A pituitary-thymus connection during aging

Thymic involution is a normal consequence of aging. It has often been speculated that if this age-associated atrophy of the thymus gland could be prevented, the natural decline that occurs in a number of T-cell-mediated immune responses could be reversed. It has recently become clear that thymic involution can indeed be reversed by altering the hormonal environment of aged animals. These data support the concept of an active and functional pituitary-thymus axis. Since thymic reconstitution can result in restoration of some T-cell responses, it would appear that intrinsic defects which exist in T cells of aged animals can be at least partially reversed. This suggests that the aged environment plays a greater role in the decline of T-cell functions than has been previously recognized. Furthermore, phorbol esters and calcium ionophores can restore suppressed proliferative responses of T cells from aged rodents, so we speculate that intrinsic defects in T cells of aged subjects lie between the recognition system for antigen/lectin and intracellular transmission of this signal.

Follow-up of patients with differentiated thyroid carcinoma. Experience at Institut Gustave-Roussy, Villejuif

The recent introduction of sTSH assays allows for a definite control of the inhibition of TSH secretion. Clinical examination and serum thyroid hormone measurements are necessary to obviate hyperthyroidism. Relapses may occur after decades of apparent complete remission. Follow-up should be pursued throughout the patient's lifetime. Two specific means allow the detection of relapses at a stage when X-rays are still normal: measurement of serum thyroglobulin and 131I total body scan. Their combined use is recommended.

Quantitative immunological differences between newly diagnosed Graves' disease patients and relapsed patients

Class 2-positive T cells, T-cell and mononuclear cell subsets, thyrotropin receptor antibodies (TRAb) and immune complexes were evaluated in 34 newly diagnosed Graves' patients and in 13 relapsed patients before a cycle of specific medical treatment. Class II-positive T lymphocytes were detected by monoclonal antibodies against different epitopes of class II antigens, whereas 4F2-positive cells were detected by 4F2 monoclonal antibody. 4F2-positive cells were statistically increased in newly diagnosed Graves' patients compared to relapsed patients (p less than 0.05). An increased percentage of class II activated T cells, detected by monoclonal antibodies L243, was found in newly diagnosed patients in comparison with relapsed subjects (p less than 0.025). Newly diagnosed Graves' patients showed a significant decrease in the ratio suppressor/cytotoxic T cells in comparison with normal control subjects but not with relapsed patients. Ninety-one % of newly diagnosed Graves' patients showed a high TRAb value, whereas only 69% of relapsed patients showed increased values (p less than 0.025). No difference was observed in the immune complex positivity between newly diagnosed Graves' patients and relapsed subjects. In conclusion, both humoral and cellular immune differences were found in relapsed patients vs newly diagnosed Graves' patients. The immunological abnormalities are quantitatively more pronounced in the latter group.

Thymic hormone containing cells--IX. Steroids in vitro modulate thymulin secretion by human and murine thymic epithelial cells

We investigated the in vitro effects (kinetics and dose-response) of adrenal and sexual steroid hormones on the secretion of thymulin, a thymic hormone, by human thymic epithelial cells in primary cultures as well as in a rat epithelial cell line. We demonstrated that all steroids tested, in a range of physiological doses, stimulated thymulin production to various extents. Progesterone and estradiol, however, were revealed to be the most efficient. Specific steroid antagonists abrogated the steroid-induced stimulation of thymulin production. These findings confirm our previous in vivo results and demonstrate that steroid hormones can act directly on thymic epithelial cells to modulate their endocrine production.

The pregnant woman's eye

The effects of pregnancy on the eye fall into three categories. Nonpathological physiologic changes in pressures, corneal sensitivity and thickness, and visual function can occur. Pathologic conditions reported to develop during pregnancy include central serous chorioretinopathy, hypertensive and vascular disorders, and uveal melanoma. Pregnancy also can affect pre-existing ocular conditions, such as diabetic retinopathy, tumors, and a variety of immunological disorders and can have beneficial effects on such pre-existing conditions as glaucoma. This review covers ocular disorders in these three categories, and summarizes the systemic changes of pregnancy and the effects of ocular medications on the fetus.

Autoimmune thyroid disease: immunological, pathological, and clinical aspects

Autoimmune thyroiditis, most notably Hashimoto's thyroiditis, appears to be increasing in prevalence and is now more easily detected by sensitive laboratory tests and more invasive procedures such as fine needle aspiration. During the last decade, marked progress has been made in the understanding of these diseases. There is a greater awareness of the interaction between the humoral and cell-mediated arms of the immune system in autoimmune thyroiditis. Recent studies implicate a subpopulation of suppressor T lymphocytes which have an antigen-specific defect, resulting in their suboptimal interaction with the helper T lymphocytes and subsequent autoimmune manifestations. There is some evidence that thyroid epithelial cells which inappropriately express HLA-DR may enhance presentation of thyroid antigens to the immune system, possibly significant in the initiation or enhancement of the autoimmune response. The presence of various antithyroid autoantibodies allows the use of laboratory assays to confirm the clinical diagnosis and predict the results of treatment. There appears to be predisposing genetic factors in the development of autoimmune thyroiditis, with some geographical and racial differences. Environmental factors, most notably dietary intake of iodine, have also been implicated in the pathogenesis of Hashimoto's thyroiditis. Several animal models have been developed addressing such issues. Ongoing studies in the areas of postpartum thyroiditis and childhood thyroiditis are helpful in clarifying their relationship with Hashimoto's thyroiditis. Graves' disease and postpartum thyroiditis are being investigated as possible causes of postpartum depression. The association of Hashimoto's thyroiditis and carcinoma of the thyroid gland is still controversial, but its relationship with malignant lymphoma is now well accepted. Thus, although the pathogenesis of autoimmune thyroiditis remains elusive, there has been significant refinement of the clinical diagnosis, and immunological abnormalities of specific intrathyroidal lymphocytes have been identified. Hopefully, these new areas of knowledge will assist in the treatment of these diseases and in the prevention of the development of malignant lymphomas of the thyroid gland.

Immunomodulatory effect of the treatment of Graves' disease on antigen-specific monocyte procoagulant activity production

The monocyte procoagulant activity (PCA) production assay has been shown to be a good parameter of cell-mediated immunity. We have studied antigen-specific PCA production in peripheral blood mononuclear cells from patients with Graves' disease to determine the effect of the treatment on the cell-mediated immune response. Peripheral blood mononuclear cells from patients with untreated or relapsed Graves' disease produced significantly greater PCA with thyroid antigen stimulation than those from normal subjects. Patients both on antithyroid drugs in the hyperthyroid state and within 3 months post-131I therapy also produced significantly larger amount of PCA than normal subjects. However, there was no significant difference in PCA production with thyroid antigen stimulation between normal subjects and patients on anti-thyroid drugs in the euthyroid state, or patients over 3 months post-131I therapy. The ratio of positive to negative PCA production in patients on anti-thyroid drugs in the euthyroid state or over 3 months post-131I therapy was significantly lower than in untreated or relapsed Graves' disease patients. Mononuclear cells from patients on propylthiouracil responded to propylthiouracil in vitro by production of PCA. Cells from normal subjects, untreated Graves' disease patients, or patients with Hashimoto's thyroiditis did not produce PCA with propylthiouracil stimulation. Mononuclear cells from patients who were on propylthiouracil for more than 3 months produced greater PCA than those on the drug for less than 3 months, suggesting sensitization of lymphocytes to propylthiouracil during the course of treatment. However, after 131I therapy, they gradually became unresponsive to propylthiouracil. This study has shown that the activity of the antigen-specific response assessed by PCA production in mononuclear cells from Graves' disease patients declined after treatment, suggesting that the treatment exerted immunomodulatory effects.

Study on nonspecific immunity in pregnant women: increased chemiluminescence response of peripheral blood phagocytes

The total number of circulating leucocytes in the peripheral blood of pregnant women progressively increased with advance in gestation because of neutrophilia. When the phagocytic activity, representing nonspecific immunity, was estimated by a luminol-dependent chemiluminescence (CL) response during phagocytosing opsonized zymosan, we observed that the CL response of whole blood and Ficoll-Paque separated polymorphonuclear leucocytes (PMNL) significantly increased throughout the pregnancy (P less than 0.01). The CL responses of mononuclear leucocytes (MN) and monocytes also increased and reached peak levels in the third trimester (P less than 0.05). These findings suggest that the phagocytic activity in pregnant women increases, not only with regard to the number of phagocytes but also with regard to individual cell function, from a relatively early stage of the pregnancy, and that this increased nonspecific immunity may compensate in part for a weakened specific immunity of the maternal host. Attention should be directed to effects of human chorionic gonadotropin (hCG) relative to the increased CL response during pregnancy.

Organ weights, T-cell proliferation, and graft vs host capabilities of hypothyroidic chickens

Thiouracil-induced hypothyroidism reduced the thymus weights of young chickens. Thyroid weights were greater in thiouracil-fed (TF) chicks, and the circulating levels of triiodothyronine and thyroxine were lower. Thiouracil treatment resulted in higher relative adrenal weights and serum corticosterone concentrations. Absolute weights of adrenals were equivalent between control and TF groups. The TF chicks showed depressions of total white blood cell counts and numbers of lymphocytes. Monocyte and granulocyte numbers were unchanged from those of controls. Thiouracil treatment lowered the phytohemagglutinin M responsiveness of peripheral blood leukocytes (PBL). On the other hand, the PBL from TF chicks produced the higher graft vs host (GvH) response. Therefore, while the hypothyroidic state impaired cycling activity in T cells, this condition did not significantly influence a functional parameter of T cells, the GvH response.

Serial serum thyroglobulin measurements in the management of differentiated thyroid carcinoma

Serum thyroglobulin (Tg) was measured on repeated occasions in 416 patients with differentiated thyroid cancer for up to 7 years after initial therapy. All patients had thyroidectomy and/or ablative 131I therapy and all measurements were done while patients were receiving T4 replacement. Tg was measured using a double-antibody radioimmunoassay. Overall correlation between serum Tg concentration and presence or absence of cancer was 95.9%. At the time of initial measurement 295 patients had serum Tg less than 5 micrograms/l, and in latest analysis only 1.7% of these patients showed evidence of disease. Initially there were 19 patients of a total of 121 with serum Tg greater than 5 micrograms/l in whom no cancer was apparent. In eight of these 19 subjects recurrent or metastatic disease has been diagnosed up to 3.5 years after the first measurement indicating that in these cases serum Tg values were 'predictive'. Serum Tg appears to be a sensitive and specific means of detecting residual, recurrent or metastatic thyroid cancer and in most situations can replace routine, expensive and inconvenient radioactive thyroid scans; these should be performed when serum Tg values are elevated or when there is clinical evidence suggesting recurrence.

Reduced serum thyroglobulin response to bovine TSH in malignant hypofunctioning solid thyroid nodules: comparison to benign nodular disease

Forty-three euthyroid patients with a single, solid, nonfunctioning thyroid nodule were submitted to fine needle aspiration biopsy and serum thyroglobulin (Tg) was measured before and after (48h) 10 U of bovine TSH. Twenty-two normal subjects were also submitted to the bTSH test. Patients with nonfunctioning nodules were divided in two groups: (I) Benign or Suspicious Cytology (n = 32), (II) Malignant tissue (n = 11). In the latter group all patients underwent surgery and the pathology findings confirmed the presence of thyroid carcinoma. Twenty-one patients with benign or suspicious cytology were also operated upon and the diagnosis was colloid goiter (n = 16) and follicular adenoma (n = 5). In eleven other patients the nodule reduced significantly in size (8) or was no longer palpable after suppressive therapy (3). Normal individuals had a basal serum Tg mean +/- SD value of 12 +/- 7.2 ng/ml and a peak Tg value of 44 +/- 47 ng/ml. Serum Tg values were significantly higher (p less than 0.01) in patients with benign and malignant nodules. However the mean absolute increment (delta Tg) after bTSH was significantly lower (p less than 0.01) in patients with malignant nodules (7.2 +/- 4.8 ng/ml) as compared with normal subjects (22 +/- 16 ng/ml) or subjects with benign nodules (31 +/- 30 ng/ml). The relative (%) serum Tg increment was also significantly lower in patients with malignant tissues (14 +/- 11) as compared to those with benign nodules (77 +/- 86) or normal subjects (247 +/- 173).(ABSTRACT TRUNCATED AT 250 WORDS)

Separation and analysis of mononuclear cells infiltrating the thyroid of patients with Graves' disease

A simple method was established for separating lymphocytes infiltrating the thyroid from thyroid epithelial cells. Namely, suspensions of minced thyroid from patients with Graves' disease were layered on a Percoll two-step density gradient (p = 1.050 and 1.077 g/ml) and centrifuged (400g, 30 min, 4 degrees C). In this way 0.1-18 X 10(5) lymphocytes/g of thyroid tissue with a purity of 65-95% were obtained. Thyroid lymphocytes were analyzed quantitatively with monoclonal antibodies by laser flow cytometry and compared with peripheral lymphocytes. The proportion of OKT3+ cells was decreased with increase in OKIa+ cells. The percentage of OKIa+ cells was significantly correlated with that of Leu12+ cells. The percentages of OKT4+ cells and OKIa+ cells were higher when analyzed with an extended gate window, which was arranged for detection of activated, large-sized lymphocytes. The percentages of OKT8+ and Leu7+ cells were not significantly different from those in peripheral blood. From these results it was concluded that the proportion of B lymphocytes is increased and that of T lymphocytes is decreased, the proportion of activated B lymphocytes is increased, some helper/inducer T cells are activated in the thyroid gland in Graves' disease, and these activated lymphocytes may be important in local production of antithyroid autoantibodies.

Immunohistochemical study of intrathyroidal lymph follicles

Tissue samples from 76 cases of thyroid disease containing germinal centers (GCs) were selected from 396 cases of various thyroid diseases for immunohistochemical analysis of the GC and follicular dendritic cell (FDC). These 76 cases included 28 cases of thyroid cancer, 23 of chronic thyroiditis, 12 of nontoxic goiter, 8 of adenoma, and 5 of Graves' disease. In many lymphoid GCs IgG, IgM and kappa and lambda light chains were detected with a lacy dendritic pattern. Only thyroglobulin (Tg), among the various thyroid-associated antigens sought, was stained in GCs and was found in the same distribution as immunoglobulins. Tg was found in all of the disease categories studied. Moreover, early components in the classical complement (C) pathway, that is, C1q, C4, C3c, C3d, and C5, were detected in almost all GCs in the thyroid tissues in a lacy dendritic pattern. C3d was intensely positive and was seen also by immunoelectron microscopy on the cell surface of FDCs. It is concluded that not only immunoglobulins but also Tg and early C components are closely related to the GC and FDC in the intrathyroidal lymph follicle.

Cellular and humoral immunity in patients with hyperthyroid Graves' disease before, during and after antithyroid drug treatment

Many reports of thyroid stimulating immunoglobulins (TSI) in relation to treatment of Graves' disease have been published and with variable results concerning prediction of permanent remission or relapse after therapy. A range of methods has been used and little has been published measuring TSI by using their ability to stimulate cyclic AMP production in human thyroid cells in monolayer culture. We therefore conducted a prospective study of the predictive value of such an assay in patients with hyperthyroid Graves' disease before, during and after treatment of one year with methimazole and thyroid hormone substitution. Furthermore, the possible relationship between activated suppressor T lymphocytes and TSI in patients followed before, during and after medical therapy has been studied. Patients were divided into two groups; group I, 15 patients, who stayed in remission and group II, 14, who relapsed during the first year after discontinuation of therapy. Mean TSI activity did not differ between the two groups before and during the first half year of medication. In the second half year of treatment, however, mean TSI activity was significantly lower in group I. TSI activity at the end of treatment appeared to have no value in predicting final outcome. Increased TSI activity in group II during treatment was reflected in an increased pertechnetate thyroidal uptake as compared to that in group I. There was no relationship between changes in TSI activity and T cell subsets (Leu 1, 2a, 3a). We found no difference in T lymphocytes between the two groups at any time during observation. Subsets of T lymphocytes in both patient groups did not differ from normal.(ABSTRACT TRUNCATED AT 250 WORDS)

Enzyme-linked immunosorbent assay (ELISA) for IgG antibodies to thyroglobulin

We used a computer programmed standard IgG curve for computer-assisted quantification of assay results for autoantibodies to thyroglobulin (Tg) by quantitative enzyme-linked immunosorbent assay (ELISA). Specific antibody levels in unknowns were quantified by comparison of their optical density readings with a standard curve of absorbance vs concentration obtained with dilutions of the reference serum. Anti-Tg antibodies were detected in 80% of the patients with chronic thyroiditis and 90% of those with Graves' disease. Anti-Tg antibodies were also detected in 14.3% of the healthy controls. The titer of anti-Tg antibodies detected by tanned red cell hemagglutination correlated well with that detected by ELISA, although, the sensitivity of the ELISA was higher. By our computer-assisted conversion method, the anti-Tg antibody can be readily and reliably quantified and low titer antibodies to Tg can be detected with adequate precision.

Increased incidence of true type I diabetes acquired during pregnancy

A longitudinal study was carried out of all patients with newly acquired insulin dependent diabetes during pregnancy (as distinct from non-insulin-dependent gestational diabetes) seen at the Copenhagen Centre for Diabetes and Pregnancy during 1966 to 1980. The series comprised 63 patients with a mean age of 27 (SEM 1) years. At diagnosis the mean fasting blood glucose concentration was 15.6 (1.3) mmol/l and mean maximal insulin dose 49 (3) IU/day. At a prospective follow up examination a mean of 8 (SEM 1) years after diagnosis 46 of 60 patients (77%) were being treated with insulin (35 (2) IU/day) and had a very low mean stimulated plasma C peptide value (0.12 (0.02) nmol/l) suggesting absent or nearly absent beta cell function. The remaining 14 patients (23%), not currently receiving insulin, appeared to be severely glucose intolerant, having a mean fasting blood glucose concentration of 13.4 (1.2) mmol/l. Thus most of these patients developing insulin dependent diabetes during pregnancy had true type I disease. Compared with the age specific incidence of type I diabetes in the background population of women the incidence was at least 70% higher in pregnant than non-pregnant women (p less than 0.001; chi 2 = 11.6; f = 1). This increased incidence occurred in the third trimester when the risk of developing type I diabetes was 3.8 times that of non-pregnant women (p less than 0.000001; chi 2 = 35.6; f = 1). Finally, the risk of developing insulin dependent diabetes during pregnancy was lower when conception occurred in the winter (p less than 0.05; chi 2 = 4.18; f = 1).

A sensitive enzyme immunoassay for anti-thyroglobulin antibody using Fab'-horseradish peroxidase conjugate. Evaluation of in vitro anti-thyroglobulin antibody synthesis by lymphocytes from patients with autoimmune thyroid disease

A sensitive enzyme immunoassay (EIA) for the detection of anti-thyroglobulin (Tg) antibodies was developed using Fab'-horseradish peroxidase (HRP) conjugate. Anti-Tg antibody was assayed by incubation with a thyroglobulin-coated polystyrene ball and then with affinity-purified anti-IgG Fab'-HRP conjugate. The HRP activity was assayed fluorimetrically. The sensitivity was 625 amol/tube and anti-Tg antibody levels between 0.5 and 200 ng/ml could be determined. The recoveries of anti-Tg antibody added to human sera at three different concentrations were 94.2-101.0%. Both within- and between-assay coefficients of variation were below 10%. Significant correlation was observed between values by the EIA and TGHA method (Kendall's rank correlation coefficient = 0.712, P less than 0.001). The present EIA for anti-Tg antibody is sensitive enough to determine anti-Tg antibody synthesized in vitro by the lymphocytes from patients with autoimmune thyroid disease and normal subjects. The amounts of anti-Tg antibody synthesized by peripheral lymphocytes from patients with Hashimoto's disease were significantly greater than those from patients with Graves' disease, although serum levels of anti-Tg antibody were usually elevated in both groups of patients. The results obtained suggest that anti-Tg antibody is synthesized in a different manner in patients with Hashimoto's disease and in patients with Graves' disease.

Role of growth hormone in regulating T-dependent immune events in aged, nude, and transgenic rodents

Growth hormone (GH) appears to play a major role in a reciprocal axis that has been postulated between the thymus and pituitary glands. Our previous studies showed that thymic structure, as well as T-cell proliferation and IL-2 synthesis, could be restored in aged female Wistar-Furth rats by the implantation of GH3 pituitary adenoma cells. These cells secrete GH and some prolactin. We have now used three different approaches to determine whether GH affects a variety of immune events in vivo in both old and young rodents, and whether GH3 cells can directly affect progenitor T-cells in nude rats that congenitally lack a thymus gland. To test the effects of GH in aged rats, 750 micrograms of pituitary-derived ovine GH was injected 2 x daily into 26-month-old Fischer 344 rats for 5 weeks. This approach demonstrated that GH augments splenocyte proliferation to T-cell lectins as well as natural killer (NK) activity at low effector:target ratios even though morphologic characteristics of the thymus were not altered. To assess the effect of GH in young rodents, mice were studied that were transgenic for the rat metallothionein-GH gene. Histologic evaluation of thymus glands revealed that the amount of adipose tissue and the number of epithelial cells and Hassall's corpuscles are augmented in transgenic mice. Splenocyte proliferation at suboptimal mitogen doses is greater in transgenic than in control littermate mice, but neither IL-2 synthesis nor antibody synthesis to sheep erythrocytes is affected. The role of pituitary hormones on progenitor T-cells was then explored by implanting GH3 cells into Rowett nude rats.(ABSTRACT TRUNCATED AT 250 WORDS)

Acquired disorders affecting the immune system and non-Hodgkin's lymphoma

A case-control study was undertaken to determine whether a prior history of a variety of acquired disorders affecting the immune system was associated with an increased risk of non-Hodgkin's lymphoma. Cases were identified over a 4-year period (1976-1979) at the Johns Hopkins Hospital and individually matched to hospital controls on age, sex, race, and year of diagnosis. For the 109 cases and matched controls who were traced and interviewed, positive associations suggesting an increase in risk were not detected. Instead, there was a suggestion of an inverse relationship. Odds ratios (ORs) were consistently less than 1 for associations between non-Hodgkin's lymphoma and several chronic infectious diseases (OR = 0.65, 95% CI = 0.35, 1.20), chronic inflammatory diseases (OR = 0.88, 95% CI = 0.43, 1.79), autoimmune disorders (OR = 0.80, 95% CI = 0.19, 3.76), and allergic disorders (OR = 0.77, 95% CI = 0.45, 1.32). A statistically significant protective association was found for surgical removal of lymphoid tissue (OR = 0.50, 95% CI = 0.27, 0.91). Adjustment for potentially confounding variables did not change these results. These findings do not support the previously anecdotally reported impression that disorders producing a chronic antigenic stimulus are associated with the development of non-Hodgkin's lymphoma.

Radioiodine therapy of thyroid disease

Ten "ideal" steps used at the University of Michigan to treat well-differentiated thyroid cancer are presented. Using this in 103 patients with well-differentiated thyroid carcinoma and metastases outside their neck, those that were freed of their disease after 131I therapy survived three times as long as those not cured of their disease. Patients successfully cured of their metastases showed better conformity to the "ideal" steps than the patients with residual metastases. Each of the most commonly asked questions about 131I treatment of thyroid carcinoma following surgical treatment are discussed.

Suppressor-cell dysfunction in children with histiocytosis-X

Suppressor-cell activity of peripheral blood mononuclear cells were examined and lymphocyte subsets analyzed in children with histiocytosis-X and in healthy, age-matched subjects. Suppressor-cell function was assessed by two methods, the indomethacin stimulation of mitogen-activated cultures and the concanavalin A-inducible suppressor-cell assay. The results of these two assays indicate that children with active disease have significantly decreased suppressor-cell activity. Additionally, the percentage and absolute number of OKT8+ lymphocytes were decreased in children with active disease. Suppressor-cell activity and lymphocyte subsets returned to normal, baseline levels with disease remission. This study documents for the first time suppressor-cell dysfunction and supports previous investigations in which suppressor T lymphocytes are deficient in children with active disease. These findings may explain certain clinical manifestations seen in children with histiocytosis-X.

Lymphocyte subsets in habitual abortion

Lymphocyte subpopulations were characterized by means of monoclonal antibodies in 25 women with habitual abortion and 21 multiparous normal women. Compared to nonpregnant women (N = 8), pregnant normal women were associated with significantly lower helper-to-suppressor ratios (1.71 +/- 0.41 versus 2.37 +/- 0.66). In contrast in pregnant women with habitual abortion (N = 13) the ratio remained high (2.32 +/- 0.73). Failure to increase the number of suppressors and a significant rise in helpers caused this increased ratio. We discuss the possible mechanisms and etiological importance of this finding in habitual abortion.

T-cell subsets and natural killer cell activity in patients with gestational trophoblastic neoplasia

Lymphocyte counts, T-cell counts, B-cell counts, helper T-cell counts, and suppressor-cytotoxic T-cell counts were performed in 38 patients with gestational trophoblastic neoplasia and 38 normal control subjects. Natural killer cell activity was also assayed in 30 patients and 30 control subjects. The percentage and count of lymphocytes and the absolute counts (but not the percentages) of T cells, helper T cells, and suppressor-cytotoxic T cells in patients with gestational trophoblastic neoplasia were significantly lower than those of normal control subjects. In high-risk patients with gestational trophoblastic neoplasia, there was also a significant reduction of the helper T cell to suppressor-cytotoxic T-cell ratio in comparison with that in normal control subjects. There was no significant difference in the B-cell counts or natural killer cell activity. The measurement of these parameters was not useful in predicting the response to chemotherapy.

L-thyroxine therapy induces a fall of thyroid microsomal and thyroglobulin antibodies in idiopathic myxedema and in hypothyroid, but not in euthyroid Hashimoto's thyroiditis

Thyroid microsomal (MAb) and thyroglobulin (TgAb) antibodies were sequentially measured by sensitive and quantitative radioassays in 17 patients with goitrous Hashimoto's thyroiditis (9 hypothyroid, 8 euthyroid) and in 19 patients with idiopathic myxedema before and at various time intervals up to 24-48 months after the institution of L-thyroxine therapy. Thyroid antibodies were also determined in 5 euthyroid subjects with Hashimoto's thyroiditis maintained without treatment for a similar period. During L-thyroxine administration a reduction of MAb with respect to the pretreatment level was found in 6 of the 9 (67%) hypothyroid patients with Hashimoto's thyroiditis and in 16 of the 19 (84%) patients with idiopathic myxedema. The decrease of MAb was highly significant in both groups (p less than 0.001 and p less than 0.0001, respectively). A fall of TgAb occurred in 2 of the 3 patients (75%) with hypothyroid Hashimoto's thyroiditis and in 9 of the 10 (90%, p less than 0.001) patients with idiopathic myxedema having abnormally elevated pretreatment TgAB levels. No consistent pattern of MAb and TgAb changes was observed in the euthyroid subjects with Hashimoto's thyroiditis, whether treated or untreated. In the hypothyroid patients with Hashimoto's thyroiditis a significant association was found between the decrease of MAb and the reduction of goiter size (p less than 0.05) occurring during L-thyroxine administration. Moreover, the decrease of MAb and TgAb in idiopathic myxedema was greater (p less than 0.05) in the patients with normalized serum TSH (less than or equal to 4 microU/ml) than in those showing only a partial reduction of serum TSH (greater than 4 microU/ml) under L-thyroxine.(ABSTRACT TRUNCATED AT 250 WORDS)

Collagen-induced arthritis and pregnancy in mice: the effects of pregnancy on collagen-induced arthritis and the high incidence of infertility in arthritic female mice

Collagen-induced arthritis (CIA) in mice is a model of inflammatory polyarthritis that has many features similar to human rheumatoid arthritis. In rheumatoid arthritis, pregnancy leads to amelioration of the disease while exacerbation develops after delivery. We used the CIA model to elucidate the role of pregnancy on disease and vice versa. The onset of arthritis in pregnant mice was delayed in the B10.RIII strains immunized with native porcine type II collagen 7-12 days prior to syngeneic [B10.RIII (susceptible to CIA) X B10.RIII] and allogeneic (B10.RIII female X B10.K male that are CIA resistant) pregnancy. In contrast, when mice were immunized on days 1-6 of pregnancy, the onset of arthritis was earlier as compared with controls. In addition, once the mice developed CIA after delivery, the disease showed markedly rapid progression as compared to the control immunized group. Humoral immune responses to type II collagen showed significantly decreased levels on day 14 (at late stage of pregnancy) both in syngeneic and allogeneic postmating immunized pregnant mice. The same effect was also seen in allogeneic premating immunized pregnant mice on day 21 (at mid-stage of pregnancy). The levels of these antibodies increased after delivery. Subclasses of IgG1 and IgG2a antibodies to type II collagen were suppressed during pregnancy. In the pseudopregnant group, these antibodies showed decreased levels on day 14, but did not differ from the control groups on day 21 and 28. Some immunoregulatory changes may play a role in these alterations in pregnant arthritic mice. In comparison to the effects of syngeneic (susceptible X susceptible) pregnancy on CIA, allogeneic (susceptible female X resistant male) pregnancy seemed to be beneficial for the affected individuals. Litter size and mean birth weight were not affected by immunization of type II collagen. After onset of CIA, both syngeneic and allogeneic matings failed to produce offspring in arthritic female mice. The estrus cyclicity was highly disturbed in arthritic female mice and gonadotropin stimulation in arthritic mice induced significantly less ova in oviducts and maturing follicles as compared to nonarthritic controls. Immunological factors yet to be elucidated may be involved in this ovarian dysfunction.

Long-term effect of iodized oil on serum thyroglobulin levels in endemic goitre patients

Serum thyroglobulin (Tg) response to bovine TSH (bTSH) was evaluated in 44 goitrous patients (grades III and IV) living in conditions of chronic iodine (I) deficiency (iodine urinary excretion less than 40 micrograms I/g) and in 26 normal subjects. After the initial clinical evaluation and laboratory tests (bTSH test, T4, T3, anti-Tg and anti-microsomal antibodies) all goitrous patients received 1 ml i.m. of iodized oil (I-oil) and were followed up for 30 months. The bTSH test was repeated at 6, 12, 20 and 30 months after I-oil in 21 subjects. A marked reduction in goitre size was observed in 85% of the patients with a concomitant significant increase in the mean serum T4 and T3 concentrations, a significant fall in the mean serum TSH level and a significant decrease in the T3/T4 ratio. Goitrous patients had elevated serum basal Tg levels (55 +/- 8 SEM micrograms/l) and a significantly mean higher peak Tg value after bTSH (200 +/- 65 micrograms/l) as compared with normal subjects (respectively, 11 +/- 1.4 and 32 +/- 3.4 micrograms/l). Larger goitres (grade IV) had a significantly higher mean peak Tg response as compared with grade III goitres. Treatment with I-oil significantly reduced the mean peak Tg response to bTSH after 6 months (59 +/- 10 micrograms/l) but at 12 and 20 months the peak Tg response after the injection rose, respectively, to 110 +/- 19 micrograms/l and 92 +/- 14 micrograms/l (P less than 0.02 as compared with 6 months), returning to the normal range only at 30 months.(ABSTRACT TRUNCATED AT 250 WORDS)

T cell subsets and thyroid-stimulating antibodies in patients with Graves' disease in clinical remission

Patients with active Graves' disease almost constantly show phenotypic alterations of T lymphocytes, such as an increase of "activated" cells recognized by various surface markers (e.g. la antigens). Such alterations are present in a certain number of apparently cured patients. The data herein reported refer to 25 patients with Graves' disease in clinical remission, in whom we have attempted to correlate T cell subset imbalances, the presence of thyroid-stimulating antibodies (TSAb) and the outcome of the subsequent relapse. The results obtained show a significant association between TSAb and the increase of la-positive T cells: no relationship was found between TSAb and other T lymphocyte subsets. One-year clinical follow-up of the patients enabled us to see relapses of hyperthyroidism in only two patients, who had shown in the first control both TSAb positivity and increased la-positive T cells. These results, in our opinion, suggest a role of la antigens expression on T lymphocytes in the clinical course of Graves' disease.

Autologous mixed lymphocyte reaction (AMLR) in man. XVI. The AMLR and monoclonal antibody-defined T cell subsets and HNK 1+ natural killer cells in normal human pregnancy

Peripheral blood mononuclear cells from 27 pregnant women and 10 age-matched non-pregnant women were examined for monoclonal antibody-defined T cells, immunoregulatory T-cell subsets, natural killer cells, activated T cells and surface Ig+B lymphocytes using a fluorescence-activated cell sorter (FACS analyzer). The autologous mixed lymphocyte reaction (AMLR) and in vitro influence of interleukin 1 (IL-1) and interleukin 2 (IL-2) on the AMLR were also studied. No significant difference was observed in the proportions of Leu 3+ (helper/inducer phenotype) and Leu 2+ (suppressor/cytotoxic) T cells during all three trimesters of pregnancy and in post-partum period when compared to non-pregnant healthy control women. T cells expressing DR antigen (evidence of T-cell activation) were significantly increased during second trimester (P less than 0.02) and in post-partum period (P less than 0.05). However, Tac+ T cells (IL-2 receptor positive T cells, another but distinct marker for T cell activation) were normal throughout pregnancy and in the post-partum period. Leu 7+ (HNK 1+) lymphoid cells (containing a population of natural killer cells) were normal during all 3 trimesters of pregnancy but were increased during post-partum period. Surface Ig+B cells were comparable to control group throughout pregnancy and during post-partum period. The AMLR was significantly deficient (P less than 0.01) during first and third trimester of pregnancy. In vitro addition of purified IL-2 restored the AMLR to the baseline levels of the controls but the AMLR was still lower than the levels in controls with IL-2.(ABSTRACT TRUNCATED AT 250 WORDS)

Thyroglobulin production by malignant thyroid tumors. An immunocytochemical and radioimmunoassay study

Four hundred thirty surgical and biopsy specimens of malignant thyroid tumors of 323 patients were analyzed by histologic and immunocytochemical examination for their thyroglobulin (TG) content. Almost 95% of the differentiated thyroid carcinomas of follicular origin contained immunoreactive TG. The authors could not demonstrate TG in anaplastic carcinomas. Postoperative follow-up and serum TG determinations were available for 111 athyroid patients. Serum TG was elevated in five patients with metastatic or recurrent moderately differentiated follicular carcinoma, in two patients with metastasizing papillary, and in one patient with anaplastic carcinoma. Four patients had detectable serum TG levels without clinical and radiologic evidence of recurrence or metastases. In addition to conventional histologic examination, immunocytochemical demonstration of TG is a reliable and valuable aid in the diagnosis, classification, and determination of the grade of differentiation of malignant thyroid tumors. From this the pathologist can provide a pathologic basis for postoperative patient management.

Thyroiditis

In this review, the major types of immune mediated thyroiditis are described and the etiology explained in the light of current theories of autoimmunity. Hashimoto's thyroiditis is a common autoimmune disease. The onset is gradual with patients presenting with symptoms of hypothyroidism, nonspecific symptoms of the autoimmune process itself, or symptoms relating to a goitre. The disease is usually relentless and, except in young patients, permanent replacement with thyroxine is eventually required. Silent thyroiditis is another autoimmune disease of more acute onset. The initial, thyrotoxic, phase lasting several weeks is due to release of thyroid hormone from damaged follicles, and radionuclidic scans show absent uptake. There often follows a hypothyroid phase with final recovery in most patients. Post partum thyroiditis is due to silent thyroiditis, or, less commonly, Hashimoto's thyroiditis, occurring three to six months after delivery. Subacute thyroiditis often follows a viral infection and is not thought to be an autoimmune disease. It presents with severe thyroid pain and tenderness with marked non-specific symptoms such as myalgia and fatigue. The initial, thyrotoxic, phase is also due to release of thyroid hormone, and radionuclidic scans show absent uptake. A hypothyroid phase often follows and recovery is complete. Hashimoto's thyroiditis appears to be due to a congenitally present, antigen specific, T suppressor lymphocyte defect. It is proposed that in silent thyroiditis there is a less severe Ts defect and a correspondingly greater decompensating factor. In post partum thyroiditis, this factor appears to be a general decline in T suppressor lymphocyte function after delivery. Subacute thyroiditis is not an autoimmune disease. The thyroid appears to be an "innocent bystander" in an immune mediated antiviral attack.

Phenotypic and functional evaluation of suppressor cells in normal pregnancy and in chronic aborters

To evaluate the potential role of immunoregulatory cells modulating the maternal immunologic response during pregnancy, we carried out phenotypic and functional studies in patients with normal obstetrical histories during each trimester and in patients with chronic idiopathic spontaneous abortions. Using monoclonal antibodies (Ortho), total numbers of T cells (T3+) and T4+ cells progressively increased during pregnancy (compared to nonpregnant controls) and then declined in the third trimester. Increased percentages of T8+, T10+, and Ia+ cells were found in the third trimester. The relative decline in numbers of T4+ cells, with increased numbers of T8+ cells, led to a significantly reduced T4/T8 ratio in the third trimester. Histamine receptors on T cells were quantitated by an immunofluorescent technique. Significantly reduced numbers of H1-type receptors were noted during the second trimester of pregnancy and this was associated with a decreased H1/H2 ratio. Functionally, histamine-induced suppression was measured in a lymphocyte proliferation assay. Patients in the first and second trimester of pregnancy had greater histamine-induced suppression of phytohemagglutinin (PHA)-stimulated proliferation at high concentrations of histamine (10(-3) to 10(-7)) but less suppression at the lower concentrations (10(-9) to 10(-11) M), compared to nonpregnant controls. In contrast, patients studied in the third trimester failed to respond to any concentration of histamine. MLC-induced suppressor activity was generated by incubating the maternal cells with either paternal or third-party mononuclear cells for 2 or 6 days and assaying the cell-free supernatant for its suppressive effects on PHA-stimulated proliferation. Maternal responses to paternal cells did not result in significant suppression in 2-day supernatants during any trimester but by 6 days the suppressive activity was equivalent to non-pregnant controls in patients during the first and second trimester. Maternal responses to third party cells was greater during the second trimester than either the first or third trimesters in both 2- and 6-day supernatants. Patients with histories of chronic idiopathic spontaneous abortions, who were not pregnant at the time of study, exhibited normal numbers of T-cell subsets and T4/T8 ratios. Numbers of both H1 and H2 receptor bearing T cells were proportionally reduced, resulting in a normal H1/H2 ratio. Despite having decreased numbers of H1 and H2 receptor bearing cells, histamine-induced suppression of PHA-stimulated proliferation was comparable to nonpregnant controls over the concentration range (10(-3) to 10(-11) M) employed.(ABSTRACT TRUNCATED AT 400 WORDS)

Phenotypic and cytotoxic characteristics of the immune cells of the human placenta

Despite some functional impairment of the newborn's T-cell immune system, most infants survive the intrauterine and perinatal period without succumbing to infection or maternal lymphocyte engraftment. The placenta may play a crucial role in protecting the infant from microbial and histocompatibility antigens. Accordingly, we studied phenotypic and functional capacities of placental cells. Placentas were obtained from uncomplicated pregnancies. Matched cord blood and maternal peripheral blood were also obtained in many instances. Fresh minced placental tissue was washed and digested with collagenase and DNase and mononuclear cells were obtained by density gradient centrifugation. The average yield was 10(6) cells/g of tissue with greater than 80% viability. Chromosome analysis of five placental preparations indicated that these cells were of fetal rather than maternal origin. The isolated placental cells consisted of trophoblasts, lymphocytes (74 +/- 3%), monocytes (16 +/- 3%), and granulocytes (8 +/- 2%). E-rosette forming cells (T cells) made up 65 +/- 2% and surface membrane immunoglobulin positive cells made up 8 +/- 1% of the placental mononuclear cells. Fluorescent activated analysis of the mononuclear cells indicated less Leu 4-positive cells (Pan-T) 43 +/- 3%, and less Leu 3-positive (T-helper cells) (25 +/- 2%), than cord and maternal cell preparations. Leu-2, DR, and B1 positive cells were similar to those in cord and maternal blood. Leu 7 and especially Leu 11 positive cells, markers for natural killer cells, were abundant in placental cells, making up 4 +/- 0.7% and 20 +/- 3%, respectively. The Leu 7/Leu 11 ratio of the placental cells was different from either the maternal or cord blood cells. Natural killer activity of placental cells against a K562 natural killer target was low, despite the abundance of cells with NK markers. The K562 activity was low in the placental cells, similar to the low NK activity of maternal and cord cells. Molt 4f killer activity was near normal. Lectin-dependent cytotoxicity using an EL-4 cell target plus PHA was low in placentas, compared to normal, maternal, or cord cell cytotoxicity. Matched samples indicated that LDCC activity was mother greater than cord greater than placenta. Antibody-dependent cytotoxicity (Raji target) of placental cells showed low activity, and again the paired studies indicated that normal controls greater than maternal greater than cord greater than placenta cytotoxicity.(ABSTRACT TRUNCATED AT 400 WORDS)

Endocrine regulation of the immune system

Immunoregulation, the major process of self-defence, appears to be more complex than has been previously thought, involving the central nervous and endocrine systems. This review demonstrates growing evidence for the hypothesis that endocrine factors from the pituitary and hypothalamus directly influence the development and function of the immune system. Both pituitary and hypothalamic hormones interfere with lymphocyte proliferation and function. Proliferation of T-lymphocytes as well as production of immunoglobulins by plasma cells seem to be hormone dependent. Clinical observations suggest that hematological, oncological, and immunological disorders known for their immune pathogenesis are associated with alterations of the endocrine homeostasis. Recently, human peripheral mononuclear cells have been shown to possess specific receptors for pituitary hormones. It is hypothesized that proteohormones act directly on lymphocytes via specific membrane receptors. Thus, the endocrine system, closely related to cortical and subcortical centers in the central nervous system, is one of the body's instruments to regulate and modulate its immune response. This hypothesized immunoregulatory pathway via the central nervous system and endocrine glands may well be of importance for the body's defence against infectious and malignant diseases. In addition, a new picture of the complex immunoregulatory mechanisms emerges for a better understanding of the function of the immune system. However, there is no single hormone which has yet been identified as being crucial for development and/or function of the immune system. It appears from the literature that a number of various proteohormones rather than a single hormone acts on immunocompetent cells.

The effect of [125I]thyroglobulin tracer heterogeneity on serum Tg RIA measurement

Comparative serum Tg RIA studies were used to evaluate the contamination of 125I-19S Tg (B) (670 000 Da) with a smaller partially immunoactive degradation product (C) (530 000 Da). B and C tracers prepared either by enzymic (GO), chloramine T (CT) or Bolton Hunter (BH) iodination methods were tested. B tracers, (either GO or CT), gave consistently higher Tg values vs C tracers at serum Tg levels greater than 30 ng/ml. No difference in values was seen with C tracers of either GO, CT or BH origin. The immunological nonidentity between B and C tracers was shown by nonparallelism between diluted high Tg sera and the Tg RIA standards. Nonparallelism existed above 30 ng/ml with all C tracers irrespective of iodination method and was, in addition, present with CT-B tracers from 3/4 Tg preparations. Only B tracers, prepared by GO or BH, consistently showed adequate parallelism. The ubiquitous nature of C contamination of B tracers prompted a comparative study of serum Tg RIA values between four different laboratories. Good interlaboratory agreement was shown for Tg values less than 30 ng/ml, whereas there was a 10- to 20-fold difference in values for sera with high Tg levels (greater than 100 ng/ml). The observed/expected ratio of values, in serial dilutions of a high Tg sera, measured in two of the laboratories, suggested that nonparallelism accounted for some interlaboratory differences. Contamination of 125I-19S Tg (B) by its breakdown product C, has potential to lower absolute serum Tg values and produce non-parallelism in diluted high Tg sera which results in aberrantly low Tg RIA values. This problem potentially limits the clinical application and relevance of serum Tg measurements in thyroid cancer patients, especially those with metastases associated with high serum Tg levels.

Graves' disease with neutropenia and marked splenomegaly: autoimmune neutropenia due to propylthiouracil

A 38-year-old man with Graves' disease taking propylthiouracil (PTU) for 6 years developed neutropenia and marked splenomegaly. After subtotal thyroidectomy with discontinuance of PTU the patient remained asymptomatic for the last two and half years. The serum obtained during the period of neutropenia demonstrated opsonic activity to neutrophils of the patient as well as of normal volunteers. This opsonic antineutrophil activity was located in the IgG fraction of the serum. Furthermore, PTU at the concentration (0.1-1.0 micrograms/ml) attainable in the patient's serum significantly stimulated [3H] thymidine incorporation in the patient's lymphocytes. These findings indicate that the patient developed autoimmune neutropenia by producing opsonic antineutrophil antibodies in association with the PTU therapy.

A high prevalence of thyroglobulin autoantibodies in adults with and without thyroid disease as measured with a sensitive solid-phase immunosorbent radioassay

Sera from 228 patients with thyroid disease and 140 healthy subjects without clinical or biochemical evidence of thyroid disease, were tested using a sensitive solid-phase immunosorbent radioassay (RIA) and a passive hemagglutination test (TRC test) for thyroglobulin antibodies (Tg-ab). With the RIA technique, Tg-ab was found in 27% of the controls (36% of the women and 15% of the men), whereas only 0.7% of them were Tg-ab positive with the TRC test. All individuals with primary hypothyroidism were Tg-ab positive with the RIA, compared with only 56% with the TRC test. Tg-ab (RIA) were found in 43/53 (81%) of the patients with toxic diffuse goiter, and in 30-40% of the patients with toxic nodular goiter, toxic adenoma, atoxic goiter, and thyroid carcinoma, the TRC test being positive in 10-17% of these patients. The high prevalence of Tg-ab in the healthy population suggests that subclinical thyroiditis is more frequent than has been assumed from antibody measurements made with less sensitive methods, and is in agreement with the prevalences reported from autopsy studies.

Diagnostic value of a single serum thyroglobulin determination on and off thyroid suppressive therapy in the follow-up of patients with differentiated thyroid cancer

To assess the significance of a single serum thyroglobulin (Tg) determination on and off thyroid suppressive therapy, serum Tg measurements have been performed in 349 serum samples from 82 patients with differentiated thyroid cancer. All samples were collected after total thyroidectomy with or without subsequent ablation of residual thyroid tissue by radioiodine. One hundred and fifty-three samples were obtained while the patients were on thyroid suppressive therapy and 196 after withdrawal of medication. The results of serum Tg assays were analysed in relation to the presence or absence of residual or metastatic thyroid tissue, as assessed by clinical and laboratory evaluation, including 131I whole body scan. In patients with thyroid residue but no metastases, undetectable serum Tg (false negative results) occurred in 45% of cases off therapy and in 92.9% of cases during therapy. In the presence of metastases no undetectable serum Tg result was found in patients off therapy, while four (6.9%) out of 58 samples from patients with bone and/or lung metastases and seven (31.8%) out of 22 samples from patients with lymph node metastases alone were undetectable (falsely negative) during suppressive therapy. Serum Tg was undetectable in sera from patients with no evidence of thyroid residue or metastatic disease in all but one (1.7%) of 59 samples on and three (5.4%) of 56 samples off suppressive therapy. These Tg results were confirmed to be truly rather than falsely positive, since evidence of metastatic disease was obtained by whole body scan after the administration of therapeutic doses of 131I.(ABSTRACT TRUNCATED AT 250 WORDS)