Suppressor T-cell abnormality in idiopathic systemic lupus erythematosus

Immune complex-mediated rheumatic diseases: the evidence and the enigmas

Clearly, many of the connective tissue disorders are intimately associated with either focal tissue evidence of immune complex deposition or markedly elevated levels of complexes during acute disease activity. In many diseases, such as systemic lupus erythematosus or rheumatoid arthritis, the immune complexes have been firmly established as basic elements in pathogenesis. In other disorders, however, the presence or measurable elevation of circulating immune complex materials may represent an epiphenomenon that reflects tissue injury secondary to the underlying inflammatory process. Much more precise definition of these problems awaits further longitudinal study.

Alterations in immunoregulatory T cell subsets in active systemic lupus erythematosus

To determine whether imbalance among subsets of human T cells exists in patients with systemic lupus erythematosus (SLE), we analyzed peripheral blood lymphocytes in SLE patients during active and inactive stages of disease. For this analysis, we used monoclonal antibodies to the surface antigens of inducer (T4) and suppressor (T5/T8) T cell subsets, as well as a common T cell antigen (T3). In contrast to normal and inactive SLE patients, the percentage of T3+ cells was reduced in all active SLE patients. More importantly, there was a selective decrease in T5+/T8+ suppressor T cells in 12 of 14 active patients, including 1 of 2 patients with drug-induced SLE. Serial analysis of three SLE patients showed a significant correlation between the presence of T5+/T8+ subset and clinical disease activity in all patients. We conclude that aberrations in suppressor T cell subsets are an important correlate of disease in patients with SLE.

Heterogeneity of the spontaneously expanded and mitogen-induced generation of suppressor cell function of T cells on B cells in systemic lupus erythematosus

Eighty percent of 31 untreated patients with systemic lupus erythematosus (SLE) had abnormalities in their spontaneously expanded and/or Con-A-induced suppressor cell function, but the association of defects detected with both systems was only 68%. Loss of spontaneous suppression related positively to disease activity (r = 0.641) and the number of T gamma cells (r = 0.624) whereas Con-A-induced suppression correlated negatively with disease activity (r = -0.456) and the number of T gamma cells (r = 0.089). Incubation of mononuclear cells from SLE patients in antiribonucleoprotein IgG caused further loss of suppression in some, but not all, instances. The suppressor cell dysfunction found in SLE may result from diverse mechanisms, including a basic defect in the generation of suppressor cells and the abrogation of suppressor function by autoantibodies.

Generation of antigen-specific suppressor cells during allergy desensitization

We used a suppressor-cell assay to study a possible mechanism of allergy desensitization. Before specific immunotherapy, blood mononuclear cells from 20 patients with ragweed hayfever failed to exhibit suppressor activity in vitro after stimulation by ragweed antigen E. However, when the 10 patients with allergic rhinitis had been desensitized by injections of ragweed extract, their mononuclear cells specifically suppressed a ragweed proliferative response six and 12 months after desensitization was begun (31 per cent and 48 per cent suppression, respectively). Suppressor mononuclear cells were not detected in 10 control subjects of in 10 patients with ragweed hayfever who were not desensitized. When mononuclear cells taken from treated patients were passed over columns containing insolubilized histamine, antigen-specific suppressor cells that could be activated by ragweed antigen were depleted. These results indicate that antigen-specific suppressor cells, probably bearing histamine receptors, are generated during desensitization to allergy and may be partly responsible for the efficacy of this therapy.

The comparative pathology of non-viral bullous skin diseases in domestic animals

In a review of non-viral bullous skin diseases of domestic animals and a 4-year study of cases presented to the New York State College of Veterinary Medicine, we found 15 diseases: pemphigus vulgaris, pemphigus vegetans, pemphigus foliaceus, pemphigus erythematosus, bullous pemphigoid, systemic lupus erythematosus, dermatitis herpetiformis, toxic epidermal necrolysis, drug eruption, epidermolysis bullosa, epidermolysis bullosa simplex, familial acantholysis, bovine congenital porphyria, impetigo and subcorneal pustular dermatosis. The 15 diseases were placed in five categories: autoimmune, immune-mediated, hereditary, bacterial and idiopathic. A histologic classification of these disorders based on the site of blister formation and other important clinicopathologic, histologic and immunopathologic findings was developed.

Methyldopa inhibition of suppressor-lymphocyte function: a proposed cause of autoimmune hemolytic anemia

To test the hypothesis that methyldopa induces red-cell autoantibodies by inhibiting the activity of suppressor lymphocytes, we studied its effect on several immune functions. Methyldopa inhibited T-lymphocyte suppression of IgG production by peripheral-blood mononuclear cells stimulated by poke-weed mitogens. This effect occurred in isolated T cells incubated with methyldopa and in T cells obtained from patients taking methyldopa. In addition, the drug caused a 30 to 80 per cent reduction in the proliferative response of peripheral-blood mononuclear cells to mitogens in vitro, and this reduction primarily involved the activation of T lymphocytes. Methyldopa also caused a persistent elevation of intracellular lymphocyte cyclic AMP in vitro and in vivo. We postulate that methyldopa alters the immune system by causing a persistent increase in lymphocyte cyclic AMP, which inhibits suppressor T-cell function. These effects may lead to unregulated autoantibody production by B cells in some patients.

Depressed T cell colony growth in systemic lupus erythematosus

Phytohemagglutinin-stimulated peripheral blood T lymphocytes, plated in agar, are capable of forming discrete lymphoid colonies. In 35 normal subjects, the average number of colonies was 6,020 +/- 351 (SEM). By contrast, in 39 patients with systemic lupus erythematosus (SLE), the mean colony number was 2,774 +/- 384, a value significantly less than controls (P less than 0.001). Normal responses were measured in 5 patients with progressive systemic sclerosis and in 7 of 8 patients with rheumatoid arthritis. Colony growth in SLE showed a strong correlation with disease activity but did not correlate with responses of blood lymphocytes to phytohemagglutinin in suspension cultures, the number of circulating T cells, or serologic abnormalities.

Effects of levamisole on in vitro suppressosr cell function in normal humans and patients with systemic lupus erythematosus

Levamisole-treated mononuclear cells from normal volunteers or from patients with systemic lupus erythematosus (SLE), when cultured with normal allogeneic lymphocytes, did not significantly influence the ability of the latter cells to proliferate when stimulated with either phytohemagglutinin (PHA) or concanavalin A (Con A). Levamisole, furthermore, did not influence the ability of Con A to induce suppressor cell function from normal mononuclear cells. When mononuclear cells from patients with SLE were treated with therapeutic concentrations of levamisole in the presence of Con A, the drug was unable to restore the ability of the Con A to induce normal suppressor cell function. SLE cells treated with a high concentration of levamisole (60 micrograms/ml) in the presence of Con A did show some suppressor cell activity on normal autologous mononuclear cells activated by Con A, but not by PHA. Although the significance of this latter finding is unclear it appears that levamisole at therapeutic concentrations does not influence in vitro suppressor cell function of normal or SLE mononuclear cells.

Suppressor cell loss and dysfunction in mixed connective tissue disease

Of 11 patients with untreated mixed connective tissue disease (MCTD) who were studied, all had decreased circulating T gamma cells, and all but one had decreased suppressor cell function of T cells on B cells, determined by a reverse hemolytic plaque-cell assay. Results in 21 normal subjects were significantly, different. Incubation of mononuclear cells from MCTD patients in purified anti-ribonucleoprotein (anti-RNP) IgG resulted in further decrease in their suppressor function. Decrease of T gamma cells and their suppressor function may be due to in vivo penetration of anti-RNP antibody into T gamma cells, causing their deletion.

Clinical and laboratory features of canine lupus syndromes

Determination of the specificities of antinuclear antibodies in the sera of 20 dogs presenting with symptoms of a lupus-like syndrome permitted their separation into 2 groups. The first group of 14 dogs all had antibody activity to DNA-histone antigen(s), and 4 of them also had antibodies to native DNA (nDNA). The Farr test with standard buffer was found to be unsatisfactory for the measurement of anti-nDNA antibodies in dog sera due to a high incidence of false positive reactions; these could be eliminated by the inclusion of sodium dodecyl sulfate in the buffer system. The second group of 6 dogs was characterized by the presence of antibodies to extractable nuclear antigen. In every serum tested diseased dogs had a diminished level of circulating thymic factor as compared to controls of the same age, suggesting that a diminution of suppressor T cells may be an etiologic factor.

Immunoregulation in Sjögren's syndrome: influence of serum factors on T-cell subpopulations

21 patients with Sjögren's syndrome (sicca syndrome) with either glandular or extraglandular involvement, but without other connective tissue diseases, were studied with regard to immunoregulatory T-cell subpopulations, B-cell function, and suppressor cell capabilities. Patients with isolated glandular disease as well as patients with extraglandular disease had normal absolute numbers of total lymphocytes, T cells, and B cells. However, 9 of 11 patients with extraglandular disease and only 3 of 10 patients with glandular disease had decreased relative proportions of T cells bearing receptors for the Fc portion of immunoglobulin (Ig)G (T(G)) which was explained by a factor that blocked the expression of the IgG Fc receptor on T(G) cells. This blockage was reversible since the factor could be removed by trypsinizing the T cells before T(G) determination. Serum from patients with abnormal proportions of T(G) cells, but not serum from patients with normal proportions of T(G) cells, blocked the expression of the IgG Fc receptor on normal T cells. The serum factor upon fractionation over Bio-Gel A 1.5 columns as well as over staphylococcal protein A-Sepharose 4B columns was found diffusely within the IgG fraction, and not in the IgM fraction. Neither patients with glandular nor patients with extraglandular disease manifested increased numbers of in vivo-activated circulating lymphocytes as determined by spontaneous anti-trinitrophenyl (TNP) plaque-forming cells (PFC). However, patients with glandular disease had reduced numbers of pokeweed mitogen-induced anti-sheep erythrocyte PFC (P < 0.01) as compared with normals and patients with glandular disease. Of note was the fact that despite the modulation of T(G) subpopulation by the serum factor in patients with extra-glandular disease, these patients manifested normal concanavalin A-generated suppressor cells of pokeweed mitogen-induced PFC responses in allogeneic co-cultures. This was unlike the suppressor cell defect previously described in this system with systemic lupus erythematosus patients. The discrepancy was attributed both to the fact that the T(G) defect was reversible and to the fact that concanavalin A-generated suppressor cells are not limited to the T(G) subset. Thus, these studies have demonstrated reversible abnormalities in T(G) cells in patients with extraglandular Sjögren's syndrome which are not associated with suppressor cell defects. The discrepancy between these findings and the immuno-regulatory defects demonstrated in systemic lupus erythematosus may explain the difference in severity of the autoimmune expression in these diseases.

Deficiency of T cell mediated regulation of anti-DNA production in systemic lupus erythematosus

Isolated B cells from normal subjects and patients with systemic lupus erythematosus (SLE) could be stimulated to produce IgM anti-DNA with pokeweed mitogen. Normal but not SLE allogeneic T cells abrogated this response. Normal but not SLE autologous T cells promoted a switch from IgM to IgG anti-DNA production. SLE is characterized by at least two types of immunoregulatory abnormalities: a defect in T suppressor function and a defect in the IgM to IgG switchover.

In vitro effects of thymosin on T-cell subsets in systemic lupus erythematosus

The possible immunomodulatory influence of thymosin on lymphocytes from patients with active systemic lupus erythematosus (SLE) has been evaluated. Such patients have decreased numbers of T-suppressor (T gamma) cells and normal numbers of T-helper (T mu) cells, resulting in an abnormally low T gamma/T mu ratio. In vitro incubation of lymphocytes from active SLE patients with thymosin resulted in a normalization of the T gamma/T mu ratio. This occurred because of a decrease in T mu cells rather than an increase in T gamma cells. The normalization of T gamma/T mu ratios in vitro in the presence of thymosin is compatible with possible in vivo immunomodulatory effects of these peptides.

Screening tests for cell-mediated immunodeficiency diseases

As our knowledge of immunology has become more sophisticated we have had to alter our ideas of the etiology of many immune deficiency diseases. Indeed, current concepts now prevalent have led to reclassification of a number of disease entities. In order to keep our diagnostic efforts abreast of the information being generated by the extensive immunology research programs now in progress, the clinical laboratory has been required to offer a new array of sophisticated tests on a relatively routine basis. This article is intended to serve as a brief review of immunobiology and immunodeficiency diseases with an indepth coverage of specialized tests generally available at the large centers. With an understanding of the principles, procedures, and pitfalls of the tests carried out the laboratory scientist is in a better position to assist the clinician in reaching the correct diagnosis. The detailed review is concerned with methods available to separate, classify, and subclassify lymphocytes and thereby allow a categorization of immune deficiency diseases. Toward that end there is a discussion of surface markers, rosetting, mitogenic and antigenic responsiveness as well as lymphokine production. With a view to present day research tests that might eventually find their way into the armamentarium of the clinical laboratory in the future, there is brief discussion of the methods presently used to classify T-cells as helper, suppressor, or effector cells, assays of some of the lymphokines, and measurement of antibody synthesis in cell culture.

Rheumatoid synovial lymphocytes lack concanavalin-A-activated suppressor cell activity

Synovial lymphocytes eluted by enzyme treatment from eleven patients with rheumatoid arthritis (RA) were investigated for the presence of concanavalin A (Con A)-activated suppressor cell activity as compared with that of peripheral blood lymphocytes of twenty normal donors. In addition, two patients with psoriatic arthritis and juvenile rheumatoid arthritis (JRA) were also investigated. Synovial lymphocytes from the eleven RA patients showed a mean augmentation of 28 +/- 13.30, and thus clearly lacked suppressor activity, whereas the mean suppression in the lymphocytes from the twenty normal donors was 13 +/- 14.40. Synovial lymphocytes from one patient with JRA and one with psoriatic arthritis showed a normal suppressor activity.

Familial abnormalities of suppressor-cell function in systemic lupus erythematosus

We tested the hypothesis that abnormalities of central immune function are genetically controlled in patients with systemic lupus erythematosus. We used an in vitro suppressor-cell assay to evaluate central immunoregulation in 15 patients, 50 of their clinically healthy family members and 41 normal persons. Impaired suppressor-cell function was found in 11 patients; there was no correlation between disease activity and test results. Abnormal suppressor-cell activity was also found in 13 first-degree relatives, 12 of whom were women. We found no correlation between results of the suppressor-cell assay and the presence or absence of lymphocytotoxic antibodies in the relatives. Impaired suppressor-cell function cannot by itself explain the pathogenesis of systemic lupus erythematosus. Our results support the hypothesis that certain abnormalities of suppressor cells are genetic markers. We propose that the development of systemic lupus erythematosus requires the participation of at least two functionally distinct classes of genes.

Lack of suppressor cell activity in rheumatoid synovial lymphocytes

Lymphocytes were eluted from the synovial tissue of seventeen patients with rheumatoid arthritis (RA) and one with ankylosing spondylitis. In eight of these patients immunoglobulin production by synovial lymphocytes in the presence and absence of pokeweed mitogen was studied. In nine patients T lymphocytes were isolated from the eluted cells, and the T helper and suppressor cell functions were evaluated in an allogeneic co-culture system. Peripheral blood lymphocytes (PBL) from twenty-eight normal donors were also studied for comparison. Immunoglobulin produced by synovial lymphocytes was higher than in PBL of normal donors. However, the stimulation index of synovial tissue lymphocytes was lower. Most of the normal donors had suppressor cell activity in their peripheral blood, whereas in synovial tissue lymphocytes a statistically significant number of patients did not have any suppressor cell activity. In contrast, the synovial tissue lymphocytes showed helper activity not differing significantly from that of the T lymphocytes from peripheral blood of normal individuals.

Erythrocyte rosette inhibition as an assay for naturally occurring T lymphocytotoxic antibody in systemic lupus erythematosus

By means of a modified sheep erythrocyte rosette inhibition assay, we were able to detect naturally occurring lymphocytotoxic antibodies in sera from patients with systemic lupus erythematosus (SLE). The incidence of lymphocytotoxic antibodies was 86% in all SLE patients, and 100% in patients with active disease. Since this assay detects only the antibodies that react with the determinants on T cells or on both T and B cells, it has a great advantage of demonstrating in combination with appropriate absorptions the antibodies specific for T cells. When an appropriate panel of target cells was used, most of the antibodies in SLE sera as detected by this assay appeared to be analogous to a natural thymocytotoxic autoantibody (NTA) of New Zealand mice in its specificity and nature. The changes in the antibody titer of a patient with SLE during the course of disease correlated well with those in the total number of T cells in the blood, the antinuclear antibody titer, and some delayed skin hypersensitivities.

Gut mucosal lymphocytes in inflammatory bowel disease: isolation and preliminary functional characterization

We have developed an enzymatic technique for isolating human intestinal mucosal lymphoid cells. This method was found to be superior to mechanical methods in regard to cell yield and survival. It is based on treating mucosa with serum-free solutions containing collagenase and deoxyribonuclease, followed by isolating the lymphoid cells through centrifugation steps involving fetal calf serum and ficoll-hypaque. Exposure of peripheral blood lymphocytes to the components of the enzymatic solution did not appreciably alter their uptake of tritiated thymidine in the presence or absence of mitogens. Application of the method to derive lymphoid cells from Crohn's disease, ulcerative colitis, and normal intestinal mucosa has shown that gut mucosal lymphocytes from inflammatory bowel disease (1) exceed the number of those from normal mucosa by a factor of 3 to 5; (2) show different degrees of tritiated thymidine uptake, spontaneously and in response to mitogens, depending upon the time they are harvested during the dissociation process; (3) are better stimulators than responders in the allogeneic mixed lymphocyte reaction; (4) generate suppressor cell activity comparable to that of peripheral blood lymphocytes; (5) cannot, in contrast to peripheral blood lymphocytes, generate antibody-dependent cell mediated cytotoxicity; and (6) produce an average of 5 times more IgM than equal numbers of peripheral blood lymphocytes.

T lymphocyte subpopulations in synovial fluid of patients with rheumatic disease

The proportion of T lymphocytes with receptors for the Fc portion of IgG (TG cells) of IgM (TM cells) was determined in synovial fluid and blood of 16 patients with various rheumatic diseases including rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis. The percentage of TG cells was low in all synovial fluid samples, whereas in the patients' blood the percentage was higher than or equal to the level found in the blood of healthy subjects. Eight patients also had a lower level of TM cells in synovial fluid as compared to the percentage found in the blood of healthy donors. In the patients' blood the percentage of TM cells was usually within the normal range. Thus the proportion of T cells lacking either receptor (Tnull cells) was higher in synovial fluid than in blood. This pattern of low TG cell and high Tnull cell percentages was found in the synovial fluid of patients with various rheumatic diseases and thus seems to be a general feature of chronic inflammatory joint exudates.

Human T-lymphocyte subpopulations: alterations in systemic lupus erythematosus

Sharply reduced proportions of T cells with Fc receptors for IgG (TG cells) were observed in blood samples from patients with systemic lupus erythematosus (SLE), mainly with active disease. This T-cell subset has previously been shown to be a suppressor in the pokeweed mitogen (PWM)-dependent B-cell differentiation. In contrast, the percentages of T cells with Fc receptors for IgM (TM cells), which have been shown to help immunoglobulin production, were not different from those of normals. TG cells present in the circulation of SLE patients were analysed for their functional capacities in antibody-dependent cell-mediated cytotoxicity and in the suppression of a PWM-induced B-cell differentiation. In both these assays TG cells from SLE patients had normal effector cell activity. This suggests that thr than a qualitative type.

Supressor activity of peripheral blood mononuclear cells in patients with chronic discoid lupus erythematosus

Significantly increased suppressor activity of peripheral blood mononuclear cells was demonstrated in patients suffering from chronic discoid lupus erythematosus.

Studies of immune functions of patients with systemic lupus erythematosus

In normal individuals T cells are stimulated to proliferate by autologous non-T cells; this is called the autologous mixed lymphocyte reaction (MLR). Previous studies demonstrated that such an autologous MLR was markedly impaired in patients with active systemic lupus erythematosus (SLE). To determine whether the defect resided in the responding cell or the stimulating cell, mixing experiments were performed using cells from identical twins. We identified two sets of identical twins discordant for SLE activity and correspondingly discordant in their degree of responsiveness in the autologous MLR. Reciprocal mixing experiments were performed in which T cells from one twin of each pair were mixed with non-T cells from the other twin of that pair. These studies indicated that patients with active SLE have a defect in the ability of non-T cells to stimulate as well as a defect in the ability of both Tgamma and Tnongamma cells to respond in the autologous MLR. Patients with inactive SLE have a defect only in responsiveness of Tgamma cells.

Mucocutaneous candidiasis and thymoma

The clinical, pathologic and immunologic features of 27 patients with chronic mucocutaneous candidiasis and thymic tumors are reviewed. This form of chronic candidiasis is unique in that the infections do not occur until after the third decade and, in contrast to patients in whom candidiasis develops during infancy or childhood, it is not accompanied by failure of endocrine organs. Instead, the patients have the disorders that often accompany thymoma, such as myasthenia gravis, hypogammaglobulinemia, and abnormalities of the bone marrow and circulating blood elements. Evidence of impaired cell-mediated immunity was found in 16 of the 21 patients in whom studies were made. The pathogenesis of the immunodeficiency in these patients is unknown. Immunosuppressive activities in the plasma of four patients were found, but none of the five patients in whom the appropriate studies were made was found to have suppressor cells. The features of this disorder are unique enough that it should be considered a syndrome, and patients in whom candidiasis develops during their adult years should be studied for the presence of thymoma.

Immunofluorescence studies of anti-T cell antibodies and T cells in systemic lupus erythematosus. Selective loss of brightly staining T cells in active disease

Peripheral blood T cells from patients with systemic lupus erythematosus (SLE) and age- and sex-matched controls were studied by flow microfluorometry by using SLE anti-cell antibodies and fluorescein conjugated antibody to human IgM. Brightly staining cells were reduced in a number of patients with active SLE. Analysis of SLE T cells separated on a discontinuous stractin gradient indicated a preferential loss of cells, especially brightly staining cells, from one fraction. Quantitation of this phenomenon indicated that an average of greater than 90% of the brightly staining T cells from that fraction was lost in active SLE. This preferential loss of a subpopulation of T cells in patients with active SLE may be responsible for many of their immunologic abnormalities.

Differential sensitivity of functional subsets of T cells to the cytotoxicity of natural T-lymphocytotoxic autoantibody of systemic lupus erythematosus

A naturally occurring T-lymphocytotoxic autoantibody (Hu-NTA) in serum from a patient with systemic lupus erythematosus (SLE) showed a differential cytotoxic effect on functionally different T cell subsets as did natural thymocytotoxic autoantibody (NTA) of NZB mice. When the normal peripheral blood lymphocytes were treated, in the presence of complement, with Hu-NTA at a dilution that eliminated 25 to 30% of Hu-NTA-sensitive T cells, there was a marked reduction or a total depletion in the ability of resultant cells to show Con A-activated suppression on the proliferative response of responder cells in mixed lymphocyte reaction. The treatment of PBL in the same manner also resulted in a marked reduction in its responsiveness to Con A and PHA. However, the responder cells to allogeneic stimulator cells in MLR were found to be much more resistant to the cytotoxicity of Hu-NTA than other functional T cell subsets tested. These results suggest that Hu-NTA is responsible for the selective loss of certain functional T cell subsets including suppressor T cells in patients with SLE.

Decreased cell-mediated cytotoxicity against virus-infected cells in systemic lupus erythematosus

Cell-mediated cytotoxicity, directed against virus-infected tissue culture cells, was studied with peripheral blood mononuclear cells from 11 patients with systemic lupus erythematosus (SLE) and 12 matched, normal subjects in a 51Cr release assay. Baseline (preimmunization) levels of cytotoxicity against target cells infected with influenza A/Victoria, influenza B/Hong Kong, Newcastle disease virus, and herpes simplex virus were significantly decreased in patients with SLE compared to normal subjects (P less than 0.001), although serum antibody levels to the respective viruses were similar in both groups. After intramuscular administration of inactivated influenza A/Victoria vaccine, SLE patients failed to generate elevated levels of cytotoxicity against A/Victoria-infected cells, in contrast to normal subjects. SLE patients responded with levels of serum hemagglutination-inhibition antibody which were similar to those of normal subjects. Thus, SLE patients manifest decreased cell-mediated cytotoxicity against virus-infected target cells, although humoral antibody responses appeared to be intact. Studies of SLE patients with influenza may help to define the role of cell-mediated immunity in the pathogenesis of certain viral infections.

Abnormality of spontaneous lymphokine synthesis by lymphocytes of patients with connective tissue disorders

Forty-seven patients with various connective tissue disorders were studied to evaluate the spontaneous release of lymphocyte factors affecting the in vitro migration of guinea pig macrophages. In the assay used the lymphocytes from 8 patients produced an excessive amount of factors inhibiting macrophage migration while the lymphocytes from 12 patients produced an enhancement of migration. There were no differences in the delayed hypersensitivity skin test responses between the 2 groups of patients. The data are consistent with either an abnormality of suppressor lymphocyte function or an altered lymphocyte subpopulation relationship as a factor in this in vitro abnormality.