Isolation of normal T cells in chronic lymphatic leukaemia

T-lymphocyte response to cytokines in B-chronic lymphocytic leukemia

The mechanisms underlying abnormal T-cell function in B-chronic lymphocytic leukemia (B-CLL) are unknown. We have studied B-CLL T-cell activation pathways in the rigorous absence of leukemic cells and with controlled numbers of accessory cells present. The responsiveness to added recombinant IL-1 and IL-2 was assessed. We have found that under optimal culture conditions B-CLL T cells had a normal PHA-induced proliferative response in terms of incorporated 3H-thymidine per T cell. Also the capacity of mitomycin-C treated B-CLL monocytes to support autologous T-cell mitogenesis was normal. However, a subtle difference between normal and B-CLL T cells emerged with respect to cytokine responsiveness. While the PHA response of purified normal T cells in the absence of monocytes was augmented by rIL-1, this could not be demonstrated for B-CLL T cells. A much greater degree of augmentation occurred with added rIL-2 in the case of both normal and B-CLL T cells. In the presence of 20% autologous monocytes rIL-1 and rIL-2 had no effect on mitogenesis. We conclude that B-CLL T cells have an abnormal profile of cytokine responsiveness which is consistent with observed abnormalities of subset distribution, and which may contribute to the clinical immunodeficiency in B-CLL.

Granulocyte-macrophage colony-stimulating factor promotes differentiation and survival of human peripheral blood dendritic cells in vitro

Interest in human dendritic cells (DC) has been heightened recently by the discovery that this cell type is a primary target of the human immunodeficiency virus, the causative agent of AIDS. DC are bone marrow-derived cells with an extraordinarily potent ability to promote the immunological activity of T lymphocytes. Unfortunately, since DC constitute less than 0.5% of peripheral blood mononuclear cells and die within a few days of their isolation, they are not readily accessible to study. We report here that granulocyte-macrophage colony-stimulating factor (GM-CSF), a cytokine with well-recognized effects on granulocyte and macrophage maturation, profoundly affects the morphology and viability of DC isolated from peripheral blood. GM-CSF not only promotes DC survival but also induces DC differentiation to mobile, reversibly adherent cells with long-branched projections. DC cultured in GM-CSF survive for up to 6 wk and retain their ability to stimulate the proliferation of T cells in allogeneic and autologous mixed leukocyte reactions.

Heterogenous response of B cell chronic lymphocytic leukaemia (B-CLL) cells to anti-human IgM antibody (anti-mu) and B cell stimulatory factor 1 (BSF-1)

B cell chronic lymphocytic leukaemia (B-CLL) cells from seven patients were examined for 3H-TdR uptake with anti-human IgM antibody (anti-mu) and B cell stimulatory factor 1 (BSF-1)/IL-4. B-CLL cells from one patient could proliferate with anti-mu plus BSF-1, but not with BSF-1 alone. B-CLL cells from two patients responded to BSF-1 alone; one could proliferate more by adding anti-mu, but the proliferation of the other cells was inhibited by adding anti-mu. On the other hand, B-CLL cells from the other four patients responded neither to anti-mu nor to anti-mu plus BSF-1. Surface densities of membrane IgM of B-CLL cells were also analysed by fluorescence activated cell sorter (FACS), but there was no correlation between proliferative response (DNA synthesis) of B-CLL cells to anti-mu and densities of surface membrane IgM. These results show that there is a functional heterogeneity of B-CLL cells with regard to proliferative response to anti-mu and BSF-1.

Granulocyte colony-stimulating factor (G-CSF) induces synthesis of alkaline phosphatase in neutrophilic granulocytes of chronic myelogenous leukemia patients

The monocyte, monocyte conditioned media (MoCM), giant cell tumor conditioned media (GCT) and a purified colony-stimulating factor (G-CSF) promote granulocyte-macrophage progenitors (CFU-GM) growth and differentiation along the neutrophil lineage and also induce alkaline phosphatase (NAP) synthesis in the neutrophilic cells of normal subjects and of patients with chronic phase chronic myelogenous leukemia (CML). However, it is not known if granulocyte-macrophage-CSF (GM-CSF), macrophage-CSF (CSF-1) or other cytokines can induce NAP synthesis from the neutrophilic cells of CML patients. The objective of this study were (a) to ascertain which of the three CFU-GM CSFs would induce NAP synthesis, and (b) to test if any of the other cytokines--interleukin-1 (IL-1), interleukin-2 (IL-2), alpha- and gamma-interferons (alpha-INF and r-INF), and phytohemagglutinin-stimulated T-cell conditioned media (TCM) would induce NAP synthesis. Light density cells obtained from the blood of patients with chronic phase CML were depleted of T cells and monocytes. These cells were cultured with various amounts of G-CSF, GM-CSF, CSF-1, IL-1, IL-2, alpha-INF, r-INF, MoCM, GCT and TCM in a suspension culture system over 6-7 days. Evaluation of the cultures indicated that G-CSF, MoCM and GCT, but not the other factors or cytokines, consistently induced NAP synthesis in a dose-dependent manner. Actinomycin-D and puromycin in separate cultures inhibited NAP synthesis without any significant reduction in cell counts. This indicated that NAP is not prepackaged in neutrophilic cells, and its synthesis occurs by a sequential transcription at the DNA level and translation at the ribosomal level. Our results suggest that the molecule which is responsible for promotion of CFU-GM growth and differentiation along the neutrophilic cell lineage is also responsible for derepression of NAP gene and initiation of NAP synthesis.

Cyclosporin-A for the treatment of pure red cell aplasia in a patient with chronic lymphocytic leukemia

A 62-year-old man with B-cell chronic lymphocytic leukemia had three separate episodes of pure red cell aplasia (PRCA). The last episode was treated with cyclosporin-A (CyA) and prednisone. After the patient was on the therapy for 2 weeks, erythropoietic recovery was observed and with continued therapy the hematocrit (Hct) became normal. The PRCA remission was associated with a fall in the blood lymphocyte count, and a reduction in the spleen and lymph node size and bone marrow lymphocyte density. At diagnosis of PRCA the blood T-cells bearing IgG Fc receptors (T gamma cells) were increased, and the marrow contained very few or no late-stage erythroid progenitors. After remission of PRCA the T gamma cell fraction decreased, and the marrow erythroid progenitor's number became normal. We speculate that therapy with CyA and prednisone inhibited the production of interleukins-1 and -2 from monocytes and T-cells, respectively, and was responsible for the reduction of the T gamma cell fraction and B-cell leukemic mass in this patient. Further, we believe that normalization of T gamma cells in association with the therapy was responsible for the PRCA remission.

PA-II, the L-fucose and D-mannose binding lectin of Pseudomonas aeruginosa stimulates human peripheral lymphocytes and murine splenocytes

Pseudomonas aeruginosa lectin PA-II agglutinates human peripheral lymphocytes and stimulates mitogenesis (predominantly in T cells), like the plant lectins PHA and Con A. Murine splenocytes are also agglutinated and stimulated by PA-II as by Con A. Sialidase treatment of the human and murine cells enhances their agglutination and augments the stimulation of human lymphocytes at low PA-II concentrations. The PA-II agglutinating and mitogenic effects are specifically inhibited by L-fucose. The bacterial source and the specificity of PA-II for L-fucose are both rare features among the hitherto described mitogenic lectins. However, since this lectin also binds mannose, a mannose-bearing receptor might be involved in its mitogenicity.

Suppressor T cell activity in lymphoid interstitial pneumonia

A case of lymphoid interstitial pneumonia was investigated for immunological abnormalities. Suppressor T cells were found. The abnormality in the lymphoid system could be corrected in vitro with levamisole. The patient thereafter developed histiocytic lymphoma and soon died without any response to chemotherapy.

Purification and saccharide-binding characteristics of a rice lectin

A lectin was purified from rice flour by aqueous extraction followed by precipitation by ammonium sulfate and affinity chromatography on p-aminobenzyl 2-acetamido-2-deoxy-1-thio-beta-D-glucoside-succinyl-aminohexylaminyl -Sepharose 4B. The molecular weight of the lectin is approximately 36,000, as determined by sedimentation-equilibrium analysis. It is a tetramer consisting of two different subunits (Mr = 12,000 +/- 1,000 and 9,000 +/- 1,000). Amino acid analysis indicated that the lectin contains very high proportions of half-cystine, glycine, and glutamic acid. All of the half-cystines are present as -S-S- bridges. The lectin agglutinates human A, B, AB, and O erythrocytes, rabbit erythrocytes, human leukocytes, and is mitogenic to human lymphocytes. The hemagglutinating activity of rice lectin is inhibited by 2-acetamido-2-deoxy-D-glucose, methyl 2-acetamido-2-deoxy-beta-D-glucoside, chitobiose, and chitotriose. N-Acetylneuraminic acid was a noninhibitor, but N-acetylneuramin-(2----3)-lactose showed weak inhibition. The agglutinating activity was also inhibited by various sialoglycoproteins. The immobilized rice-lectin bound glycophorin, alpha 1-acid glycoprotein, and fetuin. Asialoglycophorin, asialofetuin, ovomucoid, and human chorionic gonadotropin were bound only partially to the column.

Competitive prognostic value of clinicopathologic and bioimmunologic factors in primary breast cancer

Fourteen clinical, pathologic, and pretreatment bioimmunologic variables were evaluated for their significance in predicting the survival or the length of disease-free interval of 55 patients with primary breast cancer. The variables studied were: patient age; clinical stage of disease according to the International Union Against Cancer TNM classification; number of involved nodes; sedimentation rate; peripheral lymphocyte, leucocyte, and monocyte counts; serum levels of immunoglobulins IgG, IgA, and IgM; percentages of E-, "active" E-, and EAC-rosettes; and finally, the lymphoblastic transformation test value (PHA-LTT). A multivariate analysis using the Cox proportional hazards regression model was carried out, in a stepwise manner, to identify those variables most highly related to survival or to the length of disease-free interval. The Cox analysis showed that clinical stage, number of involved nodes, percentage of EAC-rosettes, sedimentation rate, and T-lymphocyte reactivity, (i.e., the T-lymphocyte sensitivity to PHA, expressed as the ratio between the PHA-LTT in counts per minute and the percentage of E-rosettes) were the significant prognostic factors for survival, whereas the number of involved nodes and the sedimentation rate were independent of importance in predicting the length of disease-free interval. The results obtained from this analysis proved the importance of some immunologic parameters in the estimation of prognosis. In addition, a prognostic score for summarizing multiple factors with potential use in stratification was derived from the multivariate analysis.

The relationship between membrane characteristics, functional reactivity of T-lymphocytes, and the progression rate of B-cell chronic lymphocytic leukemia

Study performed on 192 patients has demonstrated that the progression rate of chronic lymphocytic leukemia (CLL) is associated with the existence of T-cell defect(s). A dynamic classification system based on evaluation of tumor mass growth rate, response to therapy, and myelopoietic failure (MF) has been devised for evaluation of progression rate of CLL. Besides four basic groups (Group 1: CLL without therapy; Group 2: CLL on therapy, without remission; Group 3: CLL on therapy, partial remission; Group 4: CLL on therapy, complete remission) patients were further classified into phase (type) A (stable, indolent CLL) or phase (type) B (active, progressive CLL). The major criteria for phase A were: total tumor mass (TTM) doubling time (DT) longer than 12 months, no MF, and/or good response to therapy. The major criteria for phase B were: TTM DT less than 12 months and/or accompanying MF and/or no response to therapy. The following major findings have been demonstrated: (1) altered quantitative relationship between active and nonactive parts of T-cell compartment (E/A ratio) in the progressive phase of CLL; (2) altered B/T gamma ratio in the progressive phase of CLL; (3) more than 50% increased percentage of T gamma cells in the stable phase of CLL; (4) very low stable and absent seeding efficiency of T-cells in the progressive phase of CLL; (5) altered (delayed) DNA synthesis pattern in the progressive phase of CLL; and (6) negative local xenogeneic graft versus host reaction in the progressive phase of CLL. Based on reported results, a hypothesis regarding the possible role of T-cells in the pathogenesis of CLL was suggested.

Unaltered immunocompetence in patients with non-disseminated breast cancer at the time of diagnosis

Immunologic parameters were examined preoperatively in 104 patients with breast cancer, staged according to the TNM classification and in 95 age-matched healthy women. The immunologic evaluation in the peripheral blood included lymphocyte and monocyte counts, determination of E-rosette-forming T-lymphocytes (SER+) and B-lymphocytes (MER+), T-lymphocyte subsets defined with monoclonal antibodies (Leu-1, Leu-2a, Leu-3a) and with lectin fractionation (soybean agglutinin), lymphocyte transformation test with phytohemagglutinin (PHA) and concanavalin A (ConA), and colony formation of T-lymphocytes in agar (T-lymphocyte colony-forming cells, [TL-CFC]). Two age groups (Group A: 30-50 years; Group B: 51-70 years) and the different tumor stages (Stage I-IV) were analyzed. Patients and controls did not differ in the absolute numbers of lymphocytes, T- and B-cells. In patients of Group B, the absolute number of monocytes was increased slightly in Stage II and III and significantly in Stage IV (P less than 0.05). Similarly, the lymphocyte response to PHA was significantly reduced in Stage IV Group B only (P less than 0.05). ConA-induced lymphocyte proliferation and TL-CFC capacity were not different in patients and controls. In the small number of patients and age-matched controls in whom T-lymphocyte subsets were determined, the absolute numbers of T-cells with helper or suppressor phenotype as defined with Leu-3a, Leu-2a, or lectin fractionation with soybean agglutinin were similar. This study demonstrates that in patients with early breast cancer (Stage I-III), immunocompetence as defined by either functional in vitro studies or surface marker analysis is not significantly altered at the time of diagnosis. In contrast, patients with advanced disease (Stage IV) show a significant increase in the absolute number of monocytes and a depressed PHA responsiveness of mononuclear cells.

Thymus-derived lymphocyte enumeration in patients with uveal malignant melanoma

Thymus-derived lymphocytes (T lymphocytes) were enumerated in patients with uveal malignant melanoma. Two T-lymphocyte subpopulations were determined, the active rosette forming cells (A-RFC) and the total rosette forming cells (T-RFC). Subjects were divided into the following groups: (a) pretreatment patients, (b) patients treated by enucleation, (c) patients treated by photocoagulation, (d) patients treated by cobalt plaque radiotherapy, (e) patients treated by enucleation who developed clinically detectable metastasis, and (f) normal controls. There were no differences in the numbers of A-RFC or T-RFC in the control population, pretreatment patients, and those treated in the different ways. Statistically significant depressions of A-RFC and T-RFC levels were seen in patients with metastatic lesions, suggesting that they had an impairment of immunocompetence, as measured by T-lymphocyte rosette formation.

Lymphocyte response to pokeweed mitogen in chronic lymphocytic leukemia

The response of lymphocyte subpopulations to pokeweed mitogen (PWM) was studied in normal volunteers and patients with B-cell chronic lymphocytic leukemia (CLL). Since unfractionated peripheral blood mononuclear (PBM) cells from CLL patients consist of a markedly increased proportion of B-lymphocytes and a decreased proportion of T-lymphocytes, enriched fractions of CLL B-cells and CLL T-cells were cultured in 1:1 proportions in autologous and allogeneic combinations with normal B-cell and T-cell-enriched fractions. Cultures containing normal B-cells with either autologous or allogeneic normal T-cells responded well to PWM. CLL T-cells were capable of providing a helper function for both proliferation and differentiation of normal B-cells, which was not significantly different from that provided by allogeneic normal T-cells. CLL B-lymphocytes were unresponsive to PWM when cultured in the presence of either autologous CLL T-lymphocytes or allogeneic normal T-lymphocytes. The responsiveness of CLL B-cells was not restored by the addition of normal peripheral blood monocytes to the cultures. These experiments indicate that there is an intrinsic B-cell defect which prevents CLL B-lymphocytes from responding to PWM.

A further study on quicker re-entry of chromosomally abnormal cells to active proliferation and preferential death of chromosomally normal cells during ageing of specimens in acute myeloid leukemia (AML)

Quicker re-entry of chromosomally abnormal cells to active proliferation under culture conditions was observed in cultured peripheral blood samples, old or fresh, but not in cultured bone marrow samples. In 10 patients with AML studied using peripheral blood, the mitotic index (MI) rose after 24 h in culture and reached a peak after 48 h in culture in AA patients (with all abnormal karyotypes); the MI rose after 24 h in culture and reached a peak after 48, 72 or 96 h in culture in AN patients (mixed normal and abnormal karyotypes); the MI remained at much lower level until after 72, 96 or 120 h of culture in NN patients (all normal karyotypes). The MI at 24 and 48 h of culture was significantly higher in AN and AA patients than in NN patients. A significantly increased frequency of chromosomally normal cells after prolonged culture was observed in one patient with t(8;21). The results of this study also suggest that chromosomally normal cells are more likely to die off than are abnormal ones during ageing of specimens.

An improved technique for Ia-determination in guinea pigs

The serological typing of determinants within the guinea pig histocompatibility complex (GPLA-complex) has, until now, largely been carried out by the 51Cr-release technique. As target cells, a mixture of B and T cells from peripheral blood and lymph nodes were used. However, for the detection of Ia-determinants, which predominantly are expressed on the surface of B cells, the use of lymphocyte suspensions with a relatively low content of B cells can cause some evaluation problems. We have developed a simple method for obtaining a relatively pure suspension of B cells, making use of the ability of guinea pig T cells to form rosettes with rabbit red blood cells and the possibility of removing these by sedimentation on lymphoflot. By employing these purified B cells, an improved serological detection of Ia-determinants of the guinea pig histocompatibility complex is made possible.

Separation of human T-lymphocyte colony-forming cells on Percoll gradients

Formation of T-lymphocyte colonies in semi-solid agar by mitogen-stimulated peripheral blood mononuclear cells is a sensitive indicator of a proliferative response. The exact identity of the T-lymphocyte colony forming cell (T-CFC) is not known, nor is it known if more than one T-CFC exists. It is possible that different subsets of mononuclear cells, each responding to diverse mitogens, give rise to different T-CFC. In this study, we separated mononuclear cells into seven subsets based on their density utilizing Percoll at concentrations of 40% to 55%. Following separation, the cells from each fraction were stimulated by phytohemagglutinin (PHA), pokeweed mitogen (PWM), concanavalin A (Con A), or staphylococcal protein A (SPA), and cultured in a semi-solid agar system. Each fraction was fully characterized by immunologic and cytochemical cell markers. Monocytes were found in the light density fraction, whereas T-lymphocytes and large granular lymphocytes were predominantly seen in the heavier density fractions. B lymphocytes were concentrated in the middle density fractions. Cells from fraction 1 (the lightest density fraction) formed significantly more T-cell colonies when stimulated by PHA than did fractions 4, 5, 6, or 7. This effect was not observed when other mitogens were used. We conclude that mononuclear cells can be separated into enriched cell subpopulations by Percoll fractionation and that PHA-stimulated T-CFC may also be enriched by Percoll fractionation. In addition, the data suggest that different subsets of T-CFC may exist.

Quantitation of Fc receptor-bearing T-lymphocytes (TG and TM) in oral cancer

The lymphocytes from the peripheral blood of 30 untreated patients with oral cancer and 15 apparently healthy normal controls were studied for quantitation of T-cell subsets. When compared to age-matched controls, the patients as a group showed a significant increase in the proportion and number of TG cells (IgG Fc receptor-bearing T-cells) and a significant reduction in the TM cells (IgM Fc-bearing T-cells). The levels of total lymphocytes, T-cells, and B-cells remained in the control range. The discrepancy in the TG subset was evident in the early stages of the disease, while in TM cells, it was evident only in the advanced stages.

Active T rosettes, human autologous T rosettes, OKT8 and OKT4 cells, con A-induced suppressive activity, and autoantibodies: clinical correlations

Correlations between various T-cell subsets: OKT4, OKT8, TEh (human autologous T rosettes), and TEa (active T rosettes) cells and the concanavalin A-induced suppressor function assessed on Con A proliferation have been analyzed in 46 patients with various secondary immunological disorders. The different T subsets and the suppressive activity were also compared in patients with and without autoantibodies. Significant positive correlations were found between T-cell markers TEa-OKT8 and TEh-OKT4. Significant inverse correlations were also found between Con A-induced suppressive activity-OKT4/OKT8 ratios, and TEa-OKT4/OKT8 ratios suggesting that the subpopulations identified by the active T rosettes are probably involved in T immunoregulatory mechanisms. There was no association between the Con A-induced suppressive function or the T markers TEa, OKT4, and OKT8, and the presence of autoantibodies. Only subjects with autoantibodies had a lower percentage of T lymphocytes forming autologous rosettes. These observations emphasize the fact that lack of correlation may exist between markers or function and immune status in some patients.

Erythrocyte-rosette receptor expression by chronic lymphocytic leukemia B lymphocytes

Erythrocyte (E) rosette-forming cells have been investigated in three patients with B chronic lymphocytic leukemia whose leukemic lymphocytes were easily identifiable. A small percentage of fresh neoplastic cells formed E rosettes in two patients. In every patient, most unstimulated, cultured leukemic lymphocytes became E+ and this was further enhanced by phytohemagglutinin and pokeweed mitogen stimulation or neuraminidase treatment. These E+ B cells lacked detectable T cell antigens (except for a weak expression of an antigen associated with the helper T cell subpopulation in one case). They were unreactive or weakly reactive by immunofluorescence with a monoclonal antibody to the E receptor. However, this antibody completely inhibited E-rosette formation. The enhanced expression of E-rosette receptors by in vitro cultured cells appeared to be dependent upon the presence of a small number of E-rosetting cells at the beginning of the culture. E-rosette receptor expression by leukemic lymphocytes was most likely in a fourth case (out of 9 patients studied). This finding may account for some of the discrepancies in the study of so-called T cells in B chronic lymphocytic leukemia.

E-rosette forming cells (E-RFC) in squamous cell carcinoma of the larynx and laryngopharynx

The percentages of early and late E-RFC were measured in 25 proven cases of squamous cell carcinoma of the larynx and laryngopharynx. Both counts were depressed significantly in the patients compared to the controls (p less than 0.001). There was also a significant correlation of these counts with the severity of the disease, but there was no correlation between the counts and the duration of the disease.

Relevance of monoclonal antibodies in the diagnosis of unusual T-cell acute lymphoblastic leukaemia

3 cases of adult acute lymphoblastic leukaemia (ALL), the T-cell nature of which was identified only using a panel of monoclonal antibodies (MoAb), are described. All cases were E-rosette negative, surface immunoglobulin (SmIg) negative, common ALL (CALLA) antigen negative, terminal deoxynucleotidyl transferase (TdT) positive, and acid phosphatase positive. The T-cell origin of the blasts was demonstrated by the positivity with RFA-1, a MoAb which detects an antigen of MW 65-69000 present on the membrane of thymocytes and mature T-lymphocytes. In addition, 2 of the 3 cases were positive with OKT6, which recognizes cortical thymocytes. MoAb directed against more mature T lineage cells (OKT3, OKT4, OKT8, OKT11A) were consistently negative (less than or equal to 12%). These findings indicate that the use of a combination of MoAb is important in detecting individual cases of T-ALL, which otherwise might be classified as undifferentiated acute leukaemia or null-ALL. MoAb detecting a T-cell antigenic determinant of MW 65-69000 (e.g. RFA-1, OKT1, Leu1) appear the most specific reagents for T-ALL.

Abnormal T-cell functions in B-cell chronic lymphocytic leukemia do not imply T-lymphocyte involvement in the leukemic process: report of a case with demonstrated "polyclonality" of T lymphocytes

In a patient with chronic lymphocytic leukemia (CLL), we previously demonstrated by glucose-6-phosphate isoenzyme analysis that monoclonality was restricted to B lymphocytes. Isolated T cells expressed both isoenzymes and, therefore, were apparently not involved in the leukemic process. This report presents results of a functional analysis of the patient's T cells. Cutaneous anergy to a battery of skin tests was correlated with abnormal proliferative responses of isolated T cells to phytohemagglutinin and concanavalin A. The addition of sufficient numbers of autologous adherent cells restored mitogen responses to nearly normal levels. However, the patient's T cells failed to provide help for differentiation of allogeneic B cells in response to pokeweed mitogen. These data suggest that altered cellular immunity in CLL is not necessarily due to intrinsic T cell abnormalities. Reduced numbers of circulating accessory cells and/or an imbalance in T-cell subsets related to the expansion of the leukemic B-cell clone may play a significant role.

An improved technique for separating rosetted from non-rosetted lymphocytes

An improved technique for separating rosetted from non-rosetted lymphocytes is described. The major advantage of this new technique is the elimination of the need to mechanically resuspend the cell pellet resulting from the rosette formation step before using a density gradient to separate the rosetted from the non-rosetted cells. Instead the rosette containing cell pellet is directly overlayed with Percoll at a density of 1.078 g/ml and during a subsequent centrifugation the non-rosetted cells float to the surface of the Percoll while the rosetted cells remain in the cell pellet. The utility of this technique is illustrated by separating human T lymphocytes forming rosettes with neuraminidase treated sheep erythrocytes (En) from other mononuclear cells obtained by Ficoll-Hypaque separation of whole blood. Using several markers the resulting T cells were contaminated with less than 0.3% monocytes and 2% B cells. The non-T cell population contained less than 3% T cells. This method offers a rapid and easily reproducible means for obtaining highly purified cell populations.

T lymphocytes in B-cell chronic lymphocytic leukemia: characterization by monoclonal antibodies and correlation with Fc receptors

In 35 patients with B-cell chronic lymphocytic leukemia (B-CLL), T lymphocytes were characterized by their ability to react with OKT-4 and OKT-8 monoclonal antibodies. These T-cell subsets were also compared with the expression of Fc receptors. An imbalance in the distribution of OKT-4 and OKT-8 lymphocyte subpopulations was observed, with an overall significant reduction in the OKT-4/OKT-8 ratio. When the patients were subdivided according to Rai's staging classification, the OKT-4/OKT-8 ratio was more severely impaired in stages III and IV than in stages 0, I, and II. The correlation between the expression of Fc receptors and monoclonal antibodies revealed in both systems an increase in cells bearing suppressor phenotypes (OKT-8+ and TG+ cells) and a decrease in cells bearing helper phenotypes (OKT-4+ and TM+). However, a strict correlation between cells defined by the two assays could not be found in individual cases. In some cases a proportion of T lymphocytes (E+ and OKT-3+) did not express the OKT-4 and OKT-8 determinants; possible implications of this finding are discussed. These data provide further evidence of the T-cell abnormality in B-CLL and emphasize the importance of T-cell subsets in this disease.

Impaired production of mononuclear cell procoagulant activity in chronic lymphocytic leukaemia

Chronic lymphocytic leukaemia (CLL) is associated with a low incidence of thrombotic complications, or disseminated intravascular coagulation (DIC), or both, despite the frequent occurrence of severe infections. We have investigated the capacity of blood mononuclear cells to produce procoagulant activity when stimulated with bacterial endotoxin in 16 patients with untreated chronic lymphocytic leukaemia (CLL). Procoagulant activity generated by patients' cells after prolonged incubation with endotoxin was significantly lower than that produced by cells from a matched control group (p less than 0.001). The defect could not be attributed to an inhibitory effect of leukaemic lymphocytes. It is suggested that in CLL the monocyte has an intrinsic functional abnormality of the procoagulant response to endotoxin and possibly to other stimuli. These findings help explain why CLL patients do not develop thrombotic complications despite the high incidence of severe infectious diseases.

Chronic lymphocytic leukemia. Immunologic markers and functional properties of the leukemic cells

In 230 cases of chronic lymphocytic leukemia (CLL), marker analysis was performed with rosette techniques and a panel of xeno-antisera. A monoclonal B-cell proliferation was found in the majority of cases (94%). In most cases, the B-cells carried IgM, with or without IgD. Cytoplasmic immunoglobulin-inclusion bodies were seen in 7% of the cases of B-CLL. The number of patients with non-B/non-T-CLL was small (2%) in this series. In eight patients (4%), a proliferation of T-cells was established. These patients had a different clinical presentation and marker analysis of the lymphocytes, together with functional studies, showed that this group represented a mixture of different disease processes. Functional analysis of the B-CLL cells in 19 cases showed a poor or absent mitogen response and in nine cases the absence of the capacity to differentiate in vitro into plasma cells and/or to produce immunoglobulins.

Alveolar macrophage dysfunction in human bone marrow transplant recipients

We studied the functional characteristics of alveolar macrophages obtained by segmental pulmonary lavage from allogeneic marrow transplant recipients without evidence of ongoing pulmonary infection. The macrophages were mostly of donor marrow origin as judged by Y body fluorescence and were morphologically normal, except for the intracellular accumulation of various amounts of heterogeneous foreign materials. Macrophage function of patients studied within four months after transplantation was impaired, as measured by chemotaxis, phagocytosis and killing of Candida pseudotropicalis, and killing of bacteria. In two patients studied six and 12 months after transplantation, macrophage functions returned toward normal except for a persistent defect in killing of C. pseudotropicalis. Cytomegalovirus was cultured from the lavaged cells of two patients, but the macrophage dysfunction was independent of the cytomegalovirus isolation. These results show that alveolar macrophage dysfunction occurs in marrow transplant recipients and may be associated with their increased risk for pulmonary infections.

The presence of Burkitt-like cells in non-Burkitt's neoplasms

In four cases, the morphology of neoplastic cells from the peripheral blood and bone marrow suggested the diagnosis of American Burkitt's lymphoma or acute lymphocytic leukemia (French--American--British--Classification; FAB-L3). Cytochemical and immunologic studies, however, indicated that the neoplastic cells in one case were characteristic of acute lymphocytic leukemia (non-B, non-T-cell type); in another case, metastatic carcinoma; and in two two cases acute myelomonocytic leukemia. We conclude that cytochemical and immunologic cell markers are necessary for the diagnosis of American Burkitt's lymphoma. In addition, neoplastic cells simulating lymphoblasts of acute lymphocytic leukemia, FAB-L3 may derive from non-B lymphocytic lineage.

Disturbances in T-cell subpopulations in B-cell chronic lymphocytic leukaemia

The relative proportions of immunoregulatory T-cell subpopulations defined by OKT monoclonal antibodies are disturbed in chronic lymphocytic leukaemia (CLL) patients (even early mild cases) compared with normal subjects in the same age range. The mean ratio OKT4+:OKT8+ (helper:suppressor/cytotoxic) is reversed from the normal 1.6:1 to 1:1.9. The absolute concentration of each OKT population in the circulation is slightly higher than normal, the increase in OKT8+ being the most significant. The E-rosette-forming cells did not always correlate with OKT+ cells and, in four cases, the discrepancy between the size of the OKT3+ population and the sum of OKT4+ and OKT8+ suggested the presence of T cells with an immature (thymic) phenotype in peripheral blood. These abnormalities may account for the depressed immune function of CLL patients.

Non-Hodgkin's lymphoma with immunologic phenotype similar to non-T, non-B acute lymphocytic leukemia

A diagnosis of diffuse poorly differentiated lymphocytic lymphoma was made from a biopsy of a scapular mass on a 24-month-old child. The bone marrow and peripheral blood were not involved in the neoplastic process. Neoplastic cells stained negatively for Sudan black B, myeloperoxidase, periodic acid-Schiff reagent, alpha-naphthyl acetate esterase, and acid phosphatase. In addition, neoplastic cells did not form nonimmune rosettes with sheep erythrocytes or contain surface membrane immunoglobulin. However, neoplastic cells were positive for terminal deoxynucleotidyl transferase and "Ia-like" antigen. We conclude that this non-Hodgkin's lymphoma has a cytochemical and immunologic phenotype similar to that of lymphoblasts from cases of non-T, non-B acute lymphocytic leukemia.

Alloantigen-induced suppressor- and memory cells in chronic lymphocytic leukemia

T cell function was evaluated in patients with B cell type of chronic lymphocytic leukemia (CLL). Unseparated peripheral blood lymphocytes (PBL) and T cells from CLL patients stimulated in a primary allogeneic MLR were able to inhibit significantly a second MLR between the original responder (CLL) and stimulator (normal PBL) cell donors. Furthermore, it is shown the T lymphocytes from patients with CLL develop immunologic memory during the course of a primary MLR as evidenced by an enhanced response in secondary MLR. These results are discussed with respect to recently described imbalances of T cell subpopulations in CLL.

Modulation of endometrial lymphocyte response in menstrual cycle of fertile women

Endometrial lymphocytes were isolated in two groups of fertile women, 17 of them normal and seven with various clinical problems. In order to study their immunological properties, endometrial and blood lymphocytes were cultured with either phytohemagglutinin (PHA), concanavalin A (Con A), pokeweed (PW), or purified protein derivative (PPD). Lymphocyte response was assayed by tritiated thymidine incorporation. The percent of T cells was estimated by E-rosette formation. In the normal fertile group, endometrial lymphocyte response to PHA and to Con A was found to correlate with the days of menstrual cycle, rising in a linear fashion between days 9 and 24. In the group with clinical problems, no correlation was noted. In neither group were endometrial lymphocyte responses to PW or PPD or percent of endometrial lymphocyte rosette formation influenced by the menstrual cycle. The modulation of endometrial lymphocyte response to PHA or to Con A stimulation in normal fertile women during the menstrual cycle seems unrelated to the number of T cells.

Cell-mediated immunity in Darier's disease: effect of systemic retinoid therapy

In five patients with Darier's disease, lymphocyte subpopulations, lymphocyte responsiveness to phytohaemagglutinin (PHA), concanavalin A (Con A), pokeweed mitogen (PWM) and purified protein derivative of tuberculin (PPD), leukocyte migration inhibitory factor (LMIF) production and suppressor cell activities were studied before and during oral etretinate treatment. Pre-therapy investigations of cell-mediated immunity showed no severe immunological dysfunction, although high responses to supra-optimal Con A concentrations suggested abnormalities in immunoregulatory lymphocyte subpopulations. In addition, two patients showed enhanced LMIF production upon stimulation with Con A, PWM and PPD. Retinoid therapy decreased the number of peripheral blood total leukocytes, lymphocytes and T-cells, normalized the LMIF production, and decreased the lymphocyte responses to mitogens. Furthermore, the dose-response curve to Con A changed toward normal and the suppressor cell activity regulating Con A responses tended to increase.

Acute lymphoblastic leukemia subtypes in Israel: the Sheba medical center experience

During the period from 1978 to 1981, 52 patients with ALL were diagnosed and treated at the Chaim Sheba Medical Center. Using standard cell markers to subtype the blasts, 49 of the patients could be classified: 16 were found to be T-cell ALL, 10 common ALL, five null ALL, four pre-B and 14 were partially characterized as non-B, non-T. Analysis of the series revealed two distinctive features: high prevalence (30%) of T-cell ALL among both Jews and Arabs and a high proportion, two-thirds, of high risk patients due to high initial WBC counts, unfavourable age or T-cell characteristics. The minimal incidence of ALL among the Gaza Strip Arab children during the study period is 4:100,000, which is close to the incidence in the Western world. During previous years the leukemia incidence in the Gaza Strip was very low while the most common lymphatic malignancies were Burkitt tumor and other non-Hodgkin lymphomas.

Effect of therapy on T cell subpopulations in patients with chronic lymphocytic leukemia

We have previously demonstrated functional and quantitative imbalances in two human thymic (T) cell subpopulations, T gamma and T mu, in chronic lymphocytic leukemia (CLL) patients. Serial evaluations of the numbers of T gamma and T mu subsets in CLL were performed in order to delineate more completely the patterns of T cell abnormalities two groups of CLL patients were studied: (I) previously untreated (n = 3) and (II) stable CLL on chemotherapy (n = 12). In Group I, two of three patients had significantly increased percentages of T gamma cells (mean +/- S.E.M. = 57 +/- 5 vs 18 +/- 2 for controls). There was defective in vitro appearance of T mu cells in both groups. In Group II, repeated studies of T cell subsets revealed persistently elevated T gamma cells despite various modes of oral chemotherapy. In three CLL patients who required splenectomy a dramatic decrease in the percentages of T gamma cells was noted post-splenectomy (51 +/- 3 to 15 +/- 3). In all cases the spleen was diffusely involved with CLL. These findings indicate: (1) abnormalities of T cell subsets are present early in CLL, (2) chemotherapy does not affect the levels of T gamma cells in stable patients and (3) removal of infiltrated CLL spleens results in a dramatic decrease in the proportion of T gamma cells. This latter finding plus the increase in T gamma cells in progressive disease post-splenectomy suggest T gamma cells may be an important determinant of the course of CLL.

T-cell function in chronic lymphocytic leukaemia

Fifteen patients with chronic lymphocytic leukaemia (CLL) were studied. The diagnosis was made by a combination of clinical findings, peripheral blood morphology and cell surface markers. The Rai clinical staging (Rai et al, 1975) was used to classify all patients. Serum immunoglobins, B and T cell lymphocytes, TG and TM cell populations were evaluated in all patients before commencing treatment. No correlation was found between clinical staging and the presence or absence of hypogammaglobulinaemia. The ratios of TG to TM cells were abnormal in all patients and this abnormality paralleled the stage of the disease. While there was significant difference in the proliferative responses of highly purified T cells from patients and controls at 1 micrograms and 2 micrograms/ml of Concanavalin A (Con A) (P values = P less than 0.005 and P less than 0.01 respectively). There was no significant difference at dose 5 micrograms/ml. The ability of T cells to suppress allogeneic PBMC responses to Con A was dependent on T cell purification procedures. The significance of the results and the possible role of T cells in the pathogenesis of CLL is discussed.

A comparative study of the effectiveness of different mitogens for karyotypic analysis in chronic B cell leukemia

In order best to study the karyotypic abnormalities of nine patients with chronic lymphocytic leukemia of B cell origin, we used a combination of T and/or B cell mitogens so as to achieve an optimal proliferative response. As assessed by DNA synthesis, and subsequent cytogenetic study, pokeweed mitogen (PWM) and protein A Sepharose (PROT A) appeared to hold promise as potent stimulators of neoplastic B lymphocytes. Lipopolysaccharide from E. coli (LPS) proved to be an ineffective mitogen. Phytohemagglutinin (PHA), while producing the highest stimulation indices by DNA assay, appeared to induce predominantly diploid metaphases. Pseudodiploid clonal abnormalities were noted in three out of nine patients, while another four patients showed random structural abnormalities, including translocations, which were indicative of damage. Presence of the A33 antigen, as determined by HLA typing, was noted in five out of nine patients. The increased frequency of this antigen in patients with chronic B cell leukemia is discussed.

Angioimmunoblastic lymphadenopathy with paraproteinemia: a T- and B-cell disorder

A case is reported of angioimmunoblastic lymphadenopathy (AILD), in which a IgM Kappa monoclonal gammopathy developed. On the first admission the immunoblasts were shown to be T cells by surface-marker studies. Although the number of circulating T cells was normal, their functional capacities were markedly reduced. The patient was followed for two months at the end of which she died with hematologic features of immunoblastic plasma cell leukemia.

Cytogenetic studies of hairy cell leukemia

Mononuclear cells from peripheral blood and spleen of four patients with hairy cell leukemia (HCL) were cultured for 1 to 10 days with and without phytohemagglutinin (PHA) stimulation. Blastogenesis and mitoses were not observed in the unstimulated cells cultured for up to 3 days. Prolonging the culture time of unstimulated cells to 7 days produced blastogenic response; a further increase in culture time to 10 days showed transformed cells but not mitoses. Poor PHA response was noted in the cultures stimulated for 3 days, but cells cultured for 7 days and then stimulated with PHA entered mitosis. Surface immunoglobulins were exhibited in 78-94% of the cells in the blood and spleen of patients. In addition, these cells had tartarate-resistant acid phosphatase and were able to phagocytize latex particles by which properties they were identified as hairy cell leukemia cells. Chromosome abnormalities were present in a proportion of cells of each patient, none of them, however, were clonal.