T-lymphocytes in experimental autoimmune myasthenia gravis. Isolation of T-helper cell lines

An increase in circulating B cell-activating factor in childhood-onset ocular myasthenia gravis

BACKGROUND

Myasthenia gravis is a B cell-mediated autoimmune disorder. The pathophysiology of childhood-onset ocular myasthenia gravis remains unclear. We investigated serum B cell-activating factor levels and other immunological parameters in child patients with ocular myasthenia gravis.

METHODS

Blood samples were obtained from 9 children with ocular myasthenia gravis and 20 age-matched controls. We assayed serum concentrations of B cell-activating factor, anti-acetylcholine receptor antibody titers, 7 types of cytokines (interleukins-2, -4, -6, -10, and -17A; interferon-γ; tumor necrosis factor-α) as well as the percentages of peripheral blood CD4+, CD8+, and CD19+ cells.

RESULTS

Serum B cell-activating factor levels were significantly higher before immunosuppressive therapy in patients with childhood-onset ocular myasthenia gravis than in controls and decreased after immunosuppressive therapy. A significant positive correlation was observed between serum B cell-activating factor levels and anti-acetylcholine receptor antibody titers in patients with myasthenia gravis. Serum B cell-activating factor concentrations did not correlate with the percentages of CD4+, CD8+, and CD19+ cells or the CD4+/CD8+ ratio. No significant differences were observed in the levels of the 7 different types of cytokines examined, including interleukin-17A, between preimmunosuppressive therapy myasthenia gravis patients and controls.

CONCLUSIONS

Circulating B cell-activating factor may play a key role in the pathophysiology of childhood-onset ocular myasthenia gravis.

Acetylcholine receptor-specific T-lymphocyte clones in the normal human immune repertoire: target epitopes, HLA restriction, and membrane phenotypes

Potentially autoimmune T-lymphocyte lines specific for the nicotinic acetylcholine receptor of the neuromuscular junction have been isolated previously from patients with myasthenia gravis. We report on the isolation and expansion of T cells specific for the acetylcholine receptor of Torpedo californica or for a recombinant mammalian acetylcholine receptor alpha chain peptide (X4), from the peripheral blood of 11 healthy donors. Two major T-cell epitopes, located between amino acid positions 44-104 and 141-172, were identified using a panel of overlapping mammalian alpha chain fusion proteins. Most T lines recognized the acetylcholine receptor epitopes in the molecular context of HLA-DR molecules. Unexpectedly, all the T. californica acetylcholine receptor-specific T lines obtained from one DR4 (DRw53), DQw3 donor and two DR4, w8 (DRw53), DQw3 donors were restricted by DRw53 product(s). Using DR gene-transfected L cells as antigen presenters, in 4 lines, a close relationship between the recognized epitope and the restricting DR element was revealed. The membrane phenotype of the T. californica acetylcholine receptor-and X4-specific T lines was predominantly CD4+CD8-, with some CD4+CD8+ components. It did not significantly differ from that of control, tuberculin purified protein derivate-specific T lines raised from the same donors. These findings are in harmony with previous ones demonstrating the presence of potentially autoimmune T-lymphocyte clones within normal immune repertoires.

Autoimmune T cell recognition of human acetylcholine receptor: the sites of T cell recognition in myasthenia gravis on the extracellular part of the alpha subunit

Autoimmune T cell lines were prepared from peripheral blood lymphocytes of five myasthenia gravis patients by passage in vitro with an equimolar mixture of 18 overlapping synthetic peptides corresponding to the entire extracellular region (residues alpha 1-210) of the alpha subunit of human acetylcholine receptor (AChR). The proliferative responses of the human AChR-specific T cell lines to each of the individual peptides were determined. It was found that the profiles of the peptides recognized by the T cells were different among the five T cell lines, consistent with genetic control operating at the recognition site level. However, other regulatory influences may play important roles in the triggering of the autoimmune responses. These results suggest that the pathogenesis of this autoimmune disease is variable at the cellular-molecular level.

T cell epitopes in experimental autoimmune myasthenia gravis of the rat: strain-specific epitopes and cross-reaction between two distinct segments of the alpha chain of the nicotinic acetylcholine receptor (Torpedo californica)

T cell epitopes on the nicotinic acetylcholine receptor (A ChR) of Torpedo californica were analyzed using T cell lines isolated from Lewis, BN, and (Lewis X BN)F1 rats. All lines selected for reactivity against either native or denatured AChR or for 6 selected synthetic peptides of the AChR alpha chain expressed the CD4 membrane phenotype and recognized their antigen in the context of major histocompatibility complex class II determinants. They were tested in vitro for reactivity with each of these antigens. The results indicate that parental Lewis and BN rat T lymphocytes recognize distinct molecular epitopes on the AChR protein, whereas (Lewis X BN)F1 hybrids respond against both sets of epitopes. Two peptides (P10 and P11) which represent distinct amino acid sequences on the putatively extracellular part of the AChR alpha chain, and which share only 4 common amino acids, two of them contiguous, showed an unexpected cross-reactivity in the Lewis rat. T cells selected for either peptide co-recognize the other peptide in vitro. In addition, these cells are responsive against full length AChR. P11, in particular, appears to be a major epitope for Lewis rats immunized with AChR.

T lymphocyte recognition of acetylcholine receptor: localization of the full T cell recognition profile on the extracellular part of the alpha chain of Torpedo californica acetylcholine receptor

A series of eighteen consecutive overlapping synthetic peptides, of uniform size and overlaps, which encompass the entire extracellular part (residues 1-210) of the Torpedo californica acetylcholine receptor alpha chain were examined in vitro for their ability to stimulate lymph node cells from acetylcholine receptor-primed C57BL/6 (H-2b), C3H/He (H-2k), SWR (H-2q) and SJL (H-2s) mice. The recognition sites (T sites) by acetylcholine receptor-primed lymph node cells from these mouse strains resided within six regions on the extracellular part of the alpha chain. Three of the regions recognized by T cells coincided with regions recognized by antibodies (i.e. B cells) and one of these three regions also coincided with an alpha-neurotoxin-binding region. It is noteworthy that, in addition to sites recognized by both T and B cells, the protein has at least two sites which are recognized exclusively by T cells and to which no detectable antibody responses are directed.

Influence of T cell specificity on the heterogeneity and disease-causing capability of antibody against the acetylcholine receptor

Adoptive secondary anti-acetylcholine receptor (AChR) antibody responses were examined in rats to evaluate the influence of helper T cell specificity on the nature and disease-causing potential of antibody produced. Mixtures of B cells reactive with the intact AChR plus T cells reactive with purified AChR subunits (alpha, beta, gamma, delta) were transferred and antigen-challenged in immunologically naive recipient rats; the serum anti-AChR antibody produced was assessed by radioimmunoassay for differences in titers and by isoelectric focusing for differences in clonal heterogeneity as a function of the subunit specificity of T cells transferred. In addition, rats receiving different sources of AChR or AChR subunit-reactive T cells were examined for AChR-dependent muscle dysfunction. The results indicated a clear reduction in anti-AChR antibody concentrations and clonal heterogeneity in recipient rats receiving T cells of specificities restricted to individual subunits. However, except for a clear relationship between serum anti-AChR antibody concentration and disease induction, no particular AChR subunit-reactive helper T cell specificity appeared to preferentially cause muscle dysfunction. We conclude that if such relationships exists, T cells with specificities more restricted than those described here will have to be used.

Analysis of helper-T-cell function by acetylcholine receptor-reactive cell lines of defined AChR-subunit specificity

A small panel of cloned acetylcholine receptor (AChR)-reactive helper T cells were examined for their ability to proliferate when stimulated with AChR or purified AChR subunits. It was observed that all T-cell lines preferentially responded to the AChR alpha subunit, but that some also were stimulated by other subunits as well. This was interpreted as indicating that the alpha subunit plays a major role in anti-AChR T-cell responses, but that considerable potential cross-reactivity exists among the subunits recognized by T cells. Furthermore, a high level of "microheterogeneity" in the T-cell-specificity repertoire was suggested by the fact that even this small panel of cloned lines expressed several patterns of subunit reactivity. Finally, all cloned T-cell lines examined were found to be capable of functioning as regulatory helpers in vitro by providing the necessary signals to AChR-responsive B cells, resulting in anti-AChR antibody production.

Strategies for the modulation of neuroimmunological disease at the level of autoreactive T-lymphocytes

Cell lines of autoimmune T-lymphocytes have been established in several neuroimmunological model diseases and also in a human neurological autoimmune disease, myasthenia gravis. These cell lines generally have the T helper/inducer phenotype and recognize autoantigen in the context of class II histocompatibility antigens. Autoreactive helper T cell lines may become useful tools for the evaluation of new immunotherapeutic strategies. (1) Treatment with anti-Ia monoclonal antibodies presumably interferes with the interaction between Ia on the surface of antigen-presenting cells and the autoreactive T cell receptor; (2) Therapy with unmodified or modified autoantigen may be used to tolerize or delete the autoimmune T cells; (3) Monoclonal antibodies against the 'T cell domains' of autoantigen may prevent its recognition by the autoreactive T cells; (4) Treatment with monoclonal antibodies against T cell clonotypic or differentiation antigens may effectively delete or inactivate the autoreactive T cells. Furthermore, autoreactive helper T cells may be used to induce and establish anti-idiotypic suppressor T cell lines, or the autoimmune helper T cells may themselves display suppressive effects in an allogeneic system.

Myasthenia gravis: reactivation of clinical disease and of autoimmune factors after discontinuation of long-term azathioprine

In 15 patients with myasthenia gravis who were in stable clinical remission while receiving azathioprine, we monitored disease severity and serial autoantibody titers before and after discontinuation of azathioprine. Cellular immunoreactivity against tuberculin (PPD) and against Torpedo acetylcholine receptor (AChR) was measured serially in 11 patients. Eight of 15 patients (53%) had a clinical relapse after 3 to 11 months, necessitating the reinstitution of immunosuppressive treatment in 6 patients. Seven patients have remained clinically stable during an observation period of 20 to 40 months. Anti-AChR autoantibody titers correlated closely with the clinical course in the majority of patients, and rose markedly in 7 of the 8 patients who relapsed. Cellular stimulation indices correlated less closely with the clinical severity. Only in 3 patients did the clinical score, antibody titer, and cellular stimulation index rise concurrently. In 4 patients who had high cellular stimulation indices after the discontinuation of azathioprine, it was possible to isolate AChR-reactive inducer/helper T lymphocytes.

Myasthenia gravis and myasthenic syndromes

More than a decade ago myasthenic symptoms were observed in rabbits immunized with acetylcholine receptor (AChR) [119] and AChR deficiency was found at the neuromuscular junction in human myasthenia gravis (MG) [36]. By 1977 the autoimmune character of MG and the pathogenic role of AChR antibodies had been established by several measures. These included the demonstration of circulating AChR antibodies in nearly 90% of patients with MG [87], passive transfer with IgG of several features of the disease from human to mouse [149], localization of immune complexes (IgG and complement) on the postsynaptic membrane [30], and the beneficial effects of plasmapheresis [20, 123]. Substantial subsequent progress has occurred in understanding the structure and function of AChR and its interaction with AChR antibodies. The relationships of the concentration, specificities, and functional properties of the antibodies to the clinical state in MG have been carefully analyzed, and the mechanisms by which AChR antibodies impair neuromuscular transmission have been further investigated. The clinical classification of MG has been refined, the role of the thymus gland in the disease has been further clarified, and new information has become available on transient neonatal MG. The prognosis for generalized MG is improving, but there is still no consensus on its optimal management. Novel therapeutic approaches to MG are now being explored in animal models. Recognition of the autoimmune origin of acquired MG also implied that myasthenic disorders occurring in a genetic or congenital setting had a different cause. As a result, a number of congenital myasthenic syndromes have come to be recognized and investigated. Finally, an acquired disorder of neuromuscular transmission different from MG, the Lambert-Eaton myasthenic syndrome, has also been shown to have an autoimmune basis. In this syndrome, active zone particles of the presynaptic membrane are direct or indirect targets of the pathogenic autoantibodies.

Autoimmune human T lymphocytes specific for acetylcholine receptor

Myasthenia gravis is one of the best characterized human autoimmune disorders. Circulating autoantibodies to the nicotinic acetylcholine receptor (AChR) at the neuromuscular junction play a prominent part in the effector phase, that is, the immunoregulation. Indirect evidence, such as thymic abnormalities and the association with certain histocompatibility antigens (for example HLA-B8,-DR3) suggests a defect of immunoregulation at the level of thymus-dependent (T) lymphocytes. We report here on the isolation of autoreactive T cells from six patients with myasthenia gravis. From one of these patients, who is homozygous for HLA-DR3, we established a long-term T-cell line. The line cells are specific for purified fish and human AChR, display the surface phenotype of inducer/helper T cells and are genetically restricted to HLA-DR3. AChR-induced proliferation could be inhibited with two monoclonal antibodies against monomorphic DR determinants and also with DR3-specific alloantiserum.