The effect of costimulatory and interleukin 2 receptor blockade on regulatory T cells in renal transplantation.

Regulatory T cells (Treg) are critical regulators of immune tolerance. Both IL-2 and CD28-CD80/CD86 signaling are critical for CD4(+)CD25(+)FOXP3(+) Treg survival in mice. Yet, both belatacept (a second-generation CTLA-4Ig) and basiliximab (an anti-CD25 monoclonal antibody) are among the arsenal of current immunotherapies being used in kidney transplant patients. In this study, we explored the direct effect of basiliximab and belatacept on the Tregs in peripheral blood both in the short term and long term and in kidney biopsies of patients with acute rejection. We report that the combined belatacept/basiliximab therapy has no long-term effect on circulating Tregs when compared to a calcineurin inhibitor (CNI)-treated group. Moreover, belatacept-treated patients had a significantly greater number of FOXP3(+) T cells in graft biopsies during acute rejection as compared to CNI-treated patients. Finally, it appears that the basiliximab caused a transient loss of both FOXP3(+) and FOXP3(-) CD25(+) T cells in the circulation in both treatment groups raising important questions about the use of this therapy in tolerance promoting therapeutic protocols.

Combination therapy with a CD4-CDR3 peptide analog and cyclosporin A to prevent graft-vs-host disease in a MHC-haploidentical bone marrow transplantation model.

Graft-versus-host disease (GVHD) is a major complication associated with allogeneic bone marrow transplantation (BMT). Cyclosporin A (CsA) has been used as the basis for most immunosuppressive regimens for the prevention of GVHD, but has exhibited only limited effects and is hampered by nephrotoxicity, neurotoxicity, and hepatotoxicity. Previously, we showed that rD-mPGPtide, a structure-base designed peptide analog of the CDR3-like region of domain 1 of the murine CD4 molecule, suppressed the development of GVHD in a MHC-haploidentical murine BMT model when administered early in the course of disease. This peptide analog also inhibited T cell proliferation in mixed lymphocyte reactions (MLR) in vitro. The current results demonstrate that CsA and rD-mPGPtide exhibit an additive inhibitory effect on MLR. Furthermore, the use of CsA and rD-mPGPtide together for prevention of GVHD nearly doubled the median survival time of the mice compared to either agent alone. In addition, the combination therapy reduced the requirement for habitual administration of CsA. Therefore, the use of a CD4-CDR3 peptide can complement and potentiate the immunosuppressive effects of CsA in the prevention of GVHD following allogeneic BMT.

Inhibition of T cell activation by an autoantibody induced by murine retrovirus infection.

This report describes a murine monoclonal IgM antibody, 6E3.C4, induced by retrovirus infection of BALB/ c-H-2b mice which inhibits mitogen stimulation of both mouse and human lymphocytes in vitro. The molecule bound by this antibody appears to be an activation antigen since binding is upregulated by mitogen stimulation. Analysis of the epitope bound by mAb 6E3.C4 revealed that it is associated with a 52-kDa protein with a pI of approximately 5.7 as determined by Western blot analysis. A protein expressing this or a cross-reactive epitope was isolated and determined to be alpha-tubulin by amino acid sequencing. Reactivity with purified alpha-tubulin confirms this identification. These findings suggest a potential role for a cell surface molecule that is either alpha-tubulin or a cross-reactive molecule in the activation processes of T cells.

Inhibitory effect of a CD4-CDR3 peptide analog on graft-versus-host disease across a major histocompatibility complex-haploidentical barrier.

A structure-based designed peptide has been engineered to exhibit the same molecular surface as a portion of the CDR3-like region in domain 1 of the murine CD4 molecule. Earlier in vitro experiments indicated that this analog, known as rD-mPGPtide, inhibited T-cell proliferation in mixed lymphocyte reactions and blocked activation of both normal CD4+ T cells and T-cell lines after T-cell receptor triggering. In addition, rD-mPGPtide proved to be a potent inhibitor in vivo of CD4+ T-cell-mediated experimental allergic encephalomyelitis disease in the SJL mouse model. In this current report, we have evaluated the potential of rD-mPGPtide for suppressing the development of graft-versus-host disease (GVHD) in an irradiated major histocompatibility complex (MHC)-haploidentical murine bone marrow transplantation (BMT) model [(B6 x DBA/2)F1-->(B6 x CBA)F1 (950 cGy)]. Our results indicated that early administration of rD-mPGPtide was effective in the inhibition of alloreactive responses of the donor T cells against the host and thus delayed or prevented the onset of GVHD. The median survival time of animals treated with rD-mPGPtide was enhanced as much as four-fold with as little as a single dose of peptide at the time of transplant. Decreased alloreactivity was indicated by phenotypic and functional analysis of positively selected thoracic duct lymphocytes 4 days after transplant and by histopathological examination of skin and gastrointestinal tissue samples 4 weeks later. Therefore, the administration of a CD4-CDR3 peptide is an efficacious approach against the development of GVHD during allogeneic BMT.

The preferential expansion of functional CD4+ lymphocyte populations in vitro.

We describe a simple and inexpensive chemical procedure for the selective expansion of human CD4+ lymphocytes. The method employs L-leucine methyl ester (LME) to deplete monocytes and large granular lymphocytes, as well as to inhibit growth of CD8+ lymphocytes. LME treatment eliminates granular cells, but most CD8+ lymphocytes, B-lymphocytes, and CD4+ lymphocytes remain. Peripheral blood mononuclear cells (PBMCs) from normal and HIV-positive individuals are treated with LME for 1 h at ambient temperature and cultured in the presence of IL-2 to expand the cell number. Stimulation with the T-cell mitogens concanavalin A, phytohemagglutinin, or OKT3 antibody augments lymphocyte expansion and within 1-3 weeks the culture is greatly enriched (90-100%) in CD4+ lymphocytes. LME-treated lymphocytes expand up to 10-fold during culture in the presence of IL-2 alone and up to 400-fold following treatment with T-cell mitogens. The immune function of LME-treated and expanded peripheral blood lymphocytes was examined using the response to the recall antigens tetanus toxoid and Candida albicans. Fresh PBMCs exposed to these recall antigens proliferated readily. Similarly, LME-treated lymphocytes following expansion responded to these recall antigens with good fidelity to the original PBMC response patterns in four of six donors. The expanded and LME-treated lymphocytes also exhibited good mitogen responses in three of three donors. The LME procedure allows for the simple and inexpensive generation of expanded, immunologically functional, CD4+ lymphocytes.

NMR visibility of Pi in perfused rat hearts is affected by changes in substrate and contractility.

Nuclear magnetic resonance (NMR) spectroscopy does not always detect the total metabolite content in isolated perfused rat hearts. Alterations in NMR peak areas therefore could be caused by a change either in the metabolite content per se or in its NMR visibility. We have therefore compared the ATP, phosphocreatine (PCr), and Pi content of hearts, as determined by 31P-NMR spectroscopy, with the total, chemically determined ATP, PCr, and Pi contents of the same hearts to determine the fractions, if any, that are NMR invisible under different perfusion conditions. The three perfusion buffers used contained 1) glucose, 2) glucose plus high K+, and 3) pyruvate. Fully relaxed 31P-NMR spectra were collected during the final 10 min of perfusion in each group, and the ATP, PCr, and Pi contents were quantified using methylene diphosphonate as an external standard. The hearts were then freeze-clamped and chemically assayed for ATP, PCr, and Pi. Under all three conditions, the NMR-determined ATP and PCr contents were almost identical to the chemically determined values. However, only a portion of the chemically determined Pi was NMR visible. During perfusion with glucose-containing buffer, 39 +/- 8% of the total Pi was NMR visible, and this decreased to 12 +/- 2% (P less than 0.01) during K+ arrest and to 9 +/- 5% (P less than 0.01) during perfusion with pyruvate-containing buffer. In conclusion, whereas the total cellular content of ATP and PCr is always NMR visible during normoxic perfusion, alterations in substrate and contractile status can change the fraction of NMR-visible Pi.

Central nervous system involvement in a patient with chronic lymphocytic leukemia and non-Hodgkin's lymphoma (Richter's syndrome), with concordant cell surface immunoglobulin isotypic and immunophenotypic markers.

Central nervous system (CNS) involvement in Richter's syndrome has not been previously described. This report describes a 45-year-old man with the simultaneous occurrence of B-cell chronic lymphocytic leukemia (CLL), extramedullary large cell non-Hodgkin's lymphoma (NHL), and malignant lymphoid meningeal involvement. In this case, peripheral blood lymphocytes, cerebrospinal fluid (CSF) lymphoblasts, and malignant cells in surgical biopsy tissue obtained from a soft tissue mass all stained concordantly for immunoglobulin isotypes and for B-cell immunophenotypic markers, supporting the hypothesis of a clonal origin for the three malignant cell populations. These observations suggest that the different tumors in Richter's syndrome (CLL and NHL) may represent the clonal progression of a common neoplasm rather than independent neoplastic events. Richter's syndrome and other transformations of lymphoid malignancies (prolymphocytic transformation of CLL, blast crisis of CLL, and blastic transformation of NHL) may all represent possible routes of progression in the natural history of a single neoplasm. The present case also suggests that, in patients with B-cell CLL with CNS symptoms, the possibility of blastic transformation presenting as CNS lymphoma deserves consideration.

Hematologic manifestations in homosexual men with Kaposi's sarcoma.

Peripheral blood and bone marrow findings are presented for six homosexual males with Kaposi's sarcoma. Cytopenia in one or more cell lines was common in this group of patients, including two individuals with pancytopenia. Bone marrow findings in all patients, while not specific, were similar in that adequate numbers of normal appearing erythroid, myeloid, and megakaryocytic elements were present. Mild plasmacytosis as well as reticulin fiber increase were common findings. No patient, at time of study, demonstrated marrow involvement with Kaposi's sarcoma. We conclude that depression of peripheral blood counts in these patients was not due to marrow underproduction, and discuss possible mechanisms for increased blood cell destruction.

Segment stroke work and metabolism depend on coronary blood flow in the pig.

We determined the mechanical and metabolic effects of graded myocardial ischemia in 23 open-chest, anesthetized pigs. By connecting the midportion of the left anterior descending artery (LAD) to the carotid artery via a constant volume, calibrated pump, we reduced the flow in the LAD to 0, 25, 50, and 75% of control rates for periods of 1 h. Flows of 100% and 150% were also examined. Using pairs of ultrasonic crystals to measure segment dimensions, we calculated segment shortening and thickening, and total and systolic stroke work in the ischemic and normally perfused segments. Blood gases, pH, and lactate and inosine balances were determined from the regional coronary venous blood. At coronary blood flows of 0, 25, 50, and 75% of normal resting flow, total segment work was 8 +/- 8, 25 +/- 4, 51 +/- 5, and 80 +/- 6% of control, respectively, while systolic segment work was -2 +/- 5, -10 +/- 5, 40 +/- 5, and 86 +/- 7% of control, respectively (means +/- SE). Thus, the decrease in total segment stroke work is proportional to the decrease in flow over the range 0-100%. However, no useful work (i.e., systolic work) is done until flow exceeds 25%. Segment shortening and thickening are significantly depressed with flows diminished by only 25%. Segmental inosine production correlates with lactate production and parallels decreased mechanical performance.

Hepatitis B "e" antigen: an apparent association with lactate dehydrogenase isozyme-5.

Serums containing the "e" antigen of hepatitis B virus were subjected to electrophoresis in polyacrylamide gel. An extra band appeared in the lactate dehydrogenase isozyme pattern, but this band was undetectable in serums containing antibodies to the e antigenic determinant. Prior separation of the lactate dehydrogenase isozyme-5 fraction by chromatography of serum on minicolumns of diethylaminoethyl-Sephadex-A50 improved electrophoretic identification of the extra band. Neutralization with antibodies to the e antigen as well as by antibodies to the homologous d or y component of the hepatitis B surface antigen removed the extra band; antibodies to the lactate dehydrogenase isozyme-5 removed both the normal and the extra enzymatic band of isozyme-5. This feature of the e antigen provides an assay system for laboratory diagnosis of potential clinical usefulness and suggests its possible role in pathogenesis of hepatocellular injury.

Enzyme tests in diseases of the prostate.

Enzyme tests in diseases of the prostate focus primarily on the use of serum acid phosphatase assays in patients with suspected or histologically proved adenocarcinoma of the prostate. The purpose of this review is to consider various potential clinical uses of the assay, to examine the data available concerning the performance of the test in given clinical situations and to define those situations in which the test is actually useful. Included in this discussion will be sources of false positive and false negative values, predictive values of the test in clinical settings and efforts to minimize shortcomings.

Measurement of lactate extraction ratio by centrifugal analyzer to assess myocardial ischemia.

The measurement of blood lactate to determine myocardial lactate extraction ratio requires a high degree of within-run precision, since small changes between arterial and coronary sinus lactate may occur. These changes in man may take place at lactate levels in the normal range, 5-18 mg/dl (0.56-2.00 mmol/l). The authors have developed a method for blood lactate determination utilizing commercially available reagents in a centrifugal analyzer (Centrifichem). Within-run precision in the low normal range, 5.4 mg/dl (0.60 mmol/l), showed a coefficient of variation of 7%. Precision extends to 50 mg/dl (5.55 mmol/l), and agreement with blood lactate values obtained with the Dupont ACA is good.

Polyamines in malignant melanoma. Urinary excretion and disease progress.

Urinary polyamine concentrations in 91 samples were assayed in 79 patients with malignant melanoma who were classified as to clinical stage, as well as to activity of disease. Patients with active disease had higher mean polyamine values, increased frequency of polyamine elevations, and increased frequency of two or more elevations, than did patients with stable disease. Elevations of a single polyamine were seen as frequently in patients whose disease was considered stable as in those who showed progression. The polyamines may be useful as guides to activity of the disease, provided further studies can identify additional sources of nonspecific elevations.