Spontaneous formation of germinal centers in autoimmune mice.

The mechanisms of autoantibody production are not well understood. Germinal centers (GC) may be important sites of immune disregulation in autoimmune diseases. In this study, we document the presence of spontaneous GC formation in the spleens of several autoimmune mouse strains that spontaneously develop autoimmune Type I diabetes and a lupus-like disease. In contrast, mouse strains that do not develop lupus did not exhibit spontaneous formation of GC. In all of the autoimmune strains studied, GC were present at 1-2 months of age, a time that closely parallels the appearance of autoantibodies. Like the GC that develop after purposeful immunization, GC in autoimmune mice contained B220(+), PNA(+), and GL-7(+) B cells, and FDC-M1(+) follicular dendritic cells. In addition, spontaneously formed GC in autoimmunity and those caused by immunization were abrogated in a similar way by a short-term treatment with anti-CD40 ligand antibody. These data indicate that spontaneously forming GC in autoimmunity are similar to those appearing after purposeful immunization.

Lessons from animal models of vasculitis.

Vasculitis can occur as a primary disease or as a secondary manifestation of either another illness or a type-III hypersensitivity response to a foreign antigen. Over the past four decades, a number of animal models of vasculitis have been described. These models have served as important tools for enhancing our understanding of the basic mechanisms underlying the pathogenesis of vasculitis. In addition, animal models have made possible the preclinical testing of new therapeutic agents. Animal models of vasculitis can be broadly classified into two types--those that are experimentally induced and those that occur spontaneously. Vasculitis can be experimentally induced in animals through the stimulation of a type-III hypersensitivity response to a variety of foreign antigens, by viral or bacterial infection of vascular cells and the immune response to that infection, or by the in-vivo administration of antineutrophil cytoplasmic antibodies, estrogen, or mercuric chloride (HgCl(2)). Systemic vasculitis spontaneously develops in several strains of mice and rats. This paper reviews the current state of knowledge of several animal models of vasculitis and the lessons that have been learned from them.

Clinical value of antineutrophil cytoplasmic antibodies.

This article presents a brief review of the clinical value of antineutrophil cytoplasmic antibodies (ANCA) in the diagnosis and management of patients with various forms of vasculitis. ANCA assay methodology and testing recommendations are reviewed. The patterns of reactivity of ANCA observed by indirect immunofluorescence, the antigens recognized by ANCA, and the sensitivity, specificity, and positive predictive value of ANCA for diagnosis of different vasculitides are described. In addition, the spectrum of drugs and nonvasculitic diseases that are associated with ANCA and need to be differentiated from true ANCA-positive vasculitides are reviewed. When properly utilized and cautiously interpreted, ANCA are a useful, noninvasive diagnostic tool in the differential diagnosis of vasculitis.

Vasculitis in the Palmerston North mouse model of lupus: phenotype and cytokine production profile of infiltrating cells.

OBJECTIVE: To define the phenotype of cells in the perivascular and vascular infiltrates of Palmerston North (PN) mice and the cytokines that those cells produce. METHODS: Immunohistologic analysis, flow cytometric analysis, and reverse transcriptase-polymerase chain reaction (RT-PCR) studies were performed on tissues and cells from female PN mice and age-matched and sex-matched DBA/2 mice. RESULTS: With aging, PN mice developed a female-predominant, lupus-like disease, with a severe systemic mononuclear cell perivasculitis and vasculitis. The perivasculitis involved arteries and veins in kidney, liver, brain, and lung; the vasculitis predominantly involved veins and venules. The perivascular and vascular infiltrates in female PN mice were composed mainly of an unusual cell type that expressed phenotypic markers characteristic of both T cells (Thy1+, CD3+, CD4+, T cell receptor + [TCR+]) and B cells (B220+). In addition, the infiltrates contained a smaller number of conventional CD4+,B220- T cells and macrophages. Very few CD8+ T cells or surface Ig+ B cells were seen. Unlike the Thy1+,B220+ T cells present in MRL/lpr mice, most of which were CD4-,CD8- and TCRalpha/beta+, the majority of the Thy1+,B220+ T cells in the perivascular/vascular infiltrates of PN mice were CD4+ and expressed either TCRalpha/beta or TCRgamma/delta. By immunohistologic staining, the cells in the perivascular and vascular infiltrates in the kidneys of older PN mice were shown to produce interleukin-4 (IL-4), IL-6, and IL-10, but not IL-2, interferon-gamma, transforming growth factor beta, tumor necrosis factor alpha, or IL-1beta. By RT-PCR, the kidneys of older PN mice were found to express high levels of IL-4, IL-6, and IL-10 messenger RNA. CONCLUSION: The vascular and perivascular infiltrates in PN mice are composed predominantly of an unusual subpopulation of T cells that are Thy1+,B220+,CD4+,CD8-, express either TCRalpha/beta or TCRgamma/delta, and produce mainly type 2 cytokines. The exact role of these cells in the immunopathogenesis of lupus-like disease in PN mice remains to be elucidated.

Further characterization of the autoantibody response of Palmerston North mice.

PN mice spontaneously develop, with age, a lupus-like disease. The present study further evaluated autoantibody production in female PN mice. As early as 1 month of age, all PN mice had detectable IgM antibodies to dsDNA and ssDNA and two-thirds produced IgM anticardiolipin antibodies. By 3 months of age, all PN mice exhibited evidence of isotype switch in their autoantibody response; 88-100% had serum IgG antibodies to ssDNA and dsDNA, respectively. By 6-12 months of age, essentially all female PN mice had IgG antibodies to ssDNA, dsDNA, cardiolipin and other phospholipids (PS, PC, PI, and PG), and IgG and 63% produced IgG anti-mouse erythrocyte antibodies. In addition, 50-100% produced IgA antibodies to dsDNA and ssDNA, and one-third produced IgA anti-IgG antibodies. Antibodies to U1RNP and Sm were present in 81% of 6- to 12-month-old PN mice and 39-94% had IgG or IgM antibodies to mouse thymocytes. Although all four IgG isotypes were represented in the anti-dsDNA response, IgG1 antibodies dominated the IgG anticardiolipin response. The presence of IgA autoantibodies and the predominance of IgG1 in the IgG anticardiolipin response suggest that IL-4 and either IL-5 and/or TGF-beta serve as B cell stimulatory cytokines for autoreactive B cells in PN mice.

5'-degenerate 3'-dideoxy-terminated competitors of PCR primers increase specificity of amplification.

Amplification of a product in PCR with specific primers may be viewed as an artificial Darwinian-type "selection of the fittest". In other selective systems, such as general evolution, immune system and probably brain cortex, the stringency of selection is not absolute but rather degenerate, with selection of many highly fit units, not limited, however, to only the fittest. In PCR also, annealing of the primers is not absolutely specific. The subsequent amplification frequently leads to amplification of not only the desired product but also to less-specific sequences. Using theoretical analysis of the degenerate mode of selection, we predict theoretically and prove experimentally that 5'-degenerate, 3'-dideoxy-terminated competitors of PCR primers can be used to dramatically improve the specificity of PCR amplification without affecting the quantitation of the final specific product.

Cytokine production by T lymphocytes from young and aged mice.

We previously have shown that T cell proliferation in response to a primary signal through the CD3 epsilon chain and a costimulatory signal via the CD28 molecule is impaired in healthy, aged mice. To determine whether age-related alterations in cytokine production might explain the reduced proliferative responses of T cells from aged mice, we examined the secretion of the major T cell immunoregulatory cytokines, IFN-gamma, IL-4, and IL-2. Splenic T cells from young (2 to 4 mo) and aged (20 to 26 mo) mice were studied. T cells were stimulated with immobilized anti-CD3 epsilon chain mAb and soluble anti-CD28 mAb for 24 h. T cells from aged mice, when compared with young controls, showed increased IFN-gamma production, no difference in IL-4 production, and decreased IL-2 production. Most IFN-gamma was produced by CD8+ T cells, whereas most IL-2 and IL-4 was produced by CD4+ T cells. Both CD4+ and CD8+ T cells from aged mice produced significantly more IFN-gamma than corresponding cells from young mice. This increased production could be accounted for by increased numbers of CD4+CD44high and CD8+CD44high T cells in aged animals. CD4+CD44high and CD8+CD44high T cells from young mice produced comparable amounts of IFN-gamma as corresponding cells from aged mice. In contrast to unseparated splenic T cells, no age-related difference in IL-2 or IL-4 production by purified CD4+ T cells was observed. Similarly, when CD4+ T cells were further separated into CD44low and CD44high subpopulations, no age-related difference in IL-2 production was found. Therefore, we found no consistent evidence that diminished production of the major T cell growth factors, IL-2 and IL-4, is responsible for the age-related decrease in the proliferation of T cell subpopulations that were stimulated in vitro through the CD3 epsilon chain and costimulated via the CD28 molecule. The physiologic relevance of increased IFN-gamma production by T cells from aged mice is unknown.

An age-related decrease in rescue from T cell death following costimulation mediated by CD28.

We previously reported that T cell proliferation in response to a primary signal through the T cell receptor (TCR) and a costimulatory signal via the CD28 molecule is impaired in healthy, aged mice. Here we extend these studies to examine factors which may be involved in this defect in T cells from aged mice. To determine if age-related changes in cytokine production might be responsible, splenic T cells from young (2-4 months) and aged (20-26 months) mice were stimulated with immobilized anti-CD3 epsilon and soluble anti-CD28 mAbs in the presence of exogenous IL-2, IL-4, IFN-gamma, IL-1 alpha, or IL-6. No improvement in the proliferative response of T cells from aged mice was found following the addition of any cytokine. In addition, the decreased proliferative response of T cells from aged mice was not caused by the enhanced production of IFN-gamma or other inhibitory factors. Interestingly, despite the age-related reduction in proliferation, no significant difference was found in the percentage of live cells entering the S, G2, or AM phase of the cell cycle in stimulated T cells from young and aged mice. Instead, anti-CD28-mediated costimulation was found to rescue T cells from young mice from anti-CD3epsilon-induced cell death, but did not rescue T cells from aged mice. This failure of T cells from aged mice to respond to costimulatory signals appears to contribute to the decreased proliferation observed from cultures containing these cells, and may be involved in many other age-related alterations in immunological responsiveness.

Aged T cells are hyporesponsive to costimulation mediated by CD28.

The ability of T cells to proliferate in response to a number of stimuli is impaired in healthy, aged individuals. T cells from young (2 to 4 mo) and aged (20 to 26 mo) mice were stimulated with immobilized anti-CD3 epsilon-chain mAb and soluble anti-CD28 mAb. T cells from young and aged mice proliferated comparably in response to anti-CD3 epsilon mAb alone. However, aged T cells were significantly less responsive to costimulation by anti-CD28 mAb. This decreased response of aged T cells was seen at all dosages tested of anti-CD3 epsilon and anti-CD28 mAbs and in the presence and absence of APC. Similar results were observed when costimulation was provided by B7-transfected L cell fibroblasts. T cells from young and aged mice had comparable expression of CD28 by flow cytometry, both before and after stimulation. The defect in response to CD28 was seen both in CD4+ and CD8+ T cells and in CD44lo (naive) and CD44hi (memory) T cells. The impaired response to costimulation mediated by CD28 on T cells from aged mice may be an important factor in reduced T cell responses associated with aging.

B-cell and T-cell function in systemic lupus erythematosus.

The process of autoantibody production in systemic lupus erythematosus is characterized by findings of both an antigen-driven response and polyclonal B-cell activation. Autoantibody production does not appear to be critically dependent on the presence of the CD5+ B cell subset. Increasing evidence supports a role for T helper cell type 2 cytokines, such as interleukin-4 and interleukin-6, in promoting and perpetuating B-cell hyperactivity and autoantibody formation.

Calcium channel blockers inhibit cellular uptake of thymidine, uridine and leucine: the incorporation of these molecules into DNA, RNA and protein in the presence of calcium channel blockers is not a valid measure of lymphocyte activation.

An important role of transmembrane flux of calcium in lymphocyte activation has been previously demonstrated. Herein, we demonstrate that the calcium channel blockers verapamil and isradipine are able to inhibit in a concentration-dependent manner 3H-thymidine incorporation into DNA in phytohemagglutinin (PHA)-stimulated human peripheral blood mononuclear cells (PBMC). However, verapamil and isradipine diminish PHA-stimulated thymidine incorporation into DNA to the same extent whether they are added at the beginning of culture or 4 h prior to completion of a 72-h culture. Thus, 3H-thymidine incorporation into DNA in the presence of verapamil or isradipine is not a valid measure of mitogen-induced lymphocyte proliferation. Similarly, verapamil and isradipine also inhibit PHA-stimulated incorporation of 3H-leucine into protein and 3H-uridine into RNA whether the drugs are added at the beginning of culture or 4 h prior to completion of 24-h cultures. There is no intracellular accumulation of 3H-thymidine, 3H-leucine, or 3H-uridine into 10% trichloroacetic acid-soluble molecules during inhibition with verapamil or isradipine, suggesting that these drugs impair the cellular uptake of these substances rather than directly inhibiting their incorporation into DNA, protein, or RNA, respectively. Since previous reports documenting the inhibitory effects of calcium channel blockers on lymphocyte proliferation have utilized 3H-thymidine incorporation into DNA to measure proliferation, we have re-examined the antiproliferative effects of these drugs by determining their effect on PHA-stimulated cell cycle progression, employing cytofluorometric analysis of propidium iodide-stained cells. When added at the initiation of culture, both verapamil and isradipine inhibited in a concentration-dependent manner PHA-stimulated cell cycle progression.(ABSTRACT TRUNCATED AT 250 WORDS)

T-cell and B-cell function in lupus.

B-cell hyperactivity is characteristic of lupus and appears to be, in many instances, T-cell driven. Recent work continues to examine the paradox of T-cell activation in vivo and depressed T-cell function in vitro. The role of intrinsic B-cell abnormalities, particularly in CD5+ B cells, is an area of active investigation.

Evidence that the antiproliferative effect of verapamil on afferent and efferent immune responses is independent of calcium channel inhibition.

Calcium channel blockers are capable of inhibiting the afferent and efferent limbs of the immune responses of human peripheral blood mononuclear cells in in vitro systems. This effect is thought to be related to the ability of the calcium channel blocker to limit the transmembrane flux of calcium. We report herein that two optical enantiomers of verapamil, one (S-) which is capable of blocking the slow calcium channel and mitogen-stimulated 45Ca++ uptake into human lymphocytes, while the other (R+) is incapable of either activity, share almost identical capabilities of depressing both the afferent and efferent limbs of immunity. These observations suggest that the inhibitory effects of verapamil on various afferent and efferent immune events are, in part at least, unrelated to the inhibition of transmembrane calcium flux.

Anti-CD4 anti-idiotype antibodies in volunteers immunized with rgp160 of HIV-1 or infected with HIV-1.

We examined the sera of volunteers vaccinated with recombinant gp160 of human immunodeficiency virus type 1 (HIV-1) and control volunteers for the presence of anti-(anti-gp160 idiotype) antibodies which antigenically mimic gp160 and, therefore, bind to CD4 on human cells. Anti-CD4 antibodies were detected in the sera of 3 of 5 rgp160 recipients and 1 of 5 controls by indirect immunofluorescence using CD4-transfected HeLa cells or enzyme-linked immunosorbent assay (ELISA) using recombinant soluble CD4 as the solid phase. The control volunteer who was positive subsequently developed antibodies to HIV-1 by Western blot analysis. The anti-CD4 antibodies detected in the sera of the rgp160 vaccinees and the control volunteer appeared to be anti-idiotypic in nature, reacting with a paratope expressed on goat anti-gp160 antibodies but not on antibodies from normal goat serum. Binding to either transfected CD4+ HeLa cells or blotted anti-gp160 serum could be inhibited by preincubating the anti-CD4 serum with soluble CD4, or preincubating the cells or blotted anti-gp160 serum with recombinant gp160. Anti-CD4 antibodies were initially detectable only after the antibody response to gp160 began to decrease in the vaccinees, and the HIV-1-infected volunteer mounted a detectable anti-HIV-1 antibody response only after a decline in the anti-CD4 antibodies in his serum. These data strongly suggest that anti-CD4 antibodies which are anti-idiotypic to a paratope expressed on anti-gp160 antibodies are generated in response to both vaccination with rgp160 and infection with HIV-1.(ABSTRACT TRUNCATED AT 250 WORDS)

T-cell and B-cell function in lupus.

Investigation into the nature of the immunologic abnormalities responsible for autoantibody production continues to be an extremely active area of research in lupus. This paper reviews several areas of current research relevant to our understanding of T-cell and B-cell function in lupus.

Additive inhibition of afferent and efferent immunological responses of human peripheral blood mononuclear cells by verapamil and cyclosporine.

We have studied the effects of verapamil (0-50 microM) on the in vitro immunological function of human peripheral blood mononuclear cells in the presence or absence of cyclosporine (0-600 ng/ml). The proliferative response to phytohemagglutinin, OKT3, and alloantigens, the generation of cytotoxic T lymphocytes following allogeneic stimulation, and mitogen-induced reduction of intracellular ATP were inhibited in a concentration-dependent fashion by verapamil alone and by cyclosporine alone. When the two drugs were added to the same culture, additive inhibition was observed. A verapamil concentration of 5 microM usually reduced by at least 50% the amount of cyclosporine necessary to cause the same level of inhibition seen when no verapamil was present. The additive inhibition of the two drugs was likely not due to additive inhibition of IL-2 responsiveness, since neither drug alone inhibited the response of an IL-2-dependent T cell clone (CTLL-2) to recombinant IL-2 except at the highest concentrations tested, where a mild additive effect was noted. Nor was the additive inhibition related to an additive effect on total IL-2 receptor expression since an additive inhibitory effect on PHA-induced IL-2 receptor expression was only seen with 50 microM verapamil, while additive functional effects on mitogen- and antigen-induced proliferation and alloantigen-induced CTL generation were seen with 5 microM verapamil doses. Verapamil or cyclosporine alone inhibited IL-2 production of PHA- and phorbol ester-stimulated peripheral blood mononuclear cells--however, no additive effect was seen when the two drugs were both added to culture, probably because of the very potent inhibition by cyclosporine alone. Natural killer cell activity of human peripheral blood mononuclear cells against K562 target cells was significantly inhibited by verapamil in a concentration-dependent fashion, while cyclosporine had a more modest concentration-dependent effect. The combination of both drugs demonstrated additive inhibition. Effector function of cytotoxic T lymphocytes was modestly inhibited by either verapamil or cyclosporine alone. A combination of the highest concentrations of verapamil and cyclosporine caused an additive inhibitory effect. In summary, these data demonstrate that verapamil and cyclosporine have concentration-dependent inhibitory activities on both the afferent and efferent limbs of immunity that were additive when verapamil was used in a concentration of at least 5 microM. The additive effects are probably not related to effects on IL-2 circuitry.

Blood tests in the diagnosis of connective tissue diseases.

Making the diagnosis of connective tissue disease can at times be extremely difficult. Obtaining a complete rheumatological and medical history, and performing a thorough physical examination are absolutely essential. This article has reviewed several of the laboratory parameters which can aid the clinician in the differential diagnosis of connective tissue diseases. Which tests should be ordered in any given individual patient should be determined by the clinical setting. Careful evaluation of the laboratory data, in the context of the patient's history and physical examination, should, in general, allow the clinician to make the proper rheumatological diagnosis.