directly induced the production of cell-associated IL-1 but little or no IL-1 or TNF-alpha secretion. Combination of GM-CSF with IFN-gamma, IL-2 or TNF-alpha synergistically enhanced IL-1 secretion and had an additive effect on cell-associated IL-1 production. Combination of IL-2 with IFN-gamma or TNF-alpha also synergistically enhanced IL-1 secretion but the effect on cell-associated IL-1 production was less than additive. GM-CSF synergistically enhanced TNF-alpha secretion induced by IFN-gamma but not by lipopolysaccharide. GM-CSF did not enhance TNF-alpha secretion induced by IL-2 or TNF-alpha. In contrast, IL-2 synergistically enhanced TNF-alpha secretion induced by IFN-gamma. These results are discussed in relation to cytokine involvement in rheumatoid arthritis.

The effect of slow-acting anti-rheumatic drugs (SAARDs) and combinations of SAARDs on monokine production in vitro.

The mode of action of slow-acting anti-rheumatic drugs (SAARDs) is complex but may often include effects on cytokine (interleukin-1, IL-1, and tumour necrosis factor, TNF) production by monocytes/macrophages. Different SAARDs may have variable effects on cytokine production in vitro depending on the concentration of drug, the presence of other SAARDs and individual variation. The gold compounds gold sodium thiomalate (GST) and auranofin (AF) had a bimodal effect on cytokine production. High concentrations of GST (greater than 1 microgram/ml) weakly inhibited IL-1-beta secretion (without affecting IL-1-alpha or TNF secretion and without affecting cell-associated IL-1-alpha and IL-1-beta accumulation), and although AF (greater than 100 ng/ml) inhibited cytokine production it did so at concentrations near to the toxic range for the drug (greater than 200 ng/ml). GST and AF when used in combination inhibited cytokine production in a synergistic manner even at concentrations that would potentiate cytokine production if used individually. Hydroxychloroquine (HCQ) and sulfasalazine (SAP) were two other inhibitory SAARDs which acted synergistically in combination. Combination of HCQ and SAP with gold drugs gave variable results. D-penicillamine (D-pen) and methotrexate (MTX) were two SAARDs that generally did not affect cytokine production individually or in combination with other SAARDs. These results suggest that combination SAARD therapy may more effectively target excessive cytokine production, which is a hallmark of rheumatoid arthritis.

Cytokine regulation of human monocyte interleukin-1 (IL-1) production in vitro. Enhancement of IL-1 production by interferon (IFN) gamma, tumour necrosis factor-alpha, IL-2 and IL-1, and inhibition by IFN-alpha.

IL-1 production (secreted and cell-associated) was measured in monocyte cultures stimulated by a variety of agents in vitro. Monocytes either adherent to conventional plastic culture plates in serum-free conditions, or in suspension in culture medium containing serum were stimulated to produce IL-1 during culture. In non-adherent, serum-free conditions, monocytes produced very low or undetectable amounts of IL-1 during 20 h of culture. Lipopolysaccharide (LPS) induced equivalent amounts of secreted and cell-associated IL-1, although at very low concentrations more cell-associated IL-1 was produced. IL-1 production in response to LPS could be augmented by crude lymphokine, IFN-gamma, or tumour necrosis factor (TNF) alpha. TNF-alpha preferentially augmented the production of cell-associated IL-1 in LPS-stimulated cultures. TNF-alpha induced a significant amount of IL-1 (mainly cell-associated) directly but could also induce IL-1 secretion when combined with IL-2 or IFN-gamma, or when in the presence of serum. IL-2 acted synergistically with low concentrations of IFN-gamma or IL-1 to induce significant levels of IL-1 production. IFN-alpha did not induce any IL-1 production, but was a potent inhibitor of IL-1 production induced by a variety of stimuli. These results suggest that IL-1 production may be enhanced or reduced by different cytokines at concentrations likely to be found in chronic inflammatory lesions.

The effect of gold sodium thiomalate and auranofin on lipopolysaccharide-induced interleukin-1 production by blood monocytes in vitro: variation in healthy subjects and patients with arthritis.

The anti-rheumatic gold compounds gold sodium thiomalate (GST) and auranofin (AF) have variable and often unpredictable effects in patients treated for arthritis. As inhibition of interleukin-1 (IL-1) production may be an important effect of these drugs, we investigated their effect on IL-1 production by lipopolysaccharide (LPS) stimulated monocytes in a serum-free, non-adherent culture system. A bi-modal effect was observed: low concentrations (GST 10-250 ng/ml and AF 1-100 ng/ml) potentiated IL-1 production, and higher concentrations (GST 200-1000 ng/ml and AF10-500 ng/ml) inhibited it. This bi-modal effect was observed for both secreted and cell-associated IL-1 activity with the exception that GST failed to inhibit cell-associated IL-1 generation. The potentiating effect was dependent on the continuous presence of gold for at least the first few hours after LPS stimulation. The inhibitory effect of GST was dependent on its presence after LPS stimulation while that of AF was evident even if cells were pretreated with AF and washed before exposure to LPS. There was considerable individual variation in IL-1 production in response to LPS as well as in the effects of gold on cells from both healthy individuals and patients with arthritis. There was also some overlap in the range of concentrations of gold that potentiated and inhibited IL-1 production, and there was relative insensitivity to the inhibitory effects of gold in certain individuals. These results may explain some of the variability in the response of patients to chrysotherapy and support further studies to see if these in vitro effects might predict clinical response to gold.

The effect of gold treatment on monocyte interleukin-1 production in rheumatoid arthritis. A prospective study.

Monocyte interleukin-1 (IL-1) production in vitro was studied in 49 patients with rheumatoid arthritis (RA) and 31 controls. Twenty-six of the RA patients were studied prospectively for up to 12 months after beginning chrysotherapy. About half of the patients (group 1) exhibited pretreatment levels of monocyte IL-1 secretion (as measured by bioassay or B-IL-1) significantly higher than that of the controls. Immunoreactive IL-1 (IR-IL-1) levels, however, were similar to controls. Clinical improvement in this group of patients was modest and transient but could be associated with a fall in the level of IL-1 (B-IL-1 and IR-IL-1) secretion. Other RA patients (group 2) appeared to have normal or reduced pretreatment levels of IL-1 secretion. Chrysotherapy resulted in significant clinical improvement within 3 months, and this was associated with an increase in IL-1 (both B-IL-1 and IR-IL-1) secretion by the patients' blood monocytes to normal or supranormal levels. Thus these two groups of RA patients (which differed only in the average duration of disease) had different prognoses in relation to chrysotherapy and the effect of chrysotherapy-induced remission on monocyte IL-1 secretion was opposite. These results suggest that monocyte IL-1 production in vitro reflects changes secondary to the anti-rheumatic effects of chrysotherapy.

Interleukin-1 secretion by peripheral blood monocytes and synovial macrophages from patients with rheumatoid arthritis.

Blood monocytes and synovial fluid and tissue macrophages were examined for their ability to produce interleukin-1 (IL-1) measured in a mouse thymocyte proliferation assay. Spontaneous production of IL-1 by monocytes from patients with rheumatoid arthritis (RA) or ankylosing spondylitis was higher than that by cells from normal subjects, patients with osteoarthritis or patients with RA treated with gold. IL-1 production in response to LPS stimulation was similar in all groups. Spontaneous IL-1 production by synovial fluid macrophages from patients with RA was similar to that of their monocytes, but the response to LPS was smaller. Synovial tissue macrophages produced little IL-1. Similar results were obtained in assays of fibroblast proliferation.

Evidence for regulation of human colonic mucosal immunoglobulin secretion by intestinal lymphoid cells.

In vitro immunoglobulin secretion has been studied using isolated colonic mucosal lymphoid cell populations obtained from 41 patients with non-inflammatory intestinal disease. Cell fractions were separated into intra-epithelial and lamina propria-enriched populations. The secretion of immunoglobulins by mucosal cells appeared to be independent of mitogen stimulation. When intra-epithelial lymphocyte preparations were co-cultured with autologous lamina propria lymphocytes, the secretion of IgM was significantly depressed but that of IgA and IgG was preserved. Co-cultured of mucosal cells with autologous peripheral blood lymphocytes resulted in suppression of pokeweed mitogen stimulated and unstimulated immunoglobulin secretion. Lamina propria T cells were shown to provide helper function for the in vitro secretion of IgA and IgM but not IgG, by autologous peripheral blood B cells. Immunoglobulin secretion by lamina propria lymphocytes was shown to be partly dependent on the concentration of E-rosette forming cells. These experiments demonstrate that human colonic mucosal lymphoid cells contain specific populations of helper and suppressor cells which selectively control intestinal immunoglobulin secretion.

In vitro IgE production by peripheral blood lymphocytes and rectal mucosal biopsies and antigen-induced basophil degranulation in patients with inflammatory bowel disease.

IgE production by peripheral blood lymphocytes (PBL) and rectal mucosal biopsies in vitro has been examined in patients with ulcerative colitis (UC) and Crohn's disease (CD). The degranulation of peripheral blood basophils to food antigens has also been investigated in these patients. Mitogen-induced IgE production was reduced in patients with UC, but enhanced in PBL cultures from patients with CD. Increased numbers of basophils degranulated in the presence of cows' milk in UC patients, but normal responses occurred in patients with CD. This evidence supports the suggested role of IgE-mediated mechanisms involving mast cell/basophil interactions in the pathogenesis of inflammatory bowel disease.

Antigen-antibody complexes in inflammatory bowel disease.

One hundred and sixty patients have been studied to assess the significance of circulating antigen-antibody complexes in inflammatory bowel disease (IBD). Sera from patients with ulcerative colitis and Crohn's disease were assayed for Clq-binding antigen-antibody complexes (CIC) and the results compared with those obtained from 52 patients with other inflammatory gastrointestinal diseases (GI controls) and 26 normal volunteers (normal controls). Significantly elevated CIC levels were found in patients with active IBD compared with inactive IBD or normal controls. However, similar high levels were also found in the GI control group. CIC levels in a group of undernourished patients with Crohn's disease fell significantly after treatment with an oral nutritional supplement. The results suggest that CIC-mediated inflammation is likely to be associated with intestinal mucosal disease in a non-specific manner.

Influence of nutritional status on immune functions in patients with Crohn's disease.

Nutritional status and immune function were correlated with clinical features in 56 patients with Crohn's disease. These were divided arbitrarily into either undernourished or well nourished groups according to whether their midarm circumference was below or above 90% of ideal standard. Results were also compared with 33 patients with ulcerative colitis and 28 normal subjects. Undernourished patients with Crohn's disease had significantly reduced total lymphocyte and T lymphocyte counts and a reduced proportion of monocytes that ingested latex particles. Well nourished patients with Crohn's disease were similar to the two control groups. Twenty one undernourished patients with Crohn's disease were also followed during the course of two to four months' nutritional treatment with an enteral supplement. Nutritional therapy was associated with significant anthropometric gains as well as significant rises in total lymphocyte and T lymphocyte counts. Serum orosomucoids were significantly higher in undernourished patients and decreased significantly during nutritional therapy. The results show that undernutrition and disease acuity may be associated with reduced immunological competence in patients with Crohn's disease, but all these measurements can be improved by short term nutritional treatment.

In vitro immunoglobulin secretion by normal human gastrointestinal mucosal tissues, and alterations in patients with inflammatory bowel disease.

Intestinal mucosal immunoglobulin secretion in vitro has been studied by culture of endoscopic biopsy tissues obtained from various sites along the gastrointestinal tract. IgA and IgM were the predominant immunoglobulins produced by intestinal tissues distal to the stomach and secretion of both reached a maximum in the small intestine of normal individuals. In patients with inflammatory bowel disease, characteristic alterations in immunoglobulin production were observed in cultures of large intestinal tissue. In ulcerative colitis (UC), significant reductions in IgA secretion (P less than 0.03) occurred in the rectum during remission and IgM in the colon in active disease (P less than 0.01). However, in active Crohn's disease (CD), rectal IgM secretion was enhanced (P less than 0.004) and IgA diminished (P less than 0.01). IgG secretion was increased throughout the colon in UC especially in distal sites, due largely to significant increases in pre-formed immunoglobulin (P less than 0.02). Similar total increases were observed in colonic tissues from patients with CD, although IgG synthesis in biopsies from rectal sites was normal. These findings suggest that specific abnormalities of intestinal mucosal immunoglobulin synthesis occur in patients with both UC and CD.

Pokeweed mitogen stimulated immunoglobulin production by peripheral blood lymphocytes in vitro: evidence for disordered immunoregulation in patients with ulcerative colitis and Crohn's disease.

Production of immunoglobulins (G, A, M) by pokeweed mitogen stimulated peripheral blood lymphocytes was studied in 81 patients with inflammatory bowel disease and compared with 40 patients with mild gastrointestinal disorders (controls). Immunoglobulin production was dependent on the concentration of mononuclear cells in culture, being maximal at the lowest concentration used (2.5 X 10(5)/ml). Adherent monocytes exerted suppression when cultures were reconstituted with more than 20% of these cells. T lymphocyte depleted cells (B cells) demonstrated T cell helper/suppressor dependence for immunoglobulin production in an isotype specific manner, the optimal T cell concentration for 'helper' activity being lowest for IgG and highest for IgM. In patients with active ulcerative colitis (UC) there was a reduction in the T cell concentration for optimal helper activity that was not isotype specific suggesting an increase in non-specific T cell helper activity. T cell helper activity reverted toward control levels in patients with UC in disease remission, except in the case of IgA production where there was a significant diminution of IgA production and of T helper activity for IgA synthesis. Patients with Crohn's disease were distinguished from both UC and control patients by: (1) reduced immunoglobulin production at low lymphocyte concentrations; (2) reduced monocyte-mediated suppression of immunoglobulin production and (3) no shift in T cell concentration for optimal helper activity for IgG and IgA with active disease.