Disturbance of the blood T:B lymphocyte ratio in lepromatous leprosy. Clinical and immunologic correlations

Characterization of circulating lymphocytes by monoclonal antibodies in childhood and adult leprosy

Peripheral blood lymphocyte assays using monoclonal antibodies were done in 66 patients with leprosy, consisting of 25 children and 41 adults. The results were statistically analyzed for correlations, if any, among the different age groups and matched controls. The results, however, failed to show any significant correlation, nor was it possible to draw any conclusion as to why the disease spectrum in children tends to be incomplete (ie, there is a low incidence of the highly bacilliferous form of disease expression).

Determination of different populations of blood lymphocytes in Brazilian patients with hanseniasis

The number of B and T lymphocytes were determined in the blood of 35 Brazilian patients with leprosy: 19 lepromatous (L), 9 borderline (B), 4 tuberculoid (T), and 3 indeterminate (I) and also in a control group of 30 normal individuals. The results, were as follows. B lymphocytes, no differences between the patients with hanseniasis and the control group; T lymphocytes, there was an evident depletion in the patients with L compared to the control group and patients with T; and the average of T lymphocytes in B and I was lower than that seen in the control group and in patients with T. Despite this alteration they approach to what is found in the patients with T and the control group.

The effect of nutritional support on T-lymphocyte subpopulations in protein calorie malnutrition

T-lymphocyte subpopulations were measured in the two major types of adult malnutrition, adult marasmus and kwashiorkor-like hypoalbuminemic malnutrition. The population of T-cells (T3) and the percentage of both helper (T4) and suppressor (T8) T-cells were significantly (P less than .05) decreased in patients with kwashiorkor-like hypoalbuminemic malnutrition, but did not differ from control values in patients with adult marasmus. The ratio of helper T-cell (T4), to suppressor T-cells (T8) (range 1.2-1.6) did not vary from control values in either type of malnutrition. One week of nutritional support was not associated with a significant increase in any of the T lymphocyte subpopulations in either type of malnutrition. These T-cell subpopulation changes are consistent with the greater depression of cellular immune function seen in patients with metabolic stresses associated with kwashiorkor-like hypoalbuminemic malnutrition. With the increasing frequency in which abnormalities of T-cell subpopulations are being reported in various diseases, the coexistence of kwashiorkor-like hypoalbuminemic malnutrition should be noted for its potentially confounding effect.

Thymopentin treatment in patients with chemotherapy-resistant lepromatous leprosy

Leprosy is a chronic infectious disease caused by Mycobacterium leprae; it is chiefly involving the skin and peripheral nerves. In lepromatous leprosy there are widespread loose infiltrates with M. leprae multiplying extensively in the skin macrophages and Schwann cells of peripheral nerves. Such patients reveal a decrease of circulating T helper cells, which is still more pronounced in the cutaneous lesions. Due to the ever increasing bacterial resistance to classical dapsone and combined chemotherapy as well, an immunomodulatory approach seemed reasonable: Eight patients with long-lasting (5-40 years) disease who had become resistant to combined chemotherapy were treated with thymopentin, 50 mg s.c., 3 times weekly for 5 weeks and thereafter combined with dapsone and clofazimine for 5 months. During the trial a statistically significant increase in E-rosette-forming cells (p less than 0.05) was observed, along with a steady improvement of the bacterial status of the nasal mucus. Although the skin lesions did not disappear within the observation period of the study, it is important to realize that long-term improvement of such lesions is always initiated by clearance of bacilli from the nasal mucus, hence, thymopentin treatment appears to be a promising approach to chemotherapy-resistant lepromatous lepra.

Numerical and functional alterations of lymphocytes in human schistosomiasis

Peripheral blood mononuclear cells from 29 Sudanese children heavily infected with Schistosoma haematobium and S. mansoni were examined for lymphocyte subpopulations, for mitogen responsiveness in the absence and presence of interleukin-2 (IL-2), and for natural killer (NK) cell activity. The nutritional status was assessed by anthropometric and biochemical measurements. In comparison with a group of healthy Caucasian individuals the children with schistosomiasis showed a profound alteration of their cellular immune variables, reflecting a severe acquired immunodeficiency syndrome. The T-cell compartment, in particular the OKT4+ helper/inducer subset, was numerically reduced at the expense of an increased B-cell compartment. The patients' OKT4/OKT8 ratios were significantly diminished (median, 1.2; 95% confidence limits, 0.8-1.7) corresponding to a decreased responsiveness to the T-cell mitogen concanavalin A. Since addition of exogeneous IL-2 significantly enhanced the patients' lymphocyte proliferation in response to Con A, a defective IL-2 production was assumed to be at the origin of the impaired mitogenic response in chronic schistosomiasis. With regard to NK cell activity, most patients' lymphocytes failed to mediate significant cytotoxicity against the K562 target cell line, although normal percentages of cells with the NK phenotype (HNK-1+) were present. The results are discussed in view of immunological alterations seen in other parasitic infections with a heavy parasitic load.

Alterations in lymphocyte cell surface markers during various human infections

Peripheral blood lymphocyte cell surface markers were studied in 146 patients with various forms of acute infection using B cell identification with antisurface immunoglobulin and T cell subset enumeration with hybridoma T cell subpopulation reagents. Significant depression was recorded in total numbers of T cells and T cell helper-inducer and suppressor-cytotoxic subsets in pneumonia, acute pyelonephritis, and severe generalized sepsis. In addition, proportions of T cells being the OKT4 helper-inducer phenotype were reduced only in patients over the age of 60 with pneumonia or sepsis. Patients with severe infection frequently had multiple T cell phenotypic surface marker abnormalities. In some instances, when depressions of total T cell numbers as well as respective helper-inducer or suppressor-cytotoxic T cells were noted in the face of generalized sepsis, lack of improvement in these abnormalities during the course of treatment was associated with rapid clinical deterioration and death. On the contrary, in patients with a successful response to appropriate therapy, initial depressions of total T cell numbers and subsets improved progressively with clinical resolution of sepsis and illness.

Demonstration of T lymphocytes in leprous granuloma using the acid alpha naphtyl acetate esterase activity. An attempt at quantitative analysis

In nine leprosy patients (1 TT, 1 BT, 4 BL and 3 LLp), esterase positive lymphocytes (T Lymphocytes) were studied in frozen sections of skin biopsies by alpha naphtyl acetate esterase pH 5.8 method (ANAE) Four patients had never been treated previously and five patients exhibited clinical and bacteriological evidence of relapse for inadequate therapy at first biopsy. There was an increase in ANAE (+) lymphocyte density in granulomas when second biopsies were done after efficient treatment, evaluated by bacillary index for the eight bacilliferous patients, and clinical improvement. The significance of T cells in granulomas is discussed.

Clinical and immunologic response to antigen-specific transfer factor in drug-resistant infection with Mycobacterium xenopi

The administration of transfer factor obtained from three donors who had recovered from clinical infections with Mycobacterium xenopi to a patient who had a destructive pulmonary infection with this organism, was associated with the reversal of an unfavorable clinical course. Cavitary tuberculosis associated with resistance to all combinations of antituberculosis drugs was probably related to a concurrent depression of cell-mediated immunity of unknown origin. Antigen specific but not nonspecific transfer factor caused a rapid and prolonged improvement in both the pulmonary disease and the immunologic deficiency. Cross-reactivity between the antigenic determinants of M. xenopi and Mycobacterium tuberculosis made it possible to use transfer factor obtained from donors responsive to purified protein derivative of tuberculin. This study clearly demonstrates the additional benefits to be gained from using transfer factor that is antigen-specific in the treatment of infectious diseases.

Immunoreactivity in vitro to human testis in patients with lepromatous leprosy

Patients with lepromatous leprosy and tuberculoid leprosy, together with normal aged matched controls, were tested for in vitro immunoreactivity against a panel of soluble extracts prepared from normal human tissues. The panel consisted of a soluble homogenate of human testis as well as two partially purified fractions of this extract, and control extracts from other human tissues. Immunoreactivity was assessed by extract induced peripheral blood lymphocyte (PBL) transformation, leucocyte migration inhibition (LMI) and leucocyte adherence inhibition (LAI). Although no difference in PBL transformation, LMI, or LAI was obtained between the groups with the control tissue extracts, significant reactivity was obtained for the patients with lepromatous leprosy in at least one of the in vitro tests, when one of the testis extracts was used (Mann-Whitney test). No such reactivity to the testis extracts was obtained in the patients with tuberculoid leprosy or the normal control subjects. Of the twenty-two patients studied with lepromatous leprosy, thirteen had clinical evidence of testicular disease and nine of these patients had raised PBL transformation and LAI reactivity to the testis extracts. This finding of immunoreactivity against testicular extracts in a significant number of patients with lepromatous leprosy by at least one of the vitro tests used, suggests that the associated in vivo testicular atrophy that occurs in these patients may have an auto-immune basis.

Resistance and susceptibility of mice to bacterial infection: histopathology of listeriosis in resistant and susceptible strains

C57BL/10 mice have previously been shown to be 100 times more resistant to intravenously injected Listeria monocytogenes than are BALB/c mice due to the action of a single gene, Lr. Differences in the histopathology of listeriosis in the two strains were sought. Of the tissues examined, only liver, spleen, blood, and thymus showed changes. In the liver, Listeria localized in Kupffer cells within 3 h of infection. By 24 h these cells became surrounded by neutrophilic polymorphonuclear leukocytes. After high doses of Listeria, the susceptible BALB/c mice showed many foci surrounded by few polymorphs, whereas in the resistant C57BL/10 mice there were relatively few foci surrounded by many polymorphs. By 4 days in sublethally infected mice the polymorphs in the liver of both strains were being replaced by monocytes and macrophages. Liver morphology returned to normal by 8 days postinfection. In the blood of both strains there was a rise in total lymphocyte numbers at 24 h, followed by a fall in T-lymphocytes and recovery at 5 days. C57BL/10 mice showed an early monocytic response in the blood, whereas BALB/c mice showed a polymorph leukocytosis. In the spleens of both C57BL/10 and BALB/c mice there was an early neutrophil response and red pulp hyperemia. This was followed by a dramatic lymphocyte depletion in the T-dependent periarteriolar regions in both strains beginning 2 days after infection. Absolute numbers of Thy-1(+) cells in spleen cell suspensions also fell to 10% of normal, recovering 6 to 8 days postinfection. Surface immunoglobulin-positive B-lymphocytes and Thy-1(-), immunoglobulin-negative "null" cells rose in both strains at days 4 to 5, returning to normal levels on days 10 to 12. Whether the null cells represent lymphocytes or other cell types remains unresolved. Thymus atrophy was seen in the BALB/c mice but not in C57BL/10 mice.

Numerical changes in T cell subsets (T gamma and T mu) in leprosy patients

Eighty-six leprosy patients (49 active lepromatous, 24 inactive lepromatous 7 borderline, and 6 tuberculoid) and nine healthy controls were examined for numerical changes in T cell subsets (T gamma and T mu), and complement levels in peripheral blood to determine the roles of T cell subsets and complement in the etiology of leprosy. The percentage and number of T gamma and T mu showed no significant differences among the different clinical groups, but 4 out of 49 active lepromatous, 3 out of 24 inactive lepromatous and 3 out of 7 borderline cases showed a high prcentage of T gamma cells. Serum concentrations of C4, C3c, and C3 activator, an important factor in the alternative pathway of complement activation, were not significantly different among the groups. However, C3 activator and C3c concentrations were significantly high in active lepromatous patients complicated by an immune complex disease called "erythema nodosum leprosum" (ENL) compared with ENL-free active lepromatous leprosy.

Effect of operation and radiotherapy on antibody-dependent cellular cytotoxicity

A subpopulation of human lymphocytes bearing receptors for the Fe portion of IgG causes lysis of nucleated target cells in the presence of antibody. The reaction is known as antibody-dependent cellular cytotoxicity (ADCC) and the effector cells have been called killer (K) cells. We have measured K cell activity quantitatively in the peripheral blood of cancer patients using 51Cr labeled murine mastocytoma target cells and hyperimmune rabbit antimastocytoma antibody. ADCC was the same in males and females, was not affected by eating, smoking or the presence of infections, but was decreased in those over 65 years, during pregnancy, and in those with cachexia, or severe sepsis associated with nonmalignant diseases. It was normal in those with cancers being treated for cure and in those with benign diseases, but was decreased in those with advanced cancers. Operation did not produce a significant change in those who were not immunodepressed; in those who were immunodepressed before operation it caused a significant decrease maximal by the fifth day with recovery by the 15th day. Radiotherapy caused a decrease in K cell activity, maximal at 4 weeks, that persisted for 12 weeks with recovery after that time in those who did not have residual tumor. The values did not return to normal in those who had persistent tumor or distant metastases.

Evidence for defective immunoregulation in the syndrome of familial candidiasis endocrinopathy

We studied three children with candidiasis endocrinopathy syndrome, together with their parents and five siblings, to explore the possibility that defective immunoregulation allows autoimmune phenomena to be involved in the pathogenesis of this syndrome. Inheritance of the syndrome appeared to be autosomal recessive. Immunologic abnormalities in this family included hypergammaglobulinemia, selective IgA deficiency, anergy, autoimmune endocrinopathies and active chronic hepatitis. Defective suppressor T-cell function was noted in the two surviving children with clinically apparent disease and in a clinically normal sibling. Analysis of the immunologic abnormalities in the family suggests that defective immunoregulation rather than disordered effector mechanisms may explain the large number of immunologic defects noted. These defects, in turn, may result in the clinical manifestation of the syndrome.

Immunohistochemical observation of lysozyme in macrophages in leprosy

Lysozyme activities of skin granulomas of 24 patients in leprosy were studied. Lepra cells of all 15 lepromatous leprosy showed strong lysozyme activity in cytoplasma. In the specimens stained with lysozyme and Ziehl-Neelsen's carbolfuchsin double stain conspicuous lysozyme activity around M. leprae were observed. One borderline case was negative. Lysozyme of epithelioid cells and giant cells of 10 tuberculoid types were completely negative. These results suggest that lysozyme plays only a small role in the disposal of M. leprae in macrophages and other mechanisms than bacteriolytic function of lysozyme are responsible for the defence against these bacilli.

Surface markers on lymphocytes and cells of the mononuclear phagocyte series in skin sections in leprosy

E, EA and EAC rosetting techniques and Ig fluorescence were used in a study of receptor sites in cryostat sections of lesions through the spectrum of leprosy, and for comparison in some other mycobacterial and granulomatous lesions. Anti-C3, and trypsin were used as blocking agents. Lymphocytes in borderline lepromatous leprosy produced EA adherence and IgG fluorescence indicating B type cells. Lymphocytes in tuberculoid leprosy produced neither E or EA adherence and no fluorescence; these cells were presumed to be T cells. EAC and EA adherence was more marked in areas of macrophage infiltration, where there were few lymphocytes, than over the lympocytes themselves. Two distinct patterns emerged: (i) EA binding together with IgG fluorescence was seen in active lepromatous leprosy and could be localised to the surface of individual macrophages, and (ii) EAC binding together with IgM fluorescence was seen in the granuloma of tuberculoid leprosy and sarcoidosis, but could not be definitely related to cell surface; rather it was diffusely spread over the whole granuloma; EAC adherence was diminished by anti-C3 serum. Trypsin removed EA binding completely, but only diminished EAC adherence. It is suggested that the EA pattern indicates immunoglobulin receptors on macrophage and lymphocyte surfaces: and that the EAC binding (which is stronger than EA) involves C3 and IgM receptors at extracellular sites as well as C3 receptor sites on epithelioid cell surfaces. EA and EAC binding were enhanced in borderline tuberculoid leprosy in reaction and erythema nodosum leprosum, suggesting that immunoglobulin and complement receptor sites increase in number with enhanced hypersensitivity.

Effect of viral and bacterial pneumonias on cell-mediated immunity in humans

Cell-mediated immunity (CMI) was assessed during infection and after convalescence in 12 patients with influenza pneumonia and 10 patients with bacterial pneumonia. The patients with influenza pneumonia had a marked impairment of skin test reactivity, and their lymphocytes showed a diminished response to phytohemagglutinin and streptokinase-streptodornase stimulation in vitro. Suppression of CMI was related to the severity of the pneumonia. Patients with bacterial pneumonia showed as great a suppression of the response to phytohemagglutinin and streptokinase-streptodornase as the patients with viral pneumonia. All parameters of CMI returned to normal in both groups after convalescence. The depression of CMI could not be related to a decrease in the number of thymus-derived lymphocytes or to serum-suppressive factors in these patients.

T and CR+ lymphocyte profile in leprosy and the effect of treatment

Thymus-derived lymphocytes (T lymphocytes) and complement receptor-bearing lymphocytes (CR+ lymphocytes) were estimated by using erythrocyte rosettes and erythrocyte-antibody-complement rosettes as markers in untreated lepromatous and untreated tuberculoid patients and in healthy controls. Treated lepromatous cases were also investigated. Ten cases of untreated lepromatous patients were reassessed 6 months or more after therapy commenced. A significant decrease in both percentages and absolute numbers of CR+ cells in the untreated lepromatous leprosy subjects was observed. This decrease showed a return to normal levels after treatment. The percentage of T cells in the untreated lepromatous cases was normal; however, the absolute numbers of T cells and the total lymphocyte count showed a significant decrease. After therapy, the T cell population was unchanged but the total number of lymphocytes increased significantly with treatment. The absolute number of T and CR+ cells was significantly less in the untreated than in the treated lepromatous patients.

Extension of the mean time to death of mice with a lethal infection of Venezuelan equine encephalomyelitis virus by antithymocyte serum treatment

The mean time to death of mice infected with Venezuelan equine encephalomyelitis (VEE) virus was increased 2 days by antithymocyte serum (ATS) treatment given 1 day before and 1 day after virus inoculation. Virus assays of blood, brain, and spleen indicated that VEE virus replication was delayed by ATS. Additionally, mice treated with ATS exhibited neurological signs later than untreated mice. During the infection, the percentage of splenic B lymphocytes as determined by surface immunoglobulin staining increased. ATS treatment caused a further elevation of the percentage of splenic B lymphocytes. These results show a selective depletion of the non-immunoglobulin-bearing lymphocyte population during VEE virus infection and support the hypothesis that ATS destroys or alters an important population of cells associated with the normal course of pathogenesis and the replication of VEE virus to high titers in the mouse.

Incidence of cancer in patients with leprosy

Individuals with congenital immunodeficiences and patients who are immunosuppressed for maintenance of organ allografts experience a marked increase in the occurrence of malignancy. Patients with lepromatous leprosy also have depressed cellular immunity, but or study of 195 autopsied subjects with leprosy did not reveal an increase in the occurrence of cancer. Thirty-three of the 195 subjects with leprosy or 16.9% died of cancer, which is comparable to an age-matched group of individuals.

The immune system of the nine-banded armadillo (Dasypus novemcinctus, Linn)

The armadillo is rapidly emerging as an animal for biomedical research. A morphological study of the immune system of the armadillo was undertaken to try to demonstrate a possible defect in the morphogenesis of the lymphoid organs that could account for their susceptibility to leprosy. Blood from 20 domesticated adult armadillos revealed lymphocytes predominated among circulating leukocytes in the majority of animals, whereas in wild animals neutrophils predominated. Necropsies revealed well-developed thymus glands and the thymus-dependent areas in lymph nodes and spleens contained abundant lymphoid cells. Hence, we conclude that the susceptibility of the armadillo to leprosy cannot be explained on a morphological basis.

Abnormal spontaneous rosette formation and rosette inhibition in lung carcinoma

Fifty-five children with CID and known ADA status were studies at a workshop held in Albany, New York. Erythrocyte ADA determinations were performed in 22 of the 55 patients, 13 of whom were ADA negative. The ADA defect appears to be transmitted as an autosomal recessive trait. Some patients with CID and ADA deficiency have characteristic radiologic abnormalities of the skeleton, which are not found in other illnesses. The thymus glands of all patients with CID and ADA deficiency who could be examined have evidence of thymic involution manifested by presence of Hassall's corpuscles and differentiated germinal epithelium; this is in contrast to "classic" thymus findings in CID with normal ADA. Adenosine deaminase probably plays an important, although as yet undefined, role in lymphocyte development and/or function. The deficiency of ADA in CID is the first enzyme defect observed in a deficiency disease of specific immunity.