Identification of a second class of IgG Fc receptors on human neutrophils. A 40 kilodalton molecule also found on eosinophils.

We describe a newly recognized 40 kD FcR for IgG on human neutrophilic granulocytes. An mAb (IV3) developed against the IgG FcR of K562 cells, and specific as well for a 40 kD FcR on human monocytes and platelets, was found to purify by affinity adsorption a 40 kD protein from detergent lysates of surface-radioiodinated neutrophils. This protein, proteolytically degraded to 33 kD when purified in the absence of diisopropylfluorophosphate, is distinct from the 51-73 kD protein precipitated by the anti-neutrophil FcR mAb, 3G8, previously described by others. Complete inhibition of binding of rabbit IgG-coated erythrocytes to neutrophils was achieved only when both antibodies, IV3 and 3G8, were used. Fab fragments of IV3 were as effective inhibitors as the intact molecule. IV3 IgG or Fab fragments completely and selectively inhibited immune complex-mediated generation of superoxide by human neutrophils; superoxide generation by other stimulants was not abrogated by IV3. This antibody (IV3) bound also to human eosinophils and completely inhibited the binding of IgG-coated erythrocytes to eosinophils. IV3 appears to define the human homolog of the murine macrophage FcRII identified initially by mAb 2.4G2 and present in the mouse on both neutrophils and eosinophils.

Variability in the biological response to anti-CD20 B cell depletion in systemic lupus erythaematosus.

OBJECTIVE: To study the effects in systemic lupus erythaematosus (SLE) of B cell directed therapy with rituximab, a chimeric monoclonal antibody directed at CD20+ B cells, without concomitant immunosuppressive therapy in mild to moderate SLE. METHODS: Patients (n=24) with active SLE and failure of >or=1 immunosuppressive were recruited from three university centres into this phase I/II prospective open-label study. Patients were followed for 1 year to assess safety, efficacy and biological effects. RESULTS: In total, 18 of the patients scheduled to receive the full lymphoma dose of rituximab were evaluable for B cell levels in peripheral blood. Of these, 17 had effective CD19+ B cell depletion (<5 cells/microl). However, six of the depleted patients showed B cell return before 24 weeks. A total of 70% of patients improved by week 55, as defined by an SLE Disease Activity Index (SLEDAI) score improvement of >or=2 units from baseline. The degree of CD19+ B cell depletion was correlated with SLEDAI improvement at week 15 (r=0.84). In general, rituximab infusions were well tolerated. Approximately a third of the patients developed human anti-chimeric antibody (HACA) titres, which correlated with poor B cell depletion. Most patients (9 of 14) did not respond to immunisations with Pneumovax and tetanus toxoid. CONCLUSIONS: Rituximab is a promising new therapy for SLE. The variability of responses in patients with SLE may be related to HACA formation. The failure to respond to immunisations is surprising, in view of the apparently low risk of infections. Better biological markers are necessary to follow these patients during treatment.

Human platelet Fc receptor for immunoglobulin G. Identification as a 40,000-molecular-weight membrane protein shared by monocytes.

We have recently shown that human monocytes and U937 cells possess two molecular classes of Fc gamma receptor. One, a 72,000-mol-wt sialoglycoprotein, has high affinity for certain subclasses of human and murine monomeric IgG. The other is a 40,000-mol-wt protein (p40) with low affinity for monomeric IgG but with the capacity to bind IgG aggregates or IgG-coated particles. In the present study, a 40,000-mol-wt single chain protein, apparently identical to p40 from U937 cells, was isolated from surface-radioiodinated human platelets by affinity purification using a murine IgG2b monoclonal antibody to p40. This 40,000-mol-wt protein was not seen when control IgG2b or unrelated murine monoclonal antibodies were employed in place of anti-p40. The same 40,000-mol-wt protein was also recovered from an IgG-Sepharose affinity adsorbent, but not from ovalbumin-or myoglobin-Sepharose. The 72,000-mol-wt Fc gamma receptor of monocytes was not identified on platelets. Monoclonal anti-p40 and Fab fragments derived from this antibody blocked platelet aggregation by heat-aggregated human IgG, whereas a control murine IgG2b protein had little or no inhibitory effect at 500-1,000-fold higher concentrations. A murine IgG1 monoclonal antibody, reactive with an unrelated platelet-specific membrane antigen, did not inhibit platelet responses to aggregated IgG. Anti-p40 did not affect platelet aggregation by thrombin, collagen, or fibrinogen plus ADP. Although anti-p40 did not directly aggregate platelets in the concentrations employed, cross-linking with F(ab')2 goat anti-murine Ig induced apyrase-sensitive aggregation of anti-p40-treated platelets. This indicates that p40 possesses transmembrane linkage for platelet activation and secretion. These observations strongly suggest that this newly recognized 40,000-mol-wt platelet membrane protein serves as an Fc gamma receptor.

Acute respiratory exposure of human volunteers to octamethylcyclotetrasiloxane (D4): absence of immunological effects.

Humans are exposed to silicones in a number of commercial and consumer products. Some of these silicones, including octamethylcyclotetrasiloxane (D4), are volatile. Therefore, there is a potential for respiratory exposure. A pharmacokinetic analysis of respiratory exposure to D4 is presented in the accompanying paper (M. J. Utell et al., 1998, Toxicol. Sci. 44, 206-213). Possible immune effects of respiratory exposure to D4 are investigated in this paper. Normal volunteers were exposed to 10 ppm D4 or air for 1 h via a mouthpiece using a double-blind, crossover study design. Assays were chosen to screen for immunotoxicity or a systemic inflammatory response. Assessment of immunotoxicity included enumeration of peripheral lymphocyte subsets and functional assays using peripheral blood mononuclear cells. Because in humans there is no direct test for adjuvant effect of respiratory exposure, we analyzed proinflammatory cytokines and acute-phase reactants in peripheral blood, markers for a systemic inflammatory response, as surrogate markers for adjuvancy. These tests were repeated when the volunteers were reexposed to D4 approximately 3 months after this initial exposure. Blood was obtained prior to exposure, immediately postexposure, and 6 and 24 h postexposure. In these short-term, controlled human exposures, no immunotoxic or proinflammatory effects of respiratory exposure to D4 were found.

Oral pentoxifylline inhibits release of tumor necrosis factor-alpha from human peripheral blood monocytes : a potential treatment for aseptic loosening of total joint components.

BACKGROUND: Pentoxifylline (Trental) is a methylxanthine-derivative drug that has been used for more than twenty years in the treatment of peripheral vascular disease. Pentoxifylline is also a potent inhibitor of tumor necrosis factor-alpha (TNF-alpha) secretion, both in vitro and in vivo, and has demonstrated efficacy in the treatment of certain animal and human inflammatory diseases. Pentoxifylline has a potential therapeutic role in the treatment of aseptic loosening of total joint replacement components because it inhibits TNF-alpha secretion by particle-stimulated human peripheral blood monocytes. The purpose of our study was to determine whether the particle-stimulated secretion of TNF-alpha by peripheral blood monocytes was inhibited in volunteers who had received pentoxifylline orally. METHODS: Human peripheral blood monocytes were harvested from eight healthy volunteers and were exposed to three different concentrations of titanium particles or to 500 ng/mL of lipopolysaccharide as a positive control. The same volunteers were then given pentoxifylline (400 mg, five times per day) for seven days. Their peripheral blood monocytes were again isolated and exposed to experimental conditions, and the TNF-alpha levels were measured. RESULTS: The peripheral blood monocytes from all eight volunteers showed a significant reduction in TNF-alpha release following oral treatment with pentoxifylline. This reduction was observed at exposures of 10(7) and 10(6) titanium particles/mL and in the lipopolysaccharide-treated group, but not at 10(5) particles/mL. CONCLUSIONS: To our knowledge, this is the first study to demonstrate the ability of an oral drug to decrease the release of TNF-alpha from human peripheral blood monocytes exposed ex vivo to particle debris. TNF-alpha is involved in the pathogenesis of osteolysis and subsequent loosening of total joint arthroplasty components. The ability to suppress the release of TNF-alpha in patients with a total joint replacement may help to control osteolysis and to reduce the development of aseptic loosening. This effect could increase implant longevity and decrease the need for revision arthroplasty.

Increased levels of tumor necrosis factor-alpha and interleukin-6 protein and messenger RNA in human peripheral blood monocytes due to titanium particles.

Cytokines produced by macrophages in the periprosthetic membranes surrounding joint replacements have been implicated as causal agents in osteolysis and prosthetic loosening. The present study characterizes the response of human peripheral blood monocytes to titanium particles. Monocytes were obtained from volunteers and blood that had been donated to the American Red Cross and were cultured in the presence of titanium particles (one to three micrometers in diameter). There were consistent dose-dependent increases in the production of TNF-alpha (tumor necrosis factor-alpha) and IL-6 (interleukin-6) protein, with the greatest stimulation generally observed with a concentration of 6 x 10(5) to 6 x 10(6) particles of titanium per milliliter. The level of TNF-alpha was the greatest (fifty to 1000 times greater than the control level) after eight hours of exposure to titanium particles; the level of IL-6 was two to five times greater than the control level after sixteen hours of exposure. These increases were similar to those observed after stimulation with lipopolysaccharide and depended on de novo synthesis rather than on release from intracellular stores. The production of TNF-alpha was inhibited in a dose-dependent manner by the translational inhibitor cycloheximide and the transcriptional inhibitor actinomycin D, indicating the requirement for both mRNA (messenger RNA) and protein synthesis for the induction of cytokine synthesis by titanium particles. Although the increase in the levels of cytokine mRNA in response to titanium was rapid (thirty to ninety minutes), the increase in the level of TNF-alpha mRNA preceded that of IL-6 mRNA. The level of TNF-alpha mRNA was the greatest at ninety minutes and the level of IL-6 mRNA was the greatest at three hours. After stimulation with titanium particles, the level of TNF-alpha mRNA was increased as much as fivefold and the level of IL-6 mRNA, as much as twelvefold.

Environmentally induced asthma.

Asthma is characterized by inflammation, reversible airway obstruction, and increased airway responsiveness to various stimuli. Despite advances in understanding of the pathophysiology and in developing new treatments, asthma prevalence and mortality have been rising over the last decade, after a steady decline in the 1970s. Risk factors for environmentally induced asthma include air pollutants, tobacco smoke, wood smoke, and excessive allergen exposure. In controlled human chamber studies, asthmatics demonstrate increased susceptibility to outdoor pollutants such as sulfur dioxide, nitrogen dioxide, and acidic particles with acute reductions in lung function during and following exposures; responses are enhanced by increased ventilation, for example during exercise, or breathing cold air and/or dry air. The evidence is even stronger that inhaled indoor allergens have a causal relationship to asthma. It is possible that changes in housing conditions have led to increased levels of dust mite and other proteins in homes with consequent increases in the prevalence of sensitization. Avoidance of specific allergens such as house dust mite over months results in a reduction in clinical symptoms and bronchial hyperresponsiveness. The interaction between aeroallergens and air pollutants in triggering environmentally induced asthma is an area of active research.

RANK, RANKL and OPG in inflammatory arthritis and periprosthetic osteolysis.

Elucidation of the receptor activator of nuclear factor kappa B (RANK), its ligand (RANKL) and osteoprotegerin (OPG) as the final effectors of bone resorption has transformed our understanding of metabolic bone diseases and revealed novel therapeutic targets. Activation of the RANK-RANKL signaling pathway is directly responsible for dramatic focal erosions that are observed in inflammatory arthritis and aseptic loosening of orthopaedic implants. While these conditions share many features common to all metabolic bone disorders (e.g., osteoclastic resorption), they exhibit several unique properties, which are highlighted in this review. Most important is the relative inability of bisphosphonate therapy to inhibit osteolysis in joint inflammation and periprosthetic joint loosening and the unexpected effectiveness of anti-cytokine therapy in both rheumatoid and psoriatic arthritis. Herein, we provide a review of the role of RANK, RANKL and OPG in erosive arthritis and periprosthetic osteolysis and discuss the potential of anti-RANKL therapy for these conditions.

Accumulation of interferon gamma-producing TH1 helper T cells in nasal polyps.

We investigated the mechanisms involved in the formation of nasal polyps by examining T-cell clones and their production of soluble mediators in nasal polyps. Recently, the allergic origin of nasal polyps has been challenged. To study this question we characterized T cells from polyp tissue of allergic individuals in terms of their cytokine pattern. Nasal polyp T cells were cloned from allergic individuals undergoing polypectomy. Polyp tissue was dispersed enzymatically, and T cells were stimulated with mitogen and interleukin-2. Control T cells were obtained from peripheral blood of nonallergic donors. Cytokine production of interleukin-4 and interferon was then determined by indirect enzyme-linked immunosorbent assay tests. Polyp T-cell clones were found to produce high interferon but low interleukin-4 levels that were not significantly different from control peripheral blood T-cell clones. In addition, immunoglobulin production by dispersed polyp tissue was investigated. Immunoglobulin levels were higher in polyp tissues than in serum with immunoglobulin A predominating. These results suggest that the inflammatory reaction in nasal polyps is different than that seen in a typical type I hypersensitivity response.

B cells as a therapeutic target in autoimmune diseases other than rheumatoid arthritis.

Selective B-cell depletion with anti-CD20 therapy is a promising novel treatment option for patients with refractory autoimmune disease. The anti-CD20 antibody, rituximab, is the first therapeutic monoclonal antibody to have been approved by the European Medical Agency (EMEA) and the US Food and Drug Administration (FDA) for the treatment of relapsed, low-grade, follicular non-Hodgkin's lymphoma. Rituximab is now being studied in a range of autoimmune diseases, most notably rheumatoid arthritis, but also chronic immune thrombocytopenic purpura and systemic lupus erythematosus. Current data obtained from studies of rituximab single-agent therapy for autoimmune disease show good tolerability and sustained improvement in disease symptoms, although the precise mechanisms of action in autoimmunity remain to be fully clarified. Future research is likely to be focused on the optimization of responses with rituximab-based therapy. However, early observations suggest that this approach is likely to yield significant clinical benefits in a wide range of organ-specific and systemic autoimmune diseases.

Panel discussion on B cells and rituximab: mechanistic aspects, efficacy and safety in rheumatoid arthritis and non-Hodgkin's lymphoma.

The clinical potential of rituximab (MabThera/Rituxan), a selective B-cell-depleting agent, in the treatment of patients with rheumatoid arthritis (RA) is rapidly becoming apparent. The data presented at an official satellite symposium of the European League Against Rheumatism (EULAR) Congress (2003, Lisbon, Portugal), reinforce the rationale for the use of this novel agent in RA and have provided an early indication of its clinical efficacy, safety and tolerability. The symposium presentations were followed by a panel discussion and a question and answer session in which the participants were able to shed further light on specific mechanistic issues relating to effects on B-cell populations based on available data and their own clinical experience of rituximab. Additionally, the implications of current results for longer-term clinical efficacy and safety were discussed. It is becoming clear that rituximab (alone or in combination with disease-modifying anti-rheumatic drugs) is highly efficacious in RA. Extensive data from patients with non-Hodgkin's lymphoma show that early concerns over increased infection rates due to prolonged suppression of B cells have not been realized. The effects of rituximab on long-term RA outcomes, such as joint erosion and duration of response (particularly in patients receiving combination therapy), are eagerly anticipated.

Structure and function of human and mouse Fc gamma RII.

Receptors for the Fc portion of IgG play an important role in translating the hormonal immune response into activation of various effector cells. Some of the many processes mediated via Fc gamma Rs include endocytosis, phagocytosis, ADCC, superoxide generation, and secretion of lysosomal enzymes and cytokines. There are three different classes of Fc gamma R in humans and mice. These receptors are found on a wide variety of cells including platelets, neutrophils, eosinophils, monocytes, macrophages, large granular lymphocytes, and B lymphocytes. The cDNAs for the human Fc gamma Rs have been cloned and their structures elucidated by sequencing. Recent studies have demonstrated that the cytoplasmic domains of these receptors are crucial for signal transduction. Moreover, there is evidence that different processes triggered by the same receptor seem to require different regions of the cytoplasmic domain. This review will discuss these recent studies correlating Fc gamma R structure and function.

Role of the Vi antigen of Salmonella typhi in resistance to host defense in vitro.

The virulence of Salmonella typhi is associated with the presence of the Vi antigen. Mechanisms of Vi antigen virulence were examined in vitro. The Vi antigen-containing strain Quailes was significantly (P less than 0.025) more resistant to lysis by nonimmune serum than S. typhi 0901, which does not have the Vi antigen, and resulted in less activation of complement by the alternative pathway (P less than 0.05). Human polymorphonuclear leukocytes (PMNs) ingested strain Quailes significantly (P less than 0.01) more slowly and less completely than strain 0901 as assessed by three measures of phagocytic rate. In contrast to prior reports, the Vi antigen did not prevent an oxidative burst, measured by O2- production, chemiluminescence, and O2 consumption. The extent of the oxidative burst correlated directly and closely with the rate of phagocytosis. When the rate of PMN phagocytosis for both strains was equalized by opsonizing strain 0901 with 1% and strain Quailes with a 3% concentration of serum, the PMN oxidative burst was equal. C3 binding to strain Quailes was significantly (P less than 0.005) less than to strain 0901. Hence the Vi antigen inhibited phagocytosis by preventing C3b binding and solely as a consequence of this induced a lesser PMN oxidative burst. Furthermore, strain Quailes was significantly (P less than 0.025) less susceptible to killing by H2O2 than strain 0901. To ensure that these observations were a consequence of the Vi antigen and not other strain differences, another pair of S. typhi with and without the Vi antigen were similarly compared, and the results were the same as with strains Quailes and 0901. Strains 0901 and Quailes were killed by PMNs from a patient with chronic granulomatous disease but more slowly than by normal PMNs, indicating that S. typhi is susceptible to nonoxidative killing.

The Fc portion of intact IgG blocks stimulation of human PBMC by anti-T3.

The means by which normal human serum inhibits the activation of PBMC by OKT3 has been investigated. The Fc portion of intact IgG is shown to be the major inhibitor in human serum of this OKT3-induced stimulation. Furthermore, inhibition by IgG subclasses correlated with their ability to bind to the monocyte Fc receptor, i.e., IgG1 and IgG3 produced greater inhibition than IgG2 and IgG4, and this inhibition was competitive. In contrast, hypogammaglobulinemic serum, IgA, IgM, and F(ab')2 of IgG were not inhibitory relative to intact IgG or Fc of IgG. Because of the similarities between T3 and the idiotype-defined T cell receptor for antigen, these investigations suggest that IgG might modulate the interactions between the T cell recognition complex and anti-idiotype antibody, thus regulating the idiotype network.

The VKIIIb light chain sub-subgroup: restricted association with mu heavy chain in normal human serum.

The VKIII human kappa light chain subgroup has been serologically and structurally divided into two sub-subgroups, VKIIIa and VKIIIb. VKIIIb has been shown by others to be strikingly prevalent in IgM autoantibodies, but no studies have been performed to determine heavy chain isotype association with VKIIIb light chain in normal human serum. The VKIIIb sub-subgroup was shown here to be associated with mu heavy chain in normal human serum, but was not detected in association with gamma or alpha heavy chain. Approximately 25 +/- 15% of IgM-kappa was determined to be VKIIIb. Both intact IgG and purified light chains from pooled IgG did not bind monoclonal anti-VKIIIb, indicating that the determinants recognized by anti-VKIIIb are not merely masked in intact IgG. These results are the first report of a light chain sub-subgroup showing preferential association with a heavy chain isotype.

Human monocytes and U937 cells bear two distinct Fc receptors for IgG.

Several convergent lines of evidence have led us to propose that human monocytes and the related cell line U937 possess a second class of IgG Fc receptor (FcR) in addition to the 72-Kd high affinity FcR previously described. IgG affinity purification from detergent lysates of surface radiolabeled U937 cells has yielded both a 40-Kd IgG-binding membrane protein (p40) and the 72-Kd FcR protein. By the same procedure, only the p40 was isolated from the erythroblast cell line K562 and from the B cell lines, Daudi and Raji. Serologic cross-reactivity between the 40-Kd FcR on U937 and Daudi cells was demonstrated using a goat anti-FcR antiserum. A murine (m) monoclonal antibody, raised against the FcR of K562 cells, precipitated the 40-Kd FcR from lysates of U937 and K562 cells but not from Daudi or Raji cells. This antibody, referred to as anti-p40 (IV.3), selectively inhibited the binding of murine IgG1-coated erythrocytes to U937 cells, whereas monomeric human IgG selectively inhibited binding of human anti-Rh(D)-coated erythrocytes to U937 cells. Both Daudi and U937 cells mediated mIgG1 anti-T3 (Leu-4)-induced stimulation of T lymphocytes. In contrast, mIgG2a anti-T3 (OKT3)-induced stimulation was supported effectively by U937 cells but only modestly by Daudi cells. Intact IgG or Fab fragments of anti-p40 (IV.3) blocked mIgG1 anti-T3 (Leu-4) stimulation but not mIgG2a anti-T3 (OKT3) stimulation of T cells; monomeric human IgG blocked only OKT3-induced stimulation. The simplest interpretation of these results is that human monocytes and U937 cells bear two classes of IgG FcR, one of 72 Kd and the other, as described above, of 40 Kd. We propose that the 72-Kd FcR mediates rosette formation with red cells coated by human anti-Rh IgG as well as T cell stimulation by mIgG2a anti-T3 (OKT3) and that the 40-Kd FcR mediates rosette formation with erythrocytes bearing mIgG1 as well as T cell stimulation by mIgG1 anti-T3 (Leu-4). Furthermore, we suggest that these two FcR are the human homologues of the murine macrophage FcRI (binding mIgG2a) and FcRII (binding mIgG2b/1).

The V kappa IIIb light chain sub-subgroup. II. Isotype expression in acquired hypogammaglobulinaemia and as a function of age.

The V kappa IIIb sub-subgroup of the human immunoglobulin V kappa III light chain subgroup has at least two unique properties. First, some IgM monoclonal autoantibodies, in particular cryoprecipitable anti-IgG (Kunkel et al., 1974; Ledford et al., 1983), anti-low density lipoprotein (Ledford et al., 1983) and certain cold agglutinin (Feizi et al., 1976) antibodies predominantly contain V kappa IIIb light chains. Second, in normal adult human serum, V kappa IIIb comprises approximately 25% of the IgM but less than 0.4% of the IgG or IgA kappa-chain pools (Moynihan, Looney & Abraham, 1985). Studies have suggested an altered regulation of IgM, IgG, and IgA-V kappa IIIb in some patients with acquired hypogammaglobulinaemia, a heterogeneous group of immunodeficiencies with low serum levels of Ig. An increase in the serum levels of V kappa IIIb light chains has been noted in some of these patients (Solomon & Mclaughlin, 1969) which is apparently due to elevated levels of light chains of the V kappa IIIb sub-subgroup (Greenstein & Abraham, 1984). However, the isotype association of V kappa IIIb in these patients has not been determined. In order to clarify whether the noted increase in V kappa IIIb levels is due to its selective expression with IgM or to an abnormality of immunoregulation, the heavy chain isotypes associated with V kappa IIIb light chains have been determined in a previously studied group of adults with acquired hypogammaglobulinaemia (Greenstein & Abraham, 1984). Further, the isotype distribution of V kappa IIIb light chains in another group of functional, albeit transient, hypogammaglobulinaemics (i.e. normal neonates) has also been studied by measuring IgM-V kappa IIIb levels in cord blood, and compared to the V kappa IIIb serum levels found in aged adults (mean age 75 years).