Cellular and molecular mechanisms for reduced interleukin 4 and interferon-gamma production by neonatal T cells.

The mechanisms by which T lymphocytes acquire the capacity to produce interleukin 4 (IL-4) and other lymphokines during intrathymic and extrathymic development are poorly understood. To gain insight into this process, we determined the capacity of human neonatal and adult T lineage cell populations to produce IL-4 after polyclonal activation. IL-2 and interferon-gamma (IFN-gamma) production were studied in parallel, since their production by neonatal T cells is known to be similar or diminished, respectively, compared to adult T cells. Production of IL-4 by neonatal CD4+ T cells and IFN-gamma by neonatal CD4+ and CD8+ T cells was markedly lower compared with analogous adult cell populations, whereas IL-2 production was similar. Transcription of IL-4, as determined by nuclear run-on assays, and IL-4 mRNA-containing cells, as determined by in situ hybridization, were undetectable in neonatal T cells, whereas both were detectable in adult T cells. IFN-gamma transcription and IFN-gamma mRNA-containing cells were reduced in neonatal T cells compared with adult T cells. Reduced lymphokine production by neonatal T cells correlated with their lack of a CD45R- (putative memory T cell) population; cells with this surface phenotype comprised 30-40% of the adult CD4+ T cells and were highly enriched for IL-4 and IFN-gamma, but not IL-2 production. IL-4, IFN-gamma, and IL-2 mRNA expression by neonatal CD4+CD8- thymocytes was similar to that found in circulating neonatal CD4+ T cells. Taken together, these findings suggest that the extrathymic generation of memory T cells during postnatal life may result in an increased capacity for IL-4 and IFN-gamma gene expression. In addition, IFN-gamma and IL-2 mRNA were significantly more abundant than IL-4 mRNA in activated neonatal CD4+CD8- thymocytes and CD4+ T cells, as well as adult CD4+ CD45R- T cells. Therefore, the capacity of T lineage cells to express the IL-4 gene may be more restricted compared to other lymphokine genes beginning in intrathymic development. This restricted capacity appears to persist during postnatal extrathymic maturation of T cells.

Host cell-modified T-antigen in membranes of simian virus 40-transformed hamster cells.

Highly purified plasma membranes of simian virus 40 (SV40)-transformed hamster and mouse cells were subjected to indirect immunoprecipitation and bidimensional isoelectric focusing-immunoelectrophoresis with high-titer (greater than or equal to 512) sera against SV40 T-antigen. An SV40-specific protein of approximately 100,000 daltons and pH-4.7 isoelectric point cross-reacted immunologically with T-antigen, which indicated the presence of a T-antigen species. However, this protein appeared to be host cell modified because of its low isoelectric point and its reactivity with heterologous antisera containing antibodies specific for neuraminidase- and trypsin-sensitive carbohydrate and/or peptide moieties lacking nuclear T-antigen. Another protein specific for the membranes of SV40-transformed cells had a molecular mass near 60,000 daltons and an isoelectric point at pH 4.5 and appeared closely associated with membrane T-antigen. It coprecipitated with membrane T-antigen upon direct immunoprecipitation with anti-T serum. However, when this protein was dissociated from membrane T-antigen by isoelectric focusing in the presence of Triton X-100 and urea, its reactivity with anti-T serum was lost. This suggested that the protein was not encoded in the SV40 genome.

Simian virus 40 (SV40)-specific isoelectric point-4.7--94,000-Mr membrane glycoprotein: major peptide homology exhibited with the nuclear and membrane-associated 94,000-Mr SV40 T-antigen in hamsters.

Tryptic peptide maps of electrophoretically purified 94,000-molecular weight (relative) (Mr) nuclear and membrane-associated simian virus 40 (SV40) T-antigens, TN and TM, respectively, were compared to those of the SV40-specific isoelectric point (pI)- 4.7--94,000-Mr plasma membrane component reactive with anti-T-sera from Syrian golden hamsters. Bidimensional thin-layer electrophoresis and chromatography of TN labeled with 125I revealed about 27 tryptic peptides. A similar number of peptides was identified for TM and the pI-4.7--94,000-Mr component. A peptide homology between TN and TM or TN and the pI-4.7-94,000-Mr protein exists and indicates that the previously described pI-4.7--94,000-Mr membrane component represents TM. Only 4 of 27 peptides were labeled when TM was subjected to lactoperoxidase-catalyzed radioiodination from the outer surface of the plasma membrane. One of these TM peptides was metabolically labeled with [14C]glucosamine. The data indicate that TM is partially exposed on the cell surface and represents a glycosylated form of TN. Closely associated with TM is a pI-4.5--55,000-Mr membrane component. This component does not exhibit significant peptide homology with the 94,000-Mr SV40 protein and, therefore, appears to be coded for by the host cell genome.

Humoral and cellular immune response of adults from northeastern Brazil with chronic Trypanosoma cruzi infection: depressed cellular immune response to T. cruzi antigen among Chagas' disease patients with symptomatic versus indeterminate infection.

Infection with Trypanosoma cruzi can cause chronic Chagas' disease manifestations (cardiac, gastrointestinal), although most persons with chronic infection have no ill effects (indeterminate form). Cell-mediated immunity (CMI) responses are believed to be intrinsically important in the containment of T. cruzi and in the pathogenesis of Chagas' disease. Humoral and CMI responses were investigated in 70 T. cruzi-infected persons from an endemic area in northeastern Brazil and in 30 uninfected controls. An epidemiologic survey, physical examination, and blood evaluation were conducted for each subject. The 70 chronically infected persons were subclassified into three clinical groups: indeterminate, cardiac, and gastrointestinal. Serum was tested for antibodies to T. cruzi by hemagglutination assay, indirect immunofluorescent assay, and enzyme-linked immunosorbent assay, and for autoantibodies to tubulin. Serum levels of soluble interleukin-2 receptor (sIL-2R), albumin, and C-reactive protein (CRP) were also measured to assess one parameter each of immunosuppression, nutritional status, and inflammation. The proliferative response of peripheral blood mononuclear cells (PBMC) to T. cruzi antigens, mitogen (phytohemagglutinin), and antigen-free controls was also assessed. Our data did not reveal any significant differences in serum levels of antibodies to T. cruzi, antibodies to tubulin, albumin, CRP, or sIL-2R among the subgroups of infected individuals. The data demonstrate differences in CMI responses. Trypanosoma cruzi trypomastigote lysate stimulated proliferation of PBMC from infected persons, but not uninfected controls. Patients with symptomatic Chagas' disease (cardiac and gastrointestinal groups) had decreased cellular responses to T. cruzi lysate (median proliferation index [PI] = 3), compared with those in the indeterminate group (median PI = 9; P < 0.005). Further investigations of the mechanism of this reduced CMI response in those with chronic disease may yield insights into the pathogenesis of Chagas' disease.

The SA85-1.1 protein of the Trypanosoma cruzi trans-sialidase superfamily is a dominant T-cell antigen.

Trypanosoma cruzi currently infects 18 million people, and 30% of those infected develop a chronic inflammatory process that causes significant morbidity or mortality. The major histocompatibility complex class II (MHC-II)-restricted T-cell response is critical to the control of the infection and to the ensuing inflammatory pathology. The specific epitopes or major antigens of this response have not been identified. The parasite simultaneously expresses variant members of the trans-sialidase superfamily. To begin to analyze the MHC-II response to these variant proteins, the response to a single surface protein, SA85-1.1, was initiated. These studies have demonstrated that a biased gamma interferon (IFN-gamma) response to the SA85-1.1 protein develops during T. cruzi infection. In addition, adoptive transfer of a CD4 clone that recognizes an SA85-1.1 epitope, named epitope 1, and immunization with a peptide encoding epitope 1 were protective and suggested that epitope 1 may be immunodominant. In this report IFN-gamma intracellular staining demonstrated that splenocytes from acutely and chronically infected mice, incubated with SA85-1.1 protein or peptides that encode epitope 1, result in IFN-gamma synthesis by 4 to 6% of the splenic CD4 cells. These data indicate that during T. cruzi infection epitope 1 is a major epitope and that 4 to 6% of the CD4 cells are stimulated by a single trans-sialidase superfamily epitope and suggest that a combination of trans-sialidase superfamily proteins combines to stimulate a majority of CD4 cells. These data suggest that during T. cruzi infection the CD4 response to the trans-sialidase superfamily is critical to the protective response and to the ensuing chronic inflammatory pathology.

Trypanosoma cruzi: the effect of nitric oxide synthesis inhibition on the CD4 T cell response to the trans-sialidase superfamily.

During Trypanosoma cruzi infection the trans-sialidase superfamily stimulates the development of a large population of CD4 T lymphocytes that produces IFNgamma. These CD4 T cells fail to proliferate when stimulated in vitro. Why they fail to proliferate remains unclear. Nitric oxide is a critical component of the host immune response against T. cruzi, and to determine if NO inhibits trans-sialidase superfamily-specific proliferative responses, mice were fed either N(G)-nitro-L-arginine methylester (L-NAME), an inhibitor of inducible nitric oxide synthase (iNOS), or N(G)-nitro-D-arginine methyl ester (D-NAME), an inactive analog of L-NAME. The L-NAME-fed mice had increased parasitemia and mortality compared to the D-NAME-fed mice. Following stimulation with a T. cruzi trans-sialidase superfamily protein, splenocytes from both groups of mice failed to proliferate but continued to make similar amounts of IFNgamma, suggesting that the development of the trans-sialidase superfamily-specific CD4 response was not affected by iNOS inhibition. In addition, IL-2 receptor (IL-2R) expression was increased on T cells isolated from L-NAME-fed mice. These data suggest that during T. cruzi infection NO causes downregulation of IL-2R expression, but does not cause inhibition of trans-sialidase superfamily-specific CD4 T cell proliferation. Rather, the trans-sialidase superfamily proliferation may be inhibited by epitope variation.

The surface glycoproteins of Trypanosoma cruzi encode a superfamily of variant T cell epitopes.

Trypanosoma cruzi is an obligate intracellular protozoan parasite. During mammalian infection, extracellular and intracellular parasites simultaneously express multiple members of a polymorphic surface protein superfamily. The effect of this extensive surface protein polymorphism on the mammalian host T cell response is not known. In this report, we identified a surface protein MHC class II-restricted T cell epitope (epitope 1), and cloned 10 surface protein cDNAs that encode epitope 1 variants. All these cDNA variant epitopes were processed and presented to T cells, and some functioned as partial T cell agonists. CD4 T cells primed with epitope 1, and challenged with epitope 1, proliferated and expressed IFN-gamma and IL-4. In contrast, CD4 T cells primed with a mixture of variant epitopes and epitope 1, and challenged with epitope 1, expressed IL-4, but did not proliferate or express IFN-gamma. The data suggest that the simultaneous expression of polymorphic surface proteins that encode variant T cell epitopes may limit the expression of each surface protein epitope below a threshold level required to stimulate a protective IFN-gamma response against that epitope. This system of T cell evasion is unique and contrasts with the sequential antigenic variation used by African trypanosomes to evade Abs directed against their surface proteins.

The surface protein superfamily of Trypanosoma cruzi stimulates a polarized Th1 response that becomes anergic.

Trypanosoma cruzi is an obligate intracellular parasite that chronically infects mammals. Extracellular mammalian stage trypomastigotes simultaneously express and release multiple members of the parasite's surface protein superfamily; these extracellular proteins should stimulate MHC class II-restricted CD4 T cells. The surface protein superfamily, however, encodes variant epitopes that may inhibit this CD4 response. In this report the surface protein-specific CD4 response was investigated. CD4 cells isolated from acutely and chronically infected mice did not proliferate when stimulated with surface proteins. Adoptive transfer of surface protein-specific CD4 clones or immunization with a peptide encoding a surface protein T cell epitope protected mice during T. cruzi infection. These data strongly suggested that surface proteins were expressed and presented to CD4 cells during infection. Limiting dilution analysis identified an expanded population of surface protein-specific CD4 cells during the acute and chronic infection. These surface protein-specific CD4 cells did not produce IL-2 or IL-4, but did produce IFN-gamma. Enzyme-linked immunospot analyses confirmed that many of the surface protein-specific CD4 cells produce IFN-gamma. Together these results suggest that during T. cruzi infection a potentially protective CD4 response becomes anergic. It is possible that this anergy is induced by variant T cell epitopes encoded by the surface protein superfamily.

Pediatric rheumatology in adult rheumatology practices in Washington state.

OBJECTIVE: To determine both the extent to which adult rheumatologists treat children and their level of comfort in doing so. METHODS: A questionnaire was sent to all 77 physicians in the state of Washington who were listed as adult rheumatologists in the American College of Rheumatology (ACR) directory. RESULTS: Sixty-six questionnaires (86%) were returned; 50 were identified as being from private-practicing adult rheumatologists and were the focus of this study. Sixty-two percent of the respondents reported that they care for children; predictors included increased exposure to pediatric rheumatology during fellowship (P = 0.003), increased distance from Seattle (P = 0.001), and listing oneself in the ACR directory as treating children (P = 0.03). Most respondents reported feeling discomfort in treating children younger than 6 years of age, treating Kawasaki disease, and treating polyarteritis nodosa, but most reported feeling comfortable treating children with chronic arthritides. Impediments to referring to a pediatric rheumatologist included distance (median distance 35 miles), convenience for the family, personal preference, and experience in caring for children. Twenty-nine percent reported difficulties referring to a pediatric rheumatologist outside of one's managed care plan. Adult rheumatologists expressed interest in continuing medical education dealing with pediatric rheumatology, preferably with a lecture format in their home communities. CONCLUSION: A significant number of adult rheumatologists care for children. Pediatric rheumatologists should provide both educational and consultative support for these adult rheumatologist colleagues.

Initial intravenous gammaglobulin treatment failure in Kawasaki disease.

OBJECTIVES: To determine initial intravenous gammaglobulin (IVIG) treatment failures in Kawasaki disease (KD) and to report the outcome of retreatment and our use of pulse intravenous (IV) methylprednisolone and cyclophosphamide in patients with persistent KD. STUDY DESIGN: Retrospective analysis of the treatment and response of children with KD over 3 years. RESULTS: Fifty (77%) of 65 patients completely responded to a single treatment with IVIG (2 g/kg). Fifteen patients (23%) required retreatment; 10 patients fully responded but 5 had persistent disease (3 developed coronary aneurysms and 4 developed coronary artery thrombosis). Four of these 5 patients with persistent disease were treated with pulse IV methylprednisolone and 2 were also treated with IV cyclophosphamide. There was no progression of coronary aneurysms and no deaths. No initial patient characteristics predicted IVIG treatment failure or the development of coronary aneurysms. CONCLUSION: Nearly 23% of patients with KD may require retreatment and 8% may develop coronary aneurysm. Additional antiinflammatory therapy, such as IV methylprednisolone and IV cyclophosphamide, may be helpful in treating persistent KD.

Trypanosoma cruzi-infected macrophages are defective in major histocompatibility complex class II antigen presentation.

Trypanosoma cruzi, the intracellular protozoan parasite that causes Chagas' disease, interferes with the host immune response to establish a persistent infection. In this report, we demonstrate that macrophages infected with T. cruzi are unable to effectively present antigens to CD4 T cells. The interference is due to defective antigen-presenting cell (APC) function, as antigen-independent stimulation of the T cell in the presence of infected macrophages is not affected. The defect is distal to antigen processing and is not due to decreased major histocompatibility complex (MHC) class II expression, decreased viability, defective peptide loading in the infected macrophages, nor absence of CD28 co-stimulation. There was a role for gp39: CD40 co-stimulation during antigen presentation to the T cells we studied, but the expression of CD40 on T. cruzi-infected macrophages was not decreased. Antigen-specific adhesion between macrophages and T cells was reduced by infection. Equivalent levels of the adhesion molecules lymphocyte function-associated antigen-1, intercellular adhesion molecule-1, vascular cell adhesion molecule-1 or very late antigen-4 are found on infected and uninfected APC, suggesting that reduced expression of these adhesion molecules was not responsible for the defect in antigen-specific adhesion. The defective T cell:macrophage adhesion may be due to the reduced expression of other adhesion molecules or other changes in the cell induced by infection. Interfering with MHC class II antigen presentation in infected macrophages may help T. cruzi to blunt the immune response by the host.

Trypanosoma cruzi: monoclonal antibodies to the surface glycoprotein superfamily differentiate subsets of the 85-kDa surface glycoproteins and confirm simultaneous expression of variant 85-kDa surface glycoproteins.

Most surface glycoproteins expressed by mammalian-stage forms of Trypanosoma cruzi are homologous to the parasite's trans-sialidase and therefore are members of the parasite's trans-sialidase superfamily. Few members of this superfamily have trans-sialidase activity. The SA85-1 family is a subfamily of the trans-sialidase superfamily whose members lack trans-sialidase activity. The function of these non-trans-sialidase members remains unknown. In this report a series of monoclonal and polyclonal antibodies to the SA85-1 glycoproteins is presented. The mAbs define distinct subgroups of SA85-1 glycoproteins, and these distinct subgroups are simultaneously expressed by individual trypomastigotes, supporting previous studies indicating that multiple SA85-1 glycoproteins and trans-sialidase superfamily glycoproteins are simultaneously expressed by each trypomastigote. In addition, the antibodies define two major subsets of the SA85-1 family (subset 1 and subset 2) based on differences in migration in SDS-PAGE; the subsets do not appear to be created by differences in glycosylation. Subset 1 migrates slower and is spontaneously released or shed preferentially from the parasite surface compared to subset 2. In addition, subset 1 is attached to the trypomastigote surface by a GPI linkage. Since these glycoprotein subsets are differentially expressed, they may have different functions.

The major surface glycoprotein of Trypanosoma cruzi amastigotes are ligands of the human serum mannose-binding protein.

Trypanosoma cruzi, an obligate intracellular protozoan parasite, chronically infects mammals and causes Chagas' disease in humans. T. cruzi evasion of the mammalian immune response and establishment of chronic infection are poorly understood. During T. cruzi infection, amastigotes and trypomastigotes disseminate in the mammalian host and invade multiple cell types. Parasite surface carbohydrates and mammalian lectins have been implicated in the invasion of mammalian cells. A recent study has demonstrated that the human mannose-binding protein and the macrophage mannose receptor, two mammalian C-type lectins, bind to T. cruzi (S. J. Kahn, M. Wleklinski, A. Aruffo, A. Farr, D. Coder, and M. Kahn, J. Exp. Med. 182:1243-1258,1995). In this report we identify the major surface glycoproteins, including the SA85-1 glycoproteins, as T. cruzi ligands of the mannose-binding protein. Further characterization of the interaction between the mannose-binding protein and T. cruzi demonstrates that (i) the SA85-1 glycoproteins are expressed by amastigotes and trypomastigotes but only amastigotes express the mannose-binding protein ligand, (ii) treatment of amastigotes with alpha-mannosidase inhibits the binding of mannose-binding protein, and (iii) amastigote binding of mannose-binding protein is stable despite the spontaneous shedding of some glycoproteins from its surface. Together, the data indicate that developmentally regulated glycosylation of surface glycoproteins controls the expression of ligands that affect the interactions between T. cruzi and mannose-binding protein. It has been established that the binding of mannose-binding protein to microorganisms facilitates their uptake into phagocytic cells. Preferential opsonization of amastigotes with mannose-binding proteins may account for their clearance from the circulation and may contribute to the parasite's ability to invade different cell types.