Interleukin (IL)-1 receptor-associated kinase (IRAK) requirement for optimal induction of multiple IL-1 signaling pathways and IL-6 production.

Interleukin (IL)-1 is a proinflammatory cytokine with pleiotropic effects in inflammation. IL-1 binding to its receptor triggers a cascade of signaling events, including activation of the stress-activated mitogen-activated protein (MAP) kinases, c-Jun NH2-terminal kinase (JNK) and p38 MAP kinase, as well as transcription factor nuclear factor kappaB (NF-kappaB). IL-1 signaling results in cellular responses through induction of inflammatory gene products such as IL-6. One of the earliest events in IL-1 signaling is the rapid interaction of IL-1 receptor-associated kinases, IRAK and IRAK-2, with the receptor complex. The relative roles of IRAK and IRAK-2 in IL-1 signaling pathways and subsequent cellular responses have not been previously determined. To evaluate the importance of IRAK in IL-1 signaling, IRAK-deficient mouse fibroblast cells were prepared and studied. Here we report that IL-1-mediated activation of JNK, p38, and NF-kappaB were all reduced in embryonic fibroblasts deficient in IRAK expression. In addition, IL-6 production in response to IL-1 was also dramatically reduced in IRAK-deficient embryonic fibroblasts and in skin fibroblasts prepared from IRAK-deficient mice. Our results demonstrate that IRAK plays an essential proximal role in coordinating multiple IL-1 signaling pathways for optimal induction of cellular responses.

Correlates of insulin antibodies in newly diagnosed children with insulin-dependent diabetes before insulin therapy.

Insulin antibodies, as measured by plasma radiolabeled insulin-binding capacity, were determined in 124 newly diagnosed insulin-dependent diabetic (IDDM) children before and after 1, 3, and 5 days of insulin therapy. Controls were 35 nondiabetic children with plasma insulin binding capacity of 1.0 +/- 0.7%. The patients were divided into three groups according to their plasma insulin-binding capacity. Group 1 (N = 79) had binding within two standard deviations (SD) of the control mean, group 2 (N = 20) had insulin binding 2-6 SD above controls, and group 3 (N = 25) showed insulin-binding capacity of more than 6 SD above the control mean. After exogenous insulin therapy, plasma 125I-insulin-binding capacity dropped significantly in both groups 2 and 3, concurrent with significant increases in plasma insulin levels. The three groups differed from each other in that patients in group 3 were significantly younger than in the other groups and clinically seemed to be more severely dehydrated, as reflected in their higher levels of serum urea nitrogen, plasma glucose, potassium, and elevated pulse rate. The three groups did not differ in respect to sex, HLA-DR antigens, Coxsackie-B antibody titers, islet cell cytoplasmic antibodies, immunoglobulin level, and C-peptide levels. Only two of 446 siblings of IDDM children showed elevated insulin binding, one of whom developed IDDM 6 wk later. The presence of an insulin-binding substance probably representing insulin antibodies in some cases of newly diagnosed IDDM suggests that autoimmunity in this disorder is not limited to the B-cell membrane and cytoplasm and lends further support to the heterogeneity of IDDM.

The Pittsburgh insulin-dependent diabetes mellitus (IDDM) morbidity and mortality study. Mortality results.

A follow-up study of 1966 patients with insulin-dependent diabetes mellitus (IDDM) who were diagnosed at Children's Hospital of Pittsburgh (CHP) between 1950 and 1981 has been completed. The mean age of the population at follow-up was 21.2 yr with a mean duration of IDDM of 12.9 yr. Nine percent of the patients were deceased, a sevenfold excess in mortality compared with the U.S. population. The relative increase in mortality was greater for females than males and greater for blacks than whites. Before age 20, the primary excess in mortality was at onset of IDDM, or within 6 mo after onset, and was due to acute diabetic complications. After age 20, the annual mortality risk was approximately 2%, which was more than 20 times greater than for the U.S. population. Renal disease was responsible for the majority of these deaths. There was a reduced risk of dying for diabetic patients who were diagnosed between 1966 and 1971 compared with patients diagnosed during earlier years.

HLA heterogeneity of insulin-dependent diabetes mellitus at diagnosis. The Pittsburgh IDDM study.

Although some previous studies have suggested that insulin-dependent diabetes mellitus (IDDM) is a heterogeneous condition with variant forms being associated with HLA-DR types, the evidence, thus far, is conflicting. To address this issue, we have examined the presenting characteristics of a consecutive admission series of 200 newly diagnosed cases of IDDM from the Children's Hospital of Pittsburgh. Because HLA-DR frequencies vary by race, data are presented only for the 172 white cases with complete HLA-DR typing. HLA-DR3 was found more frequently among male cases and DR4 among female cases (P less than 0.005). Generally, patients with DR4 presented with a severer clinical picture, being more likely to have impaired consciousness and significant dehydration. In addition, patients with DR4 were more likely to be acidotic, ketotic, and to more frequently report a recent viral infection. This latter finding was supported by a greater frequency of antibodies to Coxsackie-B viruses in the DR4 cases at presentation. These results therefore suggest that there is considerable heterogeneity in IDDM, at least in presenting characteristics, according to HLA-DR type.

Effects of inflammatory cytokines and phorbol esters on the adhesion of U937 cells, a human monocyte-like cell line, to endothelial cell monolayers and extracellular matrix proteins.

The accumulation of mononuclear phagocytes at sites of chronic inflammation is dependent on an increase in the rate of extravasation of blood-borne monocytes through the vascular endothelium into the connective tissue. Once the monocytes have emigrated into the connective tissue, they may differentiate into tissue macrophages, presumably following interactions with extracellular matrix proteins. To study these processes, we tested the effects of cytokines and phorbol esters on the adhesion of U937 cells, a human monocyte-like cell line, to cultured endothelial cells (EC) and to matrix proteins. In the absence of cytokines, very few of the U937 cells adhered to EC (5% or less in most experiments). When EC were pretreated for optimal periods of time (4-8 hr) with recombinant interleukin-1 alpha (IL-1 alpha), IL-1 beta, tumor necrosis factor-alpha (TNF alpha), or lymphotoxin (LT; also known as TNF-beta), 35-85% of the U937 cells were able to bind. Interferon-gamma (IFN-gamma) and interleukin-2 (IL-2) did not stimulate U937-EC binding, even though IFN-gamma was shown to increase EC adhesiveness for T lymphocytes. Phorbol esters also greatly stimulated U937-EC adhesion but, in this case, the increase was due to an action on the U937 cells. A monoclonal antibody (MAb), 60.3, against the CD11/CD18 family of leukocyte adhesion molecules partially inhibited the adhesion of untreated and phorbol ester-treated U937 cells to noncytokine-treated EC. However, that MAb had no effect on U937 cell binding to TNF-alpha-treated EC. Thus U937 cells use both CD11/CD18-dependent and -independent mechanisms to adhere to EC. In the absence of stimulating agents, only a small proportion of the U937 cells (2-20%) adhered to fibronectin (FN), and almost none bound to either laminin (LN) or gelatin (denatured type I collagen). In the presence of phorbol esters, a much larger proportion of the U937 cells adhered to FN, with only slight increases in the proportion of cells which bound to LN or gelatin. Additional adhesion assays performed in the presence of a pentapeptide containing the amino acid sequence arg-gly-asp (RGD), which is part of one of the cell-binding domains of FN, demonstrated that the RGD-containing peptide almost totally blocked the phorbol ester-induced adhesion of U937 cells to FN. In contrast, the peptide had no inhibitory effect on the phorbol ester-induced binding of U937 cells to EC.

Immunomodulation and adenoviral gene transfer to the lungs of nonhuman primates.

Previous data from our laboratory and others have demonstrated a critical role for the CD4+ T lymphocyte in in vivo immune responses to recombinant adenoviral vectors. In rodent models, this subset of T cells is required for T cell proliferation, subsequent cytotoxic T cell generation, and production of anti-adenoviral antibodies by B cells. Both depleting and nondepleting anti-CD4 antibodies can attenuate these immune responses to recombinant adenovirus. On the basis of these data, we hypothesized that a nondepleting CDR-engrafted anti-human CD4 antibody (OKT4A) with cross-reactivity to rhesus macaques would attenuate both T and B cell responses to intrapulmonary administration of recombinant adenovirus and permit prolonged reporter gene expression and permit secondary gene transfer. Juvenile rhesus macaques were treated with PBS or OKT4A antibody (10 mg/kg) daily beginning 1 day prior to and up to 11 days after gene transfer. OKT4A resulted in significant attenuation of lymphocyte recruitment into the lung, lymphocyte-proliferative responses to both adenovirus capsid proteins and transgene protein, and adenovirus-induced interferon-gamma elaboration in whole blood and hilar lymph nodes. However, OKT4A was ineffective in attenuating adenovirus-induced IL-4 production in whole blood or hilar lymph nodes, generating neutralizing anti-adenoviral antibodies, or permitting secondary gene transfer. As all the monkeys in this protocol had baseline-detectable anti-adenoviral antibodies by ELISA that were nonneutralizing, analogous to most patients with cystic fibrosis, we postulate that anti-CD4 did not block the proliferation of memory B cells. Moreover, these data suggest that for transient immunomodulation to be successful, strategies need to focus specifically on B cell activation independent of CD4+ T cell help.

Lymphocyte adhesion to endothelial cells in vitro: models for the study of normal lymphocyte recirculation and lymphocyte emigration into chronic inflammatory lesions.

Lymphocytes preferentially leave the bloodstream to enter secondary lymphoid organs or sites of inflammation by first adhering to, and then migrating through, the walls of specialized postcapillary venules known as high endothelial venules. To study the initial adhesion event between lymphocytes and endothelial cells, two different in vitro assays have been developed. In the first, lymphocytes are incubated on frozen sections of lymphoid organs or other tissues. Under certain conditions, lymphocytes specifically bind to the endothelial cells of high endothelial venules in such sections. The results of monoclonal antibody inhibition studies have suggested that endothelial cells at various lymphoid organs, and at certain inflammatory lesions, may express organ-specific ligands on their surface, which bind to corresponding organ-specific "homing receptors" on the lymphocytes. The second assay measures the adhesion of lymphocytes to confluent monolayers of viable, cultured endothelial cells. Because pretreatment of such cell monolayers with a number of cytokines produced at inflammatory sites stimulates an increase in the adhesiveness of the cells for lymphocytes, it has been suggested that such cytokine-induced increases in endothelial cell adhesiveness may be important in the induction of lymphocyte traffic into such lesions. Unlike the homing receptor type of binding described above, the cytokine-induced increase in lymphocyte-endothelial cell adhesion is presumably non-tissue-specific. Results of monoclonal antibody inhibition studies in this system have suggested that at least two ligand-receptor interactions may be involved. Monoclonal antibodies to the lymphocyte function-associated antigen-1 greatly inhibited the adhesion of T cells to untreated endothelial cells, but had little or no inhibitory effect on T-cell adhesion to cytokine-treated endothelial cells.

Organ-specific and non-organ-specific lymphocyte receptors for vascular endothelium.

The recirculation of lymphocytes from blood to lymph and back to blood is necessary for the proper functioning of the immune system as it facilitates interactions between antigen-reactive clones of lymphocytes and antigen-presenting cells. The first step in the emigration of a blood-borne lymphocyte into either a secondary lymphoid organ or an inflammatory lesion is its adherence to vascular endothelial cells (EC) lining unique post-capillary venules known as high endothelial venules (HEV). Several groups have recently cloned and sequenced genes which may encode organ-specific lymphocyte receptors for the EC of such HEV. The extracellular portion of the putative murine lymphocyte homing receptor for peripheral lymph node HEV is composed of an N-terminal lectin-like domain, followed by an epidermal growth factor-like domain, and then two identical repeating domains which are homologous to a number of complement-binding proteins. A hydrophobic transmembrane domain and a cytoplasmic tail complete the structure. A very similar gene structure has been reported for a cytokine-inducible EC surface protein which is involved in neutrophil-EC adhesion in vitro. In marked contrast, the gene for a putative human lymphocyte homing receptor appears to belong to a gene family which encodes cell-surface molecules with receptor activity for extracellular matrix (ECM) proteins. Similarly, the cell-surface molecule which appears to be the murine lymphocyte receptor for Peyer's patch HEV is homologous, if not identical, to the human VLA-4 molecule, another receptor with binding activity for an ECM protein. It has also been demonstrated that lymphocyte function-associated antigen 1 (LFA-1) acts in a non-organ-specific manner to mediate lymphocyte-EC adhesion. Finally, other non-organ-specific lymphocyte adhesion molecules for EC may include CD4 and CD8 (which bind to class II and class I MHC antigens, respectively), and CD2 (which binds to LFA-3).

Human dermal microvascular endothelial cells behave like umbilical vein endothelial cells in T-cell adhesion studies.

The adhesion of T lymphocytes to human dermal microvascular endothelial cells (DMVEC) in vitro has been tested after stimulation of the DMVEC with gamma interferon (IFN-gamma), interleukin 1 (IL-1), or a bacterial lipopolysaccharide (LPS). These agents enhanced T-cell adhesion in a manner similar to that previously observed with human umbilical vein endothelial cells (UVEC). Moreover, phorbol ester stimulation of T cells enhanced T-cell adhesion to both DMVEC and UVEC. Unstimulated and phorbol ester-enhanced T-cell adhesion to both DMVEC and UVEC was strongly inhibited by monoclonal antibody (Mab) 60.3 against the surface membrane CDw18 glycoprotein complex. In contrast, Mab 60.3 had a much weaker inhibitory effect on the binding enhancement due to IL-1, LPS, or IFN-gamma, suggesting that these agents may enhance adhesion by a mechanism at least partially independent of CDw18. These observations suggest that DMVEC behave in a similar fashion to UVEC in T-cell adhesion studies, and support previous conclusions that modulation of lymphocyte endothelial cell adhesion by cytokines, bacterial products, and phorbol esters may be relevant to lymphocyte adhesion and migration in vivo.

T cell adhesion to extracellular matrix molecules secreted by endothelial cells cultured on a substrate of type IV collagen.

T cell emigrating from the bloodstream into lymphoid organs or sites of inflammation in the connective tissue must adhere to, and traverse, the subendothelial basement membrane (BM). The goal of the current investigation was to develop a method to study the adhesion of T cells to endothelial cell (EC)-derived extracellular matrix (ECM) as a model for the interaction of T cells with the subendothelial BM in vivo. To be certain that we were truly measuring T cell adhesion to ECM molecules secreted by the EC, it was necessary to culture the EC on a substrate to which T cells could not attach. Non-tissue culture-treated microtiter plate wells which had been coated with type IV collagen (tIVC), a major constituent of BM in vivo, were found to be suitable for this purpose since EC, but very few T cells, adhered to such wells. After incubating the EC on a substrate of tIVC in non-treated wells for a period of 48 h, the EC were gently removed from their underlying ECM and T cell adhesion to that ECM was examined. Using this system, it was observed that approximately 15-40% of human peripheral blood T cells specifically adhered to ECM molecules produced by the EC. This method should be useful as a model for the interactions of T cells and other leukocytes with the vascular BM in vivo.

Nonhuman primate responses to murine and humanized OKT4A.

A nonhuman primate antimurine response (MAMA) has been observed in 17 cynomolgus renal allograft recipients of murine OKT 4A. Neither cyclosporine, nor total-lymphoid irradiation, nor donor bone marrow preparation inhibited this antixenogeneic response. In an attempt to alter the antimurine basis of the response, a humanized chimeric OKT4A (IgG4) containing the entire variable portion of the murine OKT4A and a humanized CDR grafted OKT4A mAb sharing only the Complementarity Determining Region from the murine OKT4A, were administered to 8 cynomolgus allograft recipients. MAMA was detected in each recipient. In contrast to sera from recipients of murine OKT4A, sera from recipients of humanized OKT4A displayed no reactivity to other murine mAbs. MAMA specificity did not assay constant (C) region differences between the murine and humanized mAb; however, C region homology in humans should preclude a human antimouse antibody (HAMA) to the Fc portion of a humanized mAb. Furthermore, cynomolgus recipient serum levels of the humanized OKT4A mAb were maintained (> 1 microgram/ml) for a longer period than following treatment with murine OKT4A (murine < 12 days versus between 12 and 24 days for the humanized). If the HAMA response to humanized mAb in future clinical trials, were to be predictably anti-idiotypic, then the opportunity for treatment with sequential mAbs of differing idiotypes would be retained. Moreover, these current studies also suggest that humanized construction may influence the duration of therapeutic mAb levels. Thus, anti-idiotypic reactivity may not be as consequential to the clinical administration of humanized mAb to allograft recipients.

Pittsburgh Insulin-Dependent Diabetes Mellitus Morbidity and Mortality Study: physical activity and diabetic complications.

The long-term health consequences of chronic physical activity for patients with type I diabetes are unknown. In the current study, the association of physical activity to diabetic complications was assessed in 696 type I diabetic individuals diagnosed between 1950 and 1964. Participation in team sports in high school or college was not associated with a decreased prevalence of severe retinopathy or blindness later in life. There was, however, a suggestion of a negative association between physical activity and both cardiovascular disease and overall mortality, ie, individuals who participated in team sports were somewhat less likely to report macrovascular disease at follow-up or to have died than nonparticipants. The relationship between physical activity and diabetic complications only appeared in male subjects. The results suggest that activity early in life by patients with type I diabetes does not appear to be associated with an adverse health effect and may, in fact, be beneficial.

Interferon-gamma increases susceptibility of murine pancreatic beta cells to lysis by allogeneic cytotoxic T lymphocytes.

The selective loss of insulin-producing pancreatic beta cells which occurs in IDDM has been postulated to result from lysis by beta cell-specific cytotoxic T lymphocytes (CTL). CTL typically recognise antigen in the context of MHC class I molecules, which are normally present at low levels on beta cells. However, hyperexpression of class I antigens on islet cells has been observed in the early stages of beta cell destruction in IDDM. Since interferon-gamma (IFN-gamma) is known to increase class I expression on a number of cell types, we have investigated the responses of murine beta cells to this cytokine under various conditions. Two color immunostaining followed by FACS analysis showed that on average, only 14.9 +/- 3.1% of cultured beta cells were class I positive. However, a majority of beta cells could be induced to express class I after 24 hours of IFN-gamma treatment, and maximal induction (80-90% positive) occurred after 48 hours. Importantly, increased class I expression on beta cells could be achieved with very low concentrations of IFN-gamma (1-10 U/ml). Expression of class II MHC was never detected under any of the conditions employed to up-regulate class I. Interestingly, although islet cells were only moderately susceptible to lysis by allospecific CTL, this susceptibility was markedly enhanced by prior exposure of the islets to IFN-gamma. Taken together, these results suggest that beta cells are extremely susceptible to up-regulation of class I MHC molecules by IFN-gamma, and that this property may render these cells particularly susceptible to lysis by autologous class I-restricted CTL. Since enhanced expression of class I frequently accompanies inflammatory responses and viral infections, this property of beta cells may account in part for their selective destruction in IDDM.

Analyses on possible heterogeneity of IDDM based on presence of islet cell cytoplasmic antibody at diagnosis.

In a large, representative sample of newly-diagnosed IDDM patients, using a highly sensitive assay to detect islet cell cytoplasmic antibodies (ICA), no marked differences were found between ICA+ and ICA- patients on various clinical, genetic, immunologic, and epidemiologic characteristics. In particular, there was no evidence for associations between ICA status at diagnosis and either sex, race, family history of IDDM, HLA-DR phenotype, antibody titers to Coxsackie B viruses, immunoglobulin levels, C-peptide and glycosylated hemoglobin concentrations, or insulin requirements. The most significant relationship was between the presence of ICA and a young age at diagnosis; however, the large overlap between the distributions of the ages at onset for ICA+ and ICA- groups on this variable suggests that this association is of limited importance. These data suggest that the presence or absence of ICA at diagnosis may not be useful in defining possible subtypes of IDDM.

Familial and sporadic insulin-dependent diabetes: evidence for heterogeneous etiologies?

Heterogeneity within insulin-dependent diabetes mellitus (IDDM) has been hypothesized, but few studies have focused on differences which may exist between familial and sporadic IDDM cases. Presenting characteristics for 330 white, newly diagnosed IDDM cases were evaluated. Familial cases were older (10.2 +/- 5.1 years vs 7.9 +/- 4.2 years, P = 0.010) and had, on average, less severe metabolic disturbances at presentation, as demonstrated by lower mean hemoglobin A1 (12.6 +/- 2.4% vs 14.4 +/- 2.6%, P = 0.001) and mean insulin dose at discharge (0.62 +/- 0.35 U/kg/day vs 0.85 +/- 0.29 U/kg/day, P less than 0.001), and higher mean plasma bicarbonate concentrations (19.3 +/- 3.9 mmol/l vs 15.8 +/- 5.9 mmol/l, P = 0.023) and mean plasma C-peptide levels (0.35 +/- 0.36 pmol/ml vs 0.14 +/- 0.15 pmol/ml, P less than 0.001). Further analyses on a subset of IDDM cases (n = 100) indicated that initial differences in metabolic indices observed at diagnosis were no longer apparent at one-year post-diagnosis. These results suggest that the etiology of familial and sporadic IDDM is similar and that the less severe presentation observed at diagnosis in the familial cases may be due to earlier identification of the disease, reflecting increased parental knowledge of diabetic symptoms and/or frequent testing for diabetes.

Anti-HLA-B27 antibodies in sera from patients with gram-negative bacterial infections.

Several forms of seronegative polyarthritis are strongly associated with HLA-B27, and a number of microorganisms have been implicated in the etiology of these diseases. To explain the association between HLA-B27 and arthritis initiated by infection with these organisms, it has been proposed that there is immunologic cross-reactivity between the B27 molecule and 1 or more microbial antigens, and that this cross-reactivity leads to tolerance to such infection and/or to the production of anti-HLA-B27 cross-reactive antibodies. Such cross-reactive antibodies were detected in the sera of only 2 of 63 patients recently infected with Shigella flexneri, Campylobacter jejuni, or Yersinia enterocolitica who had highly significant antibody levels against the infecting bacterial species. Most striking was the absence of anti-HLA-B27 antibody in the serum of 16 of 17 patients who developed reactive arthritis following Yersinia infection.

Production of interleukin 1 by human endothelial cells.

Vascular endothelial cells (EC) play an important role in the emigration from the blood of the mononuclear cells that participate in the chronic inflammatory response. Because EC express a number of functions of cells of the monocyte/macrophage lineage, EC culture supernatants (ECSN) were examined for the presence of IL 1. In these supernatants, IL 1 activity was low when EC were cultured in the presence of serum. The low level of activity appeared to be due to the spontaneous production by the EC of inhibitors of the thymocyte proliferation assay of IL 1, of 70 kd and 9 kd, as measured by AcA Ultrogel filtration. When EC were cultured in the absence of serum, IL 1 activity was easily demonstrated in crude supernatants. Upon stimulation with LPS, the amounts of IL 1 activity were greatly increased. The release of IL 1 was an early event, detectable after 1 hr of incubation and reaching a maximum after 24 hr. The IL 1 activity produced by EC demonstrated a number of similarities to that of IL 1 produced by monocytes. On AcA 54 gel filtration, as with monocyte-derived IL 1, the IL 1 activity was found in two peaks of 50 to 60 kd and 16 to 18 kd. Upon chromatofocusing of the 16 to 18 kd peak, three active fractions were found, eluting near pH 7.0, 5.6, and 5.0. In addition, when LPS-stimulated ECSN and purified monocyte-derived IL 1 were incubated with a rabbit anti-IL 1 antibody, a parallel reduction in thymocyte-stimulating activity was observed, suggesting that the active agent in ECSN shared a common antigenic site with IL 1. The demonstration of IL 1 production by EC provides additional evidence that these cells, in addition to their functions as vascular cells, may also participate in some of the immune and nonimmune functions previously ascribed to macrophages.

Phorbol ester-stimulated T lymphocytes show enhanced adhesion to human endothelial cell monolayers.

Phorbol esters have been used to study changes in the adhesiveness of T cells to endothelial cells (EC) after activation. The phorbol esters 12-O-tetra-decanoylphorbol-13-acetate (TPA) and 4-beta-phorbol-12,13-dibutyrate (P(Bu)2), but not the biologically inert 4-alpha-phorbol-12,13-didecanoate, strongly increased the binding of 51Cr-labeled T cells to human umbilical vein EC monolayers in microtiter wells. Binding to fibroblasts and gelatin-coated plastic was also increased, but to a lesser extent. Increased binding was observed at 0.3 ng/ml, with maximal enhancement at 33 to 100 ng/ml. Enhancement occurred within 1 min, with maximal increase after 15 min. Preincubation studies with P(Bu)2 showed that binding enhancement was entirely attributable to an effect on T cells, with no action on EC. Additive binding enhancement was seen when phorbol esters and agents that alter adhesion by acting on EC (LPS, IL 1, or IFN-gamma) were used together. The increase in T cell adhesion to EC after T cell activation may contribute to the selective emigration of activated T cells from the blood into developing inflammatory lesions. The rapid increase in binding suggests that this may be an important mechanism for immediate localization of circulating T cells, particularly sensitized T cells, in the cellular immune response, perhaps involving the activation of these cells at the endothelial blood-tissue interface.