Preclinical studies of methylthioadenosine for the treatment of multiple sclerosis.

BACKGROUND: Methylthioadenosine (MTA) is a natural metabolite with immunomodulatory properties. MTA improves the clinical course and pathology of the animal model of multiple sclerosis, even when therapy is started after disease onset. OBJECTIVE: Our aim was to compare the efficacy of MTA in ameliorating experimental autoimmune encephalomyelitis (EAE) compared with first line approved therapies, to develop an oral formulation of MTA and to assess its pharmacokinetic profile. METHODS: EAE was induced in C57BL/6 mice by immunization with MOG(35-55) peptide in Freund's Adjuvant. Animals were treated with MTA, interferon-beta or glatiramer acetate starting the day of immunization and the clinical score was collected blind. Pharmacokinetic studies were performed in Sprague Dawley rats by administering MTA by intraperitoneal injection and orally, and collecting blood at different intervals. MTA levels were measured by high-performance liquid chromatography. RESULTS: We found that MTA ameliorated EAE in a dose-response manner. Moreover, the highest dose of MTA (60 mg/kg) was more efficacious than mouse interferon-beta or glatiramer acetate. We developed a salt of MTA for oral administration, with similar dose-response effect in the EAE model. Combination therapy assays between MTA and interferon-beta or glatiramer acetate were more effective than the individual therapies. Finally, oral MTA half-life was 20 min, with a C(max) of 80 mg/L and without signs of obvious toxicity (animal death, behavioural changes, liver enzymes). CONCLUSIONS: In the EAE model MTA is more efficacious than first line therapies for multiple sclerosis, with a dose- response effect and higher efficacy when combined with interferon-beta or glatiramer acetate. Oral MTA was also effective in the animal model of multiple sclerosis.

Regulation of leukocyte adhesion molecule-1 (TQ1, Leu-8) expression and shedding by normal and malignant cells.

The human leukocyte adhesion molecule-1 (LAM-1, TQ1, Leu-8) is involved in the binding of human leukocytes to high endothelial venules (HEV) of peripheral lymph nodes (LN). The regulation of LAM-1 expression is unique in that leukocyte stimulation induces a rapid down-modulation of LAM-1 from the cell surface. In this study, the regulation and function of LAM-1 was studied in detail in normal lymphocytes and compared with the LAM-1 of malignant leukocytes. Modulation of LAM-1 from the cell surface occurred concomitantly with the appearance of LAM-1 in the culture medium indicating that LAM-1 is cleaved from the cell surface. Shedding of LAM-1 was decreased in the presence of protein kinase C (PKC) inhibitors. As with normal lymphocytes, cells transfected with the LAM-1 cDNA and chronic lymphocytic leukemia (CLL) cells also shed LAM-1 following phorbol myristate acetate (PMA) exposure. CLL cells expressed the same Mr LAM-1 protein as normal lymphocytes and LAM-1+ CLL cells were able to specifically bind to HEV. In addition, normal lymphocytes and LAM-1+ CLL cells were capable of binding polyphosphomonester core polysaccharide (PPME) derived from yeast cell wall, a carbohydrate which mimics an essential component of the natural ligand for LAM-1, and PPME and HEV binding was specifically blocked by a new monoclonal antibody (mAb) reactive with LAM-1. The expression of LAM-1 and other adhesion molecules was examined on cells of 118 hematopoietic malignancies. LAM-1 was most frequently expressed on CLL and follicular or diffuse small cleaved cell lymphomas, whereas most other malignancies were LAM-1-. Thus, most CLL cells and some non-Hodgkin's lymphoma cells express a functionally active LAM-1 molecule which may correlate with their capacity to migrate through the circulation and disseminate into peripheral LN.

Expression of the human leukocyte adhesion molecule, LAM1. Identity with the TQ1 and Leu-8 differentiation antigens.

The LAM1 molecule is a member of the new family of cellular adhesion/homing molecules that contain a lectin-like domain at their amino-terminal end followed by an epidermal growth factor-like domain and short consensus repeat units like those found in C3/C4 binding proteins. Two mAb that react with the leukocyte adhesion molecule 1 (LAM1) were produced and used to examine the cell-surface expression of LAM1. The anti-LAM1 antibodies were reactive with the majority of blood lymphocytes, NK cells, neutrophils, and monocytes. LAM1 was also expressed by subpopulations of phenotypically immature and mature thymocytes. Blood lymphocytes rapidly modulated LAM1 from the cell surface during PMA exposure for 60 min. Coordinate with the loss of LAM1 from the cell surface, PMA-treated lymphocytes lost the ability to bind to lymph node high endothelial venules, indicating that expression of LAM1 may play a role in lymphocyte homing. Mitogen stimulation of blood T and B lymphocytes also resulted in decreased LAM1 expression, but at a slower rate. LAM1 was only weakly expressed by a minority of spleen lymphocytes. However, culturing spleen lymphocytes in media alone resulted in increased expression of LAM1 by a subpopulation of the cells (40 to 60%). Concomitant mitogen stimulation of spleen lymphocytes resulted initially in down-regulation of LAM1 expression followed by increased expression of LAM1 and then subsequent loss of LAM1 from the cell surface. The pattern of anti-LAM1 antibody reactivity was identical to that reported for the TQ1 and Leu-8 antibodies, and all of these antibodies reacted with cells transfected with the LAM1 cDNA. Thus, LAM1 is broadly expressed by leukocytes, and binding of LAM1 may participate in the process of leukocyte extravasation into lymphoid organs or sites of acute inflammation with subsequent loss of LAM1 from the cell surface.

Branhamella catarrhalis activates human B lymphocytes following interactions with surface IgD and class I major histocompatibility complex antigens.

Branhamella catarrhalis initiated DNA synthesis in human blood or spleen cells enriched for B lymphocytes but did not activate T-lymphocyte-enriched fractions. Monoclonal antibodies were used to determine which B-cell surface molecules were of importance for the activation signal. The addition of monoclonal antibodies reactive with IgD, HLA class I antigens, and B2-microglobulin to B lymphocyte cultures selectively inhibited the B-lymphocyte response to B. catarrhalis. Antibody binding to IgD and class I antigens did not inhibit B-cell proliferation following stimulation with anti-IgM beads, Staphylococcus aureus, or Epstein-Barr virus. This suggests that surface IgD is of major importance for B-lymphocyte stimulation by B. catarrhalis. Since B. catarrhalis binds HLA-ABC containing liposomes it is suggested that a similar binding of B. catarrhalis to HLA-ABC on the surface of B lymphocytes serves as an accessory factor that stabilizes the binding of B. catarrhalis to surface IgD. Activation of human B lymphocytes by B. catarrhalis resulted in changes of cell surface molecules that were quantitatively and qualitatively similar to those that resulted from the activation by S. aureus. Therefore although these two bacteria appear to activate B cells in a similar manner, they induce B-cell proliferation through interactions with different cell surface structures.

Patient status 10 or more years after 'fresh' homograft replacement of the aortic valve.

One hundred and forty consecutive patients from 12 to 74 years old (mean 52) who underwent isolated elective aortic valve replacement with antibiotic-sterilized homografts have been followed for 10 to 13 (mean 11) years. There were four (2.9%) early and 48 (34.3%) late deaths. The overall survival rate was 81% at 5 years and 65% at 10 years. Valve failure occurred in 37 (26.4%) patients and was due to degeneration in 27 (19.3%), technical failure in three (2.1%), and endocarditis in seven (5%). Freedom from valve failure was 90% at 5 years and 72% at 10 years; the mean rate of valve degeneration was 1% per year up to 5 years, 2% from 5 to 8 years, and 5% from 8 to 10 years. Functional evaluation of the patients retaining their original homograft at 10 years showed excellent or good results in 82% and fair or poor results in 18%. A multivariate regression analysis of factors influencing survival and valve failure showed that older age of the patient (p less than .01) and the development of postoperative left bundle branch block (p less than .05) adversely affected survival, and that older age and sex (female) of the patient (p less than .01), the type of original valve lesion (stenosis) (p less than .05), and the interval between death and dissection of the grafts (p less than .01) were good predictors of valve failure.

Reconstitution after transplantation with T-lymphocyte-depleted HLA haplotype-mismatched bone marrow for severe combined immunodeficiency.

Severe combined immunodeficiency (SCID) is potentially correctable by bone marrow transplantation if a patient has a suitable histocompatible donor. In the absence of an HLA-matched donor, lethal graft-versus-host disease (GVHD), which is mediated by alloreactive donor T cells, may occur. In an attempt to prevent GVHD in one SCID patient lacking a matched donor, we treated maternal haplomismatched bone marrow with a unique nonmitogenic T-cell-specific monoclonal antibody (anti-T12) and complement to remove mature T cells. Despite the removal of greater than 99% mature T cells, the child developed significant life-threatening GVHD, which was terminated by a 5-day course of intravenous anti-T12. Subsequently, immune reconstitution occurred by 6 wk: the mature circulating T cells proliferated in response to soluble and allo-antigens in vitro and provided help for B-cell immunoglobulin synthesis. The patient was removed from a protective environment and discharged without evidence of further infection. Both HLA and chromosomal analyses showed that the circulating cells in the patient were of maternal origin. More importantly, the maternal T cells were no longer reactive with recipient cells. Mixing experiments indicated that the state of tolerance that resulted in this chimera was not due to active suppression. We conclude that HLA-mismatched transplantation for SCID can be undertaken if mature alloreactive donor T lymphocytes are depleted before and after bone marrow grafting.

Cellular origin of interleukin 2 (IL 2) in man: evidence for stimulus-restricted IL 2 production by T4+ and T8+ T lymphocytes.

The human T cell subset(s) responsible for production of interleukin 2 (IL 2) was investigated in the present study. For this purpose, highly purified T4+ and T8+ T lymphocytes were stimulated with mitogens and alloantigens. Subsequently, culture supernatants were analyzed for IL 2 activity in each of two assay systems: 1) proliferation of long-term T cell lines and 2) induction of cytotoxic effector cells from a resting T8+ population incubated in MLC. Mitogen stimulation led to secretion of equivalent amounts of IL 2 from both the major T cell subsets; in contrast, after allogeneic activation, IL 2 was produced predominantly from the T4+ subset. The stimulus dependency of IL 2 production suggests that the individual functional repertoires of T4+ and T8+ T cell subsets may be linked to unique surface receptors and/or interaction molecules involved in cell triggering rather than a restricted capacity to produce lymphokine.

Subpopulations of the T4+ inducer T cell subset in man: evidence for an amplifier population preferentially expressing Ia antigen upon activation.

Prior studies demonstrated that Ia molecules were expressed on a fraction of human peripheral T4+ inducer cells upon stimulation by soluble antigen. In the present study, we utilized a fluorescence-activated cell sorter to separate antigen-activated T4+,Ia+ and T4+,Ia- populations and characterized their function. It was found that the T4+,Ia+ population contained the majority of proliferating T cells as assessed by tritiated thymidine incorporation. This proliferation largely appeared to be nonspecific. Despite macrophage repletion, elimination of the Ia+ subset of T cells with monoclonal anti-Ia antibody and complement treatment equally diminished subsequent proliferation to both the triggering antigen and an unrelated antigen. Moreover, the antigen-induced Ia+ subset of T cells alone produced a nonspecific helper factor, LMF. In contrast, the the T4+,Ia- population showed minimal proliferation to soluble antigen and did not generate LMF. Nevertheless, both T4+,Ia+ and T4+,Ia- inducer T cells were required to generate maximal immunoglobulin production by B cells in an antigen-driven system. We conclude that the human T4+ inducer T cell subset is comprised of at least 2 functionally distinct subpopulations, which are capable of acting in a synergistic fashion to provide help to B cells.

Regulation of B cell immunoglobulin secretion by functional subsets of T lymphocytes in man.

Two distinct immunoregulatory T cell subsets, termed T4+ and T5+, have been defined in man by monoclonal antibodies. Prior studies have shown that the T4+ T cell population provided help for B cell immunoglobulin (Ig) production and was required for generation of T5+ cytotoxic effector cells. In the present study, the regulatory effects of the T5+ T cell subset on B cell Ig secretion were determined in a pokeweed mitogen-driven system. It was found that the T5+ subset, in contrast to the T4+ subset, was incapable of providing help to B cells and, more importantly, could suppress Ig secretion by B cells in the presence of T4+ inducer T cells, Given earlier studies demonstrating that the T5+ T cell subset suppressed T cell responses as well, this population appears to represent the major suppressor subset in man for T-T and T-B interactions.

Two functionally distinct subpopulations of human T cells that collaborate in the generation of cytotoxic cells responsible for cell-mediated lympholysis.

A human thymus-dependent differentiation antigen, TH2 was defined by a rabbit anti-human T cell serum absorbed with autologous B lymphoblasts and leukemic cells bearing T cell markers from a patient with chronic lymphocytic leukemia. Anti-TH2 reacted specifically with thymus-derived lymphoid cells and exhibited two distinct profiles of reactivity with normal peripheral T cells as detected by indirect immunofluorescence on a FACS I. Isolation of strongly reactive, TH2+, from weakly reactive, TH2- T cells by fluorescence-activated cell sorting revealed that the TH2+ subset contained most of the killer activity in cell-mediated lympholysis (CML), but had a diminished response in MLC and a suboptimal or negligible proliferative response to soluble antigens (mumps, PPD, tetanus toxoid). In contrast, the TH2- subset contained markedly less killer activity but amplified cytotoxicity by TH2+ cells and exhibited a proliferative response to both alloantigen and soluble antigens that was often significantly greater than the response by unseparated T cells. The relevance of these findings to previously described human T cell subsets and to functional subpopulations of murine T cells is discussed.