Polymorphic structure of the tumor necrosis factor (TNF) locus: an NcoI polymorphism in the first intron of the human TNF-beta gene correlates with a variant amino acid in position 26 and a reduced level of TNF-beta production.

Since a dysregulated synthesis of tumor necrosis factor alpha (TNF-alpha) may be involved in the pathogenesis of autoimmune diseases, it was of interest to precisely locate the recently reported NcoI restriction fragment length polymorphism (RFLP) of the TNF-alpha region. However, by mapping of 56.8 kb of overlapping cosmid clones and direct sequencing, we could localize the polymorphic NcoI restriction site within the first intron of the TNF-beta gene and not in the TNF-alpha gene. To study whether regulatory mechanisms are affected by this polymorphism, we analyzed the TNF-alpha/TNF-beta production of phytohemagglutinin-stimulated peripheral blood mononuclear cells of individuals homozygous for the TNF-beta NcoI RFLP by ELISA and concomitant Northern blot analysis. On days 2-4 after stimulation with mitogen, the TNFB*1 allele corresponding to a 5.3-kb NcoI fragment presented with a significantly higher TNF-beta response. A mRNA analysis demonstrated that higher protein levels of TNF-beta correlate also with increased amounts of TNF-beta transcripts. No allelic association was found in respect to TNF-alpha production. To further investigate a possible allelic influence on transcription, we determined the DNA sequence of 2 kb of the 5' portion of our cloned TNFB*2 allele and compared it with the available TNF-beta sequences. By computer-aided recognition motif search of DNA binding factors, we report putative binding sites conserved between mouse and man in the 5' flanking region as well as in intron 1 of the TNF-beta gene, found also in other cytokine promoter sequences. In addition, by polymerase chain reaction amplification and sequencing of 740 bp of the 5' part of TNF-beta of individuals typed homozygously for the NcoI RFLP, we could show that amino acid position 26 is conserved as asparagine in the TNFB*1 and as threonine in the TNFB*2 sequence. A previously reported, EcoRI RFLP in the 3' untranslated region of TNF-beta does not segregate with either of the two alleles. Thus, four TNFB alleles can be defined at the DNA level.

The role of hepatitis C virus specific CD4+ T lymphocytes in acute and chronic hepatitis C.

Since the discovery of hepatitis C virus it has become clear that chronic hepatitis C is a major health problem throughout the world. Because antiviral agents are of limited value in the treatment of chronic hepatitis C, research has focused on the antiviral immune response for the development of both a protective vaccine and effective immunotherapies for established chronic infection. Antiviral antibodies are present in almost all patients with chronic hepatitis C but do not seem to be virus neutralizing, probably due to the high mutational rate of viral envelope proteins. Studies on the antiviral T cell response have revealed the presence of virus-specific CD4+ helper and CD8+ cytotoxic T cells in a substantial proportion of patients with chronic hepatitis C. Recent studies describe an association between strong CD4+ T helper cell activity to certain hepatitis C virus antigens and a self-limited course of acute hepatitis C and possibly also a sustained response to treatment with interferon-alpha. Therapeutic manipulation of the virus-specific T cell response may thus develop into a new approach for prevention and treatment of hepatitis C virus infection.

Chronic diarrhea as a result of intestinal microsposidiosis in a liver transplant recipient.

BACKGROUND: Microsporidia are common pathogens among patients infected with human immunodeficiency virus. They account for a substantial proportion of chronic diarrhea and malabsorption in acquired immune deficiency syndrome, but their appearance after solid organ transplantation has only rarely been reported. Methods. We report what we believe is the first case of documented Enterocytozoon bieneusi infection in a liver transplant recipient. Results. Our patient presented with chronic diarrhea and colicky abdominal pain. Although symptoms were severe, only mild microscopical mucosal changes were found in the intestinal tract. A modified trichrome stain of stool specimens revealed microsporidial spores, and species differentiation by restriction fragment length polymorphism polymerase chain reaction identified Enterocytozoon bieneusi. Albendazole therapy brought symptomatic relief but no microbiological clearance. CONCLUSIONS: Enterocytozoon bieneusi may cause chronic diarrhea not only in immunosuppression as a result of human immunodeficiency virus infection but also among patients with therapeutic immunosuppression after organ transplantation. Therefore, microsporidial infection should be considered in immunosuppressed patients with otherwise unexplained diarrhea.

Natural killer cell activity during treatment with fibroblast interferon.

Short- and long-term effects on natural cytotoxicity (NC) of i.v. administration of human fibroblast interferon (IFN--beta) was studied in patients with HBsAg positive chronic active hepatitis. Short-term kinetics demonstrated after a transient fall of NC a severalfold increase of NK activity after 24 hours. Long-term kinetics of NC revealed following features: The highest relative increase was seen during the initial phase of IFN--beta application. In all patients monitored so far the enhanced NK activity could be maintained during 2 to 4 weeks of therapy. Over a period of several weeks a gradual decrease of augmented NK activity was observed in spite of continued application of high doses of IFN--beta. These findings indicate that in-vivo administration of IFN--beta results in an augmentation of natural cytotoxicity in man. Prolonged treatment with IFN--beta seems to "exhaust" the NK cell system.

Long-term response to interferon therapy in chronic hepatitis B: importance of hepatitis B virus heterogeneity.

The long-term therapeutic efficacy of alpha IFN and the influence of preC variants on the type of response were evaluated in 25 patients with chronic hepatitis B, 14 HBeAg and 11 antiHBe positive patients, treated with alpha IFN and monitored for at least four years after discontinuing therapy. In both groups of patients, serum HBV-DNA became frequently undetectable by DNA dot blot during treatment, suggesting that alpha IFN has an antiviral effect both on HBeAg and antiHBe positive chronic carriers. However, long term follow up showed that the loss of viral DNA in antiHBe carriers was only transient, because all responder patients relapsed from 1 to 48 months after IFN withdrawal. In the HBeAg positive carriers, selection for preC mutants was observed at the end of follow up in 2 patients who seroconverted to antiHBe and remained viremic. Both the frequent occurrence of reactivations in antiHBe compared to HBeAg carriers, and the association of IFN therapy with preC mutant virus selection during long term post-treatment follow up observed in this study, indicate that preC variants are more resistant to IFN therapy than preC wild type HBV. Our data suggest therefore, that IFN therapy may be less frequently able to induce a permanent remission in patients infected with preC mutants.

Determination of Hepatitis C Virus-Specific CD4(+) T-Cell Activity in PBMC.

T-cells are the key players in the field on which the virus and the immune response try to defeat or at least control each other. Two categories of T-cells are involved: CD4(+) and CD8(+) T-cells. CD4(+) and CD8(+) T-cells have different characteristics and functions and different roles in the immune response to viruses. This chapter discusses methods to determine the CD4(+) T-cell activity.

[Interferons]. / Interferone.

The interferons are a family of proteins that are grouped together on the basis of their antiviral, antiproliferative and immunomodulatory effects. They are divided into three classes: alpha, beta, and gamma, which can be distinguished structurally, biochemically, and antigenically. Clinically they are used for the treatment of malignant tumors and of viral diseases, particularly of chronic viral hepatitis. The present role of interferons as therapeutic agents in the treatment of viral hepatitis will be critically discussed in the lecture.

Transient immunological control during acute hepatitis C virus infection: ex vivo analysis of helper T-cell responses.

Hepatitis C virus (HCV) readily sets up persistence after acute infection. Cellular immune responses are thought to play a major role in control of the virus. Failure of CD4+ T-cell responses in acute disease is associated with viral persistence but the dynamics of this are poorly understood. We aimed to assess such responses using a novel set of Class II tetrameric complexes (tetramers) to study helper T-cells ex vivo in acute disease. We analysed the HCV-specific CD4+ T-cell response in a patient with acute hepatitis c infection. We were able to track the virus-specific CD4+ T-cells directly ex vivo with HLA DR4 tetramers. Proliferative responses were absent initially, recovered as viral load dropped and were lost again during relapse. Longitudinal tetramer analyses showed expanded populations of antiviral CD4+ T-cells throughout acute infection despite lack of proliferation. A pattern of transient CD4+ T-cell proliferative responses as HCV is partially controlled is observed. Failure to control virus is associated with emergence of 'dysfunctional' CD4+ T-cell populations. Failure to control HCV in acute disease may relate to the capacity to sustain efficient immune responses as virus attempts to 'bounce back' after partial control.

Minimal T-cell-stimulatory sequences and spectrum of HLA restriction of immunodominant CD4+ T-cell epitopes within hepatitis C virus NS3 and NS4 proteins.

The hepatitis C virus (HCV)-specific CD4+ T-cell response against nonstructural proteins is strongly associated with successful viral clearance during acute hepatitis C. To further develop these observations into peptide-based vaccines and clinical immunomonitoring tools like HLA class II tetramers, a detailed characterization of immunodominant CD4+ T-cell epitopes is required. We studied peripheral blood mononuclear cells from 20 patients with acute hepatitis C using 83 overlapping 20-mer peptides covering the NS3 helicase and NS4. Eight peptides were recognized by > or = 40% of patients, and specific CD4+ T-cell clones were obtained for seven of these and three additional, subdominant epitopes. Mapping of minimal stimulatory sequences defined epitopes of 8 to 13 amino acids in length, but optimal T-cell stimulation was observed with 10- to 15-mers. While some epitopes were presented by different HLA molecules, others were presented by only a single HLA class II molecule, which has implications for patient selection in clinical trials of peptide-based immunotherapies. In conclusion, using two different approaches we identified and characterized a set of CD4+ T-cell epitopes in the HCV NS3-NS4 region which are immunodominant in patients achieving transient or persistent viral control. This information allows the construction of a valuable panel of HCV-specific HLA class II tetramers for further study of CD4+ T-cell responses in chronic hepatitis C. The finding of immunodominant epitopes with very constrained HLA restriction has implications for patient selection in clinical trials of peptide-based immunotherapies.

Transitional cell carcinoma: lymphocyte-mediated cytotoxicity.

A method of removing Fc+ lymphocytes from human peripheral blood was presented. Results upon testing the remaining cell populations for cytotoxicity against autochthonous and allogeneic target cell systems was presented.

[Experimental studies on proteolysis of hyaline membranes in vitro (author's transl)]. / Experimentelle Untersuchungen zur Auflösung von pulmonalen hyalinen Membranen in vitro

The incubation of lung tissue from premature infants with pulmonary hyaline membranes in fibrinolysis activating or fibrinolytically active solutions gave the following results. With streptokinase it was not possible to dissolve hyaline membranes (verification of the physiological lack of plasminogen in premature infants). The mean content of membranes after 24 hours showed to be 18.14 +/- 12.43% which almost corresponded to the control value of 20.24 +/- 10.54% after incubation in NaCl-solution. In comparison, solutions of plasmin, plasmin-activator or activator prepared from proactivator-plasminogen through activation with streptokinase led to a clear reduction in the membrane content, i.e. 11.00 +/- 6.50, 13.89 +/- 9.72, and 13.63 +/- 8.94%, respectively. A decrease in membranes equally strong to that after plasmin appeared after incubation for only 12 hours in trypsin (11.09 +/- 8.62%). Plasmin, plasmin-activator, and activator, but not streptokinase alone, caused also a considerable nonspecific proteolysis of the lung parenchyma which was equal to the trypsin effect, for example, with an only half as long incubation time. Since the lungs of premature infants contain the tissue activator of fibrinolysis we discuss the suggestion of Ambrus et al. (1974) to administer an injection of plasminogen to premature infants immediately after birth so that a spontaneous fibrinolysis can be favoured for developing hyaline membranes.

Purification, fractionation and assay of antibody-dependent lymphocytic effector cells (K cells) in human blood.

In this article we present methods for the purification and fractionation of human blood lymphocytes, which have been used in our laboratory to characterize antibody-dependent cytotoxic effector cells (K cells). The assay system consists of highly purified lymphocytes, 51Cr-labelled chicken erythrocytes (Ec) and IgG rabbit anti-Ec in high dilutions. Various ways of comparing K-cell potentials of different lymphocyte preparations in this system are discussed. When purified lymphocytes are partially depleted (60-85% depletion) of cells forming rosettes with sheep erythrocytes (E+ cells), the K-cell activity of the depleted fraction is increased, indicating the the majority of the E+ cells are inactive in this assay. Depletion of EAC-rosette-forming cells shows that most or all K cells have complement receptors. For depletion of B cells, the lymphocytes may be passed through glass bead columns, charg ed with F(ab')2 fragments of human IgG and F(ab')2 fragments of rabbit antibodies to the F(ab')2 part of human IgG. These columns give high yields of B-cell depleted fractions. These preparations are rich in E+ cells and contain approximately 80% of the Fc-receptor lymphocytes which form rosettes with bovine erythrocytes, coated with IgG antibodies. Their K-cell activity is unchanged or slightly elevated, indicating the mature B cells, i.e. SIg+ cells, have little or no K-cell activity. In contrast, passage of the lymphocytes through immune complex columns (ovalbumin/anti-ovalbumin) leads to approximately 70% depletion of Fc receptor-bearing cells, while most of the B cells (SIg+ cells) pass through the columns. The relative frequency of E+ cells in the passed fraction frequently shows a slight reduction. These preaparations have a very low K-cell activity, indicating that K cells are lymphocytes with Fc receptors of relatively strong avidity.

Natural cytotoxicity of human Fc gamma-receptor-positive T lymphocytes after surface modulation with immune complexes.

In humans T cells with surface receptors for the Fc fragment of IgG (Fc gamma receptors) (TG cells) are effector cells in antibody-dependent cellular cytotoxicity (ADCC) and in natural cytotoxicity. While Fc gamma receptors are required to mediate ADCC, their role in natural cytotoxicity is unknown. To investigate this question, Fc gamma receptors on effector cells were modulated by interaction with IgG immune complexes. As a consequence of this modulation, TG cells lost most of their ADCC activity but retained a significant part of their natural killer activity. Thus, these experiments demonstrate that the cytotoxic mechanisms exerted by the same cell population can be dissociated experimentally. Furthermore, they suggest that the net natural cytotoxicity of normal human lymphocytes in certain effector cell-target cell combinations is the result of distinct types of reaction.

T cell recognition of hepatitis B and C viral antigens.

The outcome of hepatitis B and C heavily depends on the appropriate virus specific T cell response. Both CD8+ and CD4+ T lymphocytes do not recognize native viral proteins but processed peptides bound to MHC class I and class II, respectively. For therapeutical intervention aimed at T lymphocytes in chronic carriers as well as for the development of new vaccines, a precise identification of immunodominant epitopes, which can be recognized by a majority of patients, is necessary. Biological features of certain viral antigens have been partly characterized in animal models, but with the availability of modern molecular technology it is possible to extend these findings to the human system. The identification of anchor residues and motifs in peptides, which are essential for binding to certain MHC class I and class II molecules, allows the prediction of MHC allele-specific epitopes within viral proteins. By the use of synthetic peptides and vaccinia expression vectors, several epitopes for cytotoxic and helper T lymphocytes have been identified in HBV and HCV antigens. In HBV infection cytotoxic T lymphocytes recognize epitopes within the polymerase protein, the envelope protein and the nucleocapsid. In HCV cytotoxic epitopes have so far been identified within the nucleocapsid, E1, E2 and NS2. Since virus specific CD8+ T lymphocytes lyse virus infected cells in vitro and seem to play an important role for viral elimination in vivo, activation of virus specific effector cells may be achieved by immunizing chronically infected patients with the MHC-allele-specific peptides. Epitopes for CD4+ T lymphocytes have been demonstrated in the majority of HBV- and HCV-proteins. Different subsets of CD4+ T lymphocytes influence the course of infection by the production of lymphokines which either support antibody production by B cells or cellular antiviral effector mechanisms. In acute and chronic HBV infection the HBcAg/HBeAg-specific T cell response is closely correlated to viral elimination and the occurrence of anti-HBe- and anti-HBs antibodies. In HCV infection the CD4+ T cell response appears to be more heterogenous, and better functional characterization of the CD4+ response to immunodominant peptide epitopes in association with certain disease stages is required. Since T cell activation, the resulting effector functions and binding of the peptide to the HLA-molecule mainly depend on the peptide structure, viral mutations leading to amino acid changes may contribute to T cell non-responsiveness or an inappropriate T cell response.(ABSTRACT TRUNCATED AT 400 WORDS)

Cytotoxicity in vitro of blood lymphocytes from bladder cancer patients and controls to allogeneic or autologous tumor cells derived from established cell lines or short-term cultures.

Blood lymphocytes from small groups of patients with transitional-cell carcinoma of the urinary bladder (TCC), clinical controls (CC) or healthy donors (HD) were tested for cytotoxicity in vitro by a 51Cr-release assay. The target cells were either from TCC or control tissue (long-term cultures) or were from short-term TCC cultures, kept in vitro for 10-20 transfer generations. When tested with allogeneic target cells from long-term cultures, TCC patients' lymphocytes tended to be more cytotoxic to TCC targets than to control targets. For the control lymphocytes this was not seen. A large proportion but not all of the cytotoxicity to these target cells was due to immunoglobulin-dependent cellular reactions, probably mediated by natural and disease-related antibodies of the lymphocyte donors, since it was significantly inhibited by Fab-fragments of rabbit antibodies to human immunoglobulin. Moreover, it was, to a large extent, mediated by lymphocytes with Fc-receptors for IgG. For seven of the TCC target cell cultures (two long-term and five short-term) autologous lymphocytes were also available for testing. While two patients were non-reactive to their own tumor cells, five reacted strongly in the autologous combinations. These autologous reactions were immunoglobulin-independent and were mediated by Fc-receptor-negative effector cells. In some instances, autologous cytotoxicity was accompanied by similar reactions to some of the allogeneic TCC targets but not to the allogeneic non-TCC control targets. On the basis of available information on HLA antigens in this material, the pattern of cross-reactions suggests that the cytotoxicity encountered in the autologous and in some of the allogeneic TCC-combinations may be the expression of antibody-independnet but specific CTL-mediated reactions, regulated by HLA. However, at the present stage of the investigation, other mechanisms must also be considered since the target cells from short-term TCC cultures were sometimes lysed by control lymphocytes in immunoglobulin-independent reactions. Whatever the explanation, the results show that the cytotoxicity observed in the in vitro systems is usually the net result of several different types of reaction. Which effector cell types and which mechanism of recognition will predominate in a given lymphocyte/target cell combination is greatly influenced by the nature and origin of the target cells used.

Heterogeneity and mechanism of action of human natural killer lymphocytes: differential distribution of receptors for Helix pomatia haemagglutinin (HP receptors).

Neuraminidase-treated lymphocytes from the peripheral blood of normal human donors were fractionated on columns charged with Helix pomatia haemagglutinin (HP) coupled to Sepharose 4B. While lymphocytes lacking HP receptors (HP-) passed directly through the column (fraction I), lymphocytes with HP receptors (HP+) were subsequently eluted in two distinct fractions with two different concentrations of the competitive hapten N-acetyl-D-galactosamine (fraction II and III, respectively). The natural cytotoxicity of these lymphocytes to various tumour target cells (K562, T24, MANO, HCV29) was tested in a 51Cr release assay. Natural cytotoxicity was found in all three fractions recovered from the HP columns. In general, the cytotoxicity of the lymphocytes in fractions I and II was significantly enhanced over that of the unfractionated lymphocytes. Surface marker analysis and fractionation studies indicated that natural cytotoxicity in these target systems is exerted by both HP+ and HP- lymphocytes bearing Fc receptors for IgG. Since the HP receptor is considered to be a marker to T lymphocytes, the findings suggest that a significant fraction of these NK cells may be of T-cell lineage. The surface marker profiles of these NK cells are very similar to those of antibody-dependent K cells. Addition of Fab fragments of immunoadsorbent-purified rabbit antibodies to human immunoglobulin inhibited the natural cytotoxicity of HP-column-fractionated lymphocytes to various degrees, indicating that part but not all of it reflects antibody-dependent K-cell reactions. Since cytotoxicity in all three HP fractions was inhibitable in this way, the results suggest that immunoglobulin-dependent natural cytotoxicity may be displayed by both HP+ and HP- effector cells.

Production of interferon alpha and interferon gamma by peripheral blood leukocytes from patients with chronic hepatitis B virus infection.

Peripheral blood leukocytes from patients with chronic hepatitis B virus (HBV) infection were studied for their capacity to produce interferon (IFN) alpha or IFN gamma. Yields of IFN alpha in leukocyte cultures stimulated with influenza A virus or human leukemic cells were significantly lower than those obtained from healthy controls. Production of IFN gamma in response to induction with protein A of Staphylococcus aureus was also significantly diminished. Defects of IFN production in leukocyte cultures showed no correlation with active viral replication or the degree of severity of HBV-associated liver disease. The demonstration of partial defects of endogenous IFN production provides a rationale for using IFN replacement therapy in patients with chronic HBV infection.

High prevalence and heterogeneity of HBV preC mutants in anti-HBe-positive carriers with chronic liver disease in southern Italy.

In this study we have investigated the prevalence and type of preC mutants in anti-HBe/HBV-DNA-positive patients with chronic hepatitis B in an endemic area. HBV-DNA from sera of 42 anti-HBe chronic HBV carriers was amplified by PCR and the preC region was directly sequenced. With one exception, all patients tested were found to be infected with viruses containing mutations in the preC region that predictably prevent precore and e antigen expression. Thirty-one patients were infected with HBV containing a stop codon; two had a mixture of wild-type and preC stop codon mutant; three had preC mutants with mutations in the translation initiation codon and two of them an additional stop codon; four had a frameshift mutation, and one had two stop codons. One patient was infected with a virus showing a mutation creating only an amino acid exchange which could not prevent HBeAg expression. The data obtained indicate a higher prevalence and heterogeneity of preC mutants in our geographical area than recognized so far in anti-HBe-positive carriers with chronic hepatitis B.

Prevalence and type of pre-C HBV mutants in anti-HBe positive carriers with chronic liver disease in a highly endemic area.

The sequence variability in the pre-C region of the hepatitis B virus (HBV) genome in the serum of 42 anti-HBe antibody positive carriers with chronic hepatitis B was studied by PCR and direct sequencing to determine prevalence and type of HBV pre-C mutants in a highly endemic area. Except for one, all patients were infected with viruses containing mutations in the pre-C region which prevent precore and e-antigen (HBeAg) expression: 33 were infected predominantly or exclusively with variants containing a stop codon; two had a mixture of wild-type and a pre-C stop codon mutant virus; three had precore variants with mutations of the pre-C initiation codon and two of them an additional stop codon; four had a frameshift mutation; and one had two stop codons. One patient was infected with viruses which contained a mutation creating an amino acid exchange which should not prevent precore and HBeAg expression. These data demonstrate that in an endemic area a higher prevalence and even broader spectrum of pre-C HBV mutants are found than has been recognized previously in anti-HBe positive patients with chronic hepatitis B.

Selection for a pre-C stop codon mutation in a hepatitis B virus variant with a pre-C initiation codon mutation during interferon treatment.

Hepatitis B virus (HBV) variants with a stop codon, a mutated translation initiation codon or other mutations in the pre-C region which prevent e-antigen expression are highly prevalent in anti-HBe chronic carriers and can be positively selected from a mixed virus infection. Our laboratories recently described pre-C variants with two pre-C mutations which prevent HBeAg expression. Here we have investigated whether there is a selective pressure for acquisition of the second pre-C mutation. By direct sequencing of amplified HBV DNA from sera of a chronic carrier taken during a 6-year follow-up, we found that genomes of a virus population virtually all had a pre-C translation initiation codon mutation and about 50% had an additional stop codon mutation. With the onset of interferon treatment, the genomes with the stop codon mutation increased to more than 95% while the frequency of the translation initiation codon mutation in all genomes remained constant. These data indicate positive selection (possibly immune-mediated and HBeAg-targeted) for a second pre-C mutation. This putative enhancement of negative translational control may be present because a pre-C translation initiation codon mutation cannot totally prevent HBeAg expression and is therefore less frequent.